1 the audiogram measurement of hearing and audiogram interpretation
TRANSCRIPT
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The AudiogramThe Audiogram
Measurement of Hearing and Audiogram Interpretation
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IntroductionIntroduction How we measure hearing How those measurements can be
recorded What the audiogram can tell us
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Purposes of audiometric Purposes of audiometric testingtesting
Monitor the effectiveness of the hearing conservation program
Identify significant threshold shift Establish readiness and fitness for
duty Ensure proper referral and diagnosis
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VocabularyVocabulary
Audiogram - A record of a person’s pure-tone hearing threshold levels
Threshold – A level of sound that a person can detect 50% of the time or more
Audiometric Zero – sensitivity of normal, young adults
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Audiometric ZeroAudiometric Zero (Ref ANSI S3.6 1996, TDH-39 earphones)
0 dB Hearing Level at 1000 Hz = 7 dB SPL
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25.5
11.58 7 6.5
9 10 9.5
15.513
0
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125 250 500 750 1000 1500 2000 3000 4000 6000 8000
Frequency (Hz)
Loud
ness
(dB
)
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•Does 0 dB HL mean the absence of sound?
•What is the intensity of a 0 dB HL pure-tone at 1000 Hz?
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Output Limits of the DOEHRS-HC Output Limits of the DOEHRS-HC
AudiometerAudiometer
-10 to 100 dB HL
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Serial AudiogramSerial Audiogram
Thresholds recorded to the nearest 5 dB Used on DD Forms 2215 and 2216,
entrance physicals and physical exam forms (SF 88 and DD 2808)
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Serial AudiogramSerial AudiogramSerial AudiogramSerial Audiogram
Left Ear500 1000 2000 3000 4000 6000
Baseline 1983/06/01 5 10 25 20 35 25Annual 1999/07/24 10 10 15 20 15 35
Right Ear500 1000 2000 3000 4000 6000
Baseline 1983/06/01 10 10 10 25 25 10Annual 1999/07/24 10 10 15 20 15 35
Mild high-frequency hearing loss at 6000 Hz bilaterally.
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Graphic AudiogramsGraphic Audiograms
Provides a pictorial representation of hearing thresholds as a function of frequency and intensity
Uses symbols and/or colors to represent right ear, left ear, bone conduction hearing and masking levels
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Graphic AudiogramsGraphic Audiograms
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500 1000 2000 3000 4000 6000
Frequency (Hz)
dB
Hea
ring L
evel
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Self-recording Audiogram
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Degrees of Hearing LossDegrees of Hearing Loss
Normal Hearing -10 - 25 dB HL Mild Hearing Loss 30 - 45 dB HL Moderate Hearing Loss 50 - 65 dB HL Severe Hearing Loss 70 - 85 dB HL Profound Hearing Loss > 90 dB HL
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Audiogram Configurations:Audiogram Configurations: Progressive noise-induced hearing loss
0
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500 1000 2000 3000 4000 6000
Frequency (Hz)
dB H
L
Mild Loss Moderate Loss Severe loss
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Hearing Loss ZonesHearing Loss Zones
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dB
Normal
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Hz250 500 1000 2000 3000 4000 6000 8000
sh
f ths
ch
p h k
Speech SoundsSpeech Sounds
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Audiogram Configurations:Audiogram Configurations: Gundecking
Left Ear500 1000 2000 3000 4000 60000 0 0 0 0 0
Right Ear0 0 0 0 0 0
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Audiogram Configurations:Audiogram Configurations: Background Noise
Left Ear500 1000 2000 3000 4000 600030 5 0 5 0 0
Right Ear30 0 5 0 0 0
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Cross-overCross-over One ear hears much better than the other
The sound presented to the test ear crosses through the skull and stimulates the hair cells of the cochlea of the non-test ear
The non-test ear is the one actually responding to the tone
Differences of > 40 dB at the same frequency between ears are suspicious
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Cross-overCross-over
0
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500 1000 2000 3000 4000 6000
Frequency (Hz)
dB
Hea
ring L
evel
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MalingeringMalingering
