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The purpose of this article is to help our clients understand the a€?audiograma€?, which is the graph that we use to chart the severity and the configuration of hearing loss.
On the audiogram, frequencies (or pitch) are depicted from left to right in Hertz, going from 250 Hz (very low pitch) to 8000 Hz (very high pitch).
Our friendly staff will be happy to discuss your particular needs and schedule an appointment with one of our registered audiologists. Key words: adaptive procedure, auditory threshold, psychometric function, threshold reversal, word recognition. Abbreviations: ANOVA = analysis of variance, CVC = consonant-vowel-consonant, HL = hearing level, HD = high density (frequency of usage word from a dense neighborhood), HS = high sparce (high frequency of usage word from a sparse neighborhood), LD = low density (low frequency of usage word from a dense neighborhood), LS = low sparce (low frequency of usage word from a sparse neighborhood), NU 6 = Northwestern University Auditory Test No. This project was funded as a merit review from the Rehabilitation Research and Development Service, Department of Veterans Affairs. Current clinical procedures typically include recognition of isolated monosyllabic or spondaic words in a format that poorly represents communication in real-life situations.
The overall project involved the development and evaluation of sentence materials based on target words selected using two criteria: word-usage frequency and word confusability based on a single phoneme substitution metric [5]. The sentences, each of which had seven to nine syllables and three target words, were homogeneous with respect to psychometric slope, range, and midpoint [5,8].
Each subject participated in a 1-hour listening session per day for 5 days during a 5- to 10-day interval.
Finally, a subset of six listeners from the 40 to 60 years group and six listeners from the >65 years group participated in a sixth session that replicated the eight conditions administered in Sessions 1 and 5. Mean thresholds (dB HL) and SDs (in parentheses) for HD control and experimental conditions across five sessions for three groups of subjects. The distribution of the datum points for the <30 years group in Figure 3(a) is tightly grouped, reflecting homogeneity in recognition performance. The second research question addressed whether or not decreases in thresholds across sessions were owing to the subjects learning the test material, learning the test and listening environment, or a combination of both learning effects. In comparison to the exposure received by the subjects to the materials in the control conditions, the practice received by the subjects to the materials in the experimental conditions was minimal. To this point, the focus has been on the control and experimental data from Sessions 1 and 5.
Mean thresholds (dB HL) (and SDs) for the HD control conditions across the four trials in Sessions 2, 3, and 4.
The threshold data for the HD condition from six of the 40- to 60-year old listeners and six of the >65 year-old listeners who participated in Session 6 (20 to 30 days following Session 5) are depicted in Figure 4. Finally, in addition to the threshold measure obtained from each set of data, the amplitudes of the last nine excursions of the threshold tracks were evaluated.
To determine the correlation between hypertensive retinopathy (which is the end-organ damage of the vessels due to chronic hypertension) with sensorineural hearing loss. Pure tone hearing threshold of 56 hypertensive patients were compared with 56 normal age and sex matched control.
The mean hearing thresholds were higher (worse) in all the frequencies on both sides in the hypertensive study group compared with normal subjects. Hypertensive patient with grade I retinopathy had higher pure tone hearing thresholds at 4,000 Hz and 8,000 Hz compared to hypertensive without retinopathy and normal control.
Hypertensive retinopathy appears to be associated with high frequency sensor neural hearing loss.
JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. While the overall incident rate for cancer increased slightly in children ages =14 years between 2005 and 2009, the death rate decreased by more than half and the 5-year survival rate for many pediatric cancers in the United States has reached upwards of 80% or more (Siegel, Naishadhamc, & Jemal, 2013). This article provides a brief overview of potentially ototoxic agents routinely prescribed to treat cancer in children.
The platinum-based compounds carboplatin and cisplatin are effective chemotherapy agents commonly used to treat a variety of childhood cancers.
The following case studies are fictitious but represent typical treatment regimens and hearing losses seen in our clinic. This patient was diagnosed and treated as an infant with six courses of carboplatin chemotherapy. Cranial radiation therapy is routinely used to treat a variety of childhood brain tumors and head and neck cancers. Radiation therapy can degrade the external ear and middle ear system, causing a temporary or permanent conductive hearing loss. A reported one-third of patients treated with cranial radiation involving the cochlea experience sensorineural hearing loss (Jereczek-Fossa et al., 2003). Often, clinical trials and hospital-driven treatment protocols have specific time points for performing audiological assessments.
