Name:______Score:______
2nd test: Speech, pure tone and masking
Audiogram Questions: Audiogram:______AD AS
- What is the 3 frequency PTA?______
- What is the 2 frequency PTA?______
- Do the PTAs and SRTs agree for either the 3 frequency PTA?______
- Do the PTAs and SRTs agree for either the 2 frequency PTA?______
- What type of loss?______
- What degree of loss?______
- What audiogram shape best describes the audiogram for each ear?______
- Is masking necessary for AC for any frequency?______
- Is masking necessary for BC for any frequency?______
- What is the SL for speech recognition (discrimination) ability? (for each level)____/___/______/___/___
- What is the HL for speech recognition (discrimination) ability? (for each level)____/___/______/___/___
- What is the ANL?______
- What speech material was used for the SRT?______
- What word list was used for the speech recognition ability or score?______
- Is this speech recognition ability (SRA) test open or closed?______
- Is masking necessary for the SRT? For any of the SRA tests?_____/______/______
- How was the speech recognition ability test (SRA) administered?______
- What is the AI? (Count the dots)______
- Based on the AI, what is predicted SRA score for words/sentences?_____/______/______
- What is the PB Max? ______
- What is the PB Min? ______
- What is the rollover index (RI)? Isthe RI significant? _____/______/______
- Is the speech recognition ability(SRA) less thanthe lower confidence limits?______
- Is there a critical difference for the PB-Max between ears?______
- Based on the type of loss, RI and confidence levels, is the loss OE, ME, IE, or AN?______
Name:______Score:______
2nd test: Speech, pure tone and masking practice
Audiogram Questions: Audiogram:______AD AS
- What is the 3 frequency PTA?______
- What is the 2 frequency PTA?______
- Do the PTAs and SRTs agree for either the 3 frequency PTA?______
- Do the PTAs and SRTs agree for either the 2 frequency PTA?______
- What type of loss?______
- What degree of loss?______
- What audiogram shape best describes the audiogram for each ear?______
- Is masking necessary for AC for any frequency?______
- Is masking necessary for BC for any frequency?______
- What is the SL for speech recognition (discrimination) ability? (for each level)____/___/______/___/___
- What is the HL for speech recognition (discrimination) ability? (for each level)____/___/______/___/___
- What is the ANL?______
- What speech material was used for the SRT?______
- What word list was used for the speech recognition ability or score?______
- Is this speech recognition ability (SRA) test open or closed?______
- Is masking necessary for the SRT? For any of the SRA tests?_____/______/______
- How was the speech recognition ability test (SRA) administered?______
- What is the AI? (Count the dots)______
- Based on the AI, what is predicted SRA score for words/sentences?_____/______/______
- What is the PB Max? ______
- What is the PB Min? ______
- What is the rollover index (RI)? Is the RI significant? _____/______/______
- Is the speech recognition ability (SRA) less than the lower confidence limits?______
- Is there a critical difference for the PB-Max between ears? ______
- Based on the type of loss, RI and confidence levels, is the loss OE, ME, IE, or AN?______