Use to record measurements and related findings for a single identified test of hearing acuity, for each ear tested separately or both ears simultaneously, via air conduction and/or bone conduction, with masking when required.
Use to record the interpretation of all measurements of hearing acuity for each ear or both ears if tested simultaneously, and an overall interpretation (or audiological diagnosis).
This archetype has been designed to capture hearing threshold determination for air conduction and/or bone conduction (with or without masking) for the following tests:
- Pure Tone Audiometry;
- Play Audiometry;
- Auditory Brainstem Response; and
- Visual Reinforcement Orientation Audiometry.
All of the data elements are recorded using a single method or protocol. If, during the test, any of the protocol parameters need to be modified, then the subsequent part of the test will need to be recorded within a separate instance of the test data, using the updated protocol parameters.
Not to be used for hearing screening assessment - use the OBSERVATION.hearing_screening archetype.
Not to be used to record other auditory assessments such as:
- Behavioural Observation Audiometry (BOA);
- Most Comfortable Listening Level (MCL) and Uncomfortable Listening Level (UCL); and
- Auditory Brainstem Response (ABR) for any purpose other than hearing threshold determination.
These assessments need to be recorded in specific archetypes for the purpose.
Organisation: Hearing Health Program, Northern Territory
Email: kerrie.lee2@bigpond.com
Date originally authored: 2012-10-10
Organisation: Hearing Health Program, Northern Territory
Email: kerrie.lee2@bigpond.com
Date originally authored: 2012-10-10
- References: Sabini P, Sclafani AP. Efficacy of serologic testing in asymmetric sensorineural hearing loss. Otolaryngol Head Neck Surg. 2000 Apr;122(4):469-76. PubMed PMID: 10740163.
- Current Contact: Heather Leslie, Ocean Informatics, heather.leslie@oceaninformatics.com
- MD5-CAM-1.0.1: 44E709631409A33DD61B5C4CE181B835
Coding with an external terminology is preferred, where possible. Applicable tests include: Pure Tone Audiometry; Play Audiometry; Auditory Brainstem Response (for threshold determination); and Visual Reinforcement Orientation Audiometry.
- Left Ear [The test stimuli were presented to the left ear only.]
- Right Ear [The test stimuli were presented to the right ear only.]
- Binaural [The test stimuli were presented to both ears simultaneously in a soundfield.]
Allowed values: {true}
Frequency is not applicable if a click stimulus is presented.
Property: Frequency
Units:
- 125.0..16000.0 Hz
Limit decimal places: 0 - 0.125..16.0 kHz
Limit decimal places: 3
Property: Loudness
Units: -10.0..120.0 dB
Limit decimal places: 0
Record as True if the clinician was unable to record a result for the test ear or binaural testing in a soundfield, as defined by the 'Test Ear' data element.
Allowed values: {true}
For example, patient was not cooperative; patient was not capable; ran out of time.
Allowed values: {true}
Property: Frequency
Units:
- 125.0..16000.0 Hz
Limit decimal places: 0 - 0.125..16.0 kHz
Limit decimal places: 3
Property: Loudness
Units: -10.0..120.0 dB
Limit decimal places: 0
This calculation is typically determined using air conduction thresholds.
Property: Loudness
Units: -10.0..120.0 dB
Limit decimal places: 1
Coding with a terminology is desirable, where possible. For example: none, mild, moderate, severe and profound. Each of these categories should be clearly defined on the basis of a dB range appropriate for age.
If there is no degree of loss, then this data element is not applicable.
- Conductive [A conductive hearing loss pattern has been identified for the Test Ear, based on the presence of an air/bone gap and bone conduction thresholds within normal range.]
- Sensorineural [A sensorineural hearing loss pattern has been identified for the Test Ear, based on no air/bone gap and thresholds outside normal range.]
- Mixed [A mixed hearing loss pattern has been identified for the Test Ear, based on the presence of an air/bone gap and bone conduction thresholds outside normal range.]
- Indeterminate [It is not possible to determine the pattern of hearing loss.]
Coding with a terminology is preferred, where possible. Not to be used for recording the interpretation for both ears when the ears are tested simultaneously - use the data element 'Overall Interpretation' instead.
- Unitary
Assumed value: false
- Symmetrical [The hearing loss is symmetrical.]
- Asymmetrical [The hearing loss is asymmetrical.]
If there is no degree of loss in both ears, then this data element is not applicable.
- Unilateral [Loss of hearing in one ear.]
- Bilateral [Loss of hearing in both ears.]
Coding with a terminology is preferred, where possible. This data element is effectively an audiological diagnosis. Binaural test results reflects either the performance for both ears (if equal hearing) or only the better ear (where there is asymmetric hearing)."
image/cgm, image/gif, image/png, image/tiff, image/jpeg, application/pdf
- Aided [The test has been conducted with the patient using a form of auditory assistance, such as a hearing aid or cochlear implant.]
