- In this video,
I'm gonna teach you how to read and understand
the results of your hearing test; coming up!
(upbeat music)
Hi guys, Cliff Olson, Dr. of Audiology
and founder of Applied Hearing Solutions
in Phoenix, Arizona.
And on this channel,
I cover a bunch of hearing-related information
to help make you a better-informed consumer.
So if you're into that,
make sure you hit that subscribe button.
And don't forget to click the bell
to receive a notification every time I post a new video.
When you have a hearing test,
your hearing care provider will plot the results
of your test on a document that looks something like this.
While most information on the internet
helps you understand the audiogram,
otherwise known as the grid portion
of this hearing test with the X's and the O's,
I wanna help you have a foundational understanding,
so you can really understand your hearing loss.
The main components of a hearing evaluation
that I will be covering in this video
include the audiogram, speech reception thresholds,
MCLs, and UCLs, word recognition scores,
speech and noise scores,
tympanometry results, and acoustic reflexes.
Let's go ahead and start with the audiogram.
This portion of the hearing test
usually gets the most attention.
Basically, this section shows us where you heard the beeps
during the hearing test,
by either raising your hand or clicking a button.
The blue X's represent your hearing sensitivity
in your left ear,
and the red circles represent your hearing sensitivity
in your right ear.
These are your air conduction thresholds,
which is when sound is played
through either foam insert earphones,
or over the ear headphones,
and that sound has to pass through your outer ear
and your middle ear before it reaches your inner ear,
which is known as the cochlea.
The blue and red angle and square brackets
indicate your hearing sensitivity
when sound is bone conducted through your skull,
bypassing the outer and middle ear,
and stimulating your inner ear directly.
These are called your bone conduction scores.
The lower your markings are in this graph,
the louder we have to play the beeps
before you can hear them,
and the worse your hearing sensitivity is.
It also goes from the low frequencies
or low pitches on the left-hand side
to the high frequencies or high pitches
on the right-hand side,
kind of like a piano keyboard.
If the square and angle brackets
are close to the X's and the O's,
then it indicates that the damage to your hearing
is inside of the cochlea itself.
If the brackets are higher on this graph,
it means that some or all of your hearing loss
is due to sound not being able to make it through
the outer and middle ear effectively.
This is something that is commonly referred to
as an Air/Bone Gap due to a visible gap
between the air conduction scores
and the bone conduction scores.
We typically look at your air conduction
and bone conduction scores in terms of severity.
Again, the lower you see the markings on this graph,
the more severe your hearing loss is.
You can see that it's possible for each ear
to have different degrees of hearing loss,
and even different degrees of hearing loss
between frequencies in the same ear.
You may also see the letter U
annotated on the audiogram as well.
This indicates your uncomfortable levels,
at which point sound becomes uncomfortably loud to you.
The lower you see these letters on the graph,
the more tolerant you are to louder sounds.
Okay, at this point,
you should have a good understanding
of the audiogram portion of your hearing test.
So let's go ahead and move on
to speech reception thresholds,
otherwise known as SRTs.
SRTs are often indicated in your speech audiometry section
on your hearing test.
The SRTs are in decibels and show the softest level
in which you can understand speech 50% of the time.
These numbers are used by your hearing care professional
to compare to your pure tone averages,
which are the 500, 1000, and 2000 Hertz average
of your air conduction thresholds in each ear.
We would expect your pure tone averages
and your SRTs to be fairly close together.
For instance, on this hearing test,
the pure tone average for the right ear is 28.33 decibels.
The SRT for the right ear is 30 decibels,
which is very close to 28.33.
It helps to verify that we are obtaining
an accurate hearing assessment.
Additionally, the higher the SRT,
the higher the likelihood
that you would have trouble understanding
soft-spoken individuals.
Inside of the speech audiometry section,
you may also see most comfortable levels,
or MCLs, and uncomfortable levels, or UCLS,
indicated for speech instead of pure tone beeps.
These are also indicated in decibels
and can be used to help identify which decibel levels
should be used to test your word recognition scores.
Next, we're gonna cover these word recognition scores,
which are abbreviated WRS,
which tell us your brain's ability to comprehend speech
when we're actually overcoming your loss
in hearing sensitivity with amplification.
Your word recognition scores will often be found
in your word recognition section of your audiogram.
You will be able to see which ear was being tested,
with the word by binaural being used
if speech was played into both ears at the same time.
You will see the presentation level of speech in dBHL,
your percentages of words correct,
and possibly a number in the Masking section,
which indicates how much static sound in decibels
was played into the opposite ear
to prevent it from assisting the ear being tested.
The higher the word recognition score percentages,
the better you are at understanding speech
when the words used during the test are amplified
to a level that overcomes your loss in hearing sensitivity,
indicated by your audiogram's X's and O's.
You should care a lot
about your word recognition score percentages
because these percentages indicate
how much benefit you should expect to receive
from hearing treatment.
