Loading…

Protocol - Audiogram Hearing Test

Add to My Toolkit
Description:

The National Health and Nutrition Examination Survey (NHANES) 2015-2016 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.

Specific Instructions:

An audiogram should be conducted in a soundproof room or booth to permit accurate hearing threshold measurements. Although the 2015-2016 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 NHANES have performed this procedure on children as young as 4 years and adults of all ages.

Protocol:

A downloadable PDF of the full 2015-2016 National Health and Nutrition Examination Survey (NHANES) Audiometry Procedures Manual is available here: https://wwwn.cdc.gov/nchs/data/nhanes/2015-2016/manuals/2016_Audiometry_Procedures_Manual.pdf.

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, foreign bodies, PE (pressure equalization) tubes, 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 tympanometry 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 (dB).

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:

  • 250 hertz,
  • 500 hertz,
  • 1,000 hertz,
  • 2,000 hertz,
  • 3,000 hertz*,
  • 4,000 hertz,
  • 6,000 hertz*,
  • 8,000 hertz.

*Test only at 3,000 and 6,000 hertz if there is > 15 dB difference in threshold from octave to octave.

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:

National Health and Nutrition Examination Survey (NHANES) Audiometry Protocol

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.

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 ages 12–19 years and adults up to 70 years

Selection Rationale

The National Health and Nutrition Examination Survey (NHANES) 2015-2016 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
Derived Variables

None

Process and Review

The Expert Review Panel #7 (ERP 7) reviewed the measures in the Speech and Hearing domain.

Guidance from the ERP includes the following:

  • Updated protocol
  • New Data Dictionary

Back-compatible: there are changes to the Data Dictionary, previous version of the Data Dictionary and Variable mapping in Toolkit archive (link)

Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). (2015–2016). 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

Hoffman, H. J., Dobie, R. A., Losonczy, K. G., Themann, C. L., & Flamme, G. A. (2017). Declining Prevalence of Hearing Loss in US Adults Aged 20 to 69 Years. JAMA Otolaryngol Head Neck Surg, 143(3), 274-285.

Choi, J. S., Betz, J., Deal, J., Contrera, K. J., Genther, D. J., Chen, D. S., … Lin, F. R. (2016). A Comparison of Self-Report and Audiometric Measures of Hearing and Their Associations With Functional Outcomes in Older Adults. Journal of aging and health, 28(5), 890-910.

Protocol ID:

