Protocol Overview

October 8, 2010

This section will be completed when reviewed by an Expert Review Panel.

The National Health and Nutrition Examination Survey (NHANES) 2008-2009 audiometry protocol tests the examinee’s hearing threshold (in decibels, dB) at 7 frequencies in a soundproof room. Examinees are asked a series of exclusionary questions, undergo an outer-ear examination (otoscopy), and then have the mobility of their eardrum tested (acoustic immittance). Pure tone signals are then presented to each ear through earphones and the intensity of the signals is varied until the level is identified at which the person is just able to hear the sound.

An audiogram should be conducted in a soundproof room or booth to permit accurate hearing threshold measurements.

Although the 2009-2010 National Health and Nutrition Examination Survey (NHANES) conducts pure tone audiometry on individuals ages 12-19 years and older than 70 years, previous versions of the National Health and Nutrition Examination Survey have performed this procedure on children as young as 4 years and adults of all ages.

A downloadable PDF of the full 2009–2010 National Health and Nutrition Examination Survey (NHANES) Audiometry Procedures Manual is available here: NHANES Audiometry Procedures Manual

The following is a summary version of the full National Health and Nutrition Examination Survey (NHANES) audiometry protocol. This is not intended to replace the actual protocol.

Eligibility Criteria

There are no conditions that would prevent an eligible, consenting examinee from completing the protocol.

Preliminary Activities

Examinees are asked to remove glasses, gum, earrings, or anything else that may interfere with the headphones. Examinees are asked to remove hearing aids. If hearing aids cannot be removed, the examinee skips the audiogram.

Pre-Exam Questionnaire

Examinees are asked about conditions that affect how the test is conducted or how results are interpreted. These questions include whether the examinee:

• has tubes in either ear
• has a cold or earache
• has been exposed to loud noise in the last 24 hours, and
• hears better in one ear or the other

Otoscopy

The technician performs a visual inspection of the outer ear and records any abnormalities of the ear, the presence of excessive ear wax, perforation or inflammation of the ear drum, and whether the ear canal is collapsed.

Acoustic Immittance

For each ear, the technician uses the size and direction of the ear canal to properly select the cuff to seal the ear canal. The technician then places the typanometer probe in the examinee’s ear, ensures an airtight seal, and performs the test.

The result of the acoustic immittance test is a graph (tympanogram) which is evaluated based on smoothness and symmetry. The test should be repeated once if the tympanogram is flat or if the results are not clear.

Audiometry

The technician ensures that the respondent has removed hearing aids and anything that might interfere with the proper placement of the headphones. The technician fits the standard headphones (or inserts headphones if there are collapsed ear canals) over the examinee’s ears and makes sure that the examinee is seated so that he/she can be seen by the examiner during the test.

Automated Protocol

The pure tone audiometry test is controlled by a computer program.

Manual Protocol

The technician will control the frequency, stimulus level, and test signals and make a threshold determination under the following circumstances:

• Examinee cannot operate the response switch
• Examinee cannot "keep up with" the automated test
• Examinee records three false positives
• Examinee threshold exceeds 100 decibels

The technician can begin manual testing after the automated protocol has begun, but must complete the test using the manual protocol.

Record the Audiometry Results

The technician records which headphones were used, which ear was tested first, whether the test was performed manually, and the threshold (in decibels) for each ear at the following frequencies:

• 500 hertz
• 1,000 hertz
• 2,000 hertz
• 3,000 hertz
• 4,000 hertz
• 6,000 hertz
• 8,000 hertz

Scoring Instructions:

Please consult the American Speech-Language-Hearing Association and National Institute for Occupational Safety and Health for the most current classification schemes.