Next, let's talk about your speech in noise score.
In this particular case, the QuickSIN test was used.
It stands for Quick Speech and Noise test.
You may see the term SNR Loss being used
when recording your results for speech,
understanding, and noise.
The higher the SNR Loss,
the more difficulty you should expect to have
in background noise.
So ideally, you would want a very low SNR Loss,
as close to zero as possible.
If you have a score of zero dB SNR Loss,
it means that the level of speech you want to hear
can be at the same level as the background noise,
and you will be able to understand 50%
of what is being said.
However, if you score something higher,
like a 10 dB SNR Loss,
you need speech to be twice as loud as the background noise
before you can understand 50% of what is being said.
Knowing your dB SNR Loss number is important
when it comes to determining if you need
additional assistance beyond hearing aids alone,
if you desire to hear well in background noise.
All right, moving right along.
Next, we need to talk about tympanometry.
Tympanometry is basically a way for us to evaluate
your outer ear and your middle ear function.
While it is not technically
a part of a comprehensive hearing evaluation,
it can be added in to provide additional insight
into your hearing and your overall ear health.
The first thing we look at is the line tracing.
This tells us a lot of information
about how your eardrum is moving.
If you have normal eardrum movement,
you will see a defined pressure peak like you see here.
The right ear, in this case,
would be considered a normal type A tympanogram.
The left ear has a really high peak,
meaning that the eardrum is hyper-mobile,
to the point where you can't even see the peak on the graph.
This is called a type A[d] tympanogram.
There are several different types of tymps
that I won't get into in this video,
but I will link a video that discusses tympanometry
in more detail in the description of this video.
For the most part,
tympanometry is designed for us to evaluate
to see if the outer ear and/or middle ear
is contributing to the hearing loss.
If this line were to appear flat,
it could possibly indicate that there's fluid
behind your eardrum or that you have a hole
in your eardrum.
Okay, the last thing that I wanna talk about
is acoustic reflex testing, or ARTs.
ARTs can help provide insight
as to how well your seventh and eighth cranial nerves
are actually functioning.
By sending a sound inside of your ear.
we can measure the reflex of your stapedius muscle
inside of your middle ear space.
The decibel levels that were required to elicit
the stapedial reflex at several different frequencies
are recorded in this section.
Without getting into too much detail,
the reflexes in the same ear that the sound was presented
is recorded under Ipsi,
and the reflexes recorded when sound was presented
in the opposite ear is recorded under Contra.
We would expect to see levels
roughly between 70 and 100 dBHL in most individuals.
If you see absent thresholds,
it could mean that the pathway of sound
along a particular portion
of your seventh or eighth cranial nerve
is not functioning properly.
However, this is not guaranteed,
as approximately 5% of the adult population
have absent reflexes
even if their neural pathways are functioning properly.
Sometimes however, elevated or absent reflexes
could suggest that the possibility
of a serious medical condition like an acoustic neuroma,
which should result in a referral to a medical doctor,
like an otolaryngologist.
On other occasions,
these reflexes are used to help identify
if someone is faking a hearing loss,
because if thresholds are present at normal levels,
it is highly likely that the person being tested
can actually hear sound.
All right, I know that this is a lot of information,
so let me go ahead and recap things for you.
A hearing test will show your audiogram,
which indicates your hearing sensitivity
at different frequencies for air conducted sound,
which are the X's and the O's,
and bone conducted sound,
which are the angle or square brackets,
as well as uncomfortable levels at individual frequencies.
It will show your speech reception thresholds,
which indicate the softest level of speech
that you can understand 50% of the time.
These should be in agreement with your pure tone averages
identified during air conduction testing.
Your hearing test may even show your most comfortable levels
and uncomfortable levels for speech as well.
It will show your word recognition scores,
which indicate your brain's ability to understand speech
when it's presented at a level
that takes into account your loss of hearing sensitivity
that was identified during the audiogram portion
of your test.
It will show your speech and noise score,
usually annotated in DB SNR Loss.
Remember, the lower the score,
the better you should expect to understand speech
in background noise.
The higher the score,
the worse you should expect to perform.
It may show your tympanometry results,
which evaluate how well your outer ear and middle ear
is functioning to see if they are contributing
to a portion of your hearing loss.
And in some cases, your hearing tests may show
your acoustic reflex thresholds
to identify if your seventh and eighth cranial nerves
are transmitting neural impulses effectively.
Okay, guys, I hope this video actually helps you
understand your hearing test a little bit better.
If not, make sure that you have
your hearing care professional review your results with you,
because understanding your hearing test results
is priority number one.
That's it for this video.
If you have any questions,
leave them in the comment section below.
If you liked the video, please share it.
And if you want to see other videos, just like this one,
go ahead and hit that subscribe button.
Also feel free to check out my website, DrCliffAUD.com.
(upbeat music)