Tone decay test

Last updated
Human Ear Anatomy of the Human Ear.svg
Human Ear

The tone decay test (also known as the threshold tone decay test or TTDT) is used in audiology to detect and measure auditory fatigue. It was developed by Raymond Carhart in 1957. In people with normal hearing, a tone whose intensity is only slightly above their absolute threshold of hearing can be heard continuously for 60 seconds. The tone decay test produces a measure of the "decibels of decay", i.e. the number of decibels above the patient's absolute threshold of hearing that are required for the tone to be heard for 60 seconds. A decay of between 15 and 20 decibels is indicative of cochlear hearing loss. A decay of more than 25 decibels is indicative of damage to the vestibulocochlear nerve. [1] [2]

Contents

Procedure

A tone at the frequency of 4000 Hz is presented for 60 seconds at an intensity of 5 decibels above the patient's absolute threshold of hearing. If the patient stops hearing the tone before 60 seconds, the intensity level is increased by another 5 decibels with the procedure repeated until the tone can be heard for the full 60 seconds or until no decibel level can be found where the tone can be heard for the full 60 seconds. The resultant measure is given as the decibels of decay. [1]

Interpretation of TDT

TD is a procedure for diagnosing retro-cochlear pathology (RCP, damage to the auditory nerve). It is part of battery of tests that aim to differentiate between cochlear and retro-cochlear pathology.[ citation needed ] According to Rosenberg, 1958:

0-5 dB Decay - Normal or Conductive
10-15 dB Decay - Mild
20-25 dB Decay - Moderate
30->35 dB Decay - Marked Decay
decay frequency vs time Tone decay test graphical.jpg
decay frequency vs time

Marked tone decay indicates probability of RCP [3] .[ citation needed ] Glaslow, 1968 stated that positive TD is one where there is at least 30 dB decay. Tillman, 1969 agreed that patients with RCP, typically have TD exceeding 30 dB. However, at the same time it would be dangerous to assume that anyone with 30 dB decay, has RCP. While everyone with less than this amount, does not have. A more predictive way of looking at TD is that each dB of decay above 15 dB, should raise the suspicion that RCP lesion may exist. The greater the TD and the number of frequencies involved, particularly the low frequencies, and then there is greater possibility of serious pathology.[ citation needed ] The index of suspicion should also be raised if the rate of decay does not diminish with increased stimulus intensity. Patients with acoustic tumor, frequently exhibit extreme an often complete TD. However, tumor size appears to be related to the severity of symptoms. Partial or complete TD was found in 60% of tumors classified as large, while, 40% of tumor is classified as small.[ citation needed ]

Fowler noted that equal loudness between the recruiting impaired ear with normal ear can be achieved only with larger sensation levels (SLs) to the normal ear. E.g. A tone at SL of 60 dB in normal ear and 30 dB in impaired ear may sound equally loud. This result suggests that the growth of loudness requiring an intensity increase of 60 dB in normal ear is achieved with an intensity increase of 30 dB in impaired ear. This indicates that recruitment for loudness growth must be occurring much more in impaired ear. This is due to abnormality in cochlea such as hypersensitivity of haircells due to damage. Recruitment is a landmark feature of SNHL of cochlear origin. Reverse Recruitment / Decruitment is a hallmark feature of SNHL of Retro Cochlear region. When recruitment is found to be associated with presence of cochlear pathology then the recruitment is known as complete recruitment. When the recruitment is associated with cochlea then the concept is known as Partial Recruitment.[ citation needed ]

Advantages

Disadvantages

Related Research Articles

Hearing loss Partial or total inability to hear

Hearing loss is a partial or total inability to hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to acquire spoken language, and in adults it can create difficulties with social interaction and at work. Hearing loss can be temporary or permanent. Hearing loss related to age usually affects both ears and is due to cochlear hair cell loss. In some people, particularly older people, hearing loss can result in loneliness. Deaf people usually have little to no hearing.

This is a glossary of medical terms related to communication disorders which are psychological or medical conditions that could have the potential to affect the ways in which individuals can hear, listen, understand, speak and respond to others.

Vestibulocochlear nerve

The vestibulocochlear nerve, known as the eighth cranial nerve, transmits sound and equilibrium (balance) information from the inner ear to the brain. Through olivocochlear fibers, it also transmits motor and modulatory information from the superior olivary complex in the brainstem to the cochlea.

