ARCHETYPE Audiogram Result (openEHR-EHR-OBSERVATION.audiogram2.v1)

ARCHETYPE ID	openEHR-EHR-OBSERVATION.audiogram2.v1
Concept	Audiogram Result
Description	Record of measurements of hearing acuity using a calibrated hearing test device, and their clinical interpretation.
Use	Use to record measurements and related findings for a single identified test of hearing acuity, for one ear at a time or both ears simultaneously. Use to record the interpretation of all measurements of hearing acuity for each ear or both ears if tested simultaneously, and an overall interpretation (or audiological diagnosis). This archetype has been designed to capture hearing threshold determination for the following tests: Pure Tone Audiometry; Play Audiometry; Auditory Brainstem Response; and Visual Reinforcement Orientation Audiometry. All of the data elements are recorded using a single method or protocol. If, during the test, any of the protocol parameters need to be modified, then the subsequent part of the test will need to be recorded within a separate instance of the test data, using the updated protocol parameters.
Misuse	Not to be used for hearing screening assessment - use the OBSERVATION.hearing_screening archetype. Not to be used to record other auditory assessments such as: Behavioural Observation Audiometry (BOA); Most Comfortable Listening Level (MCL) and Uncomfortable Listening Level (UCL); and Auditory Brainstem Response (ABR) for any purpose other than hearing threshold determination These assessments need to be recorded in specific archetypes for the purpose.
Purpose	To record measurements of hearing acuity using a calibrated hearing test device, and their interpretation by a clinician.
References	Sabini P, Sclafani AP. Efficacy of serologic testing in asymmetric sensorineural hearing loss. Otolaryngol Head Neck Surg. 2000 Apr;122(4):469-76. PubMed PMID: 10740163.
Copyright	© openEHR Foundation
Authors	Author name: Kerrie Lee Organisation: Hearing Health Program, Northern Territory Email: kerrie.lee2@bigpond.com Date originally authored: 2012-10-10
Other Details Language	Author name: Kerrie Lee Organisation: Hearing Health Program, Northern Territory Email: kerrie.lee2@bigpond.com Date originally authored: 2012-10-10
Other Details (Language Independent)	References: Sabini P, Sclafani AP. Efficacy of serologic testing in asymmetric sensorineural hearing loss. Otolaryngol Head Neck Surg. 2000 Apr;122(4):469-76. PubMed PMID: 10740163. Current Contact: Heather Leslie, Ocean Informatics, heather.leslie@oceaninformatics.com MD5-CAM-1.0.1: BCDC7D0C96AF7894B29445013B008A20
Keywords	hearing, test, audiogram, audiometry, acuity, threshold, decibels, ABR, VROA, VRA, play
Lifecycle	CommitteeDraft
Language used	en
Citeable Identifier	1013.1.1397
state
Aided Status	Aided Status: Indication regarding use of an assistive listening device by the test subject during the test. at0029::Aided [The test has been conducted with the patient using a form of auditory assistance, such as a hearing aid or cochlear implant.] at0030::Unaided [The test has been conducted without the patient using any form of auditory assistance, such as a hearing aid or cochlear implant.] Assumed value: Unaided
Pre-test Conditions	Pre-test Conditions: Identification of whether the subject was exposed to a quiet environment for a specified period prior to testing. at0124::Pre-test quiet [Test preceded by a quiet period as specified by the applied protocol.] at0125::No pre-test quiet [Test not preceded by a quiet period as specified by the applied protocol.] Assumed value: Pre-test quiet
events
Any event	Any event: Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time.
protocol
Test Environment	Test Environment: The space and conditions in which the audiometric test is administered. This data element is commonly used in industry hearing programs. at0076::Audiometric booth [Sound-treated room designed to attenuate nominal outside noise.] at0077::Minimal background noise [Non sound-treated room with minimal background noise.] at0078::Moderate background noise [Non sound-treated room with moderate background noise.] at0079::High background noise [Non sound-treated room with high background noise.]
Test Stimulus	Test Stimulus: Identification of the frequency-specific stimulus used in measuring the hearing threshold. at0035::Tone burst [The test stimulus is a tone burst.] at0036::Click [The test stimulus is a click.] at0080::Warble tone [The test stimulus is a frequency modulated tone.] at0081::Pure Tone [The test stimulus is a pure tone.]
Click Stimulus Specification	Click Stimulus Specification: Identification of parameters specifying a click stimulus.
