Clinical Audiology. An Introduction

Preface
Acknowledgments
About the Authors
Contributors

Chapter 1. The Profession of Audiology in the United States
Learning Objectives
What Is an Audiologist?
What Is an Audiologist’s Role?

Identification of Hearing Loss
Assessment and Diagnosis of Hearing Loss
Treatment of Hearing Loss
Assessment and Treatment of Balance Function
Education
Prevention
Research
Related Activities
Scope of Practice

Where Do Audiologists Practice?

Private Practice
Physician’s Practices
Hearing and Speech Clinics

Relation to Other Professions

Otolaryngology
Other Medical Specialties
Speech-Language Pathology
Non-Audiologist Hearing Aid Dispensers

The Evolution of Audiology

The Professional Heritage of Audiology
The Clinical Heritage of Audiology

Professional Requirements

Becoming an Audiologist
Academic and Clinical Requirements

Summary
Discussion Questions
Information Sources
Organizations
Resources

Section I. Hearing and its Disorders

Chapter 2. The Nature of Hearing
Learning Objectives
The Nature of Sound

What Is Sound? 
Properties of Sound

The Auditory System

Outer Ear
Middle Ear
Inner Ear
Auditory Nervous System
Anatomy Physiology

How We Hear

Absolute Sensitivity of Hearing 
Differential Sensitivity
Properties of Pitch and Loudness 

Summary
Discussion Questions
Resources

Chapter 3. The Nature of Hearing Disorder
Learning Objectives
Degree and Configuration of Hearing Sensitivity Loss
Ear Specificity of Hearing Disorder
Type of Hearing Loss

Conductive Hearing Loss
Sensorineural Hearing Loss
Mixed Hearing Loss
Suprathreshold Hearing Disorder
Functional Hearing Loss

Timing Factors Impacting Hearing Disorder
Summary
Discussion Questions
Resources

Chapter 4. Causes of Hearing Disorder
Learning Objectives
Auditory Pathology
Conductive Hearing Disorders

Congenital Outer- and Middle-Ear Anomalies
Impacted Cerumen
Other Outer-Ear Disorders
Otitis Media with Effusion (OME) 
Complications of OME
Otosclerosis
Other Middle-Ear Disorders

Sensory Hearing Disorders

Congenital and Inherited Sensory Hearing Disorders
Acquired Sensory Hearing Disorders

Neural Hearing Disorders

Auditory Neuropathy Spectrum Disorder
VIIIth Nerve Tumors and Disorders
Brainstem Disorders Temporal-Lobe Disorders
Other Nervous System Disorders

Summary
Discussion Questions
Resources
Articles and Books
Web Sites

Section II. Audiological Diagnosis

Chapter 5. Introduction to Audiological Diagnosis
Learning Objectives
The First Question

Referral-Source Perspective 
Importance of the Case History

The Audiologist’s Challenges

Evaluating Outer- and Middle-Ear Function 
Measuring Hearing Sensitivity
Determining Type of Hearing Loss 
Measuring Speech Recognition 
Measuring Auditory Processing
Measuring the Impact of Hearing Loss
Screening Hearing Function

Summary
Discussion Questions
Resources
Articles and Books
Web Sites

Chapter 6. Audiological Diagnostic Tools: Pure Tone Audiometry
Learning Objectives
Equipment and Test Environment

The Audiometer 
Transducers
Calibration
Test Environment

The Audiogram

Threshold of Hearing Sensitivity 
Modes of Testing 
Audiometric Symbols 
Audiometric Descriptions

Establishing the Pure-Tone Audiogram

Patient Preparation 
Audiometric Test Technique
Air Conduction 
Bone Conduction 
Masking
Audiometry Unplugged: Tuning Fork Tests

Summary
Discussion Questions
Resources

Chapter 7. Audiological Diagnostic Tools: Speech Audiometry
Learning Objectives
Speech Audiometry

Uses of Speech Audiometry 
Speech Audiometry Materials 
Clinical Applications of Speech Audiometry
Predicting Speech Recognition

Summary
Discussion Questions
Resources

Chapter 8. Audiological Diagnostic Tools: Immittance Measures
Learning Objectives
Immittance Audiometry
Instrumentation
Measurement Technique
Basic Immittance Measures

