Audiologic / Diagnostic
Speech and Hearing Centers
One out of ten people suffers from a speech or hearing disorder, potentially impairing their communication process. At the EARtech Speech & Hearing Centers, we are committed to improving communication problems through the evaluation, diagnosis, and treatment of speech and hearing disorders. From young children to older adults, our focus is on determining the cause and providing the best treatment available to effectively improve your communication.
Steven E. Berman, Ph.D., serves as the director of the Speech, Hearing, & Balance Center, providing patients with more than 20 years of experience in treating speech and hearing disorders. He works closely with additional members of the treatment team, including otolaryngologists, certified audiologists, and speech pathologists, to provide compassionate, comprehensive speech and hearing services.
Supporting Your Doctors and Teachers
The staff at the Speech and Hearing Centers, headed by Dr. Steven E. Berman, provides evaluations, recommendations, and support to family physicians, child-study team members, school psychologists, speech pathologists, reading specialists, and teachers. We also assist long-term care and other health care facilities.
Audiological Tests & Services
The audiologist will look at the outer ear (the pinna) checking for any misformation. The audiologist will use an otoscope, an instrument that contains a light and a magnifying lens, to examine the ear canal and eardrum. The ear canal is examined for the presence of excessive wax (cerumen), or foreign objects (food, toys, pieces of cotton swabs, etc). The eardrum (tympanic membrane) is examined for any perforation and signs of fluid or infection. The audiologist will look for any indicators suggesting the need for referral for a medical evaluation and/or treatment.
Tests of Hearing and Listening
The audiologist will conduct tests of hearing tones. This is called pure-tone audiometry. The results are recorded on a graph called an audiogram. The audiologist will also determine speech reception threshold or the faintest speech that can be heard half the time. Then the audiologist will determine word recognition or ability to recognize words at a comfortable loudness level
Tests of Middle Ear Function
The audiologist may also take measurements that will provide information about the status of the outer and middle ear. These are called acoustic immittance measures. Tympanometry, one aspect of immittance testing, can assist in the detection of fluid in the middle ear, perforation of the eardrum, or wax blocking the ear canal. Acoustic reflex measurement, another aspect of immittance testing, can add diagnostic information about middle ear function and hearing loss.
After the test battery is completed, the audiologist will review each component of the audiologic evaluation to obtain a profile of hearing abilities and needs. Additional specialized testing may be indicated and recommended on the initial test results. Audio logical evaluation may result in recommendations for further follow-up such as medical referral, educational referral, hearing aid/sensory aid assessment, assessment for assistive listening devices, audiologic rehabilitation assessment, speech and language assessment, and/or counseling.
As you can see, an audiologic evaluation is much more than "just a hearing test!"
Dr. David Weesner, Au.D.
NJ Hearing Aid Dispenser #25MG00064200
Pure tone audiometry is completed in a soundproof booth- a room with special treatment to the walls, ceiling, and floor to ensure that background noise does not affect test results. Only those sounds that the audiologist introduces into the room, either through earphones or through speakers located in the room, will be heard. Sounds may also be sent through a special headset "vibrator" that has been placed just behind the ear or on the forehead. In testing hearing for tones, a pure tone air conduction hearing test is given to find out the faintest tones a person can hear at selected pitches (frequencies) from low to high. During this test, earphones are worn and the sound travels through the air in the ear canal to stimulate the eardrum and then the auditory nerve. The person taking the test is instructed to give some type of response such as raising a finger or hand, pressing a button, pointing to the ear where the sound was received, or saying "yes" to indicate that the sound was heard. Sometimes children are given a more play-like activity (conditioned play audiometry) to indicate response. They may be instructed to string a peg, drop a block in a bucket, or place a ring on a stick in response to hearing the sound. Infants and toddlers are observed for changes in their behavior such as sucking a pacifier, quieting, or searching for the sound and are rewarded for the correct response by getting to watch an animated toy (visual reinforcement audiometry). The audiologist uses a calibrated machine called an audiometer to present tones at different frequencies (pitches) and at different intensity (loudness) levels. A signal of a particular frequency (something like a piano note) is presented to one ear, and its intensity is raised and lowered until the person no longer responds consistently. Then another signal of a different frequency is presented to the same ear, and its intensity is varied until there is no consistent response. This procedure is done for at least six frequencies. Then the other ear is tested in the same way. The frequency or pitch of the sound is referred to in Hertz (Hz). The intensity or loudness of the sound is measured in decibels (dB). The responses are recorded on a chart called an audiogram that provides a graph of intensity levels for each frequency tested.
In some cases, it is necessary to give a pure tone bone conduction hearing test. In this test, the tone is introduced through a small vibrator placed on the temporal bone behind the ear (or on the forehead). This method "by-passes" blockage, such as wax or fluid, in the outer or middle ears and reaches the auditory nerve through vibration of skull bones. This testing can measure functionality of the inner ear independent of the functionality of the outer and middle ears.
Air conduction test results indicate hearing losses that are either conductive or sensorineural. Bone conduction test results reflect only the sensorineural component. By comparing air conduction and bone conduction test results, the audiologist can determine whether there is a hearing loss due to a problem in the outer or middle ear. If air and bone conduction thresholds are the same, the loss is sensorineural. If there is a difference between air and bone thresholds (an air-bone gap), the loss is conductive or mixed.
