3.

3 Interpretation of Audiometric Test

3.3.1 Audiogram
A graphical representation of audiometry
result is called audiogram.
or
A graphical representation of frequency and
intensity(threshold level of hearing)
or
A graphical representation of persons
hearing loss.

Threshold level of Hearing

A minimum level at which a person hear is
called threshold level of hearing.
Hearing Paths
Air conduction- It is the transmission of
sound to the auditory canal through
headphone
Hearing Paths Cont…
Bone conduction:- It is the transmission of sound to the cochlea by
bones of skull or mastoid bone through bone vibrator.
Air &Bone Conduction
Audiogram Keys

Reading And color

Red…..for Right Ear
Blue………For Left Ear
Air Conduction
Black …………Bone Conduction
Air Conduction………free Hand
full line
Bone Conduction………..Free
Hand Dotted line ------

Types Of Hearing Loss

 Conductive Hearing Loss

If A.C And B.C Difference (ABG) is greater than 15dB And
B.C is Normal
B.C Normal Mean (-10 to 20dB)
ABG Is Air Bone Gap
 Sensorineural Hearing Loss
If A.C And B.C Difference (ABG) is 15dB and less than this
dB And B.C is also impaired
A.C And B.C both are impaired
A.C=B.C OR With in 15dB
 Mixed Hearing Loss
If A.C And B.C Difference (ABG) is greater than 15dB.B.C Is
Impaired.
A.C, B.C >15 dB
Mild Hearing Loss

Profound Hearing Loss

 3.2.3 PURE TONE AUDIOMETRY
SINGLE
PURE TONE FREQUENCY
PURE TONE SIGNAL
AUDIOMETRY
MEASURMENT OF
AUDIOMETRY HEARING

What is Pure Tone?

A single Frequency tones/signals are called pure tone.
What is Audiometry?
The measurement of the hearing is called Audiometry.
Audiometry is the collection of techniques which is used to
measure hearing loss sensitivity using electric equipment named as
audiometry.
Audiometer
An electronic device which is used fir the process of
Audiometry.
An Electronic device which is used for hearing assessment is
called audiometer.
Pure Tone Audiometry
Pre Requisites/Test Environment / Protocol of Test
Child should be accompanied with his parents.
Be tested in a sound proof room/Sound treated room.
Room Should be ventilated and comfortable sitting.
Room should be free for visual distraction.
Toys and games out of side.
Child be seated in a small chair at low table and parents seated
next to him.
Subject should not see teacher s arm moving in operating
audiometer.
Purpose of audiometry
To measure threshold of hearing using A/C And B/C and arrive at
degree of hearing loss
Audiometer Checks
Allowed to warm up for 15 mints
Head phone & Bone vibrator serial no check
All dial and switches.
Listen to output from headphone & bone vibrator.
Interrupter switch.
conditioning
To make a simple response.
Signal through head phone near child.
Signal well above child threshold.
Place put headphone on the child external auditory canal.
If child upset .parents may wear to encourage him.
Test Method
Start testing and intensity (Hearing threshold level) 60 dB at 1 k Hz
frequency.
To make response when tone is heard.
Westlake & Haugman Method used(10down,5 up).
Right ear test First 1kHz,then higher i.e 2k ,4k and 8 k Hz.and then
lower i.e 500&250Hz.
Intensity reduced 10 dB until no response.
Then intensity increased in 5dB step until response.
If response two out of three Auditory thresholds.
Then the other ear in same way.
Note down the reading against each frequency and plot on
audiogram.
Patients /Equipment's Variable
Attention
Comfortable
Room temperature.
Room ventilation.
Free visual & auditory distractions.
Regular calibration
Cross talk between headphone
Masking
If ABG (Difference between A/C And B/C ) is greater than 40dB then
Masking is needed.
Masking is done in non test ear(better ear) .
Masking is a noise.
It is process by which threshold of audibility raised by the presence
of an other sound.
Principles of Masking
Rule 1
A/C need masking .A/C. difference is greater than 40db.
Rule 2
B/C needs masking ,A/C And B/C difference is 15dbor More
Rule 3
A/C needs masking ,ABG (Air Bone Gap)is 40 dB.
 3.3.2 Tympanometer
Basic Immittance Measures
 Tympanometry
 Acoustic Reflex Thresholds
 Acoustic Reflex Threshold Decay
Tympanometry
 “A way of measuring how acoustic immittance of the middle ear
system changes as air pressure is varied in the external ear canal”
 The graphical representation of complaince and pressure is called
tympanogram
Normal tympanometer consists on
 Shape
 Pressure: -100 mm H2O or DaPa
 Compliance: 0.3-1.6 cc
compliance
The reciprocal of acoustic stiffness
Pressure
 Force per unit area is called pressure
Purpose

 to deduct middle ear disorders by the performance of the ear

drum
 to measure the acoustic reflexes stappdeanc muscles and tensert
tempany
 it is done for just middle era to determine the function of middle
are properly
Normal Tympanogram
Tpye A Type As
 Normal sharp inverted problem in Stappes