Tympanometry 
Acoustic Reflexes

Principles of Interpretation
Clinical Applications

Middle-Ear Disorder 
Cochlear Disorder 
Retrocochlear Disorder

Summary
Discussion Questions
Resources

Chapter 9. Audiological Diagnostic Tools: Physiologic Measures
Learning Objectives
Auditory Evoked Potentials

Measurement Techniques
The Family of Auditory Evoked Potentials 
Clinical Applications

Summary
Otoacoustic Emissions

Types of Otoacoustic Emissions 
Relation to Hearing Sensitivity 
Clinical Applications

Summary
Short Answer Questions 
Discussion Questions
Resources

Chapter 10. The Test-battery Approach to Audiological Diagnosis
Learning Objectives
Determination of Auditory Disorder
The Test Battery Approach in Adults

Value of a Comprehensive Test Battery
The Audiometric Test Battery
Diagnostic Thinking and Avoiding Errors
The Test Battery in Action

The Test Battery Approach in Pediatrics

Diagnostic Challenges 
The Test Battery
The Test Battery in Action

Different Approaches for Different Populations

Infant Screening
Auditory Processing Assessment
Functional Hearing Loss

Summary
Discussion Questions
Resources

Chapter 11. Communicating Audiometric Results 
Learning Objectives
Talking to Patients

Information to Convey
Matching Patient and Provider Perspectives

Writing Reports

Documenting and Reporting 
Report Destination
Nature of the Referral 
Information to Convey 
Sample Reporting Strategy

Making Referrals
Summary
Discussion Questions
Resources

Section III. Audiological Treatment

Chapter 12. Introduction to Audiological Treatment
Learning Objectives
The First Questions

The Importance of Asking Why 
Assessment of Treatment Candidacy

The Audiologist’s Challenge

Amplification — Yes or No? 
Amplification Strategies
Approaches to Fitting Hearing Instruments
Approaches to Defining Success 
Treatment Planning

Summary
Discussion Questions
Resources

Chapter 13. Audiological Treatment Tools: Hearing Aids
Learning Objectives
Hearing Instrument Anatomy

Microphone
Other Sound Input Sources
Amplifier
Loudspeaker
Hearing Instrument Styles

Hearing Instrument Physiology

Audibility
Hearing in Background Noise

Consideration for Hearing Aid Options

Acoustic Considerations
Instrumentation Considerations
Patient Factors

Special Considerations: Conductive Hearing Losses and Single-Sided Deafness
Summary
Discussion Questions
Resources

Chapter 14. Audiological Treatment Tools: Implantable Hearing Technology
Learning Objectives
Cochlear Implants

Internal Components
External Components
Signal Processing
Candidacy for Cochlear Implants
Hybrid Cochlear Implants

Bone-Conduction Implants

Internal Components
External Components
Signal Processing
Candidacy for Bone-Conduction Implants

Middle-Ear Implants

Types of Middle-Ear Implants
Candidacy for Middle-Ear Implants

Summary
Discussion Questions
Resources

Chapter 15. Audiological Treatment Tools: Hearing Assistive and Connectivity Technologies 
Learning Objectives
The Challenges of Complex Environments
Hearing Assistive Technology

Alerting Devices
Remote Microphone Systems

Telecommunication Access Technologies
Assistive Listening Devices

Personal Amplifiers
Personal Sound Amplification Products
Over-the-Counter Hearing Aids

Summary
Discussion Questions
Resources

Chapter 16. Audiological Treatment Tools: Verification and Outcome Measures
Learning Objectives
Hearing Aid Selection and Fitting

The Prescription of Gain
Hearing Instrument Selection
Hearing Instrument Fitting and Verification

Orientation, Counseling, and Follow-up
Assessing Outcomes
Post-Fitting Rehabilitation

Auditory Training and Speechreading 
Educational Programming

Summary
Discussion Questions
Resources

Chapter 17. Different Treatment Approaches for Different Populations
Learning Objectives
Adult Populations

