 Hi Greg, I'm Melissa. Hi, how are you? Good, come on through. I'm Greg. We're going to follow a typical audiometry test session with an adult client. And so, what brings you in today? Well, I'm having a bit of trouble hearing and background noise. I listen to a lot of live music. After greeting the client, the audiologist's first step is taking a detailed case history. Okay, and how long has that been going on for? Probably about six months to a year. The history allows the audiologist to elicit information about the patient's main concerns, their hearing and balance history, and other relevant medical background information. Okay, and so you say you listen to a lot of music? Yes. Is that to do with your job, or is it a recreation? No, usually a recreation. Yep. Okay, and so how often are you doing that? This is a good opportunity to build a rapport with the client and to informally gauge the degree of a client's communication difficulties. That's great. So what we'll do is I'll just have a look on your ears for a start and then we'll get on with the hearing test. Some clues about some conditions that may affect hearing can be obtained through an otoscopic examination of the client's ear canals. Good. And we'll just check the other one. Otoscopy also establishes whether the patient's ear canals are sufficiently free of wax or other debris to proceed with testing. Okay, so just through into this room here, we're going to do a tympanogram now. Immittance audiometry is sensitive in detecting middle ear disorders. What we're doing is just checking how your ear drum is moving. So it gives us an idea of your middle ear function. So I'm just going to put this little rubber tip in your ear. You'll feel a bit of a change in pressure, but you don't need to do anything. In tympanometry, the mobility of the middle ear system is measured while varying the air pressure in a sealed ear canal. Immittance audiometry also provides an important objective cross-check of the pure tone audiometric results. Now for the audiogram. There we go. I'll just have a seat there. There we go. So I'll just give you that button there. So what's going to happen is I'm going to put some headphones in your ears, and you'll hear beeps in one ear at a time. So whenever you hear a beep, you're just going to press that red button, even if it's very soft. Okay? I'm just going to put these in your ears. These are right clipped onto your jacket? Yeah, sure. Okay, so it just sort of goes in your ear like a foam earplug. The procedure for establishing an audiogram from an adult client begins with air conduction testing using pure tone stimuli. Headphones or these insert earphones are used to deliver the stimuli to the client's ears one at a time. The client responds to the sounds they hear, usually by pushing a response button. The tests establish the patient's threshold of hearing for each of a number of frequencies that are important for understanding speech. The audiologist starts at an intensity level that's easily audible to the client. The level is then decreased in intensity by increments of 10 decibels, making sure the tones are not presented in a predictable rhythm or pattern until the client no longer responds. At this point, the intensity level is increased in 5 decibel increments until a response is obtained. This is repeated until the client has responded to two out of three ascending presentations. On the audiogram, the thresholds are recorded as crosses for the left ear and circles for the right ear. Air conduction thresholds reflect the integrity of the total peripheral auditory mechanism. It's not possible to determine the location of any pathology along the auditory pathway using air conduction alone. Therefore, if a hearing loss is detected, further testing is carried out using bone conduction testing to help establish the site of lesion. Alright, you're doing well so far. What we're going to do this time is put this headband on and this little box just sits on the bone behind your ear. So all you need to keep doing is exactly what you have been doing. So just pressing that button whenever you hear the beep. This time you could hear it in either ear. In the case shown here, the site of lesion is found to be the cochlea itself rather than the middle or outer ear. Once testing is complete, the audiologist integrates the data across each of the different tests and presents the findings to the client. Right, that was great Greg, so we're finished there. So just showing you the results, there's two graphs here, for the right ear and the left ear. And they're graphs of your hearing levels. If necessary, the audiologist may provide some counseling on hearing or balance difficulties and make recommendations regarding rehabilitation or further assessments. Looking at these low and the mid pitches here, your hearing's looking absolutely fine. What's happening is as we get into these higher pitches, it's sloping off down to a more mild to a moderate hearing loss, just at the very highest pitch there. A formal report is usually prepared and sent to the client, as well as to other relevant health professionals. What I'll do is write out a full letter with a copy of the results and send them out to you in the mail.