Other Audiologic Procedures
There are a variety of other audiologic procedures that assess the auditory system and determine the presence of hearing loss. They are sometimes used independently and sometimes used to complement the standard audiologic test battery. They help to supplement information from behavioral testing or to resolve conflicting information from behavioral testing. They are auditory evoked potentials, otoacoustic emissions testing, and acoustic immittance measures.
Speech audiometry includes determining speech reception threshold (SRT) and testing of word recognition. Speech reception threshold testing determines the faintest level at which a person can hear and correctly repeat easy-to-distinguish two-syllable (spondaic) words. Examples of spondaic words are "baseball", "ice cream", "hot dog", "outside", and "airplane.” Spondaic words have equal stress on each syllable. The individual repeats words (or points to pictures) as the audiologist’s voice gets softer and softer. The faintest level, in decibels, at which 50% of the two-syllable words are correctly identified, is recorded as the Speech Reception Threshold (SRT). A separate SRT is determined for each ear. Tests of word recognition attempt to evaluate how well a person can distinguish words at a comfortable loudness level. It relates to how clearly one can hear single-syllable (monosyllabic) words when speech is comfortably loud. Examples of words used in this test are "come", "high", "knees", "chew." In this test, the audiologist’s voice (or a recording) stays at the same loudness level throughout. The individual being tested repeats words (or points to pictures). The percentage of words correctly repeated is recorded for each ear. Thus, a score of 100% would indicate that every word was repeated correctly. A score of 0% would suggest no understanding. Word recognition is typically measured in quiet. For specific purposes, word recognition may also be measured in the presence of recorded background noise that can also be delivered through the audiometer.
Auditory Evoked Potentials
Electrodiagnostic test procedures give information about the status of neural pathways. These procedures are used with individuals who are difficult to test by conventional behavioral methods. They are also indicated for a person with signs, symptoms or complaints suggesting a nervous system disease or disorder.
Auditory brainstem response (ABR) is an auditory evoked potential that originates from the auditory nerve. It is often used with babies. Electrodes are placed on the head (similar to electrodes placed around the heart when an electrocardiogram is run), and brain wave activity in response to sound is recorded.
Otoacoustic Emissions (OAE)
Otoacoustic emissions (OAE) are inaudible sounds emitted by the cochlea when the cochlea is stimulated by a sound. When sound stimulates the cochlea, the outer hair cells vibrate. The vibration produces an inaudible sound that echoes back into the middle ear. The sound can be measured with a small probe inserted into the ear canal. Persons with normal hearing produce emissions. Those with hearing loss greater than 25-30 dB do not.
Acoustic Immittance Measures
Acoustic immittance measures are a battery of tests including tympanometry, acoustic reflex, and static acoustic impedance. Tympanometry introduces air pressure into the ear canal making the eardrum move back and forth. The test measures the mobility of the eardrum. Tympanograms or graphs are produced which show stiffness, flaccidity, or normal eardrum movement. We all have an acoustic reflex to sounds. A tiny muscle in the ear contracts when a loud sound occurs. The loudness level in decibels at which the acoustic reflex occurs, and/or the absence of the acoustic reflex, gives diagnostic information that aids in identifying location of the problem along the auditory pathway. Through static acoustic measures, the physical volume of air in the ear canal is measured. This test is useful in identifying a perforated eardrum or the openness of ventilation tubes.
Our sense of balance is determined by our visual system, the inner ear, and our sense of movement via muscles (kinesthetic sense). When these systems don’t work together and function properly, we become dizzy. Dizziness is a symptom. Any disturbance in the inner ear, with or without hearing loss or ringing in the ears (tinnitus), may cause a feeling of dizziness. Dizziness can be caused by disease such as Meniere’s Disease, by small calcium deposits in the inner ear, drugs which are toxic to the vestibular (balance) system, head trauma, and other conditions not necessarily related to the vestibular system. Balance system assessment is conducted to detect pathology with the vestibular or balance system; to determine site of lesion; to monitor changes in balance function; or, to determine the contribution of visual, vestibular, and proprioceptive systems to functional balance. Vestibular or balance system assessment is indicated when a person has nystagmus (rapid involuntary eye movement), complaints of vertigo (dizziness) balance dysfunction, gait abnormalities, or when pathology/disease of the vestibular system is suspected.
These tests measure the ability of the tympanic membrane (eardrum) to be moved (compliance) when a positive and negative pressure is applied and accompanied by a tonal input. This information reveals the degree of conductive hearing loss that may be present and other useful information (reflex of ear muscles, possible drum perforations, etc.
Speech Evaluation and Therapy
This therapy is used for the evaluation and remediation of various speech and language disorders that include, but are not limited to, aphasia, articulation, and voice and stuttering disorders.
These studies are used for the evaluation and treatment of swallowing functions as a result of difficulties from a stroke or other neurological problem.
Steven E. Berman, Ph.D.
New Jersey Audiology/Speech Language Pathology #YB00008
Pennsylvania Audiology License #AT000227-L
Pennsylvania Speech Pathologist License #SL-000887-L