Alternate Binaural Loudness Balance

Dika Amelinda I

Pendahuluan

Test nada murni merupakan dasar dari semua pemeriksaan audiologi

Test nada murni mempunyai keterbatasan

Audiogram nada murni gambaran jenis ketulianKetulian konduktifKetulian sensorineuralKetulian campur

Audiogram nada murni tidak dapat membedakan 2 jenis ketulian sensorineural yaitu Sensoris (Cochlear)Neural (Retrocochlear)

Sensorineural Hearing Loss (SNHL)

Caused by damage, disease, or malformation of the inner earSensory loss associated with inner ear

damage Neural loss if hearing nerve cannot send the

impulse to the brain

Sound can be perceived as distorted or weak

Untuk membedakan tuli cochlea dan tuli retrocochlea perlu pemeriksaan audiologi khusus (ex : Audiometri khusus)

Audiometri khususTes SISI (short increment sensitivity

index)Tes ABLB (alternate binaural

loudness balans test)Tes Kelelahan (Tone decay)Audiometri tutur (speech audiometri)Audiometri Bekesay

Compares loudness growth in an impaired

ear versus a normal hearing ear Discovery of abnormal loudness growth in

cochlear pathology

Latar Belakang tes ABLB

Loudness Recruitment

Ditemukan Fowler (1928) Khas untuk ketulian cochlear Pada recruitment fungsi cochlea

lebih sensitif

Prinsip Umum tes ABLB

Tes Recruitment SNHL unilateral Compare the loudness growth between the

same frequency for the two ears

Pada tes ABLB diberikan intensitas

bunyi tertentu pada frekuensi yang sama pada kedua telinga, sampai kedua telinga mencapai persepsi yang sama disebut balans negatif

Bila balans tercapai terdapat recruitment positif

Cara Pemeriksaan Tes ABLB

• Test is performed by alternating a fixed frequency between the two ears, keeping the intensity in the good ear constant while varying the intensity in the impaired ear

• The client's task is to state whether the signal is “softer between the two ears,” “louder than” or “equal” in loudness to the reference (normal/good) ear

Initially, a brief tone 15 dB above threshold is applied to the good ear. Then the tone is presented briefly to the bad ear 15 dB above its threshold,

and the patient is asked whether the tone was louder or softer than that heard in the good ear.

necessary adjustments are made to the intensity going to the bad ear until a loudness balance is obtained with the good ear.

Then, the intensity to the good ear is increased by another 15 dB, and another balance is obtained with the bad ear. Loudness balancing is continued in 15-dB steps until sufficient information is obtained about the growth of loudness in the bad ear.

Interpretasi hasil tes ABLB

A. Complete recruitment If the loudness difference completely disappears between the two ears at higher intensities, the condition is called complete recruitment and is indicative of damage to the inner ear

B. No recruitmentIf the difference in loudness level between the two ears is unchanged at higher intensities, recruitment is absent

GAMBARAN AUDIOGRAM

C. Partial recruitment If equal loudness judgments fall between

those of complete and no recruitment

D. DecruitmentThe poor ear needs an ever increasing amount of intensity for a signal to sound equally loud to the good ear. In this case the SL difference is 15 dB or more in the poor ear than in the good ear

GAMBARAN AUDIOGRAM

Audiogram Rekrutmen binaural positif

Advantages Effective test of recruitment Effective in detecting cochlear disorder Easy and quick to administer

Disadvantages

Cannot be administered in cases of bilateral hearingloss

Less effective in detecting retrocochlear pathology