Pure tone and speech audiometries

All about tonal and vocal hearing tests

Hearing tests in detail: from the tone audiogram to the speech audiogram

Have you ever wondered what pure tone and speech audiometries are? Do you know what it is used for? Read this article to understand the differences and when this exam needs to be performed.

Pure tone audiometry

A pure tone and audiometry test is an examination prescribed by a medical specialist in the case of suspected hearing impairments. This test aims to detect hearing ability, from a quantitative point of view. The test can be performed in two ways:

  • the 'liminal' test which assesses the hearing threshold by stimulating the subject’s capacity to perceive a sound in a frequency range from 0125 to 8 kHz;
  • the 'supraliminal' test which assesses frequencies above the liminal threshold, thus above 8 kHz.

The pure tone audiometry test must be rigorously performed by a physician who is a specialist in hearing impairments, such as, an ENT doctor or audiometric technician who is very experienced in detecting hearing problems.

This examination is performed by exposing the subject to simple stimuli in a silent booth and, while performing the examination, the doctor or technician reports any abnormalities that may appear in the audiogram as they represent underlying symptoms of a hearing deficit; any deficit detected may be caused by trauma or disease. Anyone can undergo this examination as it is a simple procedure that has no contraindications against both children and the elderly.

Tonal audiogram: what you need to know

The purpose of the audiogram is to assess hearing ability. Simply put, the audiogram is a chart that concretely represents the patient's hearing ability based on the audiometric test result. The test makes it possible to record the hearing threshold, also known as the patient's minimum level of auditory perception, based on the frequencies to which they were subjected.

The chart is made using standard tracings on which different pitches of sound are recorded in relation to intensity. Sound height, also known as the function of frequency, and intensity, which is measured in decibels, are taken into account. If the test gives a result of zero, which means the measurement line is positioned at zero, the patient who underwent the test has normal hearing. Two values are taken into consideration:

  1. the area pathway, the pathway by which sound passes from the outer ear to the inner ear (this mechanism allows the activity of hearing);
  2. the bone pathway, the pathway by which vibrations reach the inner ear through the bones of the skull.

How to read a pure tone audiogram?

The audiogram has two axes: on the vertical axis we can read the volume and intensity of the tones (in decibels); on the horizontal axis we will find the lowest tones.

  • On the y-axis, the vertical axis, the hearing loss expressed in decibels (dB) is indicated. At the top, the acoustic definition is indicated. This means sounds of 0 dB intensity and below, which represent the various hearing losses.
  • On the x-axis, the horizontal one, the various frequencies are shown. The frequencies most commonly used for examinations are 125 - 250 - 500 - 1000 - 2000 - 3000 - 4000 - 8000 Hz, which represent the main perceivable frequencies for humans. 
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Speech audiometry

The speech audiometric examination aims to assess the patient's ability to understand words at a given sound intensity. It is an examination suitable for everyone, adults and children, and is noninvasive. The examination, which lasts about 15 minutes, takes place in a silent booth: the patient will wear headphones to listen to words at different intensities; the activity required of the patient is to repeat to the doctor or audiometric technician the word heard. The results of this test, similarly to the pure tone audiometric examination, are reported within a chart.

Speech audiogram: what you need to know

During the examination, the patient has to repeat out loud a list of words spoken at different volumes, the examiner then rates your ability to understand speech discrimination with a percentage. This percentage is then graphed on a special voice audiogram, similar to the pure tone audiogram.

How to read a speech audiogram?

Reading a speech audiogram is similar to the pure tone audiogram: the percentage of the responses that the examiner poses to the patient is graphed on special audiogram divided into three parts that correspond to three thresholds:

  1. the first threshold corresponds to a percentage of intelligibility equal to 0%: in this case the word is not perceived and understood as such, but as a generic sound;
  2. the second corresponds to a level of comprehension equal to 50%;
  3. the third represents a high level of comprehension, equal to 100%.

A line joins the three thresholds, the so-called 'articulation curve', which usually has an italic S shape. Once graphed, the responses then are evaluated by calculating how far the perception threshold deviates from the 100% threshold.

When should a hearing test be performed?

When one suffers from a hearing impairment, even a mild one, it is highly recommended to have a pure tone or speech audiometric examination. Even in the case of tinnitus. In this way, the specialist can detect the patient's sensitivity to different frequencies and prescribe an adequate hearing solution.

Postponing the test or underestimating it could make all the difference in the case of a hearing impairment. In fact, it is not only the elderly who are affected by hearing loss, it is also young adults and children. Tackling this at an early stage is key as hearing loss at an young age can lead to problems with language development and learning. Choose an Amplifon centre, choose excellence for hearing problems. Hearing better is feeling better.

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