{"id":1525,"date":"2010-12-06T11:23:34","date_gmt":"2010-12-06T11:23:34","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/audiometry-tone-threshold-audiogram\/"},"modified":"2023-10-25T12:23:10","modified_gmt":"2023-10-25T11:23:10","slug":"audiometry-tone-threshold-audiogram","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-ear-nose-mouth-throat-and-neck\/hearing\/audiometry-tone-threshold-audiogram\/","title":{"rendered":"Audiometry: Tone Threshold Audiogram"},"content":{"rendered":"<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Requirements<\/strong><\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Quiet room.<\/span><\/li>\n<li><span style=\"color: #003366;\">Audiometer <em><strong>[Figure 12]<\/strong><\/em>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1522\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-12.jpg\" alt=\"\" width=\"400\" height=\"300\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-12.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-12-300x225.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 12<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\">Various different types of <span style=\"color: #33cccc;\"><strong>audiometers<\/strong><\/span> are available. There are simple screening audiometers with which only loss of hearing can be determined in the <span style=\"text-decoration: underline;\">high<\/span>, <span style=\"text-decoration: underline;\">middle<\/span> and <span style=\"text-decoration: underline;\">low frequencies<\/span>. Others are very sophisticated instruments with which both the air and bone conductivity can be measured accurately at <span style=\"text-decoration: underline;\">different frequencies<\/span> and <span style=\"text-decoration: underline;\">sound levels<\/span>, allowing the nature and extent of the hearing loss to be determined precisely. In many cases, it is also possible to determine the cause of the hearing loss with these instruments.<\/span><\/p>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/122523005?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\"><\/iframe><\/p>\n<hr \/>\n<h3><span style=\"color: #003366;\">Procedure<\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">Inform the patient before starting the examination that you are positioning them so that they cannot see the audiometer or your movements <em><strong>[Figure 19]<\/strong><\/em>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Ask the patient, when they hear a bleep sound, to raise a hand at the side of the ear with which the sound was heard <em><strong>[Figure 20a]<\/strong><\/em>.<\/span><\/li>\n<li><span style=\"color: #003366;\">Start by testing the ear that the patient reports hearing best with.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1523\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-19.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-19.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-19-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 19<\/span><\/strong><\/span><\/p>\n<hr \/>\n<p><span class=\"jce_caption\" style=\"display: inline-block; color: #003366;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-1524\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-20a.jpg\" alt=\"\" width=\"400\" height=\"299\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-20a.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/EarNoseMouth_enm-fig-20a-300x224.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><strong><span style=\"width: 400px; display: block;\">Figure 20a<\/span><\/strong><\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Position yourself behind the patient and check that they actually are unable to see the audiometer and your actions.<\/span><\/li>\n<li><span style=\"color: #003366;\">Present the patient with a tone with an <span style=\"color: #33cccc;\"><strong>intensity of 30 dB<\/strong><\/span> (<em>this is the threshold value between normal hearing and loss of hearing<\/em>) and a <span style=\"color: #33cccc;\"><strong>frequency of 1000 Hz<\/strong><\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">If the patient indicates hearing this tone, <span style=\"text-decoration: underline;\">reduce<\/span> the intensity <span style=\"color: #33cccc;\"><strong>by 10 dB<\/strong><\/span> and continue doing so until the patient indicates no longer hearing the tone.<\/span><\/li>\n<li><span style=\"color: #003366;\">When this occurs, increase the intensity of the tone again <span style=\"color: #33cccc;\"><strong>by 5 dB<\/strong><\/span> and assess whether the patient can hear the tone.<\/span><\/li>\n<li><span style=\"color: #003366;\">If they can hear it, lower the tone by <span style=\"color: #33cccc;\"><strong>another 5 dB<\/strong><\/span> to check whether the lower intensity can be heard after all.