Guidelines for Testing
Audiometry Tests
1. Otoscopic examination
2. Pure tone audiometry
Pure tone audiometry (PTA) of both ears. using an audiometer. The four key frequencies of 500Hz, 1000Hz, 2000Hz, and 4000Hz should be used.
Standards: (to age 60)
<16dB - Normal
16-20 - Proceed to investigate hearing further
>20dB - Not normal
Further Tests
For further testing of hearing the following tests are suggested. Additional tests may be performed as deemed necessary.
a) Tuning Fork Tests
A bone conduction test is often carried out as part of a routine pure tone audiometry (PTA) test in adults. This is recommended for umpires.
Bone conduction involves placing a vibrating probe against the mastoid bone behind the ear. It tests how well sounds transmitted through the bone are heard.
The clinically useful tuning fork tests include:
i. Rinne Test.
In this test air conduction of the ear is compared with its bone conduction. A vibrating tuning-fork is placed on the patient's mastoid and when he stops hearing, it is brought beside the meatus. If he still hears, AC is more than Be. Alternatively, the patient is asked to compare the loudness of sound heard through air and bone conduction. Rinne test is called positive when AC is longer or louder than Be. It is seen in normal persons or those having sensorineural deafness. A negative Rinne (BC > AC) is seen in conductive deafness and indicates a minimum air-bone gap of 15-20 dB.
A prediction of air-bone gap can be made if tuning forks of 256, 512 and 1024 Hz are used.
A Rinne test equal or negative for 256 Hz but positive for 512 Hz indicates air-bone gap of 20-30 dB.
A Rinne test negative for 256 and 512 Hz but positive for 1024 Hz indicates air-bone gap of 30-45 dB.
A Rinne negative for all the three tuning forks of 256, 512 and 1024 Hz, indicates air-bone gap of 45-60 dB.
Remember that a negative Rinne for 256, 512 and 1024 Hz indicates a minimum AB gap of 15, 30, 45 dB respectively.
Note: False negative Rinne. It is seen in severe unilateral sensorineural hearing loss. Patient does not perceive any sound of tuning fork by air conduction but responds to bone conduction testing. This response to bone conduction is, in reality, from the opposite ear because of transcranial transmission of sound. In such cases, correct diagnosis can be made by masking the non-test ear with Barany's noise box while testing for bone conduction. Weber test will further help as it gets lateralized to the better ear.
ii. Weber Test
In this test, a Vibrating tuning fork is placed in the middle of the forehead or the vertex and the patient is asked in which ear the sound is heard. Normally, it is heard equally in both ears. It is lateralized to the worse ear in conductive deafness and to the better ear in sensorineural deafness. In weber test, sound travels directly to the cochlea via bone. Lateralization of sound in weber test with a tuning fork of 512 Hz implies a conductive loss of 15-25 dB in ipsilateral ear or a sensorineural loss in the contralateral ear.
b) Tympanometry
A standard Tympanometer is used for testing. Using Jerger Tympanogram Curves, a Type A is considered normal. Other curves may require further investigation or treatment.
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AUDITORY TESTING
To be performed by an ENT specialist
Please attach audiometry graph
Certification
I have examined _______________________________________ and recommend the following:
[ ] Fit for umpiring with no restriction
[ ] Fit for umpiring subject to the following (state in comments space below)
[ ] Unfit for umpiring due to the reasons states below (in comments space)
Comments: ____________________________________________________________________
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Signed: Date:
Print Name: Dr. _________________________________________
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