Export Variables

Variable Name	Variable ID	Variable Description	Version	Mapping
PX200101_Hearing_Aids	PX200101010000	Does the examinee have hearing aids that cannot be removed?	4	N/A
PX200101_Ear_Tubes	PX200101020000	Do you now have a tube in your right or left ear [if Yes, indicate affected ear(s)]?	4	N/A
PX200101_Cold_Sinus_Problem	PX200101030000	Have you had a cold, sinus problem or earache in the last 24 hours?	4	N/A
PX200101_Cold_Sinus_Specify_Cold	PX200101030101	(If yes) Which have you had (check all that apply)? Cold	4	N/A
PX200101_Cold_Sinus_Specify_Sinus_Problem	PX200101030102	(If yes) Which have you had (check all that apply)? Sinus problem	4	N/A
PX200101_Cold_Sinus_Specify_Earache_Right	PX200101030103	(If yes) Which have you had (check all that apply)? Earache, right ear	4	N/A
PX200101_Cold_Sinus_Specify_Earache_Left	PX200101030104	(If yes) Which have you had (check all that apply)? Earache, left ear	4	N/A
PX200101_Cold_Sinus_Specify_Earache_Both	PX200101030105	(If yes) Which have you had (check all that apply)? Earache, both ears	4	N/A
PX200101_Cold_Sinus_Specify_Refused	PX200101030106	(If yes) Which have you had (check all that apply)? Refused	4	N/A
PX200101_Cold_Sinus_Specify_Dont_Know	PX200101030107	(If yes) Which have you had (check all that apply)? Don't know	4	N/A
PX200101_Loud_Noise_Exposure	PX200101040000	Have you been exposed to loud noise or listened to music with headphone in the past 24 hours?	4	N/A
PX200101_Loud_Noise_When	PX200101040100	(If Yes) How many hours ago did the noise or music end?	4	N/A
PX200101_Loud_Noise_When_No_Answer	PX200101040101	(If Yes) How many hours ago did the noise or music end?	4	N/A
PX200101_Hear_Better_In_One_Ear	PX200101050000	Do you hear better in one ear than the other?	4	N/A
PX200101_Right_Ear_Comment	PX200101060000	Enter a comment to describe the right ear	4	N/A
PX200101_Right_Ear_Abnormality_Describe	PX200101060100	If answer is "Abnormality, type unknown", enter a comment:	4	N/A
PX200101_Left_Ear_Comment	PX200101070000	Enter a comment to describe the left ear	4	N/A
PX200101_Left_Ear_Abnormality_Describe	PX200101070100	If answer is "Abnormality, type unknown", enter a comment:	4	N/A
PX200101_Right_Ear_Acoustic_Immittance	PX200101080000	Right ear acoustic Immittance	4	N/A
PX200101_Right_Ear_Acoustic_Immittance_Coded	PX200101080100	Right ear acoustic Immittance	4	N/A
PX200101_Right_Ear_Tympanogram_ID	PX200101080200	Right ear tympanogram ID:	4	N/A
PX200101_Left_Ear_Acoustic_Immittance	PX200101090000	Left ear acoustic Immittance	4	N/A
PX200101_Left_Ear_Acoustic_Immittance_Coded	PX200101090100	Left ear acoustic Immittance	4	N/A
PX200101_Left_Ear_Tympanogram_ID	PX200101090200	Left ear tympanogram ID:	4	N/A
PX200101_Audiometry_First_Ear_Tested	PX200101100000	Ear tested first	4	N/A
PX200101_Audiometry_Ear_Could_Not_Obtain	PX200101110000	Could not obtain	4	N/A
PX200101_Audiometry_Headphones_Used_Original_Test	PX200101120000	Headphones used (original test):	4	N/A
PX200101_Audiometry_Right_Ear_Test_Mode	PX200101130000	Test mode right ear	4	N/A
PX200101_Hz_Switched_Manual_Right_Ear	PX200101130100	If mixed, indicate Hz when switched to manual mode (Right Ear)	4	N/A
PX200101_First_1000Hz_Threshold_Right_Ear	PX200101130200	1000 Hz (first) threshold (Right Ear):	4	N/A
PX200101_First_1000Hz_Right_Ear_CNO	PX200101130201	1000 Hz (first) threshold (Right Ear):	4	N/A
PX200101_500Hz_Threshold_Right_Ear	PX200101130300	500 Hz threshold (Right Ear):	4	N/A
PX200101_500Hz_Right_Ear_CNO	PX200101130301	500 Hz threshold (Right Ear):	4	N/A