<\/span><\/li>\n<li><span style=\"color: #003366;\">If the 5 dB increase is not heard either, increase the tone intensity by <span style=\"color: #33cccc;\"><strong>another <\/strong><\/span><\/span><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>5 dB<\/strong><\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">The lowest tone intensity that can be heard is considered to be the <span style=\"text-decoration: underline;\">threshold<\/span> for that tone.<\/span><\/li>\n<li><span style=\"color: #003366;\">Once this has been determined for the 1000 Hz frequency, move up to the <span style=\"text-decoration: underline;\">next frequency<\/span> and repeat the whole procedure. <\/span><\/li>\n<li><span style=\"color: #003366;\">This should be done until the highest measurable frequency on the audiometer has been tested. <\/span><\/li>\n<li><span style=\"color: #003366;\">Finally, investigate the frequencies <span style=\"color: #33cccc;\"><strong>below 1000 Hz<\/strong><\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">If a patient does not indicate hearing a tone presented at <span style=\"color: #33cccc;\"><strong>30 dB<\/strong><\/span>, increase the intensity by <strong>10 dB<\/strong>, until the patient indicates hearing the tone.<\/span><\/li>\n<li><span style=\"color: #003366;\">Subsequently check whether a <span style=\"color: #33cccc;\"><strong>5 dB decrease<\/strong><\/span> in intensity can be heard.<\/span><\/li>\n<li><span style=\"color: #003366;\">The lowest intensity tone that can be heard is considered the threshold for that tone.<\/span><\/li>\n<li><span style=\"color: #003366;\">Repeat the test in the same manner for the other ear.<\/span><\/li>\n<\/ul>\n<hr \/>\n<h3><span style=\"color: #003366;\"><strong>Interpretation Of The Findings<\/strong><\/span><\/h3>\n<ul>\n<li><span style=\"color: #003366;\">If the air (<em>and bone<\/em>) conduction curve shows a hearing <span style=\"text-decoration: underline;\">threshold<\/span> of <span style=\"color: #33cccc;\"><strong>30 dB or less<\/strong><\/span>, the hearing is <span style=\"text-decoration: underline;\">normal<\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">If both the air and bone conduction curve show a threshold of <span style=\"color: #33cccc;\"><strong>more than 30 dB<\/strong><\/span> <span style=\"text-decoration: underline;\">sensorineural hearing loss<\/span> is indicated. <\/span><\/li>\n<li><span style=\"color: #003366;\">If the threshold is between <span style=\"color: #33cccc;\"><strong>30 and 60 dB<\/strong><\/span>, the hearing loss is <span style=\"text-decoration: underline;\">moderate<\/span>, and if the threshold is <span style=\"color: #33cccc;\"><strong>greater than 60 dB<\/strong><\/span> there is <span style=\"text-decoration: underline;\">severe hearing loss<\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">If only the air conduction curve shows a loss of <span style=\"color: #33cccc;\"><strong>over 30 dB<\/strong><\/span> and the bone conduction curve shows no abnormalities, the patient is suffering from <span style=\"text-decoration: underline;\">conductive hearing loss<\/span>. <\/span><\/li>\n<li><span style=\"color: #003366;\">Again, between <span style=\"color: #33cccc;\"><strong>30 and 60 dB<\/strong><\/span> indicates <span style=\"text-decoration: underline;\">moderate hearing loss<\/span> and anything <span style=\"color: #33cccc;\"><strong>above 60 dB<\/strong><\/span> represents <span style=\"text-decoration: underline;\">severe hearing loss<\/span>.<\/span><\/li>\n<li><span style=\"color: #003366;\">A combination of sensorineural and conductive hearing loss is also possible.<\/span><\/li>\n<li><span style=\"color: #003366;\"> In such cases, <span style=\"text-decoration: underline;\">air conduction<\/span> will always be <span style=\"text-decoration: underline;\">worse<\/span> than <span style=\"text-decoration: underline;\">bone conduction<\/span>.<\/span><\/li>\n<\/ul>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Requirements Quiet room. Audiometer [Figure 12]. Figure 12 Various different types of audiometers are available. There are simple screening audiometers with which only loss of hearing can be determined in the high, middle and low frequencies. Others are very sophisticated instruments with which both the air and bone conductivity can be measured accurately at different [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[38],"tags":[132],"class_list":["post-1525","post","type-post","status-publish","format-standard","hentry","category-hearing","tag-the-examination-of-the-ear-nose-mouth-throat-and-neck"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Audiometry: Tone Threshold Audiogram - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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