Pure-Tone Air-Conduction and Bone-Conduction Threshold Audiometry with and without Masking in Adults and Older Children (ECPG)

- Annexes

Editorial Independence:

● This guideline was developed without any external funding.

● All the guideline development group members have declared that they do not have any competing interests.

Annex 1: Guideline Flowchart

Annex 2: Tables of appraisal of selected guidelines: Currency (table 1), Content (table 2) and Quality (table 3) of the selected guidelines.

1.Assessment of Currency (table 1):

No	Guideline name	Organization	Date of publication	Date of review	Age Demography
1	Pure-tone air-conduction and bone- conduction threshold audiometry with and without masking	British Society of Audiology	January 2017	January 2022	Adult and old children
2	Pure-tone air-conduction and bone- conduction threshold audiometry with and without masking	British Society of Audiology	August 2018	2023	Adult and old children
3	ASHA 2005	American Speech-Language-Hearing Association (ASHA)	2005	-------	Adult
4	French Society of ENT (SFORL) guidelines (short version): Audiometry in adults and children	French Society of ENT (SFORL)	Jaunuary 2018		Adult and Children

2- Assessment of Quality (Table 2)

Assessment of quality
Domain	BSA 2017	BSA 2018	ASHA 2005	SFORL 2018
Transparency	A	A	A	A
Conflict of interest	B	B	B	B
Development group	B	B	B	B
Systemic Review	B	B	B	C
Grading of evidence	D	D	B	D
Recommendation	B	B	B	B
External Review	A	A	A	A
Updating	A	A	C	B

3- Content (Table 3)

Content
Criteria	BSA2017	BSA2018	ASHA 2005	SFORL 2018
Credibility	IBSA 2011 9	BSA 2011 9	ANSI2004 9	7
Observability	9	9	8	5
Relevance	9	9	8	6
Relative Advantage	9	8	7	6
Easy to install and understand	9	9	7	7
Compatibility	9	9	7	6
Testability	9	9	9	6
Total	63	62	55	43

Annex 3: The risks and benefits of added and/or modified statements.

Original statement

The statement to be adapted:

Action

Benefits

Risk/Harm

1- 3000 and 6000 Hz may be required in cases of high frequency hearing loss

3000 and 6000 Hz should be done in all cases.

Detection of v dips at these 2 frequencies facilitates early detection of suspected cases of retrocochlear lesions, very important in noise induced hearing loss, and in tinnitus patients.

Increase the examination time.

2- Audiometric symbols

Not including the masked air conduction symbols

According to ASHS, 1990

The original in the document did not involve the masked air conduction symbols.

No harm

3- Audiometric descriptors and configurations

Mild hearing loss:	21-40
Moderate hearing loss:	41-70
Severe hearing loss:	71-95
Profound hearing loss:	excess of 95

Four audiometric descriptors are given. These are based on the average of the pure-tone a-c hearing threshold levels at 250, 500, 1000, 2000 and 4000 Hz

Mild	26-40
moderate	41-55
Moderately severe	56-70
severe	71-90
profound	More than 91

● Five audiometric descriptors are given According to ASHA, 2015 but in contrary to ASHA 2015, we adopt the average of pure tone hearing threshold at frequencies (250Hz, 500 Hz, 1KHz, 2KHz, and 4KHz) instead of 250Hz to 2KHz.

● We also clarify that as described previously by Northern and Downs (2002) that 15 dB HL as the upper limit for normal hearing for children between 2 and 18 years of age

More precise and widely used

No harm

Averages do not imply any particular configuration of hearing loss and do not exclude additional terms (e.g. profound high-frequency hearing loss) being used.

The configuration, or shape, of the hearing loss refers to the degree and pattern of hearing loss across frequencies.

For example, a hearing loss that only affects the high tones would be described as a high-frequency loss.

On the other hand, if only the low frequencies were affected, the configuration would show poorer hearing for low tones and better hearing for high tones. Some hearing loss configurations are flat, indicating the same amount of hearing loss for low and high tones (ASHA, 2015).

Moreover, if there is V dip at certain frequency, it should be described.

We adapt the following table for the configuration description: quoted from Schlauch, R. S., & Nelson, P. B. (2009).

Flat	<5-dB rise or fall per octave
Gradually falling	5- to 12-dB increase per octave
Sharply falling	15- to 20-dB increase per octave
Precipitously falling	Flat or gradually sloping, then threshold increasing at 25 dB or more per octave
Rising	>5-dB decrease in threshold per octave
Peaked	20-dB or greater loss at the extreme frequencies, but not at the mid frequencies
Trough	20-dB or greater loss in the mid frequencies (1,000–2,000 Hz), but not at the extreme frequencies (500 or 4,000 Hz)
Notched	20-dB or greater loss at one frequency with complete or near-complete recovery at adjacent octave frequencies

More precise and more informative.

No harm

4- Guidelines of PTA in outbreaks:

No statements were described in BSA as how to deal in highly infectious circumstances as in COVID 9

During The terrible COVID 19 outbreak, we adapt the American Academy Guidelines that were prescribed for vestibular testing during COVID with slight modification.

Very beneficial to protect the health provider staff and also the personnel seeking the PTA

Time consuming and costly.