200102

Variables:
Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX200102_Audiogram_Hearing_Test_Automated_Protocol
PX200102060000 Was an automated protocol using a pure tone more
audiometry test performed? show less
N/A
PX200102_Audiogram_Hearing_Test_Cold_Earache
PX200102030200 Do you have a cold or earache? N/A
PX200102_Audiogram_Hearing_Test_Collapsed_Ear_Canal
PX200102040600 Has the ear canal collapsed? N/A
PX200102_Audiogram_Hearing_Test_Ear_Tested_First
PX200102080200 Which ear was tested first? N/A
PX200102_Audiogram_Hearing_Test_Ear_Tubes
PX200102030100 Do you have tubes in either ear? N/A
PX200102_Audiogram_Hearing_Test_Examinee_False_Positives
PX200102070300 Did the examinee record three false positives? N/A
PX200102_Audiogram_Hearing_Test_Examinee_Operate_Response_Switch
PX200102070100 Was the examinee unable to operate the more
response switch? show less
N/A
PX200102_Audiogram_Hearing_Test_Examinee_Pace
PX200102070200 Was the examinee unable to 'keep up with' more
the automated test? show less
N/A
PX200102_Audiogram_Hearing_Test_Examinee_Seated
PX200102050500 Is the examinee seated? N/A
PX200102_Audiogram_Hearing_Test_Examinee_Threshold_100_Decibels
PX200102070400 Was the examinee's threshold over 100 more
decibels (dB)? show less
N/A
PX200102_Audiogram_Hearing_Test_Headphones_Describe
PX200102080100 Which headphones were used? N/A
PX200102_Audiogram_Hearing_Test_Hearing_Aids
PX200102020100 Do you use hearing aids? N/A
PX200102_Audiogram_Hearing_Test_Hearing_Aids_Removal
PX200102020200 Have you removed your hearing aids? N/A
PX200102_Audiogram_Hearing_Test_Hearing_Aids_Removal_Ability
PX200102020300 Are you able to remove your hearing aids? N/A
PX200102_Audiogram_Hearing_Test_Hear_Better_Ear
PX200102030400 Do you hear better in one ear or the other? N/A
PX200102_Audiogram_Hearing_Test_Left_Ear_Threshold_1000_Hertz
PX200102080403 What was the threshold (in decibels) at 1000 more
hertz for the left ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Left_Ear_Threshold_2000_Hertz
PX200102080404 What was the threshold (in decibels) at 2000 more
hertz for the left ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Left_Ear_Threshold_200_Hertz
PX200102080401 What was the threshold (in decibels) at 250 more
hertz for the left ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Left_Ear_Threshold_3000_Hertz
PX200102080601 What was the threshold (in decibels) at 3000 more
hertz for the left ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Left_Ear_Threshold_4000_Hertz
PX200102080405 What was the threshold (in decibels) at 4000 more
hertz for the left ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Left_Ear_Threshold_500_Hertz
PX200102080402 What was the threshold (in decibels) at 500 more
hertz for the left ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Left_Ear_Threshold_6000_Hertz
PX200102080602 What was the threshold (in decibels) at 6000 more
hertz for the left ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Left_Ear_Threshold_8000_Hertz
PX200102080406 What was the threshold (in decibels) at 8000 more
hertz for the left ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Left_Ear_Threshold_Octave_Difference
PX200102080500 Was there a difference of more than 15 more
decibels in threshold from octave to octave for the left ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Loud_Noise_Past_Day
PX200102030300 Have you been exposed to loud noise in the more
last 24 hours? show less
N/A
PX200102_Audiogram_Hearing_Test_Outer_Ear_Abnormalities
PX200102040100 Are there any abnormalities visible in the more
outer ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Outer_Ear_Excessive_Ear_Wax
PX200102040200 Is there a presence of excessive ear wax in more
the outer ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Outer_Ear_Foreign_Bodies
PX200102040300 Is there a presence of foreign bodies in the more
outer ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Outer_Ear_Pressure_Equalization_Tubes
PX200102040400 Is there a presence of PE (pressure more
equalization) tubes in the outer ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Perforation_Inflation_Ear_Drum
PX200102040500 Is there a presence of perforation or more
inflation of the ear drum? show less
N/A
PX200102_Audiogram_Hearing_Test_Performed_Manually
PX200102080300 Was the test performed manually? N/A
PX200102_Audiogram_Hearing_Test_Remove_Interference
PX200102010000 Have you removed anything that might more
interfere with headphones, such as but no limited to glasses, gum, earrings? show less
N/A
PX200102_Audiogram_Hearing_Test_Right_Ear_Threshold_1000_Hertz
PX200102080703 What was the threshold (in decibels) at 1000 more
hertz for the right ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Right_Ear_Threshold_2000_Hertz
PX200102080704 What was the threshold (in decibels) at 2000 more
hertz for the right ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Right_Ear_Threshold_200_Hertz
PX200102080701 What was the threshold (in decibels) at 250 more
hertz for the right ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Right_Ear_Threshold_3000_Hertz
PX200102080901 What was the threshold (in decibels) at 3000 more
hertz for the right ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Right_Ear_Threshold_4000_Hertz
PX200102080705 What was the threshold (in decibels) at 4000 more
hertz for the right ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Right_Ear_Threshold_500_Hertz
PX200102080702 What was the threshold (in decibels) at 500 more
hertz for the right ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Right_Ear_Threshold_6000_Hertz
PX200102080902 What was the threshold (in decibels) at 6000 more
hertz for the right ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Right_Ear_Threshold_8000_Hertz
PX200102080706 What was the threshold (in decibels) at 8000 more
hertz for the right ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Right_Ear_Threshold_Octave_Difference
PX200102080800 Was there a difference of more than 15 more
decibels in threshold from octave to octave for the right ear? show less
N/A
PX200102_Audiogram_Hearing_Test_Size_Direction_Ear_Canal_Seal
PX200102050100 Has the size and direction of the ear canal more
been used to properly select the cuff to seal the ear canal? show less
N/A
PX200102_Audiogram_Hearing_Test_Standard_Insert_Headphones
PX200102050400 Was a pair of standard headphone or insert more
headphones (if there are collapsed ear canalds) fitted over the examinee's ears? show less
N/A
PX200102_Audiogram_Hearing_Test_Tympanogram_Results
PX200102050300 Is the resulting tympanogram flat or are the more
results inconclusive? show less
N/A
PX200102_Audiogram_Hearing_Test_Tympanometry_Probe_Seal
PX200102050200 Is an airtight seal achieved after placing more
the tympanometry probe in the examinee's ear? show less
N/A
Speech, Language and Hearing
Measure Name:

Audiogram Hearing Test

Release Date:

June 4, 2019

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