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Course Description
This course examines the principles of audiologic evaluation, including consideration of pure-tone and
speech audiometry, clinical masking, acoustic immittance battery, calibration and standards, behavioral
site-of-lesion testing, Otoacoustic Emissions, and various pathologies that affect auditory-vestibular
systems.
Prerequisite: Open to HSLS majors only, or permission of the instructor or department chair.
Co-requisites: HSL815, HSL817, HSL840
This course meets the 2012 ASHA Standards and Implementation Procedures for the Certificate of
Clinical Competence in Audiology as listed below:
b. Determination of candidacy of persons with hearing loss for cochlear implants and other
implantable sensory devices and provision of fitting, mapping, and audiologic
rehabilitation to optimize device use
c. Counseling relating to psychosocial aspects of hearing loss and other auditory dysfunction,
and processes to enhance communication competence
University Policies: All may be found in the Graduate Catalog or the following link:
http://www.gallaudet.edu/Documents/Grad/Gallaudet-Graduate-Catalog-2012-2013.pdf
A. Academic Integrity
Academic Integrity Policy can be found in the current Graduate Catalog, and is also posted on Blackboard
under Syllabus. It can also be found at http://aaweb.gallaudet.edu/graduate-catalog.xml (Page 27). All
allegations regarding violations of the Universitys Policy on Academic Integrity will be investigated and
treated with utmost seriousness. Please read the Gallaudet University Policy on Academic Integrity, as you
will be responsible for its content. If you are unsure as to any part of the Policy, please discuss it with the
instructor or your academic advisor. Please familiarize yourself with the concept of due process. Violations
of the Academic Integrity Policy (e.g., cheating, plagiarism, abuse of computers) will result in a failing grade
for the course (i.e., grade of XF on transcript), and/or expulsion from the University.
Adherence to these professional standards of behavior and communication are essential elements of
professional competence. Failure to meet these standards reflects adversely upon the individual's
suitability for professional service and may be grounds for dismissal from the Graduate School.
In compliance with Title IX, Gallaudet University prohibits discrimination in employment as well as in
all programs and activities on the basis of sex. The Title IX Coordinator monitors compliance with the
regulations of this law. Individuals with questions or concerns about Title IX, and/or those who wish to
file a complaint of non-compliance, may contact the University's Title IX Coordinator.
Course Policies:
Attendance Policy:
On time or early attendance is expected at every scheduled class. Students may have two excused
absences during the semester. Excused indicates that arrangements were made BEFORE the scheduled
class start time. In addition, recurrent late arrivals or early departures will result in a drop of your
assignment grade.
Cellphone Usage:
Email and voice mail messages are acceptable in the case of illness or accident, but constant
texting/cell-phone usage or time devoted to social media is highly discouraged during class.
Computer Usage:
Computers can be used for note-taking and googling information related to course discussion but shall
not be used for other purposes- such as social media or YouTube.
Grading
A. Weighting System
Final course grades will be based on a calculation of percentage correct out of a potential
100%. The following grade scale and weighting systems will be used in determining final
course grades
Exams (50%)
Mini-Quizzes- Readings (10%)
Lab Assignments (30%)
Case Presentation (5%)
Critical Thinking Assignment (5%)
Exams (50% of the grade) There will be two exams, Midterm (25%) and Final (25%). Final exam
is cumulative of material learned throughout the semester. The knowledge and skills examined include
the materials covered in class, lab and other exercises, and your readings. Your ability to synthesize
information from various sources will also be assessed. Study guides will not be provided; however,
you may refer to the unit objectives.
Mini-Quizzes (10% of the grade)- Readings are assigned prior to each class. To ensure that students
have read material prior to class, mini-quizzes consisting of a few questions will be administered prior
to the first class for that week. Each mini-quiz will be administered during the first 10-15 minutes of
class, except for the first week of the course when no mini-quizzes will be administered
(See Appendix A).
Assignments (30% of the grade) Several lab and case-based exercises will be assigned to reinforce
concepts covered in class or readings. (See Appendices B & C) All written assignments must
conform to the APA style, 6th ed. Late submissions will generally not be accepted unless it is
professor granted extension.
Case Presentation (5% of the grade) Students will be paired and present on a case, chosen from a
number of possible pathologies. Presentations are between 30 and 40 minutes (See Appendix C).
Problem-Based, Critical Thinking Assignment (5% of the grade)- Students will be paired up and
asked to answer questions based on three different cases (See Appendix D).
Readings will be added to the list throughout the semester. For the updated list of readings, see
Blackboard under Readings. Assignments are due Sunday night unless otherwise indicated.