- Unaided [The test has been conducted without the patient using any form of auditory assistance, such as a hearing aid or cochlear implant.]
Assumed value: Unaided
- Pre-test quiet [Test preceded by a quiet time period for the test subject as specified by the applied protocol.]
- No pre-test quiet [Test not preceded by a quiet period for the test subject as specified by the applied protocol.]
Assumed value: Pre-test quiet
- Soundfield [The stimulus is presented via a loudspeaker located at least one metre away from the subject.]
- Insert earphone [The stimulus is presented via insert earphones.]
- External headset [The stimulus is presented via external headsets - either circumaural or supraaural..]
- Mastoid [The posterior part of the temporal bone, including the mastoid process.]
- Forehead [Area of the head bounded by the normal hairline, eyebrows and the temples on either side.]
This data element is commonly used in industry hearing programs.
- Audiometric booth [Sound treated room that provides a test environment that meets audiometric standards for ambient noise inside the booth.]
- Minimal background noise [Non-sound treated room with minimal background noise.]
- Moderate background noise [Non-sound treated room with moderate background noise.]
- High background noise [Non-sound treated room with high background noise.]
- Tone Burst [The test stimulus is a tone burst.]
- Click [The test stimulus is a click.]
- Warble Tone [The test stimulus is a frequency modulated tone.]
- Pure Tone [The test stimulus is a pure tone.]
- Narrow Band Noise [The test stimulus is a narrow band noise centred on the specified frequency.]
Property: Time
Units: millisec
Property: Time
Units: millisec
Property: Time
Units: millisec
Not applicable for ABR testing.
- Minimum response level [The softest level at which a subject responds to a stimulus.]
- 2/3 responses [The softest level at which the subject responds to two out of three consecutive threshold runs.]
- 3/6 responses [The softest level at which the subject responds to three out of six consecutive threshold runs.]
- 1 dB [Step size of one decibel.]
- 5 dB [Step size of five decibels.]
- 10 dB [Step size of ten decibels.]
- 20 dB [Step size of twenty decibels.]
- Ascending [Threshold is calculated based on the ascending runs where the stimulus moves from below threshold to above threshold.]
- Descending [Threshold is calculated based on the descending runs where the stimulus moves from above threshold to below threshold.]
Details of the headphones and bone conductors that are calibrated to be used in conjunction with a specific hearing test instrument will be nested as specific CLUSTER archetypes within the CLUSTER.hearing_test_instrument archetype.
Include:
openEHR-EHR-CLUSTER.device-hearing_
For example: hearing aid or bone conductor aid.
Include:
openEHR-EHR-CLUSTER.device.v1 and specialisations
If an appropriate value set can be determined, this could be coded. The maximum occurrences of this data element have been set to two to allow for both narrative and a coded value to be selected in a template.
- dB SPL [The test stimuli are calibrated using the sound pressure level scale.]
- dB HL [The test stimuli are calibrated using the hearing level scale.]
- dB nHL [The test stimuli are calibrated using the normal hearing level scale.]
If recording the Criteria as a narrative, it is possible to identify the frequencies used for non-standard Pure Tone Average as free text.
Choice of:
Coded Text- 3 frequency average [The pure tone hearing threshold is calculated using 0.5, 1 and 2 kHz.]
- 4 frequency average [The pure tone hearing threshold is calculated using 0.5, 1, 2 and 4 kHz.]
Text
For example: binaural difference in bone conduction thresholds of >10 dB at two consecutive frequencies or >15 dB at one frequency (0.25–8.0 kHz).
For example, the co-operation of the test subject or description of the method used for testing.
Judith Boswell, Adelaide Hearing Consultants, Australia
Stephen Chu, NEHTA, Australia
Kimberley Crebbin, NT Hearing Services, Australia
Kathy Currie, Northern Territory Health, Australia
Lisa Dawson, NT Hearing, Northern Territory
Jade Frederiksen, Hearing Health Program, DoH, Australia
Sam Harkus, Australian Hearing, Australia
Sam Heard, Ocean Informatics, Australia
Paul Hickey, Hearing Health Program, Australia
Oliver Hosking, Remote Health NT, Australia
Anthony Leech, Hearing Health, Australia
Kerrie Lee, Ngaanyatjarra Health Service, Australia (Editor)
Heather Leslie, Ocean Informatics, Australia (Editor)
Rebecca Matthews, NT Hearing Services - NTG, Australia
Ian McNicoll, Ocean Informatics UK, United Kingdom
Mark Ramjan, NT Department of Health, Australia
Bojana Sarkic, Northern Territory Government, Australia
Kelly Simmons, Department of Health, Australia
Prasha Sooful, Royal Darwin Hospital, Australia
Fiona Wake, RAHC, Australia
Kelly Simmons, Department of Health, Northern Territory