Introduction
Audiometry is one of the most common procedures performed by an audiologist. It helps to measure one’s ability to discriminate between different sound intensities and speech.
Definition
Audiometry is an objective assessment tool used to detect hearing problem and hearing loss for all age groups older than 6 months.
Purposes
- To detect hearing problems.
- To prevent delayed speech and language development.
Types
- Diagnostic or clinical audiometer.
- Screening audiometer.
- Computer-based audiometer.
- Automatic audiometer.
Indications
- Routine screening.
- Evaluation of hearing loss.
- Children with delayed speech and language development.
- Patient with preexisting hearing deficit.
- Patient with complaints of tinnitus.
- Unexplained behavior changes.
Contraindications
- Cerumen obstruction.
- Otitis externa.
- Infant younger than 6 months.
Articles
| Articles | Purpose |
| Audiometer | To assess the ability to hear. |
| Quiet room | To avoid unusual disturbance. |
| Correct earpiece | To ensure a good seal of the external canal. |
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure to the patient. | Allays anxiety and obtains cooperation from the patient. |
| 2. | Obtain informed consent from the patient. | Serves as legal evidence. Prevents litigation of the staff. |
| 3. | Position the patient in a comfortable sitting position. | General preparation before the procedure. |
| 4. | Inspect the ear canal by flashing light into the auditory canal, gently grasping the pinna, and pulling up and back. | To detect for any abnormalities such as infection and cerumen obstruction. |
| 5. | Earphones are connected to a machine which delivers the tones and different sounds of speech to one ear at a time. | To identify hearing loss. |
| 6. | Instruct the patient to raise his or her left hand if the sound is heard in the left ear. Repeat the same in the right ear. | To indicate hearing tone. |
| 7. | Document the procedure. Record each tone of the lowest possible volume that the patient heard. Interpret the findings. | Serves as legal evidence and prevents duplication of care. |
Interpretation
| Value | Range of Hearing Ability |
| <25 dB | Normal |
| 25-40 dB HL | Mild |
| 41-65 dB HL | Moderate |
| 66-90 dB HL | Severe |
| >90 dB HL | Profound |
(HL-hearing loss.)
Special Considerations
- Use nonverbal cues, simplified instructions, or caregiver assistance.
- Consider objective tests like otoacoustic emissions (OAE) or auditory brainstem response (ABR) if subjective testing is unreliable.
- Provide instructions in the patient’s preferred language.
- Use speech audiometry in the native language when possible.
- Conduct tests in a sound-treated booth to minimize ambient noise. If unavailable, choose the quietest possible location and monitor background noise levels.
- Avoid echo-prone spaces. Use soft furnishings or acoustic panels to reduce reverberation.
- Ensure minimal interruptions and visual distractions to maintain patient focus.
- Audiometers must be calibrated annually or per manufacturer guidelines to ensure accuracy.
- Choose appropriate headphones or insert earphones based on patient comfort and ear canal anatomy
- Apply masking when needed to isolate the test ear, especially in cases of asymmetric hearing loss.
- Explain the procedure clearly. Emphasize the importance of honest responses and encourage patients to signal even faint sounds.
- Use a systematic approach (e.g., Hughson-Westlake method) to identify the softest sound the patient can hear at each frequency.
- Patients should avoid loud noise for at least 14 hours before testing to prevent temporary threshold shifts.
- Clean headphones, bone oscillators, and response buttons between patients
- Use for headphones or insert tips, especially in high-risk or immunocompromised individuals.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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