While carboplatin is substantially less ototoxic than cisplatin, both can lead to serious hearing loss requiring the use of assistive listening technology, preferential classroom seating, additional educational resources, and hearing aids. Managing hearing loss in patients who receive radiation therapy for head and neck tumors can be complex. Pediatric oncology patients treated with platinum agents or cranial radiation are at risk for developing significant hearing loss. The ASHA Action Center welcomes questions and requests for information from members and non-members.
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RehabilitationCochlear implant users of all ages can practice speaking and listening skills with interactive and downloadable (re)habilitation activities. An audiogram is a graph illustrating a person’s usable hearing and the amount of hearing loss that an individual has for each ear.
Often people wonder if it is possible to describe hearing loss in terms of a a€?percentage of lossa€™. These are different tones, and as we go from left to right, the frequency value gets higher and the tones are higherpitched.
These marks represent how loud a tone must be for the person to hear it in a quiet environment (in the sound booth). The audiogram can help explain the hearing difficulties you may experience in different situations.
Three target words, based on word-usage frequency and word confusability, were embedded within the seven to nine syllable sentences. The senior author is a senior research career scientist supported by the Rehabilitation Research and Development Service. The validity of these tests depends on the assumption that the paradigms represent everyday speech. The aspect of the project reported here examined the learning effects associated with repeated presentations of word-recognition materials with the use of sentence materials and an adaptive psychophysical procedure. The three groups were included to determine if practice on the listening task had different effects on listeners of various age groups and degrees of hearing loss.
Left ears were used on the odd number subjects and right ears were used on the even number subjects. Session 6 was included to determine the extent of the carryover associated with the learning effects that were observed in the first five sessions. This second finding, which answers the first research question, indicates that for each of the three subject groups, the thresholds improved significantly between the first and fifth session.
In contrast to the <30 years group, the datum points for the other two subject groups progressively become less homogeneous as age and degree of hearing loss increase. From Figure 2 and Table 1, comparison of the thresholds for the experimental and control conditions obtained in Session 1 indicates essentially no difference between the two sets of data. The thresholds for the control and experimental conditions were lowered by the same amount between Sessions 1 and 5 (Table 1, right column).
Sessions 2, 3, and 4 were used as control conditions in which eight thresholds (four HD and four HS) were obtained from each subject in each session. For comparison, the mean data from the respective subsets of subjects obtained in Sessions 1 through 5 are shown. The mean track excursion sizes (in decibel) are depicted in Figure 5 for the various HD listening conditions, listening sessions, and subject groups.


Comparisons of pure tone hearing threshold are made among different group (grade) of hypertensive retinopathy patients and control (non-hypertensive patients). Advancements in the diagnosis and treatment of childhood cancers have led to these increased long-term survival rates.
A case study approach using fictional audiological test results representative of actual cases seen in our clinic will be used to describe various types of hearing loss caused by platinum-based chemotherapeutic agents and cranial radiation therapy.
Conductive hearing loss can be the result of skin reactions, otitis externa, cerumen occlusion, chronic eustachian tube dysfunction, and middle ear effusion.
These time points are predicted based on several factors, such as diagnosis, treatment plan, patient age, and ototoxicity risk.
Audiologists have a unique opportunity to implement an ototoxicity monitoring protocol for these patients and to promote early intervention (i.e.
WorkersThe Right Kind of Guesswork: If your student has trouble making inferences, knowing why the student struggles is the first step in deciding on a treatment strategy. The softest tone at which a person can hear at each frequency is marked on the audiogram at that frequency and intensity. It indicates how much your hearing varies from normal and, if there is a hearing loss, where the problem might be located. The amount of hearing loss is depicted from top to bottom, and is measured in decibels (loudness). We can draw a line between the circles and crosses to show how hearing loss can slope up or down at different pitches.
It is valuable for a person with hearing loss to understand which pitches of sound are difficult to hear because it can help them understand how hearing speech and other important sounds will be affected. In addition, the configuration of the hearing loss on the audiogram is essential information when choosing and programming hearing aids. Thresholds were obtained for the control lists in Sessions 1 to 5 and for the experimental lists in Sessions 1 and 5.
