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UNDERSTANDING FALSE RESPONSES DURING PTA SESSION


During pure tone audiometry testing (PTA), responses from the patient is very crucial in obtaining the correct patient's hearing threshold. The mistake from taking wrong responses from the patient will lead to wrong diagnosis of hearing level. That why, understanding the patient's responses is very important during PTA session.

 Situation where the patient give clear and consistent response during testing:
video

False responses can be divided into 2 categories:

1) False-positive response
Refer to the patient responds when he should not have responded.

Note: Please do non-stimulus trial to check for false positive response especially in pediatric cases. How? Just don't present the stimulus about 5 seconds to see whether the child wait for stimulus or not.

Situation where patient give false positive response:
video



Examples:
a) Patient confused by his tinnitus
b) Patient probably not understood the instructions.
c) It could be due to tactile stimulation or acoustic radiation.
d) Clinician presenting the stimulus very rhythmic since the patient can expect the tones at certain times.

2) False negative response
Refer to patient fails to respond when he should have responded.

Situation where patient give false negative response:This patient actually has normal hearing in both ears but he is malingering his response to get poor hearing result.
video


Examples:
a) Equipment problems (ex: the stimulus cannot be presented at the headphone cord was faulty)
b) Clinician errors that can prevent a signal from reaching the patient (Clinician press the wrong button to present the signal).
c) Some elderly patient, they want to be very sure the signal is there before they will respond.
d) Malingerer patient (patient who trying to make their hearing to be worse for claim SOCSO)
e) Can be due to technical reasons ( collapsing ear canal and standing wave by presenting the pure tone signal through speaker) 




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