Dr.

YOS SOPHORN
PREAH ANG DUONG HOSPITAL

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 To detect the presence of hearing
loss.
 To determine the severity of
hearing loss.
 To determine the nature of hearing

loss (CHL, SNHL or mixed).

◦ Using A/C and B/C

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 Air Conduction (by headphones)

Brain

outer middle inner auditory

ear ear ear nerve

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 Bone
Conduction (by bone
conductor)
Brain

inner auditory
ear nerve

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 Air Conduction = Hearing lossBrain

outer middle inner auditory

ear ear ear nerve
 Bone Conduction = Normal
Brain

inner auditory
 Conclusion: ear nerve

 Outer or middle ear

OKproblem
OK (CHL)
 Mix hearing loss

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 Air Conduction = Hearing lossBrain

outer middle inner auditory

ear ear ear nerve
 Bone Conduction = Hearing loss
Brain

inner auditory
ear nerve
 Conclusion:
 Inner ear or neural problem (SNHL)

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 Air Conduction = Hearing lossBrain

outer middle inner auditory

ear ear ear nerve
 Bone Conduction = Hearing loss
(less than AC) Brain

inner auditory
 Conclusion: ear nerve
 Outer or middle problem and an inner ear or
neural problem (mixed loss)

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 The test is performed in a sound-
treated room.
 Examination by otoscopy.
 The patient wears headphones

through which pure tones are

presented.
 The ears are tested separately.

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 The patient is asked to respond to
each sound heard through the
headphones.
 Begin with the better ear.
 Start at 1000 Hz at 30 dB above

expected threshold.
 Tones are presented for 1-3 s.

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 If the patient responds to a given
tone, decrease the intensity by 10 dB
and present again.
 If the patient fails to respond,

increase the intensity by 5 dB.

 Continue in this manner until

threshold is determined.

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 The lowest level of intensity at which
sound pressure will produce the
sensation of hearing.
 The lowest level at which a response is

obtained on at least two out of three

ascending presentations.

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 Repeat procedure for 2000,
4000, 8000, 500, and 250 Hz in
that order.
 Re-test 1000 Hz.
 Repeat for other ear.
 Mask where necessary.

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 Note: If the difference between thresholds for two
adjacent frequencies is greater than 20 dB HL the
mid-frequency should be also tested.
◦ 750 Hz (between 500 and 1000 Hz)
◦ 1500 Hz (between 1000 and 2000 Hz)
◦ 3000 Hz (between 2000 and 4000 Hz)
◦ 6000 Hz (between 4000 and 8000 Hz)

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 Bone conduction is performed after air
conduction.
 The bone conductor is placed on the

mastoid bone of ear with the better A/C

results.
 The bone conductor should not touch the

pinna and should be in direct contact with

the skin (not obstructed by hair.)

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 Perform bone conduction at 1000,
2000, 4000, and 500 Hz in that
order.
 Patient instruction and method as

A/C.
 Mask where necessary.
 Record results on audiogram using

appropriate symbols.
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 Right Ear
O = Air conduction
(masked if necessary)
 Left Ear
X = Air conduction
(masked if necessary)
 Right and Left Ear
= Threshold below this level

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 Right and Left Ear
= Bone conduction (not masked)
 Right Ear
[ = Bone conduction (masked)
 Left Ear
] = Bone conduction (masked)

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 Right and Left Ear
= Threshold at or below this level
 Right Ear
= Uncomfortable Loudness Level
 Left Ear
= Uncomfortable Loudness Level

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 Right Ear
= Air conduction
(not masked - shadow)
 Left Ear
= Air conduction
(not masked - shadow)

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 Maskingis necessary to prevent
the non-test ear from hearing
sounds presented to the
opposite ear.

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 Narrow-band
 Centre frequency coincides with
the test tone and the bandwidth is
between one-third and one-half
of an octave.

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 Excessive wax
 Foreign body
 Discharge/infection in ear canal

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 Faulty equipment
 Poor instructions
 Ambient noise
 Excessive wax
 Headphones placed incorrectly
 Bone conductor placed incorrectly

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 Visual clues
 Rhythmical presentations
 Inappropriate masking
 Poor concentration
 Tinnitus affecting ability to hear

tones
 Non-organic hearing loss

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 Air Conduction
◦ Pure tones at 20 and 60 dB for
each frequency from 250 to 8000
Hz
◦ Masking noise at 40 dB for each
frequency from 250 to 8000 Hz

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 Bone Conduction
◦ Pure tones at 20 and 40 dB for
each frequency from 500 to 4000
Hz

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