Onset Ramp	Onset Ramp: Time over which the stimulus grows to full amplitude. Property: Time Units: millisec
Offset Ramp	Offset Ramp: Time over which the stimulus depletes to zero amplitude. Property: Time Units: millisec
Total Duration	Total Duration: Total duration of the click stimulus. Property: Time Units: millisec
Threshold Determination Protocol	Threshold Determination Protocol: Protocol used to measure the hearing threshold for pure tone, play and visual reinforcement orientation audiometry only. Not applicable for ABR testing.
Threshold Definition	Threshold Definition: Definition of the threshold level used in the test. at0128::Minimum response level [The softest level at which a subject responds to a stimulus.] at0129::2/3 responses [The softest level at which the subject responds to two out of three consecutive threshold runs.] at0130::3/6 responses [The softest level at which the subject responds to three out of six consecutive threshold runs.]
Step Size	Step Size: The step size (in decibels) of the change in the stimulus intensity. at0095::1 dB [Step size of one decibel.] at0096::5 dB [Step size of five decibels.] at0097::10 dB [Step size of ten decibels.] at0098::20 dB [Step size of twenty decibels.]
Direction	Direction: The direction of change in the stimulus intensity. at0100::Descending/Ascending [Initial direction of change of the stimulus intesity is descending, followed by ascending.] at0101::Ascending/Descending [Initial direction of change of the stimulus intensity is ascending, followed by descending.]
Test Device	Test Device: Details of device used to conduct the test. Include: openEHR-EHR-CLUSTER.device-hearing_test_instrument.v1 and specialisations
Headphones	Headphones: Details of earphones used to conduct the test. Include: openEHR-EHR-CLUSTER.device-headphone.v1 and specialisations
Bone Conductor	Bone Conductor: Details of the device used to present bone conduction stimuli. Include: openEHR-EHR-CLUSTER.device.v1 and specialisations
Reliability	Reliability: Narrative description of the reliability of the test results, as determined by the tester. If an appropriate value set can be determined, this could be coded. The maximum occurrences of this data element have been set to two to allow for both narrative and a coded value to be selected in a template.
Test Modifications Required	Test Modifications Required: Narrative description of any modfications to the standard methodology required to enable successful completion of the test.
Calibration Reference dB	Calibration Reference dB: Scale used for acoustic calibration check. at0090::db SPL [The sound pressure level scale was used.] at0091::dB HL [The hearing level scale was used.] at0092::dB n [The normal hearing level scale was used.]
Criteria for Pure Tone Average	Criteria for Pure Tone Average: The criteria on which the Pure Tone Average is calculated. The average is based on air conduction thresholds and masked thresholds replace unmasked thresholds when applying the formula. If recording the Criteria as a narrative, it is possible to identify the frequencies used for non-standard Pure Tone Average as free text. Choice of: Coded Text at0062::3 frequency average [The pure tone hearing threshold is calculated using 0.5, 1 and 2 kHz.] at0063::4 frequency average [The pure tone hearing threshold is calculated using 0.5, 1, 2 and 4 kHz.] Text
Criteria for Asymmetry	Criteria for Asymmetry: The criteria on which asymmetry is defined in the test result interpretation. For example: binaural difference in bone conduction thresholds of >10 dB at two consecutive frequencies or >15 dB at one frequency (0.25–8.0 kHz).
Comment	Comment: Additional narrative about the protocol for the audiogram not captured in other fields. For example, the co-operation of the test subject or description of the method used for testing.
data
Test Result Name	Test Result Name: Identification of the Audiometry test performed. Coding with an external terminology is preferred, where possible. Applicable tests include: Pure Tone Audiometry; Play Audiometry; Auditory Brainstem Response (for threshold determination); and Visual Reinforcement Orientation Audiometry.
Test Details	Test Details: The test measurements and interpretations which can be recorded per ear, or for both ears simultaneously.
Air Conduction Test	Air Conduction Test: Measurements recorded using pure tones presented by air conduction.
Test Ear	Test Ear: Identification of the ear to which the test stimulus is being presented. at0008::Left Ear [The test stimuli were presented to the left ear only.] at0009::Right Ear [The test stimuli were presented to the right ear only.] at0049::Binaural [The test stimuli were presented to both ears simultaneously in a soundfield.]
Masking	Masking: A frequency masking stimulus was applied to the non-test ear to more accurately determine hearing thresholds in the test ear. Record as 'True' if masking techniques were used as part of the threshold determination. Allowed values: {true}
Measurement	Measurement: The measured frequency/threshold level pair.
