Objective Assessment of Hearing

Description

This book bridges the gap between theory and clinical application for electro-acoustic and electro-physiologic assessment of hearing loss across the age range. Strategies and techniques for screening and diagnosis of hearing loss are presented clearly and simply. The authors incorporate findings of accumulated clinical experience and recent clinical research in a readable review of electro-acoustic measures (immittance measures and otoacoustic emissions) and electro-physiologic measures (electrocochleography, ABR and ASSR) that are essential for best practice in audiology today. This book is a one-stop resource for clinicians who are responsible for the diagnostic auditory assessment of children and adults.

Table of contents

Chapter 1: Rationale for Objective Hearing Assessment

• Differentiate screening versus diagnostic measures
• Differentiate auditory dysfunction vs. hearing sensitivity vs. hearing
• Cross-check principle revisited … test battery approach (classic quote)
• What we need to get from a hearing assessment
  Degree of hearing loss
  Configuration
  Symmetry
  Frequency specific thresholds
  Ear specific thresholds
  Valid and reliable measures
• Clinical limitations of behavioral audiometry
  Age
  Neurological immaturity
  Sensitivity and specificity
• Identification (screening) of hearing loss (auditory dysfunction)
  Distinguish between auditory vs. hearing sensitivity vs. hearing (cortical function)
  Purpose of hearing loss identification
  Principles of screening
  Principles of sensitivity and specificity
  Options for screening
• Factors influencing hearing loss identification
  Age
  State of arousal
  TABLE for all techniques
• Estimation of hearing thresholds
  Purpose of hearing threshold estimation with electro acoustic techniques
• Factors influencing hearing threshold estimation
  Age
  State of arousal
  TABLE for all techniques

Chapter 2: Immittance Measurements

• Introduction and historical perspective
• Anatomy and physiology in a nutshell (Figures)
• Identification of hearing loss (screening)
  Tympanometry
  Single vs. multi-component
  Low vs. high frequency probe tone
  Jerger classification
  ASHA guidelines
  Gradient
• Wide Band Reflectance
• Acoustic reflex thresholds for broad-band noise signals
• Estimation of hearing loss
• Sensitivity Prediction by Acoustic Reflex (SPAR)
• Other acoustic reflex predictive techniques
  Acoustic reflex thresholds for broad-band noise signals
• Clinical considerations and constraints (TABLE)
  Subject factors (list as many as possible)
• Pathologic factors (list as many as possible)
  Summary of clinical application

Chapter 3: Otoacoustic Emissions (OAEs)

• Screening for hearing loss
  Transient OAEs (TEOAEs)
  Distortion product OAEs (DPOAEs)
  Automated techniques
• Estimation of hearing loss
  Relation of OAEs to the audiogram
  Statistical attempts to estimate hearing loss with OAEs
• Clinical considerations and constraints
  Subject factors
  Pathologic factors
  Auditory neuropathy
  Summary of clinical application

Chapter 4: Electrocochleography (ECochG)

• Identification of hearing loss
• Estimation of hearing thresholds
  Electrode options
  Dynamic range for intensity
  Frequency specificity
  Clinical considerations and constraints
  Subject factors
  Pathologic factors
  Sedation and anesthesia
  Auditory neuropathy
  Summary of clinical application

Chapter 5: Auditory Brainstem Response (ABR)

• Screening for identification of hearing loss
  Automated ABR
  Detection algorithms and techniques
• Estimation of hearing thresholds
  Stimulus options
  Tone-burst ABRs
  Latency-intensity functions
  Bone conduction ABRs
• Clinical considerations and constraints
  Subject factors
  Pathologic factors
  Sedation and anesthesia
  Alternative non-sedation strategies
  Auditory neuropathy
  Summary of clinical application

Chapter 6: Auditory Steady State Response (ASSR)

• Background to the ASSR
• Defining the ASSR
  Response physiology
  Neural generators
  Stimulus characteristics
  Type of stimuli
  Presentation of stimuli
  Clinical stimulus protocols
  Response measurement
  Improving the signal-to-noise ratio
  Clinical recording protocols
  Response analysis
  Spectral analysis
  Phase analysis
  Considerations in analysis
• Estimating hearing thresholds
  General subject factors
  Hearing loss characteristics
  Bone conduction
  Sound-field measurements
  Sedation & anesthesia
  Remaining clinical questions
• Summary of clinical application

Chapter 7: Recommendations for Objective Identification and Estimation of Hearing Loss

• Guidelines, recommendations, and standard of care
• New directions for research
• Combined OAE/ABR hearing screening technique
  Infants
  Pre-school and school-age children
  Adults
• Test battery approach for estimation of hearing loss
  Children
  Adults
• Once again … what we need to get from a hearing assessment
• Advantages of electro-acoustic and electro-physiologic measures

Chapter 8: Illustrative Case Reports and Clinical Findings

• Normal hearing
• Conductive hearing loss
• Sensory hearing loss
• Auditory neuropathy
• Complex case

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REFERENCES
APPENDICES
A. Clinical forms
B. Normative data