WEEK DATE TOPIC READING & ASSIGNMENTS DUE OUT OF CLASS TIME
Introductions Katz-Chapter 1 Chapter Readings =
Scope of Practice 0.5 hours
Bb:
History/Overview of
Lubinski-Chapter 1 (5-7, 15-22, Bb readings = 3.0
Audiology
1 8/31 24-31)
Code of Ethics hours
Stach- Chapter 1
ASHA Code of Ethics
Otoscopy
Gelfand- Chapter 2 (38-40)
Bb: reference sites for visual
inspection and otoscopy
Tuning Fork Tests Chapter Readings =
5.0 hours
Martin and Clark (21-25)
Gelfand (151-154) Bb readings: 1.0 hour
Tuning Fork tests
Pure Tone Audiometry Pure-Tone Audiometry
3 9/14 Air and Bone Bb: Medwetsky (Fundamentals
Audiogram of the Audiogram)
Interpretation- part 1
Martin & Clark (Chapter 4)
Gelfand- Chapter 5 (127- 150)
Katz- Chapter 4 (50-57)
Midterm Exam
7b 10/14
Tympanometry Chapter Readings =
1.5 hours
Bb: Hunter & Shahnaz Chapter- 4
Immittance Measures Bb chapter = 2.0 hours
8 10/19 Tympanometry Gelfand Chapter-7 (205-222)
Immittance Measures Lab/Report = 6.0 hours
Advanced Due 10/25: PIPB Functions
Multi-Frequency Chapter Readings =
Tympanometry 4.0 hours
Bb: Hunter: Chapter 5
Bb chapter = 3.0 hours
Katz: Chapter- 9 (148-161)
Immittance Measures
Advanced (contd)
Acoustic Reflexes Acoustic Reflexes
9 10/26 Bb: Hunter & Shahnaz:
Chapter 6
Katz: Chapter- 10
Katz : Chapter- 19
10 11/2
Additional Readings:
In addition to chapters in texts, there will be additional required readings that will supplement
class lectures (see References); these readings will be made available on Blackboard.
The student is responsible for reading all required materials in preparation for class, with mini-
quizzes to examine understanding of read material to be administered at the start of each class.
References
Blackwell, K.L., Oyler, R.F., Seyfried, D.N. (1991). A clinical comparison of Grason Stadler insert
earphones and TDH-50P standard earphones. Ear and Hearing, 12(5): 361-362.
Boothroyd, A.
DeRuiter, M., Ramachandran, V. (2010). Basic Audiometry Learning Manual. San Diego, CA: Plural
Publishing.
Erber, N.P., Alencewicz, C.M. (1976). Audiologic evaluation of deaf children. Journal of Speech and
Hearing Disorders, (41): 256-267.
Kramer, S., Guthrie, L.A. (2014). Audiology Workbook, 2nd ed. San Diego, CA: Plural Publishing.
Lubinski, R., Golper, L.C., Fratalli, C.M. (2007). Professional Issues in Speech-Language Pathology
and Audiology, 3rd ed. Clifton Park, NJ Delmar/Cengage Learning, Chapter 1.
Also Utilized:
Access to Otis, a virtual patient computer software, is available in the HSLS computer lab.
Value = 10%
On-site, mini-quizzes will be administered at the onset of the first class of that particular week for
which the readings have been assigned. These quizzes will be approximately 10 minutes in duration
though if more time is needed, this will be provided. Quiz questions may take the format of multiple-
choice, fill in the blanks, true/false, logical or ordering of choices.
The goal of these quizzes is to prepare you prior to class presentation so that you will be better
prepared to (a) follow the presentation; (b) be an active participant- be it in class discussions or posing
questions based on the material that you have read/been presented, and (c) make it easier to ultimately
retain the information that you have learned in class.
Value = 30%
Labs # B1-B3 are each worth 5% toward your final lab grade, while Labs #B4 and #
B5 are worth 7.5% each toward your final lab grade.
OVERALL OUTLINE
Cover Page: - Lab Title & Student Name
Introduction:
- Define the particular clinical aspect that will be examined and question(s) to be
answered during this lab
- Provide background evidence-based information from the literature that pertains
to this topic and provide citations
Hypothesis:
- Based on your review of the literature and assignment task, what do you expect
your results to reveal and why?- use citations as appropriate
Methods:
- Rationale for your Methods (use citations as appropriate)
- Equipment used, techniques(s) deployed, # and type of subjects, etc.
Results:
- What did you find?