Frequency	Frequency: The stimulus frequency tested. Frequency is not applicable if a click stimulus is presented. Property: Frequency Units: 125.0..16000.0 Hz Limit decimal places: 0 0.125..16.0 kHz Limit decimal places: 3
Threshold Level	Threshold Level: The stimulus intensity at threshold for the test frequency. Property: Loudness Units: -10.0..120.0 dB Limit decimal places: 0
No Test Result	No Test Result: No test result is available for the test ear. Record as True if the clinician was unable to record a result for the test ear or binaural testing in a soundfield, as defined by the 'Test Ear' data element. Allowed values: {true}
Reason for No Test Result	Reason for No Test Result: Reason why no result is available for the test ear. For example, patient was not cooperative; patient was not capable; ran out of time.
Bone Conduction Test	Bone Conduction Test: *
Test Ear	Test Ear: Identification of the ear to which the test stimulus is being presented. at0008::Left Ear [The test stimuli were presented to the left ear only.] at0009::Right Ear [The test stimuli were presented to the right ear only.] at0049::Binaural [The test stimuli were presented to both ears simultaneously in a soundfield.]
Hearing Threshold Interpretation	Hearing Threshold Interpretation: Interpretation of a series of audiometric measurements for purposes of hearing threshold assessment.
Pure Tone Average	Pure Tone Average: The average pure tone threshold according to the specified averaging criteria. This calculation is typically determined using air conduction thresholds. Property: Loudness Units: -10.0..120.0 dB Limit decimal places: 1
Degree of Loss	Degree of Loss: Category of the degree of hearing loss derived from the dB threshold values. Coding with a terminology is desirable, where possible. For example: none, mild, moderate, severe and profound. Each of these categories should be clearly defined on the basis of a dB range appropriate for age.
Type of Loss	Type of Loss: Identified type of hearing loss for the test ear, based on all measurements. If there is no degree of loss, then this data element is not applicable. at0068::Conductive [A conductive hearing loss pattern has been identified for the Test Ear, based on the presence of an air/bone gap and bone conduction thresholds within normal range.] at0067::Sensorineural [A sensorineural hearing loss pattern has been identified for the Test Ear, based on no air/bone gap and thresholds outside normal range.] at0066::Mixed [A mixed hearing loss pattern has been identified for the Test Ear, based on the presence of an air/bone gap and bone conduction thresholds outside normal range.] at0069::Indeterminate [It is not possible to determine the pattern of hearing loss.]
Clinical Interpretation	Clinical Interpretation: Clinical interpretation of all measurements for the test ear. Coding with a terminology is preferred, where possible. Not to be used for recording the interpretation for both ears when the ears are tested simultaneously - use the data element 'Overall Interpretation' instead.
Articulation Index	Articulation Index: An algorithm to predict the amount of speech that is audible to a patient with a specific hearing loss. Unitary Numerator: 0.0..1.0 Assumed value: false
Symmetry of Loss	Symmetry of Loss: An interpretation about the symmetry of hearing loss, based on all hearing acuity measurements for both ears. If there is no degree of loss in both ears, then this data element is not applicable. at0072::Symmetrical [The hearing loss is symmetrical.] at0073::Asymmetrical [The hearing loss is assymmetrical.]
Laterality of Loss	Laterality of Loss: An interpretation about the laterality of hearing loss, based on all hearing acuity measurements for both ears. If there is no degree of loss in both ears, then this data element is not applicable. at0133::Unilateral [Loss of hearing in one ear.] at0132::Bilateral [Loss of hearing in both ears.]
Overall Interpretation	Overall Interpretation: Overall clinical interpretation of the measurements and related findings using an audiometer. Coding with a terminology is preferred, where possible. This data element is effectively an audiological diagnosis.
Test Result Image	Test Result Image: Digital representation of the entire result. image/cgm, image/gif, image/png, image/tiff, image/jpeg
Comment	Comment: Additional narrative about the test results and intepretation not captured in other fields.
Other contributors	Judith Boswell, Adelaide Hearing Consultants, Australia Stephen Chu, NEHTA, Australia Kimberley Crebbin, NT Hearing Services, Australia Kathy Currie, Northern Territory Health, Australia Jade Frederiksen, Hearing Health Program, DoH, Australia Sam Harkus, Australian Hearing, Australia Sam Heard, Ocean Informatics, Australia Paul Hickey, Hearing Health Program, Australia Oliver Hosking, Remote Health NT, Australia Anthony Leech, Hearing Health, Australia Kerrie Lee, Ngaanyatjarra Health Service, Australia (Editor) Heather Leslie, Ocean Informatics, Australia (Editor) Rebecca Matthews, NT Hearing Services - NTG, Australia Ian McNicoll, Ocean Informatics UK, United Kingdom Mark Ramjan, NT Department of Health, Australia Bojana Sarkic, Northern Territory Government, Australia Prasha Sooful, Royal Darwin Hospital, Australia Fiona Wake, RAHC, Australia
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