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Protocol - Audiogram Hearing Test

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Description:

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.

Protocol:

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:

0–25 dB

Normal hearing

26–40 dB

Mild hearing loss

41–55 dB

Moderate hearing loss

56–70 dB

Moderately severe hearing loss

71–90 dB

Severe hearing loss

91+ dB

Profound hearing loss

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

Protocol Name from Source:

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

Availability:

Publicly available

Personnel and Training Required
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.
Equipment Needs
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 [alink[NHANES_audiometry_09.pdf|NHANES Audiometry Procedures Manual]].
Requirements
Requirement CategoryRequired
Major equipment Yes
Specialized training Yes
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual Yes
Mode of Administration

Clinical Examination

Life Stage:

Child, Adolescent, Adult, Senior

Participants:

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

Specific Instructions:
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.
Selection Rationale

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.

Language

English, Spanish

Standards
StandardNameIDSource
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
Derived Variables

None

Process and Review

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

Source

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.

General References

None

Protocol ID:

200101

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX200101_2000HzRestest_Left_Ear_CNO PX200101160401 2000 Hz threshold (Left Ear): 4 N/A
PX200101_2000HzRestest_Right_Ear_CNO PX200101150401 2000 Hz threshold (Right Ear): 4 N/A
PX200101_2000HzRestest_Threshold_Left_Ear PX200101160400 2000 Hz threshold (Left Ear): 4 N/A
PX200101_2000HzRestest_Threshold_Right_Ear PX200101150400 2000 Hz threshold (Right Ear): 4 N/A
PX200101_2000Hz_Left_Ear_CNO PX200101140501 2000 Hz threshold (Left Ear): 4 N/A
PX200101_2000Hz_Right_Ear_CNO PX200101130501 2000 Hz threshold: 4 N/A
PX200101_2000Hz_Threshold_Left_Ear PX200101140500 2000 Hz threshold (Left Ear): 4 N/A
PX200101_2000Hz_Threshold_Right_Ear PX200101130500 2000 Hz threshold: 4 N/A
PX200101_3000HzRestest_Left_Ear_CNO PX200101160501 3000 Hz threshold (Left Ear): 4 N/A
PX200101_3000HzRestest_Right_Ear_CNO PX200101150501 3000 Hz threshold (Right Ear): 4 N/A
PX200101_3000HzRestest_Threshold_Left_Ear PX200101160500 3000 Hz threshold (Left Ear): 4 N/A
PX200101_3000HzRestest_Threshold_Right_Ear PX200101150500 3000 Hz threshold (Right Ear): 4 N/A
PX200101_3000Hz_Left_Ear_CNO PX200101140601 3000 Hz threshold (Left Ear): 4 N/A
PX200101_3000Hz_Right_Ear_CNO PX200101130601 3000 Hz threshold: 4 N/A
PX200101_3000Hz_Threshold_Left_Ear PX200101140600 3000 Hz threshold (Left Ear): 4 N/A
PX200101_3000Hz_Threshold_Right_Ear PX200101130600 3000 Hz threshold: 4 N/A
PX200101_4000HzRestest_Left_Ear_CNO PX200101160601 4000 Hz threshold (Left Ear): 4 N/A
PX200101_4000HzRestest_Right_Ear_CNO PX200101150601 4000 Hz threshold (Right Ear): 4 N/A
PX200101_4000HzRestest_Threshold_Left_Ear PX200101160600 4000 Hz threshold (Left Ear): 4 N/A
PX200101_4000HzRestest_Threshold_Right_Ear PX200101150600 4000 Hz threshold (Right Ear): 4 N/A
PX200101_4000Hz_Left_Ear_CNO PX200101140701 4000 Hz threshold (Left Ear): 4 N/A
PX200101_4000Hz_Right_Ear_CNO PX200101130701 4000 Hz threshold: 4 N/A
PX200101_4000Hz_Threshold_Left_Ear PX200101140700 4000 Hz threshold (Left Ear): 4 N/A
PX200101_4000Hz_Threshold_Right_Ear PX200101130700 4000 Hz threshold: 4 N/A
PX200101_500HzRestest_Left_Ear_CNO PX200101160201 500 Hz threshold (Left Ear): 4 N/A
PX200101_500HzRestest_Right_Ear_CNO PX200101150201 500 Hz threshold (Right Ear): 4 N/A
PX200101_500HzRestest_Threshold_Left_Ear PX200101160200 500 Hz threshold (Left Ear): 4 N/A
PX200101_500HzRestest_Threshold_Right_Ear PX200101150200 500 Hz threshold (Right Ear): 4 N/A
PX200101_500Hz_Left_Ear_CNO PX200101140301 500 Hz threshold (Left Ear): 4 N/A
PX200101_500Hz_Right_Ear_CNO PX200101130301 500 Hz threshold (Right Ear): 4 N/A
PX200101_500Hz_Threshold_Left_Ear PX200101140300 500 Hz threshold (Left Ear): 4 N/A
PX200101_500Hz_Threshold_Right_Ear PX200101130300 500 Hz threshold (Right Ear): 4 N/A
PX200101_6000HzRestest_Left_Ear_CNO PX200101160701 6000 Hz threshold (Left Ear): 4 N/A
PX200101_6000HzRestest_Right_Ear_CNO PX200101150701 6000 Hz threshold (Right Ear): 4 N/A
PX200101_6000HzRestest_Threshold_Left_Ear PX200101160700 6000 Hz threshold (Left Ear): 4 N/A
PX200101_6000HzRestest_Threshold_Right_Ear PX200101150700 6000 Hz threshold (Right Ear): 4 N/A
PX200101_6000Hz_Left_Ear_CNO PX200101140801 6000 Hz threshold (Left Ear): 4 N/A