Although syllable and word tests may give insights into certain perceptual problems, syllable and word tests do not reasonably approximate everyday listening conditions. Egan reported that with multiple trials of listening to words in an ambient noise [6], recognition performance improved from about 60 percent correct to about 80 percent correct over 5 successive practice days. Briefly, the sentences were grouped into one of the following four categories based on the word category of the three target words: (1) HD (high density)-high frequency of usage from a dense neighborhood, (2) HS (high sparce)-high frequency of usage from a sparse neighborhood, (3) LD (low density)-low frequency of usage from a dense neighborhood, and (4) LS (low sparce)-low frequency of usage from a sparse neighborhood. The control lists were materials that were administered in each of the five sessions that served as practice items with multiple thresholds being established in each session.
During Sessions 1 and 5, thresholds for four experimental conditions (HD, HS, LD, and LS) were obtained, as were thresholds for four control conditions (two randomizations of HD and HS).
This is an expected finding when the variability associated with the hearing sensitivity between groups and within groups reflected in the pure-tone audiometric findings is considered (see Figure 1).
The practice received on the control conditions improved the word-recognition performance by the subjects on the control materials.
These control conditions provided the subjects with practice on the listening task and materials.
A general characteristic of both the control data (open symbols with solid lines) and the experimental data (filled symbols with dashed lines) is that the excursion size decreased as the number of sessions increased.
Development of a test of speech intelligibility in noise using sentence materials with controlled word predictability.
Speech recognition in noise at higher than normal levels: Decreases in scores and increases in masking. The mean hearing threshold is higher in all frequencies in the presence of retinopathy compared to control. Unfortunately, a number of adverse side effects, including hearing loss, continue to be a concern for all involved.
Ototoxicity monitoring before, during, and after treatment is an important component in the early detection and management of hearing loss in young cancer patients. Cranial radiation can potentially damage any of the auditory structures extending from the external ear to the higher auditory pathways. Hua and colleagues (2008) demonstrated that pediatric patients did not experience hearing loss when the mean cochlear radiation dose was less than 35 Gy.
Thus, long-term audiological follow-up is recommended for patients considered high risk (cochlear exposure >35 Gy) for radiation-induced hearing loss. This protocol was adapted from the ototoxicity monitoring guidelines issued by the American Speech-Language-Hearing Association (1994) and the American Academy of Audiology (2009).
Of course, the patient should be evaluated at any time during or after therapy if a noticeable change in hearing occurs.
Patients with serious high-frequency hearing loss typically benefit from hearing aids and assistive listening devices. These recommendations are based on the extent of the conductive hearing loss and are made in collaboration with an ENT physician. Analysis of ototoxicity in young children receiving carboplatin in the context of conservative management of unilateral or bilateral retinoblastoma. For example, 250 Hertz (Hz) sounds like the dripping of a faucet, while the high-pitched ringing of the telephone is about 8000 Hz. Conversational voice level is around 65 dB, and 120 dB is very, very loud – about as loud as a jet taking off when you are standing just 25 meters away. This process ensures that without your approval, data will not be transferred to the social networks. Higher decibels are towards the bottom of the graph, and they represent greater hearing loss. For example, if someone has a hearing loss that is more severe for high-pitch sounds, then the lines on the graph will slope downward as it moves from left (low tones) to right (high tones).
Egan did not attribute the improved performance to any particular aspect of the listening-response task. The categorization of low versus high frequency of word usage was based on the entire set of familiar monosyllabic consonant-vowel-consonant (CVC) words in the pocket lexicon, which was described by a 7-point rating scale [9]. For a given subject, then, the control lists were used throughout the five sessions to provide practice on the listening and response task, whereas the experimental sentence lists were used only during Sessions 1 and 5. During Sessions 2, 3, and 4, thresholds for eight control conditions were established (two conditions-HD and HS, by two randomizations, by two replications). Likewise, the recognition performance of the subjects improved on the experimental materials on which no practice was received during Sessions 2, 3, and 4. The mean thresholds for the HD condition (and SDs) for the four trials within each of Sessions 2, 3, and 4 are listed in Table 2 for each of the subject groups.
