Table 1. Considerations for Pure-Tone Audiometry.

Issue Test considerations
1 Regulatory compliance (e.g., OSHA, MSHA) Consult applicable regulatory requirements for specifics and required documentation.
2 Developmental or chronological age of the participant Use age-appropriate test modifications, such as visual reinforcement audiometry, conditioned play, conditioned orientation response, or computerized audiometry. When testing pediatric patients, it may be advisable to test at 500 Hz and then 2000 Hz in each ear before testing additional frequencies in both ears.
3 Claustrophobia Instruct the patient how to exit the booth or test with the booth door ajar. If door is left open, consider use of insert earphones to minimize effects of ambient noise.
4 Exaggerated or non-organic hearing loss Reinstruction, counseling, and reexamination are valid strategies. In compensation cases, use ascending threshold technique.
5 Collapsed ear canal Use insert earphones, support the pinna from behind to prevent the collapse or test with the participant's mouth open (Reiter & Silman, 1993).
6 Tinnitus Use a pulsed signal or a warble tone to help distinguish the test signal from the tinnitus.
7 Physical limitations for motor response Modify motor response task or use verbal response task.
8 Compensation or forensic Familiarization to the test tone before threshold measurement is not recommended. Consult applicable regulatory requirements.
9 Severe/profound hearing loss Begin testing with low-frequency pure tones.
10 Difficult to test Reinstruction, counseling, and reexamination are valid strategies. Use alternative objective measures. Modify behavioral procedures as appropriate to cognitive abilities. Repeat familiarization task at test frequencies other than 1000 Hz when responses are inconsistent.
11 Unilateral loss Use appropriate masking, rule out testing errors, and verify proper function of audiometer and transducers.
12 Atypical threshold responses such as identical thresholds in both ears or unusual configurations Consider reinstruction and/or retest to verify threshold response accuracy. Verify proper function of audiometer and transducers.