1. SITE OF LESION TESTING:
Distinguishing:
Sensory (cochlear) from neural (retro-cochlear) disorder.
Different sources of conductive disorder

2. MEASURES OF SUCCESS: SENSITIVITY
Percentage of persons with a disorder who show up on your test as having that disorder.
In this application, % of persons with neural disorder that show a “neural result” on the site of lesion test.

3. MEASURES OF SUCCESS: SPECIFICITY
percentage of persons without a disorder who show up on your test as not having that disorder.
In this application, % of persons with a cochlear disorder (or no auditory disorder at all) who show up on your test as not having any neural disorder.

4. Loudness Recruitment Tests
Based on the changes in loudness perception that accompany different auditory disorders.

5. Loudness Growth Patterns

6. Recruitment:
"Abnormal growth of loudness" or, persistence of normal loudness above threshold. More common at higher frequencies.

7. Complete: loudness curve meets normal line

8. Partial: loudness curve approaches normal line

9. Hyper- loudness curve crosses above normal line

10. Recruitment is consistent with cochlear damage
from noise
ototoxic substances
aging
and other causes

11. Decruitment: Abnormal impairment of loudness growth
loudness curve actually moves away from normal line
lack of functioning nerve cells to code intensity
associated with retro-cochlear (VIIIth n.) lesions.

12. Decruitment

13. The Alternate Binaural Loudness Balance (ABLB)Test
requires:
- normal hrg in one ear at freq to be used
- difference in  between ears > 25 dB

14. ABLB tones pulse alternating between ears 2 or 3 times per judgement.
pt is asked which ear is louder or same
- begin at 20 SL in poorer ear,
- 0 SL in better ear.
- adjust level in better ear 5 dB steps.

15. ABLB - find level where loudness judged equal.
- increase poorer ear by 10 or 20 dB and repeat adjustments in better ear.

16. PLOTTING ABLB RESULTS:
Use the “LADDERGRAM”
Connect decibel values judged equally loud

17. ABLB SUCCESS?
Sensitivity = 51%
Specificity = 88%

18. The Alternate Monaural LB (AMLB) Test
tone alternates between 2 frequencies in the same ear.
judgment and procedure is similar to ABLB,
but comparing "the high pitch versus the low pitch.”
generally this is harder for people to do.

19. Differential Intensity Discrimination
The Short Increment Sensitivity Index (SISI)
The High Level SISI

20. The Short Increment Sensitivity Index
detection of brief (200 ms) 1 dB-increments in a 20 SL tone
20 trials
> 70 % = cochlear damage
< 30 % = other damage or normal

21. B. High Level SISI at 75 dB HL Results: > 70 % = normal or cochlear
< 30 % = retrocochlear

22. SISI SUCCESS?
Sensitivity = 68%
Specificity = 90%

23. Tone Decay: Loss of audibility for a tone that is on continuously.
Greater decay is indicative of retrocochlear problem.
There are different methods:

24. Some Tone Decay Tests
Carhart: begin at 0 SL, up in 5 dB steps until tone is heard for a full minute
Olson-Noffsinger: begin at 20 SL, up until heard for full minute.

25. Tone Decay Results: Type I: no decay: norm, conduct or cochlear
Type II: heard for longer times as level is increased: cochlear
Type III: No growth with increasing level: retrocochlear

26. TONE DECAY SUCCESS?
Sensitivity = 75%
Specificity = 91%

27. Bekesy Audiometry: Pt. controls level of tone,
Continuous tone: tone on constantly (C)
Interrupted tone: pulsed on and off (I)
Adaptation should only occur for C, not I

28. Bekesy Results: I: C and I overlap: norm or cond.
II: C below I at freqs of HL: Cochlear
III: I follows loss, C drops to bottom: Retro
IV: C below I by dB: Coch or Ret
V: I below C: False hearing loss

29. BEKESY AUDIOMETRY SUCCESS?
Sensitivity = 42%
Specificity = 95%

30. Acoustic Reflex/ARD Success?
Sensitivity = 85%
Specificity = 86%

31. Auditory Evoked Potentials:
ABR: within 10 ms of click: Brainstem disorders.
EcochG: Meniere's disease
MLR: Primary auditory cortex: difficult to pin down.
Late Cognitive Potentials: processing of sense info

32. Auditory Brainstem Response:
Response within 10 ms of stimulus
waves labeled with Roman numerals
Peaks I, III, and V most useful
Latencies are the key measure
Disorders will produce delays

33. ABR SUCCESS?
Sensitivity = 97%
Specificity = 88%

34. Middle Latency Response
10-80ms
From primary auditory cortex
Highly variable--poor clinical utility
Some correlation to Central Auditory Processing Disorders

35. Late Cognitive Potentialsms
Processing of sensory information
From Primary Auditory and Aud. Association Cortex
Varies with Attention/Subject wakefulness

36. P-300 Obtained in “oddball” task Not just auditory
Reflects Change in Working Memory-- “Aha!”
Changes in latency and amplitude with variety of disorders