PX200101_6000Hz_Right_Ear_CNO PX200101130801 6000 Hz threshold: 4 N/A
PX200101_6000Hz_Threshold_Left_Ear PX200101140800 6000 Hz threshold (Left Ear): 4 N/A
PX200101_6000Hz_Threshold_Right_Ear PX200101130800 6000 Hz threshold: 4 N/A
PX200101_8000HzRestest_Left_Ear_CNO PX200101160801 8000 Hz threshold (Left Ear): 4 N/A
PX200101_8000HzRestest_Right_Ear_CNO PX200101150801 8000 Hz threshold (Right Ear): 4 N/A
PX200101_8000HzRestest_Threshold_Left_Ear PX200101160800 8000 Hz threshold (Left Ear): 4 N/A
PX200101_8000HzRestest_Threshold_Right_Ear PX200101150800 8000 Hz threshold (Right Ear): 4 N/A
PX200101_8000Hz_Left_Ear_CNO PX200101140901 8000 Hz threshold (Left Ear): 4 N/A
PX200101_8000Hz_Right_Ear_CNO PX200101130901 8000 Hz threshold: 4 N/A
PX200101_8000Hz_Threshold_Left_Ear PX200101140900 8000 Hz threshold (Left Ear): 4 N/A
PX200101_8000Hz_Threshold_Right_Ear PX200101130900 8000 Hz threshold: 4 N/A
PX200101_Audiometry_Ear_Could_Not_Obtain PX200101110000 Could not obtain 4 N/A
PX200101_Audiometry_First_Ear_Tested PX200101100000 Ear tested first 4 N/A
PX200101_Audiometry_Headphones_Used_Original_Test PX200101120000 Headphones used (original test): 4 N/A
PX200101_Audiometry_Left_Ear_Test_Mode PX200101140000 Test mode left ear 4 N/A
PX200101_Audiometry_Right_Ear_Test_Mode PX200101130000 Test mode right ear 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_Dont_Know PX200101030107 (If yes) Which have you had (check all that apply)? Don't know 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_Earache_Left PX200101030104 (If yes) Which have you had (check all that apply)? Earache, left ear 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_Refused PX200101030106 (If yes) Which have you had (check all that apply)? Refused 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_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_First_1000HzRestest_Left_Ear_CNO PX200101160101 1000 Hz (first) threshold (Left Ear): 4 N/A
PX200101_First_1000HzRestest_Right_Ear_CNO PX200101150101 1000 Hz (first) 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_Threshold_Right_Ear PX200101150100 1000 Hz (first) threshold (Right Ear): 4 N/A
PX200101_First_1000Hz_Left_Ear_CNO PX200101140201 1000 Hz (first) threshold (Left Ear): 4 N/A
PX200101_First_1000Hz_Right_Ear_CNO PX200101130201 1000 Hz (first) threshold (Right Ear): 4 N/A
PX200101_First_1000Hz_Threshold_Left_Ear PX200101140200 1000 Hz (first) threshold (Left Ear): 4 N/A
PX200101_First_1000Hz_Threshold_Right_Ear PX200101130200 1000 Hz (first) threshold (Right Ear): 4 N/A
PX200101_Hearing_Aids PX200101010000 Does the examinee have hearing aids that cannot be removed? 4 N/A
PX200101_Hear_Better_In_One_Ear PX200101050000 Do you hear better in one ear than the other? 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_Hz_Switched_Manual_Right_Ear PX200101130100 If mixed, indicate Hz when switched to manual mode (Right Ear) 4 N/A
PX200101_Left_Ear_Abnormality_Describe PX200101070100 If answer is "Abnormality, type unknown", enter a comment: 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_Comment PX200101070000 Enter a comment to describe the left ear 4 N/A
PX200101_Left_Ear_Tympanogram_ID PX200101090200 Left ear tympanogram ID: 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_Right_Ear_Abnormality_Describe PX200101060100 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_Comment PX200101060000 Enter a comment to describe the right ear 4 N/A
PX200101_Right_Ear_Tympanogram_ID PX200101080200 Right ear tympanogram ID: 4 N/A
PX200101_Second_1000HzRestest_Left_Ear_CNO PX200101160301 1000 Hz (second) threshold (Left Ear): 4 N/A
PX200101_Second_1000HzRestest_Right_Ear_CNO PX200101150301 1000 Hz (second) threshold (Right Ear): 4 N/A
PX200101_Second_1000HzRestest_Threshold_Left_Ear PX200101160300 1000 Hz (second) threshold (Left Ear): 4 N/A
PX200101_Second_1000HzRestest_Threshold_Right_Ear PX200101150300 1000 Hz (second) threshold (Right Ear): 4 N/A
PX200101_Second_1000Hz_Left_Ear_CNO PX200101140401 1000 Hz (second) threshold (Left Ear): 4 N/A
PX200101_Second_1000Hz_Right_Ear_CNO PX200101130401 1000 Hz (second) threshold: 4 N/A
PX200101_Second_1000Hz_Threshold_Left_Ear PX200101140400 1000 Hz (second) threshold (Left Ear): 4 N/A
PX200101_Second_1000Hz_Threshold_Right_Ear PX200101130400 1000 Hz (second) threshold (Right Ear): 4 N/A
Research Domain Information
Measure Name:

Audiogram Hearing Test

Release Date:

October 8, 2010

Definition

This measure is a hearing test to assess hearing sensitivity.

Purpose

This measure is used to evaluate the auditory system of an individual and is capable of identifying hearing problems in any part of the auditory system.

Keywords

Audiogram, Audiometry, Hearing test, Pure tone audiometry, National Health and Nutrition Examination Survey, NHANES, Speech and Hearing