- Summarize your main findings (such as group means) in either tables and/or
figures, or use EXCEL spreadsheets, whichever you feel can best describe the
results. Use APA format for Table/Figure headers
- Submit the raw data in the form of figures/tables in your appendix (please see
the Appendix section)
Discussion &
Conclusion(s):
- What are the implications of your findings?
- In the conclusion, indicate if your results confirmed your hypothesis or did they
reveal different findings? If different, what do you think may explain what may
account for this?
References:
- Any references cited in your report are noted in the References section which
follows the Discussion & Conclusion section. Please use APA format (e.g., cite
chapter authors and the text their chapter is found). Please follow APA format.
Appendices: - Appendices appear as the last component of any report, project, dissertation or
article. This is where you provide the raw data that you obtained in conducting
the experiment (please identify by labels for whom the data was obtained but no
identifying information).
Cite your sources in APA style. Also, write in an organized fashion with well-
constructed sentences using APA format, as these Lab Plans will ultimately lead you
to be better prepared when you must present papers on future assignments.
The following provides the scoring rubric for Labs #B1 - # B3. Labs #B4 and #B5 have separate
scoring rubrics, which are identified when each of the latter labs are described.
** Please see next page for the grid that delineates the scoring rubric.
LAB ASSIGNMENTS
Assignment Specifics: To seek thresholds for any three frequencies in the range of 250 -8,000 Hz in
either the right or left ear in two different individuals using the ascending and descending techniques.
On an EXCEL spreadsheet indicate the (a) Client #; (b) Ear chosen; (c) Air or Bone conduction;
(d) Procedure (descending/ascending) chosen, (e) Frequencies presented and (f) Levels presented and
the listeners response at each level (- heard) or (- missed) both from Insert Wingding fonts .
For the purpose of this lab, in the Descending approach commence testing at 30 dB HL. For the
Ascending approach commence at -10 dB HL.
Before conducting the experiment, use the Lab Planning/Reporting document to guide your
thought process prior to commencing the lab.
Methodology
1. Three students will collaborate in this assignment (each student will test the other two students).
Please confirm that all of you participating in this project have normal hearing acuity. If your
group includes someone with hearing loss, then seek a third individual to serve as a second
subject.
2. You will assess each of your two colleagues by presenting 250 Hz and 3,000 Hz tones to one ear
via (i) supra-aural as well as (ii) insert phones.
4. Once thresholds have been obtained, present narrow band (NB) noise to the contralateral ear. The
initial noise level will commence at 10 dB above the threshold obtained in the test ear. For each
increase in noise level (increase in 5 dB steps), reassess if the subject can still hear the
presentation tone in the test ear. Continue to increase the noise level in the non-test ear until the
subject is no longer able to hear the tone in the test ear. Then decrease the noise once more (10
dB down steps) until the test tone once more is heard; then increase the noise once more (5 dB up
steps) until the subject no longer hears the tone. Do this until you have twice ascertained the same
noise level that just masks out the test tone.
Do this step for both 250 Hz and 3,000 Hz for both the supra-aural and insert phones for each of
your two subjects.
Results
1. For both the supra-aural and insert phone conditions for each of the two subjects you tested, in the
results section display a table that indicates (a) the thresholds for both subjects at 250 and 3K Hz,
(b) NB noise level at each frequency that results in overmasking, (c) specific noise level-threshold
differences (interaural attenuation) values.
Discussion
Present your conclusions and implications of these findings. Relate these findings to the literature.
1. Materials to be used: (a) 36 spondees used in our clinic and (b) 15 AB-Isophonemic Word
Lists (these 15 lists can be found in the Appendix B of the 1984 Boothroyd articles that are in
your references.
3. Spondees and AB- Isophonemic words will be presented via live voice with the goal of
ascertaining % correct as a function of dB presentation level. Only normal hearing individuals
(ears) will be used to obtain data in this study.
Spondees:
Prior to carrying out the actual lab, use the 36 spondees to create a total of six randomized, 10
item spondee lists (i.e., 10 spondees per list, total of six lists).
First, obtain the subjects SRT as you normally would do. Then prior to each presentation
level familiarize the subject to all of the spondees within each 10-item list. Commencing at
5 dB below the SRT, present 10 spondees and calculate # correct/10 and convert this to its
corresponding percentage. Increase in 5 dB steps and present 10 spondees at each level until
you get two ascending levels in a row where the subject gets all 10 spondees correct
(i.e., 100%).