Otosclerosis Condition characterized by an abnormal bone growth in the middle ear

Otosclerosis is a condition of the middle ear where one or more foci of irregularly laid spongy bone replace part of normally dense enchondral layer of bony otic capsule in the bony labyrinth. This condition affects one of the ossicles resulting in hearing loss, tinnitus, vertigo or a combination of symptoms. The term otosclerosis is something of a misnomer. Much of the clinical course is characterized by lucent rather than sclerotic bony changes, so the disease is also known as otospongiosis.

Audiology

Audiology is a branch of science that studies hearing, balance, and related disorders. Audiologists treat those with hearing loss and proactively prevent related damage. By employing various testing strategies, audiologists aim to determine whether someone has normal sensitivity to sounds. If hearing loss is identified, audiologists determine which portions of hearing are affected, to what degree, and where the lesion causing the hearing loss is found. If an audiologist determines that a hearing loss or vestibular abnormality is present, they will provide recommendations for interventions or rehabilitation.

Acoustic reflex Small muscle contraction in the middle ear in response to loud sound

The acoustic reflex is an involuntary muscle contraction that occurs in the middle ear in response to loud sound stimuli or when the person starts to vocalize.

Sensorineural hearing loss Hearing loss caused by an inner ear or vestibulocochlear nerve defect

Sensorineural hearing loss (SNHL) is a type of hearing loss in which the root cause lies in the inner ear or sensory organ or the vestibulocochlear nerve. SNHL accounts for about 90% of reported hearing loss. SNHL is usually permanent and can be mild, moderate, severe, profound, or total. Various other descriptors can be used depending on the shape of the audiogram, such as high frequency, low frequency, U-shaped, notched, peaked, or flat.

Audiometry is a branch of audiology and the science of measuring hearing acuity for variations in sound intensity and pitch and for tonal purity, involving thresholds and differing frequencies. Typically, audiometric tests determine a subject's hearing levels with the help of an audiometer, but may also measure ability to discriminate between different sound intensities, recognize pitch, or distinguish speech from background noise. Acoustic reflex and otoacoustic emissions may also be measured. Results of audiometric tests are used to diagnose hearing loss or diseases of the ear, and often make use of an audiogram.

Presbycusis, or age-related hearing loss, is the cumulative effect of aging on hearing. It is a progressive and irreversible bilateral symmetrical age-related sensorineural hearing loss resulting from degeneration of the cochlea or associated structures of the inner ear or auditory nerves. The hearing loss is most marked at higher frequencies. Hearing loss that accumulates with age but is caused by factors other than normal aging is not presbycusis, although differentiating the individual effects of distinct causes of hearing loss can be difficult.

Audiogram Graph showing audible frequencies

An audiogram is a graph that shows the audible threshold for standardized frequencies as measured by an audiometer. The Y axis represents intensity measured in decibels and the X axis represents frequency measured in hertz. The threshold of hearing is plotted relative to a standardised curve that represents 'normal' hearing, in dB(HL). They are not the same as equal-loudness contours, which are a set of curves representing equal loudness at different levels, as well as at the threshold of hearing, in absolute terms measured in dB SPL.

The auditory brainstem response (ABR) is an auditory evoked potential extracted from ongoing electrical activity in the brain and recorded via electrodes placed on the scalp. The measured recording is a series of six to seven vertex positive waves of which I through V are evaluated. These waves, labeled with Roman numerals in Jewett and Williston convention, occur in the first 10 milliseconds after onset of an auditory stimulus. The ABR is considered an exogenous response because it is dependent upon external factors.