These results indicate that over the 20- to 30-day interval, the listeners retained a portion of the listening sophistication that had been acquired during the initial five test sessions. However, the difference was found to be only statistically significant in the mean hearing threshold between grade I and control at 4,000 Hz and 8,000 Hz on both sides and at 1,000 Hz and 2,000 Hz on right ear. For these reasons, long-term follow-up is essential in pediatric patients exposed to platinum chemotherapy. At the conclusion of treatment, conditioned play audiometry revealed normal hearing sensitivity at 500 Hz, sloping from a mild to severe hearing loss at 1000-8000 Hz, bilaterally (Figure 1c).
Thus, hearing loss can present as conductive, mixed, sensorineural, or retrocochlear in nature (Jereczek-Fossa, Jarowski, Milani, & Orecchia, 2003). Acute complications to the middle ear system, resulting in otitis media and eustachian tube dysfunction, have been documented in 40% of patients treated with radiation therapy (Jereczek-Fossa et al., 2003).
However, risk for hearing loss significantly increased when the mean cochlear radiation dose rose above 35 Gy (Hua et al., 2008). As shown in Figure 3a, a baseline audiological evaluation prior to cranial radiation revealed normal hearing sensitivity, bilaterally.
This protocol serves as a guideline only (Figure 4 [PDF], Ototoxicity monitoring protocol for platinum chemotherapy and cranial radiation therapy). Patients diagnosed with severe or fluctuating hearing loss should be followed more frequently than the ototoxicity protocol indicates, at least until hearing loss stabilizes. Hearing aids that offer open fitting options and frequency compression technology have improved hearing aid acceptance and long-term use in our patient population. Managing patients diagnosed with radiation-induced sensorineural hearing loss can be more challenging. In cases when cancer treatment cannot be altered, audiologists play an integral part in providing counseling, aural rehabilitation, and coordination of services in educational settings.


She participates in direct patient care, mainly ototoxic monitoring and aural rehabilitation in the pediatric oncology population. Platinum compound-related ototoxicity in children: long-term follow-up reveals continuous worsening of hearing loss. The efficacy of early identification and intervention for children with hearing impairment.
Ototoxicity due to cis-diamminedichloroplatinum in the treatment of ovarian cancer: influence of dosage and schedule of administration.
Understanding your audiogram can help you and your audiologist manage your hearing loss effectively. The mean thresholds (1) for the three subject groups were significantly different, (2) for the experimental conditions and the control conditions were not significantly different, and (3) for Session 5 were significantly lower than in Session 1. Sparse and dense refer to similarity neighborhoods in an assumed representation of the mental lexicon. Because of the limited number of LD and LS sentences, the LD and LS lists were always used as experimental lists. The task of the subject was to repeat the sentence, with scoring based on the three target words in each sentence. This finding was expected as the subjects were selected from specific age-related categories that reflect different degrees of hearing loss. Egan noted a 20 percent (4 dB to 5 dB) improvement in the recognition of the PB-50 words presented in noise on 5 successive days. High-frequency hearing is affected first, with hearing loss eventually progressing to the lower frequencies with increasing cumulative doses (Li et al., 2004). This hearing loss example is typical of high dose cisplatin treatment, particularly in children diagnosed and treated at less than 5 years of age. This example demonstrates the increased risk of ototoxicity being present at a young age (<6 months) and the delayed onset of hearing loss sometimes seen in patients receiving carboplatin. Cranial radiation has also been shown to exacerbate hearing loss when administered with concurrent or adjuvant platinum-based chemotherapies (Low, Toh, Wee, Fook-Chong, & Wang, 2006). Audiological testing 2 years post treatment indicated normal hearing sensitivity, bilaterally (Figure 3b). At this time, cochlear implantation for this population is rare, as hearing loss is typically contained in the high-frequency range, sparing the low frequencies. Generally, hearing aids and assistive listening devices are recommended for these patients. She is active in clinical research involving the effects of ototoxic agents and the efficacy of otoprotective drugs. Predicting cisplatin ototoxicity in children: the influence of age and the cumulative dose. In this example, the speech sounds that are under (louder than) the left and right hearing levels will be hard by the individual but the speech sounds located above (softer than) the hearing levels indicated on the graph will not be heard by this individual. The first question addressed whether or not thresholds measured with sentence materials changed with repeated measures. Four experimental lists (HD, HS, LD, and LS) and two control lists (HD and HS) were selected for each listener. If two or three of the target words were recognized, then the level of the subsequent sentence was decreased 2 dB; if fewer than two of the target words were recognized, then the level of the subsequent sentence was increased 2 dB.