For each dB presentation level, write down the corresponding percentage correct score. Then
plot the results on a graph (EXCEL is likely your easiest way to do so) for each of the three
subjects assessed and display this as a function of the starting level (i.e., the starting point for
each subject on the graph is each subjects SRT - 5 dB level; you can refer to this as 5 dB
SL, and then compare each subjects results relative to this level even though the actual dB HL
levels may vary between subjects) in the Appendix. Thus, the presentation percentages are at
the same corresponding sensation levels.
Increase in 5 dB steps and present a new list each time. Continue to increase levels until you
get a word recognition score of at least 90 %.
To best do this exercise and avoid any learning of the lists, I am asking you to do the
following:
(a) Student #1 evaluates Student #2, while Student #3 is not in the room (note that if the
presenter has used 7 lists and the subject still has not achieved a 92% score, then the presenter
should do lists #1 and #2 again since the subject likely would have repeated very few, if any,
of the items correctly from those lists when presented at 5 dB below or at SRT); (2) Student #2
evaluates Student #3- using the same lists used when Student #2 was evaluated (follow the
same guidelines for when subject #2 was assessed); (3) Student # 3 can present the remaining
7 to 8 lists to Student #1 (i.e., lists not used in assessing subject #2 and # 3).
4. Average and plot the results in sensation level across all three subjects, commencing with the
percentage score at -5 dB sensation level (i.e., SRT -5 dB HL) and continuing to plot until a
plateau is reached.
Plot the mean results as a function of sensation dB level. You will create two graphs:
I. One graph will consist of (a) Mean % Spondee Recognition Score, (b) Mean % AB-word
recognition score, and (c) Mean % Phoneme Word recognition Score as a function of
sensation level.
II. A second graph will consist of the mean Initial Consonant, Vowel, and Final Consonant
Recognition AB scores as a function of sensation level.
5. You will write each report individually, though obviously you will report on the same data
(but do not collaborate on how you will present the data). Using the APA lab format that you
have used in past assignments, present an:
Introduction to the topic- including what the research would suggest concerning the
slope of the PI functions for each of the different stimuli, what likely underlie these
differences, and, in turn, your hypothesis to what you expect to find
Indicate the methodology used to conduct this experiment
Go over the results, including tables/graphs that display the data (listed in the
appendix), as well as mean data (displayed in Results section) for each type of stimuli
In the discussion, summarize the findings, how they relate to your hypothesis, and the
implications of these findings for everyday clinical usage.
Different grading rubrics are utilized for Labs # B4 and #B5 than for the earlier
assignments. Each lab is graded on a basis of 100 points (each lab has its own
scoring rubric) and a grading value of 7.5 % each.
This next assignment is somewhat different than the labs you have completed up to now. Rather than
it being an investigatory assignment, it is more of a practical experience in learning how to conduct a
full immittance test battery, and, the many ways it can assist the clinician. The value of this
assignment will be higher than the previous labs (thus, accounting for a greater weighting in
determining your final grading for the labs). I will also be using a different scoring method, whereby
I will score each of the sections- each with differing point totals, adding up to a total of 100 points.
Please see the scoring rubric on page 22.
I will first provide an overview of the assignment, then provide guidelines as to what I would like you
to include in your report.
I am asking that you do the above test battery on two subjects. Specifically, please obtain the
following measures from both ears of each subject:
Tympanometry
Physical Volume
Middle Ear Pressure
Static Acoustic Admittance
Tympanogram Type (A, B, C, etc.) for the 226 Hz probe tone
Middle Ear Resonance Frequency- as determined by the point which delta B crosses the X-
axis (obtained using multi-sweep tympanometry: see pages 4-75 to 4-81 of the GSI- Tympstar
manual)
Acoustic Reflexes
Contra Reflex Thresholds (.5K, 1K, 2K, and 4K Hz)
Ipsi Reflex Thresholds (.5K, 1K, and 2 KHz)
Introduction:
Please indicate the importance of incorporating acoustic immittance measures into a clinical test
battery and how the various components listed above (tympanometry, acoustic reflexes and acoustic
reflex decay) can contribute to the audiological assessment (please examine the literature and cite
references). That is, what can the results from each of the various procedures help us better
understand diagnostically (please note that since this is not a research lab, you do not have to generate
a hypothesis).
Method:
Please describe the equipment used and program parameters that allowed you to derive each of the
various results (e.g., which GSI Tympstar hardware/software features did you access and the specific
methodology used- such as what range of middle ear pressure was encompassed in deriving the
tympanogram, middle ear resonance, how you went about obtaining the acoustic thresholds, what
guided you in determining the actual reflex threshold levels that you conducted acoustic reflex decay,
etc.).