Pretending to have a hearing loss by waiting until the sound is quite loud before pressing the response button
IAW Article 115, Paragraph 194, a person may be charged with malingering if he/she pretends to have a hearing loss that is later found to be non-existent
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Automatic RechecksAutomatic Rechecks
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Sensorineural Hearing LossSensorineural Hearing Loss
Determined by a complete audiological evaluation
Compare air-conduction and bone-conduction pure-tone thresholds
Look at acoustic immittance test results
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Sensorineural Hearing LossSensorineural Hearing Loss
0
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500 1000 2000 3000 4000 6000 8000
Frequency (Hz)
dB
Hea
ring L
evel
Left Ear Right Ear BC Left Ear
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Conductive Hearing LossConductive Hearing Loss
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500 1000 2000 3000 4000 6000 8000
Frequency (Hz)
dB
Hea
ring L
evel
Left Ear Right Ear BC Left Ear
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Counseling PatientsCounseling Patients
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Explain the Test ResultsExplain the Test Results Provide privacy for explanation Both ears tested Frequencies tested The lower the threshold, the better
the hearing Review each ear in terms of
intensity and frequency
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Appropriate ExplanationsAppropriate Explanations Within normal limits Loss in the high or low frequencies Loss in one or both ears Hearing has changed or remained
the same
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Making DiagnosesMaking Diagnoses
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Medical Legal Requirements Medical Legal Requirements Regardless of TypeRegardless of Type
•Patient’s name, SSN, (MOS, SSI, Job Patient’s name, SSN, (MOS, SSI, Job Location, and Unit Identification Code)Location, and Unit Identification Code)
•Examiner’s name, SSN, and Examiner’s name, SSN, and certification numbercertification number
•Date of TestDate of Test
•Make, model, and serial number of Make, model, and serial number of audiometeraudiometer
•Calibration date of audiometer.Calibration date of audiometer.
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DOEHRS-HC supplies most of the necessary medical legal audiogram
information
AUTOMATICALLY
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DD Form 2215DD Form 2215 Reference Audiogram
For all military and noise-exposed civilians Performed before noise-hazardous duties
or as soon as possible thereafter Noise-free period of at least 14 hours
before the test No temporary ENT problems the day of test Refer for low-frequency or high-frequency
hearing loss After a permanent STS, re-establish a new
baseline
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DD Form 2216DD Form 2216 Hearing Conservation Data
Periodic audiogram Annual 90 - Day Termination Other
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FormsForms General Information
Maintain audiograms for entire period of employment plus 5 years
Test must be performed by audiologist, physician, persons certified by CAOHC, or one who has received equivalent military training
Equivalent military training includes this course. The certification from this course and other Army courses is only 5 years
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Audiogram ReviewAudiogram Review Trained personnel must review all
audiograms for validity and proper patient disposition.
Who Reviews? Initially any Hearing Conservation Technician Problem audiograms must be reviewed by an
audiologist, otolaryngologist or other physician
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Audiograms to ReferAudiograms to Refer
DD 2215’s
> 25 dB at 500, 1000, and 2000 Hz
> 55 dB at 3000, 4000, or 6000 Hz
DD 2216’s
Significant Threshold Shift (STS) computed from the average of 2000, 3000, & 4000 Hz in either ear in comparison to the baseline or reference hearing test (DD2215)
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Factors Affecting ValidityFactors Affecting Validity
Poor test environment - audiometric test booth does not meet background noise criteria
Cross-over hearing Uncooperative patients
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Review QuestionsReview Questions Does an audiometric booth need to be
perfectly soundproof?
Excessive noise in an audiometric test booth will probably effect which frequency?
When hearing levels between ears at the same frequency differ by 50 to 70 dB, what should you suspect is going on?