PX200101_Second_1000Hz_Threshold_Right_Ear	PX200101130400	1000 Hz (second) threshold (Right Ear):	4	N/A
PX200101_Second_1000Hz_Right_Ear_CNO	PX200101130401	1000 Hz (second) threshold:	4	N/A
PX200101_2000Hz_Threshold_Right_Ear	PX200101130500	2000 Hz threshold:	4	N/A
PX200101_2000Hz_Right_Ear_CNO	PX200101130501	2000 Hz threshold:	4	N/A
PX200101_3000Hz_Threshold_Right_Ear	PX200101130600	3000 Hz threshold:	4	N/A
PX200101_3000Hz_Right_Ear_CNO	PX200101130601	3000 Hz threshold:	4	N/A
PX200101_4000Hz_Threshold_Right_Ear	PX200101130700	4000 Hz threshold:	4	N/A
PX200101_4000Hz_Right_Ear_CNO	PX200101130701	4000 Hz threshold:	4	N/A
PX200101_6000Hz_Threshold_Right_Ear	PX200101130800	6000 Hz threshold:	4	N/A
PX200101_6000Hz_Right_Ear_CNO	PX200101130801	6000 Hz threshold:	4	N/A
PX200101_8000Hz_Threshold_Right_Ear	PX200101130900	8000 Hz threshold:	4	N/A
PX200101_8000Hz_Right_Ear_CNO	PX200101130901	8000 Hz threshold:	4	N/A
PX200101_Audiometry_Left_Ear_Test_Mode	PX200101140000	Test mode left ear	4	N/A
PX200101_Hz_Switched_Manual_Left_Ear	PX200101140100	If mixed, indicate Hz when switched to manual mode (Left Ear)	4	N/A
PX200101_First_1000Hz_Threshold_Left_Ear	PX200101140200	1000 Hz (first) threshold (Left Ear):	4	N/A
PX200101_First_1000Hz_Left_Ear_CNO	PX200101140201	1000 Hz (first) threshold (Left Ear):	4	N/A
PX200101_500Hz_Threshold_Left_Ear	PX200101140300	500 Hz threshold (Left Ear):	4	N/A
PX200101_500Hz_Left_Ear_CNO	PX200101140301	500 Hz threshold (Left Ear):	4	N/A
PX200101_Second_1000Hz_Threshold_Left_Ear	PX200101140400	1000 Hz (second) threshold (Left Ear):	4	N/A
PX200101_Second_1000Hz_Left_Ear_CNO	PX200101140401	1000 Hz (second) threshold (Left Ear):	4	N/A
PX200101_2000Hz_Threshold_Left_Ear	PX200101140500	2000 Hz threshold (Left Ear):	4	N/A
PX200101_2000Hz_Left_Ear_CNO	PX200101140501	2000 Hz threshold (Left Ear):	4	N/A
PX200101_3000Hz_Threshold_Left_Ear	PX200101140600	3000 Hz threshold (Left Ear):	4	N/A
PX200101_3000Hz_Left_Ear_CNO	PX200101140601	3000 Hz threshold (Left Ear):	4	N/A
PX200101_4000Hz_Threshold_Left_Ear	PX200101140700	4000 Hz threshold (Left Ear):	4	N/A
PX200101_4000Hz_Left_Ear_CNO	PX200101140701	4000 Hz threshold (Left Ear):	4	N/A
PX200101_6000Hz_Threshold_Left_Ear	PX200101140800	6000 Hz threshold (Left Ear):	4	N/A
PX200101_6000Hz_Left_Ear_CNO	PX200101140801	6000 Hz threshold (Left Ear):	4	N/A
PX200101_8000Hz_Threshold_Left_Ear	PX200101140900	8000 Hz threshold (Left Ear):	4	N/A
PX200101_8000Hz_Left_Ear_CNO	PX200101140901	8000 Hz threshold (Left Ear):	4	N/A
PX200101_First_1000HzRestest_Threshold_Right_Ear	PX200101150100	1000 Hz (first) threshold (Right Ear):	4	N/A
PX200101_First_1000HzRestest_Right_Ear_CNO	PX200101150101	1000 Hz (first) threshold (Right Ear):	4	N/A
PX200101_500HzRestest_Threshold_Right_Ear	PX200101150200	500 Hz threshold (Right Ear):	4	N/A
PX200101_500HzRestest_Right_Ear_CNO	PX200101150201	500 Hz threshold (Right Ear):	4	N/A
PX200101_Second_1000HzRestest_Threshold_Right_Ear	PX200101150300	1000 Hz (second) threshold (Right Ear):	4	N/A
PX200101_Second_1000HzRestest_Right_Ear_CNO	PX200101150301	1000 Hz (second) threshold (Right Ear):	4	N/A
PX200101_2000HzRestest_Threshold_Right_Ear	PX200101150400	2000 Hz threshold (Right Ear):	4	N/A
PX200101_2000HzRestest_Right_Ear_CNO	PX200101150401	2000 Hz threshold (Right Ear):	4	N/A
PX200101_3000HzRestest_Threshold_Right_Ear	PX200101150500	3000 Hz threshold (Right Ear):	4	N/A
PX200101_3000HzRestest_Right_Ear_CNO	PX200101150501	3000 Hz threshold (Right Ear):	4	N/A