Results:
For each subject, create a summary table that lists the results you obtained for each of the various test
measures. Also, please include a printout for one of the ears from one of your two subjects for each
of the following: (1) a 226 Hz tympanogram; (2) from the multifrequency sweep, the display of the
middle ear resonance based on delta B; (3) results from one acoustic reflex series (ipsilateral or
contralateral); (4) results of reflex decay for one of the frequencies assessed.
Discussion:
Please interpret each of the two subjects findings relative to normative values, and, indicate if they
were within norms, or, if any were deviant from what you would have expected relative to normative
values.
Conclusion:
Please discuss how the overall results would have assisted you relative to their diagnostic value had
they been included as part of an actual hearing assessment, such as: (a) what did the results indicate
relative to each clients middle ear status; (b) auditory nerve/lower auditory brainstem function;
(c) facial nerve status, etc.
Similar to the acoustic immittance lab, this lab is more of a practical experience in learning how to
conduct OAE and how using this technique can assist the clinician.
Using the Otoacoustic Emissions equipment available at Gallaudet University, each student will
conduct both transient and distortion OAE assessments from a normal hearing individual. Both ears
are to be assessed.
Subsequently, you will conduct both transient and distortion product omissions on both ears of the
subject.
Transient OAE
Please indicate:
Overall stimulus level
# Presentations in quiet versus noise
% Reproducibility (i.e., cross correlated power spectrums)
dB S/N ratio at each of the frequency bands displayed
Method:
Please describe the equipment used and indicate the program parameters separately for the Transient
and Distortion Product OAEs. Please indicate:
Each of the software features accessed
Transient OAE: Overall TEOAE stimulus level and the setting of total # of sweeps to be
accepted
DPOAE: Frequency ratio of F2:F1, F1 and F2 dB SPL levels, and total # of sweeps presented
(how was this # of presentations chosen?)
Results:
For your client, create a table that lists the following results you obtained:
1. Client Related Information
Client Age
AC Thresholds
Tympanometry
Ipsilateral Acoustic Threshold 1KHz
For your client, now create a second table that lists the following results obtained for each ear
separately:
Value = 5%
Format
30 minute case study presentations (real or imaginary clients; if real, please do not use actual
names)
PowerPoint; may use additional visual and audio aids
In the Wednesday class on 11/11, paired groups will be chosen via randomized drawing; in
addition, the date selection (and group # for that day) for each group will also be determined via
the randomized drawing;
Presentations will be conducted on Wednesday, December 2 and the week of December 7th
Content
Each paired group will choose a pathology from the list of topics provided at the end of this
Appendix (or suggest an alternative pathology, however, this must be professor approved) and
inform this instructor at the latest by Sunday 11/15. In an effort to avoid duplication this will be
done on a first notification basis (please indicate your first and second alternatives). If a
pathology is already selected, I'll assign a topic to your group. You will be informed of your topic
as soon as possible (no later than Wednesday, 11/18) on which pathology topic you will be
presenting.
Present a case real or fictional, but with the approved pathology
o Start with Case History Info
- Primary complaint(s)
- Medical and any relevant birth history; for the purpose of your presentation, please
do not state any medical issues that would clearly give away the underlying
pathology (e.g., the client has had an ultrasound that has determined .)
- Ear/Hearing related issues
- Any relevant findings from elsewhere (such as headaches/high blood
pressure for which he takes medication).
o Present the audiometric findings (real or extracted from publications)
- Present other findings, as appropriate (such as previous audios)
o Summarize/integrate the test findings
Do not tell the class what the underlying pathology is until you have presented the background
case history information have everyone guess.
Once you have presented the case and you have informed the class of the diagnosis, please:
Present on the typical presentation of this pathology, including:
o Descriptions
o Prevalence
o Symptoms
o Audiometric presentations
Other key findings youd expect
o Typical interventions that are implemented
Dont forget citations, and refer to them as you present in this portion of the presentation (rather than
one big list at the end)
** An example of a previous student presentation will be provided ahead of time, so that you can
better understand what is expected. This example's pathology cannot serve as your presentation
topic.
Student Name(s):
Presentation Date:
Comments:
Comments:
On Wednesday, November 11 th (upon completion of content lectures), I will present three different
cases for students to review. Students will pair up and during the subsequent weeks will examine
these cases for:
Accuracy/congruency of test results
Completeness of testing or should any other tests be done to derive a more complete profile?
Based on what has been presented (and from all testing that might need to be done), the clients
diagnostic profile
Upon handing out this assignment, the corresponding rubric will also be disseminated.