Over the years, I have had quite a few audiograms.
When I was a government employee, I got them yearly. I remember once when the person administering the test stopped it, opened the door to the booth, and asked me if I understood that I was supposed to press the button when I heard the tone. I did hear it, but thought it was just my tinnitus. Since that time, every audiogram I have done used either a warbling, or interrupted tone. I have been doing the “Audiogram Direct” feature of Target lately, and I believe it gives a better result because I get to adjust the level of the tone and take my time in deciding if I hear it or not. In a booth audiogram, by the time I realize I am actually hearing something, it might have increased in level by several dB. When I was at the VA last week, I mentioned this to the Audiologist. She said that the VA audiogram presents each tone 3 times to eliminate possible errors. I have had an audiogram at the VA and this definitely wasn’t the case. In fact, it seemed much less thorough than one I had at an ENT’s office a few years back. So, is it normal for the tones to be presented 3 times? If so, I have never had that happen. This is just one of many inconsistent things I have been told by VA Audiologists.
Over the years, I have had quite a few audiograms.
I asked my audiologist if there could be an inaccuracy in the test she had just done because I told her I was sure I had pressed the button by accident one time. She told me that there would be no problem because each tone was randomly done multiple times for just that reason. Apparently the 3 times are not done all-in-a-row at the same time.
There is an agreed upon standard for measuring hearing thresholds which is that someone else presents the tones (e.g. you don’t know they are coming) and you correctly identify 50% of the presentations on ascending runs. All of the research building prescriptive targets has been based on this definition of a hearing threshold.
Neurons fire in a statistical way with top-down influences. There is no true there-not-there-exact threshold for your hearing. When you present the tones to yourself, you are changing the signal detection rules and you will generally measure “better” thresholds. They aren’t actually better, they are just different.
If you fit based on your own audiometric measurements, you will generally be underfit relative to prescriptive targets (which are based on the standard definition of thresholds).
Pulsed audiometry is nice for tinnitus. Warble-tone is inappropriate because it will underestimate thresholds in sloping losses because of side-frequency hearing.
We know when you press the button incorrectly and we ignore it.
The only time false-positive button presses really interfere with testing is when someone is super button happy and is pressing all the time. It generally doesn’t affect the results, it just makes it all take longer to confirm thresholds. But patients tend to hit the button incorrectly on a rhythm. You may find the clinician presenting tones a bit rhythmically when they are above threshold, but once they get down around threshold they shouldn’t be. They are trained not to.
Tinnitus rarely affects results. It just feels like it does.
The under fit statement using self done audiogram makes since.
Comparing professional audiogram to self done audiogram falls right into what you have said.
The kicker is word recognition with aids using self done audiogram has been better. I have been pushing gains up based on your recommendations of under fitment.
I have never had an audiogram where the tones were presented more than once. Definitely not the one done by the VA. In that one, instead of pressing a button, I was told to tell the tester when I heard the tone. The results were pretty much in line with a test I had a couple of years previous at an ENT’s office. The VA test showed that my ski slope begins at a lower frequency than the other test, which I suspect is due to declining hearing due to age. At around 5 to 6 KHz, it drops to 100 dB, but the VA test didn’t show that. And, they didn’t even include the 6 KHz results. The results I get with Audiogram Direct show less loss. But, not all that much less. I think around 10 dB. I do realize that I can’t achieve really quiet surroundings, and the levels aren’t calibrated. The place I retired from had a SPL meter and calibrator. I might check to see if they still have them. At one time, they had a old device for doing audiograms. I need to check that out as well. Since I have a real problem with loud sounds, prescriptive gains never work for me. I explained that to the VA, but they still program my aids so they are very uncomfortable. I am interested in hearing what they have to say when I go back in 2 months and tell them the aids still aren’t helping.
Have you been tested for UCL? Your upper comfort levels need to be part of your hearing aid fitting.
My last hearing test at the VA as totally different than I have had in the past. For one thing I was given the word test with both male and female voices. Then I was given the tone test two times too. My Audi gave me the first round of test then he called in another Audi that gave me the second test. The test my Audi gave me matched the one I had back in November of 2018, and the one the female Audi gave me matched the one I had back in January of 2019 when I was asking for a review of my disablity by the VA. I asked the both of them to explain. As it turns out I cannot understand female voices worth a darn, but I do very well with the male voice. As for as the tone test is concerned they could not agree on the differenes in the two. They matched up except for the my worse frequencies of 1500 - 2500 hz. There is a 10db difference. I got worse reading with the first test than the second test, and by the time I got to the second round of tones I was very stressed at trying to hear the tones. And my tinnitus was even worse with the second test.
They should be using taped words.
I have seen similar results also.
With all the discussions on REM this very fact of inconsistent audiograms to build a prescription from bring up questions.
There is a Widex thread talking about this very thing. Using the Widex software with aids and acoustics in place to test the audiogram are proving best.
It’s a tuff spot to prove or disprove. The OTC hearing aids have an interest in how audiograms are done and how to prescribe a fitting.
They were using taped words. But one did male voices the other female voices.
My audiologist has a tinnitus survey as part of the intake paperwork; she explained that based on my responses she would do a 3x repetition of each tone. So that’s how my testing is done now.
Rick, I can’t remember anything like that ever being done. It certainly isn’t on the copy of my audiogram they gave me. I can’t remember word recognition being done except for once about 4 years ago. I did 85% at 80 dB. Which means I do pretty well if you talk loudly.
We do a lot to try to minimize variability, but there will always be variability within the individual which we cannot overcome unless we find a more sensitive objective measure.
I think audiograms are like some other diagnostic tests. They work well for some, but not others. For instance, in my eye doctor’s office, I can regularly see 20/20 or 20/30 on an eye chart, but out in the world, I have a lot of vision problems. Glasses help, but that is about all. Same with hearing aids. It would seem that you would just amplify the frequencies I can’t hear enough, and I could hear very well. That isn’t so. I disagree with those who say that all the sounds I find painfully annoying is just because I haven’t really heard them well for so long. Sorry, I just don’t buy that.
I’ve taken quite a number of tests in the last 25 years. I followed the instructions. All went well except for the word recognition part in the last test I did about 7 months ago. It was far too loud (95 dB). I felt that my brain tried to shut it out. I was at the verge of yanking out whatever was mounted on my ears just before the test ended. When I asked if it should be repeated at a lower volume the HIS said not to worry. She said I did very well. I think the loudness affected that part of the test.
At 95 dB, I wouldn’t have finished the test. Ouch!