I.

Need for test battery

approach
Diagnostic Audiology
Diagnostic audiology is the use of audiologic
tests to determine the location of a
problem in the auditory system and, in many
cases, further insights about the disorder.

For audiologists to make correct diagnoses,

an audiologic test battery is used.
Test Battery
 A test battery is a series or combination of
tests used to assess the auditory system.

Audiometric tests are used in conjunction

with one another to help reinforce or,
alternatively, rule out the diagnosis of a
particular type of hearing loss or the site of
lesion.
Audiological Tests
Puretone air-conduction and bone-conduction
testing
Speech testing
Tympanometry
Acoustic reflex thresholds
Otoacoustic emissions (OAEs).
CROSS-CHECKING TEST RESULTS

The major reason that an audiologist uses a

diagnostic battery is to be able to check the
results of individual tests with each other.

 The idea that “the results of a single test

are cross-checked by an independent test
measure” is referred to as the cross-check
principle (Jerger and Hayes, 1976, p. 614).
The goal of comparing the results of two or
more tests is :
To increase the rate of correct
identification of disorders (hit rate) and
 To decrease the rate of diagnosing a
disorder when no disorder exists (false
alarm rate) (Turner, 2003).
II. Integration of results
audiological tests/Cross
check Principle
Cross check for PTA
Cross-checks for Puretone Air
Conduction
Only obtained puretone air-conduction
thresholds- would not be able to accurately
diagnose the type of hearing loss.

Air-conduction audiometry is normally cross

checked with bone-conduction audiometry
or tympanometry to rule out a conductive
component of the hearing loss.
ABG>10dB-Conductive Hearing loss

AC –Normal , Jerger Type B or Type C-

conductive component.
OAE
OAEs-outer hair cells of the cochlea, but their
measurement may be affected by disorders
in the conductive pathway.
Ruling out a nonorganic hearing loss
To verify outer hair cell function and the
degree of cochlear hearing loss
Diagnosis of conductive components
Auditory neuropathy spectrum disorder
(ANSD), and other retrocochlear disorders.
ART
Acoustic reflexes can be used to help identify
the presence of hearing loss in young
children as well as in adults with language
and/or cognitive issues that may reduce the
validity and reliability of behavioral measures
(Hall, 2010).

Acoustic reflexes can also be used to determine

site of lesion within the auditory pathway,
specifically in differentiating between cochlear
and retrocochlear pathologies.
SRT
A puretone average (PTA) is usually
calculated as the average of the air-
conduction thresholds at 500, 1,000, and
2,000 Hz for each ear.

Normally, the PTA should agree with the

speech recognition threshold (SRT), meaning
that the PTA and SRT should be within 10
dB of one another in the same ear.
1.PTA >SRT by 10 dB –audiogram
configuration is sharply sloping or
sharply rising.
Two-frequency PTA by averaging the two
lowest (e.g., best) thresholds at 500, 1,000,
and 2,000 Hz.
The two-frequency PTA should then be in
agreement with the SRT.

2. PTA and SRT may disagree is if a person is

malingering or intentionally
Cross-check
Considerations
for Pediatric Testing
The behavioral responses obtained via behavioral
observation audiometry (BOA) or visual
reinforcement audiometry (VRA) are considered to
be accurate reflections of a child’s true
thresholds when these tests are conducted
carefully (Madell and Flexer, 2008).

Children often do not respond as consistently or as

quickly as adults, it is possible that a child’s
behavioral responses may still be elevated compared
to actual thresholds-unreliable (Baldwin et al., 2010).
 Regardless of the judged reliability of such
measures, audiologists should use objective
tests such as OAEs and tympanometry
acoustic reflexes as cross-checks for
pediatric behavioral responses (Baldwin et
al., 2010; Littman et al., 1998; Madell and
Flexer, 2008).
The Joint Committee on Infant Hearing Position
Statement (JCIH; American Academy of Pediatrics,
2007) also recommends that electrophysiological
measures be employed as a cross-check for
behavioral response audiometry for children
younger than 6 months chronological age.

The statement further stresses the importance of

obtaining behavioral thresholds as soon as
possible using the most age-appropriate method
“to cross check and augment physiologic
findings” (American Academy of Pediatrics, 2007, p.
910).
Electrophysiological Tests
as Cross-checks
Electrophysiological tests can be used to
cross check behavioral measures, as well
as to cross check each other and to help
confirm diagnoses of certain disorders
(Stapells, 2011).
Cross checking test results to diagnose
ANSD: “ . . . the presence of a [cochlear
microphonic] or reversing waves at the
beginning of the trace does NOT make a
diagnosis of ANSD . . . without the cross-
check of middle-ear muscle reflexes
(MEMR), OAEs, and an ABR latency-
intensity function” (p. 32).
Order of Tests
Administered
Testing begin with the objective tests unless
contraindicated.

1. A good idea of the type and degree of

hearing loss before beginning the subjective
tests.

2. Reduced risk for misdiagnosis of disorders

such as ANSD and vestibular schwannoma,
failure to detect a patient who is
malingering.
If the patient’s hearing is completely normal
(with no listening complaints) or the patient is
profoundly deaf (with previous documentation
to support the initial diagnosis)

OAEs and acoustic reflexes will be unlikely

to add further information about the patient

Tympanometry for everyone

When test results seem in disagreement,
1. first check the tester (rule out the
clinician’s own mistakes)
2. check the equipment (rule out malfunction
or equipment performing out of calibration)
3. check the patient (rule out patient error or
pseudohypacusis).