Adult Sensorineural Hearing Loss 
Geriatric Sensorineural Hearing Loss

Pediatric Populations

Pediatric Sensorineural Hearing Loss 
Auditory Processing Disorder

Other Populations

Conductive Hearing Loss
Severe and Profound Sensorineural Hearing Loss

Summary
Discussion Questions
Resources

Section IV. Vestibular System Function and Assessment

Chapter 18. Introduction to Balance Function and Assessment
Learning Objectives
The Vestibular System

Anatomy & Physiology
The Vestibulo-ocular Reflex

Disorders of Dizziness and Balance

Benign Paroxysmal Positional Vertigo
Superior Canal Dehiscence
Vestibulotoxicity
Vestibular Neuritis/Labyrinthitis
Ménière’s Disease
Vestibular Migraine
Central Balance Disorders
Falls Risk in the Elderly

The Balance Function Test Battery

Importance of Case History
Videonystagmography/Electronystagmography (ENG/VNG)
Rotary Chair
Video Head Impulse Test (vHIT)
Vestibular Evoked Myogenic Potential (VEMP)
Posturography

The Test Battery in Action

Expected Outcomes in Vestibular Disorders
Illustrative Cases

Summary
Discussion Questions
Resources

Glossary
Appendix A. Audiology Scope of Practice
Appendix B. Audiology Standards of Practice
Appendix C. Answers to Discussion Questions
Index

The third edition of Clinical Audiology: An Introduction provides a comprehensive enhancement of all the introductory material available in previous editions of this stimulating textbook. Students can gain an understanding of the scope of the field of audiology and feel prepared to dive deeper into the subject as they progress through their courses. This essential book, now with even more exciting content and features, focuses on the clinical nature of audiology to familiarize students with the many challenging questions encountered by an audiologist.

This textbook is intended primarily for beginning-level students in the fields of audiology and speech-language pathology. It is intended for the first major courses in audiology, whether it be at the undergraduate or graduate level.

Whether your goal is to pursue a career as an audiologist or a speech-language pathologist, Clinical Audiology: An Introduction, Third Edition is the most comprehensive, accessible book available to provide you with the clinical understanding to advance in your chosen field.

• New Coauthor: Virginia Ramachandran, AuD, PhD
• Two new chapters on implantable hearing technology and hearing assistive and connectivity technologies
• Updated descriptions of hearing disorders and their causes
• Expanded focus on diagnostic approach strategies
• Expanded audiological treatment section
• Updated hearing aid technology and verification approaches
• An introduction to vestibular system assessment 

Key Features

• Chapter objectives at the beginning of each chapter preview the concepts to be discussed.
• End of chapter discussion questions aid students in applying concepts.
• End of chapter summaries outline the key points from the chapter improve retention
• Margin notes provide key terms and definitions.
• Bolded key terms draw attention to important concepts throughout the text.
• Clinical notes describe particular techniques students might consider using.
• Comprehensive glossary and index

Brad A. Stach, PhD, is Director of the Division of Audiology, Department of Otolaryngology-Head and Neck Surgery, of the Henry Ford Hospital in Detroit, Michigan. Dr. Stach has served in audiology leadership positions in Houston, Washington, D.C., Palo Alto, Halifax, and St. Louis. He has also held faculty appointments at the Baylor College of Medicine, Georgetown University, Stanford University, Dalhousie University, Washington University of Saint Louis, and Wayne State University, among others. Dr. Stach is the author of a number of books, bookchapters, and articles and is an editorial consultant for several professional journals. He was a founding board member of the American Academy of Audiology and has served as its President and the Chair of its Foundation Board of Trustees.

Virginia Ramachandran, MSW, AuD, PhD, is an Educational and Training Specialist at Oticon, Inc. Prior to this, she was a Senior Staff Audiologist and the Research Coordinator for the Division of Audiology at Henry Ford Hospital in Detroit, MI, as well as an Adjunct Assistant Professor and the Clinical Educational Coordinator for the Audiology program at Wayne State University. Her professional leadership services have included the Executive Board of the American Academy of Audiology, the Board of Directors of the Accreditation Commission for Audiology Education, and as President of the Michigan Academy of Audiology. Dr. Ramachandran serves on the Editorial Board for Plural Publishing, Inc.