Type Ad Type B
 Dislocation of MIS Otitis Media
 Chapter# 8
Rehabilitation Strategies for HI
Rehabilitation
 The action of restoring someone to health or normal life through training and
therapy after imprisonment, addiction, or illness is called rehabilitation.
 the action of restoring something that has been damaged to its former condition.
1.Diagnosis
The identification of the nature of an illness or other problem by examination of the
symptoms.
2. Screening
The evaluation or investigation of something as part of a methodical survey, to
assess suitability for a particular role or purpose.
3.Medical treatment
Medical treatment means the management and care of a patient to combat
disease or disorder. Medical treatment includes: ... Administration of oxygen to
treat injury or illness.
1. Medicine
Used if foreign particle wax infection in ear drum inter in the ear
perforations in ear otitis media externa vertigo tinnitus
2. Radio therapy
The treatment of disease with ionizing radiation called radiation therapy.
o In radiotherapy, high-energy rays are often used to damage cancer
cells and stop them from growing and dividing. A specialist in the
radiation treatment of cancer is called a radiation oncologist.
3. Operation/surgery
a) Stapedectomy
A stapedectomy is a surgical procedure of the middle ear performed in
order to improve hearing. If the stapes footplate is fixed in position, rather
than being normally mobile, then a conductive hearing loss results. There
are two major causes of stapes fixation.
b) Tympanoplasty
Tympanoplasty is the surgical operation performed for the reconstruction
of the eardrum (tympanic membrane) and/or the small bones of the middle
ear (ossicles).
 c) Myringoplasity
Myringoplasty is the closure of the perforation of pars tensa of the
tympanic membrane. When myringoplasty is combined with ossicular
reconstruction, it is called tympanoplasty. The operation is performed with
the patient supine and face turned to one side.
Hearing aid
an electronic device usually worn in or behind the ear of a hearing-
impaired person for amplifying sound
8.2 Educational treatment
 Need of individuals
 Selection of school
Selection of school based on mainstreaming or segregation
Its depend on parents to addmittion their child either in integration
or inclusive education
 Least restrictive environment
Means that a student who has a disability should have the opportunity to
be educated with non-disabled peer, to the greatest extent appropriate
 Selection of curriculum
The curriculum must be related to their disability.
Seven criteria for the selection of curriculum
I. Self sufficient
II. Significance
III. Validity
IV. Interest
V. Utility
VI. Learn ability
VII. Feasibility
 Co-curricular activities

8.3 Vocational treatment

Definition
 Vocational rehabilitation is a process which enable person with functional,
psychological, development cognitive and emotional impairment or health
disaililties to overcome barriers to accessing ,maintaining or returning to
employment or other useful occupation .
Parts of those continues and coordination process of rehabilitation which involves
the provision of those vocational guideness.
According to disable person convention 1983 recommendation 159 ILO.
Training and selective placement design to unable a disable person to secure
retain and advance in suitable impalement further a disabled person integration
into society
Process of vocational rehabilitation basic principles
 Identification
Door to door visit, interview, visit of school, telephonic
investigation, classification, function, events
 Registration
Personal data, disability data, client’s exceptional comments
 Social assessment
Background information, home environment, family integration
 Vocational assessment
Attitude, writing, function, abilities, cleanliness of client.
Experience, behavior with coworker
 Vocational training
Composing, graphing, handcraft, glass painting, home decoration,
greeting card, phone repairing, selling, electric work, welding,
sport man, social worker
Training Environment for HI
 Friendly
 Modeling
 Reward
 Trait with in community
  Use of tools and equipment
 Special teaching aid
 Advance technologies
Selection of occupation in which training is to be provided
 Economical suitable for client
 Available in community
 Easy to cope
 Easy to assess
Placement of HI on job training spot
 Lack of attention
 Lack of confidence
 Lack of social adjustment
 Lack of communication
 Lack of punctuality
Placement on income generation
 Selection placement
 Knowing the worker
 Knowing the job
 Matching the worker with jobs.
Follow up
 To ensure that placement is still successful
 Training spot
 Client satisfaction
 Selection of trait
 Guidance and counseling
 Social adjustment
 Problem solving

8.4 Early management of Hearing loss

 Rehabilitation
  The action of restoring someone to health or normal life through
training and therapy after imprisonment, addiction, or illness is called
rehabilitation.
the action of restoring something that has been damaged to its former
condition
 Restore
 Early diagnosis
3.Medical treatment
Medical treatment means the management and care of a patient to
combat disease or disorder. Medical treatment includes: ...
Administration of oxygen to treat injury or illness.
 Medicine
 Radio therapy
 Operation/surgery
a. Stapedectomy
b. Tympanoplasty
c. Myringoplasity
Hearing aid
 an electronic device usually worn in or behind
the ear of a hearing-impaired person for
amplifying sound
Educational treatment
 Need of individuals
 Selection of school
 Least restrictive environment
 Selection of curriculum
 Co-curricular activities