Pure-tone audiometry

Pure-tone audiometry is the main hearing test used to identify hearing threshold levels of an individual, enabling determination of the degree, type and configuration of a hearing loss and thus providing a basis for diagnosis and management. Pure-tone audiometry is a subjective, behavioural measurement of a hearing threshold, as it relies on patient responses to pure tone stimuli. Therefore, pure-tone audiometry is only used on adults and children old enough to cooperate with the test procedure. As with most clinical tests, standardized calibration of the test environment, the equipment and the stimuli is needed before testing proceeds. Pure-tone audiometry only measures audibility thresholds, rather than other aspects of hearing such as sound localization and speech recognition. However, there are benefits to using pure-tone audiometry over other forms of hearing test, such as click auditory brainstem response (ABR). Pure-tone audiometry provides ear specific thresholds, and uses frequency specific pure tones to give place specific responses, so that the configuration of a hearing loss can be identified. As pure-tone audiometry uses both air and bone conduction audiometry, the type of loss can also be identified via the air-bone gap. Although pure-tone audiometry has many clinical benefits, it is not perfect at identifying all losses, such as ‘dead regions’ of the cochlea and neuropathies such as auditory processing disorder (APD). This raises the question of whether or not audiograms accurately predict someone's perceived degree of disability.

Auditory masking occurs when the perception of one sound is affected by the presence of another sound.

Cortical deafness Medical condition

Cortical deafness is a rare form of sensorineural hearing loss caused by damage to the primary auditory cortex. Cortical deafness is an auditory disorder where the patient is unable to hear sounds but has no apparent damage to the anatomy of the ear, which can be thought of as the combination of auditory verbal agnosia and auditory agnosia. Patients with cortical deafness cannot hear any sounds, that is, they are not aware of sounds including non-speech, voices, and speech sounds. Although patients appear and feel completely deaf, they can still exhibit some reflex responses such as turning their head towards a loud sound.

Diplacusis, also known as diplacusis binauralis, binauralis disharmonica or inter aural pitch difference (IPD) is a type of hearing disorder that is the perception of a single auditory stimulus as sounds of a different pitch in the two ears. It is typically, though not exclusively, experienced as a secondary symptom of sensorineural hearing loss, although not all patients with sensorineural hearing loss experience diplacusis or tinnitus. The onset is usually spontaneous and can occur following an acoustic trauma, for example an explosive noise, or in the presence of an ear infection. Sufferers may experience the effect permanently, or it may resolve on its own. Diplacusis can be particularly disruptive to individuals working within fields requiring acute audition, such as musicians, sound engineers or performing artists.

Mary Florentine is a Matthews Distinguished Professor at Northeastern University., specialising in psychoacoustics with interests in models of hearing, non-native speech comprehension in background noise, cross-cultural attitudes towards noise, and hearing loss prevention. Her primary collaborator is Søren Buus.

Bone-conduction auditory brainstem response or BCABR is a type of auditory evoked response that records neural response from EEG with stimulus transmitted through bone conduction.

Acoustic trauma is the sustainment of an injury to the eardrum as a result of a very loud noise. Its scope usually covers loud noises with a short duration, such as an explosion, gunshot or a burst of loud shouting. Quieter sounds that are concentrated in a narrow frequency may also cause damage to specific frequency receptors. The range of severity can vary from pain to hearing loss.

Recruitment, in medicine, is a physical condition of the inner ear that leads to reduced tolerance of loudness. It commonly occurs in individuals who suffer hearing loss due to cochlear damage. While low-magnitude sounds cannot be heard in the affected ear(s), the perceived loudness increases over-proportionally with sound volume once the auditory threshold has been overcome. This can result in a reduced tolerance to loudness, as loud sounds may be perceived louder than normal.

Diagnosis of hearing loss

Identification of a hearing loss is usually conducted by a general practitioner medical doctor, otolaryngologist, certified and licensed audiologist, school or industrial audiometrist, or other audiometric technician. Diagnosis of the cause of a hearing loss is carried out by a specialist physician or otorhinolaryngologist.

References

  1. 1 2 Dhingra, L. and Dhingra, Shruti (2014). Diseases of Ear, Nose and Throat & Head and Neck Surgery, p. 26. Elsevier Health Sciences. ISBN   8131236935
  2. Kramme, Rüdiger; Hoffmann, Klaus-Peter; and Pozos, Robert (eds.) (2011). Springer Handbook of Medical Technology, pp. 205–206. Springer. ISBN   3540746587
  3. Jerger, J.; Jerger, S. (1975-07-01). "A Simplified Tone Decay Test". Archives of Otolaryngology–Head & Neck Surgery. 101 (7): 403–407. doi:10.1001/archotol.1975.00780360003001. ISSN   0886-4470. PMID   1147822.

Further reading