Second, as indicated earlier, the thresholds obtained in Session 5 were significantly lower than the thresholds obtained in Session 1. First, as was reported earlier, as the session number increased, the thresholds decreased, a relation that is true for each subject group. Although these differences are small, the findings indicate that as practice on the listening task increased, the subjects became more proficient at the listening-response task. Re-evaluation 3 years post treatment revealed significant bilateral hearing loss (Figure 3c). Occasionally, some patients experience progressive hearing loss, creating the need for cochlear implantation.
However, it has been our experience that many patients with sensorineural hearing loss from radiation exposure exhibit significantly poor speech understanding, typically poorer than would be expected in the presence of better pure tone thresholds. Delayed onset and progressive hearing loss have been documented in patients treated with platinum-based chemotherapy and cranial radiation therapy. White's research interests include the long-term effects of ototoxic medications, specifically hearing loss progression. Her audiological interests include diagnostic audiology, ototoxic monitoring, and clinical research. Ototoxicity in children receiving platinum chemotherapy: Underestimating a commonly occurring toxicity that may influence academic and social development. Late onset hearing loss: a significant complication of cancer survivors treated with cisplatin containing chemotherapy regimens. The threshold track was terminated after 12 reversals with the first 3 reversals discarded and the last 9 reversals used to compute threshold, which was defined as the midpoint of the excursion. Second, the thresholds for a given condition changed little, if any, across trials of a given session. This case represents a patient who was exposed to radiation levels above 35 Gy but did not experience hearing loss until approximately 3 years after treatment.
Thus, the patient may not perceive benefit from conventional hearing aids and ultimately reject amplification.
For these reasons, long-term monitoring is imperative to ensuring proper management of patients exposed to ototoxic agents. Sensorineural hearing loss after radiotherapy and chemoradiotherapy: a single, blinded, randomized study.
Words from each lexical category were used three at time to form the sentences in a format similar to that used by Plomp and Mimpen or Bench and Bamford [4,10].
In addition to the threshold metric, the amplitudes of the excursions of the threshold tracks were evaluated.
Although the thresholds for the three groups of listeners are displaced from one another in Figure 2, the functions for the three groups across the five sessions are essentially parallel. Neither study, however, was designed to examine the learning components that contributed to the improved performances that were observed. Because the sizes of the track excursions of the control and experimental conditions changed by similar amounts between Sessions 1 and 5, one can conclude, as with the threshold measures, that the equivalent changes in performance on the control and experimental conditions were owing to practice or exposure on the test procedure and test environment and not to learning the target stimulus words and sentences.
While high frequencies are typically affected initially, some patients present with atypical hearing loss configuration as evident in this example.
This finding indicates that the improvements noted in recognition performances across the sessions were the same for all groups. The decrease in threshold must be attributable to improvement that the subjects experienced with repeated practice in Sessions 2, 3, and 4 with the task. Thus, the thresholds across trials within a session remain remarkably stable, which is in contrast to the systematic decrease in thresholds that was observed across sessions.
Qaddoumi and colleagues (2012) demonstrated that infants treated with carboplatin at less than 6 months of age were at greater risk for developing ototoxicity compared with older children treated similarly. Trial use of other options, such as FM technology or CROS hearing devices, is often recommended and can be successful, particularly for patients with asymmetrical hearing loss. Thus, age differences and degree of hearing loss did not influence the degree of improvement in performance noted between Sessions 1 and 5.
Ongoing counseling and coordination of services with educational audiologists, specialists with hearing impairment, speech-language pathologists, and other professionals are important in helping patients return to the classroom and receive the appropriate resources they need to succeed. Long-term sensorineural hearing deficit following radiotherapy in patients suffering from nasopharyngeal carcinoma: a prospective study. Severe ototoxicity following carboplatin-containing conditioning regimen for autologous marrow transplantation for neuroblastoma. Because substantially more words met selection criteria in the HD and HS categories than in the LD and LS categories, the HD and HS categories had two lists each, whereas the LD and LS categories had one list each.
The data from the experimental conditions, however, provide insight that differentiates the two types of learning effects.



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