OofM


Audiometry Book


Basic Audiometry Manual

The Basic Audiometry Learning Manual (see readinglist) is a good source of information for Audiometry, Otoscopy and Tympanometry and Reflexes.  However, the book does not describe BSA procedures but of course the principles of finding threshold and masking are essentially the same.  There is a further complication.  The book does not use BSA symbols, see below for replacement figures with BSA symbols.  Throughout the book the term "unmasked" is used.  The correct term is "not masked".  "Unmasking" is an entirely different psychoacousic phenomenon.    Please mentally replace "unmasked" with "not masked" throughout the book.  The book is a useful resource to help with your learning, but unfortunately it contains: protocols which do not match ours, terms which do not match ours, and some statements which are highly misleading.  See "corrections list" below.  I appreciate that it is awkward to have all these differences.  I will try and find a better book, but I doubt one exists. 


Page What Notes
86 Figure legend Use BSA symbols from the BSA Audiometry protocols
87 Figure legend, should read, left air-conduction threshold 30 dB HL at 1000 Hz.  Our symbol 'X' means masked if required, rather than "unmasked" as mention.
100 Figure 13.8, see replacement Figure HERE Figure uses different symbols, see replacement.  Note the "no responses to masked air- or bone stimuli..." would be shown as circles with down right arrow, and [ with down right arrows on a separate audiogram for the right ear.
101 Figure 13.9, see replacement Figure HERE Figure uses different non BSA symbols.  The text states that the thresholds are unmasked (not masked).  Remember that the proper open circle symbol in BSA means "masked if required".  Thus the audiogram as shown would be a working audiogram containing thresholds BEFORE the masking process started.  You might use the shaded circle symbols at the thresholds shown once masking has been completed, to show they were shadows.  BUT, there is no requirement to show shadows on the audiogram.  So, the figure is an incomplete audiogram and would not be left like that!
101 Figure 13.10, see replacement Figure HERE same issue as Figure 13.9 above.
102 Figure 13.11, see replacement Figure HERE BSA symbol for not masked BC is different, and we use separate audiograms for each ear (ideally).
103 Figure 13.12, see replacement Figure HERE BSA symbol for not masked BC is different, and we use separate audiograms for each ear (ideally).
107 Table 13.1 We use different data for minimum IA.  40 dB for supra-aural (THD-39) and 55 dB for fully inserted insert (ER-3A).
107 Paragraph on effective masking.
"A 30 dB narrow band noise centered at 1000 Hz effectively masks a 30 dB HL pure tone at 1000 Hz".
 The quotation is incorrect for the definition of EML we use. 
Remember 30 dB EML raises the threshold to 30 dB according to our calibration standards.  The statement in the book is different.
109 Clinical note describes a different protocol to BSA and must not be used IGNORE THIS CLINICAL NOTE!  IGNORE THE METHOD in the 2nd paragraph.  READ BSA procedure.  The procedure in the book is different and NOT correct for us!
110 Figure 13.21, see replacement Figure HERE Figure does not use BSA symbols.  Note right AC thresholds are the not-masked ones and so this audiogram is incomplete.  Remember open circles mean masked if required, there is no symbol for not-masked (closed/shaded circles are for shadows but optional).
110 Procedure text Procedure book text says start by masking with 10 dB EML.  This procedure is incorrect and remember the definition used here for EML is also different.  Ignore the procedure comments on this page!
pp
111 - 114
Principles correct but we use 10 dB steps in masker level.
Areas of "undermasking".
We use 10 dB steps in masking level.  Areas marked undermasking are described as "direct peripheral masking in the non-test ear" in BSA protocols.  The one-to-one increase of threshold with masker shows that the threshold comes from the non-test ear.  The term area of "effective masking" is misleading too, the masker is effective at lower levels in the non-test ear which is why the threshold increases with increasing masker.  The effective masking part shown on Figure 13.29 really means that the non-test ear cannot hear the tone at all whilst the test ear can.  So in that sense it is effective at allowing us to see true threshold of the test ear.  However, the terms are a little misleading.  See BSA procedures which describe things in a much better way.
p115 Figure 13.30, see replacement Figure HERE We use different symbols, the triangle has a different meaning for us.  See new figure.  Remember that the AC symbols mean "masked if required for us".
p116 Figure 13.31, see replacement Figure HERE see above
p119 Figure 13.36, see replacement Figure HERE as above, unclear what is meant to be shown here.  One would probably also put masked BC symbols with NOT REACHED, or UNCERTAIN (down/up arrows) whereas the audiogram in the book just has a text comment
p119 Figure 13.37, see replacement Figure HERE Updated to BSA symbols, remember that our symbols are "masked if required" so this audiogram is incomplete and cannot be left like that.  We do not have a symbol for not masked.  Also recall that we say "not masked" rather than "unmasked".
p121 Figure 13.40 is identical to figure 13.37 So, remember once again that we do not have a symbol for not-masked thresholds.  Thus the masked figure is the same as the not-masked one, and the not-masked one is incomplete and can only be used if a clear note is added to it saying that masking was not done.
pp 122 - 123 Text The explanation is ok but we would not say "area of effective masking" this is misleading.  The masker was effective in the non-test ear during the one-to-one increase of threshold with masker.  We would use, "direct peripheral masking in the non-test ear", "true threshold" for flat line, "cross-masking" for the 2nd final one-to-one increase of threshold with masker.
p124 Figure 13.45, see replacement Figure HERE Replacement figure with BSA symbols for not masked BC and masked AC
p125 Figure 13.46, see replacement Figure HERE Replacement BSA symbols
p126 Figure 13.47, see replacement Figure HERE Replacement BSA symbols
p128 Figure 13.49, see replacement Figure HERE Replacement BSA symbols.  Note that in this case not masked BC has been performed on both ears.  It would not normally be.  Note that it "appears" that the not masked BC thresholds on either ear are not identical when you might expect them to be if IA is 0 dB.  There is mention of this in the text.



Dr Tim Wilding