PX200101_4000HzRestest_Threshold_Right_Ear	PX200101150600	4000 Hz threshold (Right Ear):	4	N/A
PX200101_8000HzRestest_Threshold_Right_Ear	PX200101150800	8000 Hz threshold (Right Ear):	4	N/A
PX200101_8000HzRestest_Right_Ear_CNO	PX200101150801	8000 Hz threshold (Right Ear):	4	N/A
PX200101_First_1000HzRestest_Threshold_Left_Ear	PX200101160100	1000 Hz (first) threshold (Left Ear):	4	N/A
PX200101_First_1000HzRestest_Left_Ear_CNO	PX200101160101	1000 Hz (first) threshold (Left Ear):	4	N/A
PX200101_500HzRestest_Threshold_Left_Ear	PX200101160200	500 Hz threshold (Left Ear):	4	N/A
PX200101_500HzRestest_Left_Ear_CNO	PX200101160201	500 Hz threshold (Left Ear):	4	N/A
PX200101_Second_1000HzRestest_Threshold_Left_Ear	PX200101160300	1000 Hz (second) threshold (Left Ear):	4	N/A
PX200101_Second_1000HzRestest_Left_Ear_CNO	PX200101160301	1000 Hz (second) threshold (Left Ear):	4	N/A
PX200101_2000HzRestest_Threshold_Left_Ear	PX200101160400	2000 Hz threshold (Left Ear):	4	N/A
PX200101_2000HzRestest_Left_Ear_CNO	PX200101160401	2000 Hz threshold (Left Ear):	4	N/A
PX200101_3000HzRestest_Threshold_Left_Ear	PX200101160500	3000 Hz threshold (Left Ear):	4	N/A
PX200101_3000HzRestest_Left_Ear_CNO	PX200101160501	3000 Hz threshold (Left Ear):	4	N/A
PX200101_4000HzRestest_Threshold_Left_Ear	PX200101160600	4000 Hz threshold (Left Ear):	4	N/A
PX200101_4000HzRestest_Left_Ear_CNO	PX200101160601	4000 Hz threshold (Left Ear):	4	N/A
PX200101_6000HzRestest_Threshold_Left_Ear	PX200101160700	6000 Hz threshold (Left Ear):	4	N/A
PX200101_4000HzRestest_Right_Ear_CNO	PX200101150601	4000 Hz threshold (Right Ear):	4	N/A
PX200101_6000HzRestest_Threshold_Right_Ear	PX200101150700	6000 Hz threshold (Right Ear):	4	N/A
PX200101_6000HzRestest_Right_Ear_CNO	PX200101150701	6000 Hz threshold (Right Ear):	4	N/A
PX200101_6000HzRestest_Left_Ear_CNO	PX200101160701	6000 Hz threshold (Left Ear):	4	N/A
PX200101_8000HzRestest_Threshold_Left_Ear	PX200101160800	8000 Hz threshold (Left Ear):	4	N/A
PX200101_8000HzRestest_Left_Ear_CNO	PX200101160801	8000 Hz threshold (Left Ear):	4	N/A

The National Health and Nutrition Examination Survey (NHANES) 2008-2009 audiometry protocol is one of the most widely used protocols to measure hearing sensitivity and was selected as the best practice methodology.

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). (2009–2010). National Health and Nutrition Examination Survey Audiometry Procedures Manual. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Child, Adolescent, Adult, Senior

English, Spanish

Adolescents and adults, ages 12-19 years and older than 70 years

This protocol should be completed by a medical technician capable of performing a visual examination of the outer ear (otoscopy), testing the mobility of the eardrum (acoustic immittance), and performing the audiometry protocol.

A complete list of the equipment and supplies needed for audiometry can be found in Appendix A of the National Health and Nutrition Examination Survey Audiometry Procedures Manual NHANES Audiometry Procedures Manual.

Standard	Name	ID	Source
Common Data Elements (CDE)	Hearing Audiogram Hearing Test Assessment Score	3144946	CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)	Audiogram hearing test proto	62977-4	LOINC

None

Clinical Examination

None

Requirement Category	Required
Average time of greater than 15 minutes in an unaffected individual	Yes
Major equipment	Yes
Specialized requirements for biospecimen collection	No
Specialized training	Yes

This section will be completed when reviewed by an Expert Review Panel.