Speech OSCE

Question 1

How to calculate the initial presentation level for speech audiometry (PI Max)?

Answer 1

Based on the 2000 Hz thresholds

<50 dB HL, add 25 dB
50 - 55 dB HL, add 20 dB
60 - 65 dB HL, add 15 dB
70 - 75 dB HL, add 10 dB

Question 2

If puretone thresholds are within the normal range, what is the initial speech presentation level?

Answer 2

35 - 40 dB HL

Question 3

What is an acceptable PI Max score?

Answer 3

90% or greater

Question 4

If the initial presentation level did not result in >90%, what do you do?

Answer 4

Present at 10-15 dB HL higher

Question 5

How do you calculate the half-peak level in speech audiometry?

Answer 5

Test 10-20 dB below the PI Max level

If the score is still well above 50%, drop by 5 - 15 dB until you get 50% of their PI Max score

Question 6

How do you cross check the half peak level with the audiogram?

Answer 6

• Flat loss: HPL +/- 15 dB of 1000 Hz threshold
• Precipitious: HPL +/- 15 dB of average loss of 2000 and 4000 Hz

Question 7

How do we classify PI Max speech scores?

Answer 7

Excellent or good = 90 – 100%

Slight difficulty = 78 – 88%

Fair to moderate difficulty = 66-76%

Poor or great difficulty = 54 – 64%

Very poor = <52%

Question 8

How do you obtain an accurate PI function?

Answer 8

You need at least 3 scores at different intensities.

Question 9

What is the maximum level you should test to?

Answer 9

• Generally you should not go above 90 dB
• If the client has a severe or profound loss, or a large conductive hearing loss, you may be able to test at 100 dB
• Many transducers begin to distort at levels above 90 dB

Question 10

When do you need to mask speech audiometry?

Answer 10

Mask if:

Speech Presentation level - IAA ≥ best BC (non-test ear)

IAA:
Supra aural + shallow: 40 dB
Inserts: 50 dB

Question 11

How to calculate the speech masking level?

Answer 11

Masking level (non-test ear) =

Presentation level (test ear) - IAA + Largest significant AB-gap (NTE) + 10 dB

Question 12

What is the initial presentation level for speech detection?

Answer 12

10dB below the best AC threshold

Question 13

What is the speech detection protocol?

Answer 13

• Start at 10dB below the best AC threshold
• Present one word at each level, increase in 5 dB steps until word is heard
• Go down in 10 dB steps
• SDT = level at which the client detects words on 2/3 ascending trials

Question 14

True or false: SDT should be plotted on the PI function

Answer 14

False, it should be a noted on the audiogram summary sheet

Question 15

How do you use the SDT to cross check the audiogram?

Answer 15

SDT should be within +/-10dB of the best puretone threshold between 250 and 4000 Hz

Question 16

What is the possible overmasking level?

Answer 16

BC (test ear) + IAA

Question 17

What are the IAA values

Answer 17

Puretone
Inserts: 60 dB (at or below 1kHz), 50 (above 1kHz)
Supra: 40 dB

Speech
Supra: 40 dB
Inserts: 50 dB