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Syllabus Laboratorium Physiology- Audiology

Special Sense System
For Student

A Sequence
I. Introduction : 30 min
II. Pre Test
III. Activity Lab : 120 min
- Discussion 30 min
- Hearing examination and audiometry interpretation 90 min

B Topic
1. Hearing physiology
2. Basic hearing examination using the tuning fork and the voice test
3. Audiometric interpretation according to the coding guidelines

C Venue
Biomedical Laboratory Faculty of Medicine, Bandung Islamic University

D Equipment
1. Poster
2. Barany noise box device (noisy ticking wrist watch)
3. Tuning fork
4. Audiogram

E Pre-requisite
HOMEWORK ASSIGNMENT

To be collected to your tutor at the day of lab activity

1. Explain anatomic features that is related in each conductive system and sensorineural
system.
2. What is the definition of air conduction and bone conduction?
3. What is sound? how do we hear sound?
4. What is the standard unit used in measuring sound intensity?
5. Explain how to interpret hearing examination using the tuning fork?
6. Define types of hearing losses including their etiologies and brief pathophysiology
7. What is cross hearing, why should it be prevented?

- Content lab in manual book ( pre and post test will be taken from the manual, if scorring pre test
less than 50, can not allowed the lab activity )
- Bring your text book, reference book, e-book etc.

F Activity Lab
1. Students will be divided into groups
2. Discuss about the homework
3. Practice the hearing examination and audiometry interpretation
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I. Anatomic feature of hearing organ Check

list

Explain the picture below

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Identify and explain the structure below

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II. Hearing Examination

1. Whisper test

2. Voice test

This picture shows a voice test being performed, the examiner in the left of
the picture while the patient on the right with the distance only one meter from
one another. Note that one of the ears (non-test ear) of the patient is being masked by a
Barany noise box device.

Principles:
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 A basic examination to roughly predict a level of hearing loss.

 Note that before performing the vioce test, the patients view towards the
examiners lips should be veiled either by a piece of paper or maybe a
drape, this is meant to prevent lip-movement reading by patients, because
most deaf patients are experts at reading lip movements.
 Hearing examination is performed with the distance between the examiner
and the patient just 1 (one) meters apart, done in a sound-proof room.
 Each ears are examined one at a time, the untested ear is given a masking
voice such as produced by a barany noise box device, otherwise a noisy
ticking wrist watch will suffice. Just place the wrist watch by pressing against
the non-test ear.
 Masking on the non test ear is crucial to prevent cross hearing.

Hearing Interpretation:

• Normal ( 0-25 dB): Hears whisper

• Mild Hearing Loss (26-40 dB): Able to hear and repeat words produced with a
loudness of a normal communication voice
• Moderate Hearing Loss (41-60 dB): Able to hear and repeat words produced with a
loud voice
• Moderate-severe Hearing Loss (61-80 dB): Able to hear and repeat words shouted
near the ear
• Profound Hearing Loss : Not able to hear and repeat words shouted near the ear

2. Tuning Fork Examination

If hearing is diminished, try to distinguish between conductive and sensorineural hearing
loss. You need a quiet room and a tuning fork, preferably of 512 Hz or possibly 1024 Hz.
These frequencies fall within the range of human speech (300 Hz to 3000 Hz)—functionally
the most important range.
Forks with lower pitches may lead to overestimating bone conduction and can also be felt
as vibration.
Set the fork into light vibration by briskly stroking it between thumb and index finger or by
tapping it on your knuckles.

 Compare air conduction (AC) and bone conduction (BC) (Rinne test).
Place the base of a lightly vibrating tuning fork on the mastoid bone, behind the ear
and level with the canal. When the patient can no longer hear the sound, quickly place
the fork close to the ear canal and ascertain whether the sound can be heard again.
Here the “U” of the fork should face forward, thus maximizing its sound for the patient.
Normally the sound is heard longer through air than through bone (AC > BC).
In conductive hearing loss, sound is heard through bone as long as or longer than it is
through air (BC = AC or BC > AC). In sensorineural hearing loss, sound is heard longer
through air (AC > BC).

 Test for lateralization (Weber test).

Place the base of the lightly vibrating tuning fork firmly on top of the patient’s head or
on the midforehead.
Ask where the patient hears it: on one or both sides. Normally the sound is heard in the
midline or equally in both ears. If nothing is heard, try again, pressing the fork more
firmly on the head.
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In unilateral conductive hearing loss, sound is heard in (lateralized to) the impaired ear.
Visible explanations include acute otitis media, perforation of the eardrum, and
obstruction of the ear canal, as by cerumen. In unilateral sensorineural hearing loss,
sound is heard in the good ear.

3. Audiometry

- Is a hearing assesment using pure tone with test results written into a graphic
that is named an audiogram.
- Written in the audiogram are two hearing components : the air conduction and
bone conduction, both written with specific symbols to differentiate each
component and in different colours to specifiy right from left ear.
- Symbols used in an audiogram:
 Results for the left ear is written in blue and right ear in red
 Non masking symbols for air conduction
 “X” for left ear
 “O” for right ear
 Non masking symbols for bone conduction
 “<” for right ear
 “>” for left ear
- Interpretation of audiometric results.
 Because hearing depends on the integrity of the air conduction
component, the level of hearing will be measured from this
component.
 Level of hearing for each air conduction components : counted by
the adding each decibel-results on each communication freq as
at,500,1000, 2000 and 4000Hz , finally the the total sum is divided in
4, the result will be the mean-level of hearing for each air
conduction component.
 Compare the equation result with the hearing loss chart, define the
patients level of hearing loss of each ear.
 Define the type of hearing loss; conductive or sensorineural, (will be
discussed below)
 Lastly, write your interpretation, that consists of the degree of
hearing followed by the type of hearing loss, example: moderate
sensorineural hearing loss, moderate-severe mixed hearing loss, etc
 Try to practice your interpretation skill on some practice-
audiometric charts.
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Degree of Hearing Loss

0 to 25 dBHL  within normal limits
26 to 40 dBHL  mild loss
41 to 55 dBHL  moderate loss
56 to 70 dBHL  moderate to severe loss
71 to 90 dBHL  severe loss
More than 90 dBHL  profound loss

Types of Hearing Loss

1. Conductive hearing Loss
Principles of interpretation:
 Bc Tresholds within normal limit
• Ac Tresholds beyond the normal hearing range (greater than 25 dB)
• Air-bone gap between Bc and Ac more than 10 dB
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2. Sensorineural hearing loss

Principles of interpretation:
 Both Bc and Ac are not within the normal hearing range
 Gap between the Bc and Ac < or =10 db, or both component are in one line.

3. Mixed Hearing Loss

Principles of interpretation:
 Both Bc and Ac components are not within the normal hearing range
 Air-bone Gap between both components more than 10 dB
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III. Audiogram Interpretation Exercises

1.

2.
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3.

4.
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5.

6.
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7.

Reference
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1. Guyton et al., Textbook of Medical Physiology

2. Bates, Guide to Physical Examination and History Taking

3. Barbara Skurr, Audiometri Klinis