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when the responses of good ear are recorded falsely as responses of the bad ear, we call this a

shadow curve


this term is used when the evaluator identifies the existence of a shadow curve

cross over or cross hearing


the process in which one sound is blocked out by another sound and is used to prevent the test sound from being heard by the nontest ear; we place the noise in the nontest ear to keep it busy so that we are able to obtain true thresholds in the test ear



what is the difference, in decibels, between the intensity of sound that was presented to the poorer ear and the amount of sound that actually reached the good ear

interaural attenuation

bone conduction=0 dB
headphones= 40 dB
inserts= 60 dB


______is a bilateral contraciton of the stapedius muscle when an intense sound is introduced to an ear; another part of the middle ear test battery

an acoustic reflex


both sides



special number



a bilateral contraction

acoustic reflex


why do audiologists measure the acoustic reflex

to obtain info about the integrity of the auditory system both at the peripheral level and at the brainstem level


name two middle ear muscles

tensor tympani


muscle which attaches to the malleus

tensor tympani


muscle which is attached to the stapes



when the ____muscle contracts, it stiffens the middle ear system, which lowers the admittance (compliance)



the lowest level tone that will elicit a reflex



the tone for an acoustic reflex can be at any frequency, but typically audiologists measure acoustic reflexes at 4 frequencies

500, 1000, 2000, 4000 Hz


purpose of acoustic reflexes

1. detection of middle ear pathology
2. differentiating cochlear from retrocochlear pathology
3. estimate treshold sensitivity
4. use in cross check with pure tone testing


name two ways to measure the acoustic reflex

ipsilateral reflex test (ipsi)
contralateral reflex test (contra)


reflex measured on the same side as the stimulus

ipsilateral reflex test


reflex measured on the opposite side of the stimulus

contralateral reflex test


reflex will be labeled off of the _____side

stimulus; (left ipsi; right contra etc)


normal range of acoustic reflex

70- 95 dB; usually around 85 dB


the reflex will be absent or elevated if :

-the tone is not sufficiently loud enough
- a hearing loss is present, especially conductive
-middle ear disorders
-damage to the VIII cranial nerve
-Damage to portions of the brainstem or auditory cortex


the reflex is usually absent or present at higher SL

conductive loss


-the reflex is usually present at a reduced SL
-ARTs obtained at 60dB SL or less are a sign of recruitment and of a SNHL (Metz)

sensory loss


the reflex is absent or present at a higher SL

Neural loss


a term used to describe a test situation in which a clients hearing is assessed while he or she is seated in the sound- treated room or booth

sound field testing


the sound stimulus is delivered through ______ mounted in the booth instead of through headphones



sound field testing can be useful in both

aided or unaided conditions


with hearing aids/ cochlear implants, bone anchored hearing devices etc



without any device



JCIH recommends that all infants have access to a hearing screening using physiologic measures by

1 month of age


types of behavioral pediatric assessments

-behavioral observation audiometry (BOA)
- Visual reinforcement audiometry (VRA)
-Conditioned play audiometry (CPA)


____ is a methodology used when attempting to subjectively test the hearing of a child birth to 6 or 7 months; child's response must be time locked to the stimulus; requires a subjective response from the child each time the sound is heard

BOA behavioral observation audiometry


reflexive responses include

eye blinks
startle responses
sucking reflex


auditory stimuli used in BOA may include

warbled tones
unfiltered/ filtered speech
music stimuli


what are the jobs of the two audiologist performing the BOA test?

1.) Manipulating the audiometer and monitoring behavioral responses of the child
2.) in the sound booth and is responsible for keeping the individual engaged and providing an extra set of eyes to help ensure validity and reliability of the results


has the basic premise that a child has a natural instinct to turn searchingly for an interesting sound when its heard, but the child will continue to do this when "rewarded" with an appealing visual stimulus

Visual Reinforcement Audiometry VRA


jobs of the two audiologists during a VRA

1.) Manipulating the audiometer and presenting the test sounds through the speakers
2.) directly facing the child and will keep the child engaged during the test process


test stimuli used for VRA

warbled tones
narrowband noise
live or recorded speech


what happens in a VRA

the child is situated between the two speakers at the calibration point in the sound booth at an angle to observe a noticeable head turn as the child search for the sound; sound presented through the speakers; child's attention is then directed toward the sound and the animated toy is activated


utilized for children 2.5- 5 years old
designed to gain audiological test results by making the evaluation process into a game
the child is conditioned to play a game

conditioned play audiometry CPA


what do the two audiologist do during the CPA

1.) manipulating the audiometer and monitoring behavioral responses
2.) playing with the child and providing feedback to the audiologist who is manipulating the audiometer


with the CPA we are typically able to obtain info regarding ________

the severity, type, and configuration of hearing loss


when doing sound field testing, you are not obtaining ear specific info, but __________

only obtaining info about the BETTER HEARING EAR


_____is a critical element alf a comprehensive evaluation because our daily activity of listening is not composed merely of beeps, but is a complex neurological process called speech perception

audiometry along with pure tone audiometry


types of speech audiometry tests

-speech recognition threshold or speech recognition threshold;
- speech detection threshold/ speechawareness threshold; -word discrimination testing
- most comfortable listening level
-uncomfortable listening level


_______provides a measure of a person's threshold for the recognition of speech stimuli

speech recognition threshold SRT


the basic purpose of the SRT is to

determine the intensity level just loud enough for the person to barely hear speech


word that has two syllables with equal emphasis on each syllable EX hotdog, icecream, baseball

spondee words; used in an SRT


how do you do an SRT

one ear at a time;
patient repeats the words that they hear even if the words are very faint;
presented at a comfortable loudness level in order to familiarize the listener with 8-10 test words
adjust volume of these same words that we find the AC and BC thresholds


what determines a patients ability to discriminate speech at a comfortable listening level; uses monosyllabic words; words presented at 30 or 40 dB HL above the SRT

speech discrimination testing or word recognition score


involves a patient's responses to the presence of speech; however, whereas the SRT require that the person detect and recognize a word, this requires that the person indicate that they are aware of a speech sound and does not require one to identify the speech sound

speech awareness/ detection threshold


_____is the dB level that has been determined to be the most comfortable volume level at which a patient subjectively prefers to listen to speech

Most comfortable listening level (MCL)


what is the purpose of the MCL

to determine the level that the patient has the easiest time listening to speech, which results in the patient's best possible speech understanding ability


_____is the limit of acceptable amount of sound in dB, beyond which the patient would find sound to be unacceptably loud or painful to listen to for a sustained period of time

Uncomfortable listening level (UCL)(LDL) (TD)


______is the mathematical difference between the lowest level at which an individual begins to hear speech (SRT) and the upper limit of comfort for speech (UCL)

Dynamic Range (DR)


What is used particularly involving the assessment and fitting of hearing aids?



a large percentage of individuals with hearing loss experiences the sensation of abnormal growth in loudness this is termed ______

recruitment (loud sounds get louder faster)