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Clinical Hearing Tests

Clinical Hearing Tests Clinical Hearing Tests

CLINICAL HEARING TESTS

Hearing assessments are crucial for diagnosing auditory function and identifying potential hearing impairments. Several clinical tests are employed to evaluate hearing thresholds and sound localization. The Finger Friction Test, the Watch Test, and the Free Field Voice/Speech Test are among these tests.

(i) Finger Friction Test:

The Finger Friction Test is a basic screening tool for assessing hearing thresholds and sound localization capabilities. In this test, the examiner generates a clicking sound by snapping their thumb and middle finger together near the patient’s ear. The patient is instructed to close their eyes and listen for the sound, allowing the examiner to evaluate the patient’s auditory perception.

(ii) Watch Test: Historically, the Watch Test was a common method used by clinicians before the development of audiometers. In this test, the examiner brings a ticking watch close to the patient’s ear. The distance at which the patient can hear the ticking sound is measured, providing insight into their auditory sensitivity.

(iii) Free field voice/ Speech Test: The Free Field Voice/Speech Test is a structured assessment designed for clinical environments. This test evaluates each ear separately while masking the opposite ear to prevent sound interference. Masking can be achieved by having an assistant rubbing the index finger on the patient’s tragus or by using a Barany noise box.

Procedure: Speech test must be done in quiet surroundings. 

  • Patient Positioning: The patient stands 6 meters away from the examiner, facing the test ear, with their eyes closed to eliminate visual cues from lip reading.
  • Masking: An assistant blocks the non-test ear by applying pressure on the tragus, or alternative masking methods are employed.
  • Testing: The examiner speaks spondee words (e.g., “iceberg,” “sunlight,” “bathroom”) or alphanumeric combinations (e.g., “Y3G,” “6BZ”) while gradually moving closer to the patient. The distance at which the patient can hear the conversational voice is recorded.
  • Whispered Voice Test: The examiner then whispers spondee words, and the distance at which the whispered voice is heard is also measured.

Interpretation: The results of the Free Field Voice/Speech Test can indicate the presence of hearing loss. A patient with a hearing loss greater than 30 dB, does not hear a whispered voice from a distance of 2 feet from the test ear. The sensitivity of this test is reported to be 95%, with a false-positive rate of 10%. If a patient can hear a voice from 2 feet away, it suggests that their pure tone threshold is better than 30 dB HL.

Disadvantage: Despite its utility, the Free Field Voice/Speech Test has limitations. The standardization of the intensity and pitch of the voice used during testing is often questioned, and external ambient noise can interfere with the accuracy of results. These factors can affect the reliability of the test outcomes, highlighting the need for careful consideration during clinical assessments.

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    Download full PDF Link:

    Clinical Hearing Tests Best Lecture Notes Dr Rahul Bagla ENT Textbook


    Reference Textbooks.

    • Scott-Brown, Textbook of Otorhinolaryngology-Head and Neck Surgery.
    • Glasscock-Shambaugh, Textbook of Surgery of the Ear.
    • P L Dhingra, Textbook of Diseases of Ear, Nose and Throat.
    • Hazarika P, Textbook of Ear Nose Throat And Head Neck Surgery Clinical Practical.
    • Mohan Bansal, Textbook of Diseases of Ear, Nose and Throat Head and Neck Surgery
    • Hans Behrbohm, Textbook of Ear, Nose, and Throat Diseases With Head and Neck Surgery.
    • Salah Mansour, Middle Ear Diseases – Advances in Diagnosis and Management.
    • Logan Turner, Textbook of Diseases of The Nose, Throat and Ear Head And Neck Surgery.
    • Rob and smith, Textbook of Operative surgery.
    • Anirban Biswas, Textbook of Clinical Audio-vestibulometry.
    • Arnold, U. Ganzer, Textbook of  Otorhinolaryngology, Head and Neck Surgery.

    Author:

    Dr. Rahul Bagla ENT Textbook

    Dr. Rahul Bagla
    MBBS (MAMC, Delhi) MS ENT (UCMS, Delhi)
    Fellow Rhinoplasty & Facial Plastic Surgery.
    Renowned Teaching Faculty
    Mail: msrahulbagla@gmail.com
    India

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