About the Book

This book bridges the gap between theory and clinical application for electro-acoustic and electro-physiologic assessment of hearing loss across the age range. Strategies and techniques for screening and diagnosis of hearing loss are presented clearly and simply. The authors incorporate findings of accumulated clinical experience and recent clinical research in a readable review of electro-acoustic measures (immittance measures and otoacoustic emissions) and electro-physiologic measures (electrocochleography, ABR and ASSR) that are essential for best practice in audiology today. This book is a one-stop resource for clinicians who are responsible for the diagnostic auditory assessment of children and adults.

About The Authors

James W. Hall III, PhD, is an internationally recognized audiologist with over 40 years of clinical, teaching, research, and administrative experience. He received his bachelor’s degree in biology from American International College, his master’s degree in speech pathology from Northwestern University, and his PhD in audiology from Baylor College of Medicine under the direction of James Jerger. During his career, Dr. Hall has held clinical, academic, and administrative positions at major medical centers, and leadership roles in the American Academy of Audiology. He is the author of over 200 peer-reviewed publications, invited articles, and book chapters and also 10 textbooks. Dr. Hall now holds academic appointments as Professor at Salus University and the University of Hawaii.

De Wet Swanepoel, PhD, is an Associate Professor and clinical research audiologist at the Department of Communication Pathology, University of Pretoria, South Africa, and Adjunct Professor at the University of Texas at Dallas, Callier Center for Communication Disorders. His research and clinical interests are in the field of early identification and diagnosis of infants with hearing loss, including electro-physiologic and electro–acoustic assessment procedures. Dr. Swanepoel also has an interest in auditory functioning in special populations such as persons infected with HIV/AIDS. He has received several awards and research grants for his work in these areas from institutions like the Medical Research Council and National Advisory Council on Innovation. He has published numerous peer-reviewed articles and regularly presents at international conferences. He is also a regional editor for the International Journal of Audiology and reviews for several international journals.

Table Of Contents

  • Chapter 1: Rationale for Objective Hearing Assessment

A Word About Terminology
Important Terms and Concepts
Detection versus Diagnosis
Clinical Limitations of Behavioral Audiometry
Cross-Check Principle Revisited

Chapter 2 Aural Immittance Measurements
Historical Perspective
Current Status of Immittance Measures
Functional Anatomy
External Ear Canal
Middle Ear
Cochlear and Retrocochlear Pathways
Identification (Screening) of Auditory Dysfunction
Jerger Tympanogram Classification System
Single versus Multi-Frequency and Multi-Component
Wide Band Reflectance
Acoustic Reflex Thresholds for Broadband Noise Signals
Diagnosis of Auditory Dysfunction
Tympanometry Findings in Auditory Dysfunction
Toynbee and Valsalva Techniques
Sensitivity Prediction by the Acoustic Reflex (SPAR)
Other Acoustic Reflex Predictive Techniques
Contraindications to Acoustic Reflex Measurement
Diagnosis Value of Patterns of Aural Immittance Findings
Case A: Vertical Acoustic Reflex Pattern (Mild Conductive)
Case B: “Inverted L” Acoustic Reflex Pattern (Moderate
Case C: Vertical Acoustic Reflex Pattern (Facial Nerve
Case D: Diagonal Acoustic Reflex Pattern (Sensory)
Case E: Diagonal Acoustic Reflex Pattern (Neural)
Case F: Inverted L Acoustic Reflex Pattern (Neural)
Case G: Horizontal Acoustic Reflex Pattern (Brainstem)
Case H: “Uni-Box” Acoustic Reflex Pattern (Brainstem)

Chapter 3 Otoacoustic Emissions
Screening for Hearing Loss
OAE Test Protocols for Newborn Hearing Screening
Pass versus Refer Criteria
Simple Steps for Minimizing Refer Rate
Combined OAE and Admittance/Reflectance Technologies
OAE Screening with Tele-Health Technology
Newborn Hearing Screening with OAE and ABR
Two-Step Hearing Screening with OAE and ABR
Combined OAE and ABR Hearing Screening
School Age and Pre-School Screening
School-Age Children
Pre-School Children
Estimation of Hearing Loss
Estimating Hearing Loss with OAEs
Differences Between OAE and Audiogram Findings
Clinical Considerations and Concerns
Subject (Non-Pathological) Factors
Pathologic Factors

Chapter 4 Electrocochleography (ECochG)
Test Protocol
Estimation of Hearing Thresholds
Diagnostic Applications of ECochG
Enhancement of ABR
Auditory Neuropathy
Clinical Considerations and Constraints
Subject Factors
Pathologic Factors
Concluding Comment

Chapter 5 Auditory Brainstem Response (ABR)
Hearing Screening for Identification of Hearing Loss
Automated ABR
Clinical Findings
Estimation of Hearing Thresholds
Air-Conduction Click-Elicited ABR Measurement
A Practical Test Protocol
Bone Conduction Click-Elicited ABR Measurement
Rationale and Indications
A Practical Bone Conduction ABR Protocol
Frequency-Specific (Tone Burst) ABR Measurement
A Practical Tone Burst ABR Protocol
Analysis and Interpretation
Steps in ABR Analysis
Analyses of ABR Waveforms for Air Conduction Click
Analyses of ABRs for Bone Conduction Stimulation
Analyses of Frequency-Specific ABRs (Tone Burst
Clinical Considerations and Constraints
Non-pathologic Factors
Pathologic Factors
Noise, Sedation, and Anesthesia
ABR Measurement Without Sedation or Anesthesia
Plotting Electrophysiologically-Estimated Auditory Thresholds

Chapter 6 Auditory Steady State Response (ASSR)
Historical Perspective on the Auditory Steady-State Response
Defining the Auditory Steady-State Response
Response Generation
Neural Generators
Stimulus Characteristics
Type of Stimuli
Presentation of Stimuli
Response Acquisition
Improving the Signal-to-Noise Ratio
Response Analysis
Spectral Analysis Approach
Phase Analysis Approach
Considerations in Response Detection
Subject Factors
Internal Noise
Objective Hearing Assessment with the Auditory Steady-State Response
Hearing Screening
Estimating Behavioral Threshold
Threshold Accuracy
Auditory Neuropathy
Artifactual Responses
Bone Conduction Auditory Steady-State Responses
Sound-Field ASSR
Clinical Protocols and Equipment
Future Applications of the Auditory Steady-State Response

Chapter 7 Recommendations for Objective Identification and Estimation of Hearing
Recommendations for Detection
Newborns and infants
Combined OAE/ABR Infant Hearing Screening
Pre-School and School-Age Children
Recommendations for Diagnosis
Infants Younger Than 6 Months
Infants 6 to 36 Months
Children and Adults
Test-Battery Approach
New Directions for Research
Detection of Hearing Loss
Diagnosis of Hearing Loss

Chapter 8 Illustrative Case Reports and Clinical Findings
Case: Frequency-Specific ABR for an Infant Under Melatonin-Induced
CASE: ABR Evaluation of an Awake Child
CASE: Auditory Neuropathy and Conductive Hearing Loss
CASE: Bilateral Conductive Loss
CASE: Unilateral Sensory Hearing Loss
CASE: Bilateral Profound Sensory Hearing Loss


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