The proctor will explain the whole procedure briefly. After that, the time is clicking and calculated. The test starts at this point.

 1) Setup the audiometer

 The proctor will ask test-takers to set-up the audiometer to prepare for a test.

1. First, find an electrical outlet for the audiometer.
2. Place the clean towel on the table
3. Place the otoscope, left specula, right specula, hand sanitizer, and sanitizing cloth on the towel.
4. Spend 10 to 15 seconds sanitizing your hands.
5. Take one sanitizing cloth, and clean the headphone completely and place on the towel. Be sure to clean inside headset as well.
6. Clean the bone oscillator using a sanitizing cloth. Place the bone oscillator on the towel.
7. Clean the audiometer.

You should finish this part in 2 minutes

7. State clearly the following biological check:

First, I do the biological check. Every morning, after I clean up the equipment, I check the air, bone and masking frequencies and intensity. Also, I calibrate my audiometer annually.

8. After stating the biological check, take one sanitizing cloth and clean the headphone again. Wear the headphone so that the red side is on the right ear and the blue side is on the left ear.

9. Sit down on the chair and choose 1000 Hz. Increase and decrease the intensity dial or knob for 5 seconds.

10. Stand up and take one sanitizing cloth and clean the headphone that was just used. Place the headphone on the towel.

11. Take one new sanitizing cloth and clean the bone oscillator, and place the bone oscillator on the mastoid area. Be sure the bone oscillator does not touch the Pinna or hair.

12. Increase and decrease the intensity at 1000 Hz.

13. Take one new sanitizing cloth, clean the bone oscillator, and place the bone oscillator on the towel.

14. Do with the Headphone for the air conduction test, and do with Bone Oscillator for the bone conduction test.

15. State clearly as follows:

Everything seems to be fine. I finished the biological check.

You should finish the biological check in 3 minutes.

2) Otoscopic inspection

After your statement, the proctor may say examine the ear canal before the audiometric testing.

1. Tell the instructor about the examination of ear canal

Now, I examine the ear canal of my patient. Mr. A, I will examine your ear canals with my otoscope. I will start with your right ear by a bridge and brace technique.

2. After sanitizing your hands, pick up the otoscope and the specula with right tip and CLEAN. Use the bridge and brace technique.

3. Describe the conditions of right ear:

I see the first bend; the ear canal wall is clean and free of ear wax. I see the second bend and the ear drum is clear. I see the cone of light. External Pinna looks normal. Color and texture appear well. (Look at the back side of the Pinna.)

4. Clean the right specula. Put the specula on the table and change to a left speculum.

5. Describe all the conditions of the left ear:

I see the first bend; the ear canal wall is clean and free of ear wax. I see the second bend and the ear drum is clear. I see the cone of light. External Pinna looks normal. Color and texture appear well. (Look at the back side of the Pinna.)

6. Clean the otoscope and put it down on the clean towel.

7. State clearly as following:

Both ear conditions are suitable for the audiometric testing.

8. Otological conditions

At this moment, I ask about eight otological conditions set by the FDA for any referrals before I perform the audiometric testing. Mr. A, please answer clearly.

1. Do you have congenital or traumatic deformity of the ear?
2. Do you have a history of active drainage within the last 90 days?
3. Do you have a history of sudden or rapid hearing loss within the last 90 days?
4. Do you have acute or chronic dizziness?
5. Do you have unilateral hearing loss of sudden or recent onset within the last 90 days?
6. Do you have an audiometric air-bone gap equal to or greater than 15 dB at 500, 1000, 2000 Hz?
7. Do you have visible evidence of significant cerumen or foreign body in the ear canal?
8. Do you have pain or discomfort in the ear?

3) Audiometric testing

If all items are answered negatively, proceed to the audiometric testing. Mr. A, do you have a better ear? (Your subject should say NO) Then I will start with your right ear.

Mr. A, you will hear a series of beep tones. When you hear the beep tones, please raise your hand. It is also important to raise your hand even if the sound is very faint or very small.

1. Turn the position of the patient 90 degrees.
2. Before putting on the headphone or bone oscillator, I must clean up the headphone or bone oscillator.
3. Before I put the bone oscillator, I must sanitize my hands.
4. Before placement of headphones, I must check with two fingers for collapsed canals.
5. I place the headphone from the front.
6. I place the headphone from right to left.
7. There will be 4 to 5 questions.
8. Wash hands, headphone, and bone oscillator before and after the audiometric test.

1. Begin by testing both ears using air conduction testing at 250, 500, and 1000 Hz. ( or 500, 1000, 2000, or 1000, 2000, 4000)

State: Now I will perform the air conduction test. I will start at 40 dB in the right ear by Houston/Westlake descending order with 3 confirmations.

After this, I mark the threshold using Red and Blue pen on the audiogram.

2. Test the right ear at 250 & 500 Hz using bone conduction. (or 500 & 1000, or 1000 & 2000)

9. Before I put the bone oscillator, I must sanitize my hands and clean the bone oscillator.

State: Now I will perform the bone conduction test. I will start at 40 dB in the right ear by Houston/Westlake descending order. The bone oscillator should not touch the Pinna or hair. Also, I would do the Weber test before starting the bone conduction test, but this time I will just place the oscillator on the mastoid area.

After this, I mark the threshold using Red and Blue pen on the audiogram.

3. Masking the right ear. Test the left ear at 250 & 500 Hz using bone conduction. (or Masking the ear, test the left ear at 500, 1000, 2000 or Masking the ear, test the bone conduction right ear at 250, 500, 1000, 2000)

State: Mr. A, you will hear a windy noise in your right ear, please ignore the noise in that ear, and concentrate on the beep tones in the left ear. When you hear the beep tones in the left ear, please raise your hand. Do you understand? Also, I will use Hood’s Plateau method to find the test results.

10. Cover the headphone at the right ear and open at left ear. I may need to find the right ear air threshold or left ear bone threshold at 250 & 500 if there are no indications of the threshold.

After this, I mark the threshold using Red and Blue pen on the audiogram.

4. Test for threshold of discomfort (UCL) in both ears at 1000 & 2000 Hz. (and 2000 & 4000)

11. Turn the position of the patient to your side that will allow you to observe the patient’s facial expression.

State: Mr. A, I am going to test your discomfort level in your ears. You will hear beep tones. The tone will gradually get louder. When the tone gets loud enough to become annoying, please raise your finger like this.  If the tone becomes so loud that you can not listen any more, please raise your full hand like this. I will start at 70 dB. Do you understand this procedure?

After this, I mark the threshold using Red and Blue pen on the audiogram.

11. When finished, clean and pack all equipment and leave the station.
12. Do not forget to thank the proctors.

Tips:

1. You must mask no matter how much the non test ear threshold. For example, in air conduction or bone conduction, if the NTE threshold at 1000 Hz is 10 dB, the masking level should be 20 dB (NTE10 dB + 10 dB.). In the book, you do not need to mask if the non-test ear is less than 40 dB. However, during the exam, masking is required!

2. Do not retest 1000Hz in the exam. For example, if you need to test 500, 1000, and 2000 Hz, you just need to test 1000, 2000, and 500 in order.

3. Air conduction masking: Effective masking = AirNTE + 10 dB

4. Bone conduction masking: Effective masking = AirNTE + Occlusion effect + 10 dB

                        Occlusion effect =         250 Hz—- 15 dB

                                                                 500 Hz—- 15 dB

                                                                 1000 Hz—-10 dB

                                                                Above 1000 Hz—0 dB