A Synopsis of the AFP article "Audiometry Screening and Interpretation"

Audiometry Screening and Interpretation

JENNIFER JUNNILA WALKER, MD, MPH, U.S. Army Health Clinic, Schofield Barracks, Hawaii

LEANNE M. CLEVELAND, AuD, Fort Richardson Troop Health Clinic, Joint Base Elmendorf-Richardson, Alaska

JENNY L. DAVIS, AuD, Landstuhl Regional Medical Center, Landstuhl, Germany

JENNIFER S. SEALES, AuD, General Leonard Wood Army Community Hospital, Fort Leonard Wood, Missouri

Am Fam Physician. 2013 Jan 1;87(1):41-47.

     Hearing loss is a common problem in the elderly and is becoming an increasing issue in younger patients due to self inflicted injury through "that damm rock and roll!". It can also be seen in patients exposed to excessive noise from motorcycles,  firearms, and work related trauma. The USPSTF does not rule for or against screening in asymptomatic patients, but screening questionnaires and clinical evaluation during a complete physical (remember those cranial nerve II tests?-whispered voice and finger rub?)can be effective. 

     If hearing loss is suspected, you can further evaluate the patient with pure tone audiometry. There are several products on the market and they are all equally effective. The 2 parameters that are checked are frequency and sound. To check, you can start at 1000 Hz. Start at a clearly audible level. If the patient can hear it, you lower the intensity by 10 db until the patient can no longer hear it. Then increase by 5 db to narrow the results. Start with the good ear first and do it twice in each ear to get an accurate result. At the patients threshold, they should be able to pick up the sound half of the time. By the way, this is called the "Hughson- Westlake method". You can check the other frequencies in this same manner (1000, 2000, 3000 ,4000, 500 and 250). Also make sure you are doing this in a quiet room.  The upper limit for normal is 25-30 db in adults and 15-20 in children. Sometimes the opposite ear will pick up sound and give you a false result, so you can give the opposite ear some ambient noise to distract it 

     Hopefully in your physical exam you did weber's, rinne's, and an otoscopic exam to rule out conduction deficits and canal collapse from floppy cartilage.