Audiology on the Praxis SLP: The Focused Review

Audiology is a small but reliable slice of the Praxis 5331 — usually 3–6 items across screening, hearing-loss identification, and the SLP's scope in aural rehabilitation. If audiology was your least favorite graduate class, this is the focused review that gets you those points.

Hearing screening basics

• ASHA pure-tone screening: 20 dB HL at 1000, 2000, 4000 Hz. A "refer" at any frequency in either ear = fail.
• OAEs (otoacoustic emissions): newborn and difficult-to-test populations. Tests cochlear outer hair cell function.
• Tympanometry: measures middle-ear function. Type A = normal; Type B (flat) = middle-ear effusion; Type C (negative pressure) = eustachian tube dysfunction; Type As = shallow (otosclerosis); Type Ad = deep (ossicular disarticulation).

Reading an audiogram in 30 seconds

• X axis = frequency (Hz), low to high, left to right.
• Y axis = intensity (dB HL), quiet at top, loud at bottom.
• Bone conduction (BC) < air conduction (AC) with a gap = conductive.
• BC and AC both depressed, no gap = sensorineural.
• Both a gap AND depressed BC = mixed.

Degree of hearing loss (memorize this table)

• Normal: −10 to 15 dB HL
• Slight: 16–25
• Mild: 26–40
• Moderate: 41–55
• Moderately severe: 56–70
• Severe: 71–90
• Profound: 91+

Types of hearing loss — high-yield distinctions

• Conductive: outer/middle ear (otitis media, cerumen, ossicular chain). Often medically treatable.
• Sensorineural: cochlea or auditory nerve (presbycusis, noise exposure, ototoxicity, congenital). Not medically reversible; amplification or cochlear implant.
• Mixed: conductive + sensorineural components.
• Auditory neuropathy spectrum disorder (ANSD):present OAEs, absent/abnormal ABR. Speech understanding disproportionately poor for the audiogram.

SLP scope in aural rehabilitation

The SLP does NOT fit hearing aids or program cochlear implants. The SLP DOES:

• Screen for hearing loss and refer to audiology.
• Provide auditory training and speech-language therapy for children and adults with hearing loss.
• Support spoken-language development for children with cochlear implants (LSLS-informed practice).
• Counsel families on communication modalities.
• Collaborate on IEPs for D/HH students.

Amplification quick facts

• Hearing aids: amplify sound. Any degree of loss.
• Cochlear implants: bypass damaged hair cells, directly stimulate auditory nerve. Candidacy: severe-to-profound sensorineural loss with limited benefit from hearing aids.
• Bone-anchored hearing aids (BAHA): conductive or single-sided deafness.
• FM/DM systems: improve signal-to-noise ratio in classrooms.

Pediatric red flags to refer

• Failed newborn hearing screen
• Not startling to loud sounds by 3 months
• Not babbling by 9 months
• Fewer than 50 words or no word combinations by 24 months (rule out hearing loss before diagnosing language disorder)

On the exam, if a case includes chronic otitis media plus a speech or language delay, hearing screening/referral is almost always in the answer. When in doubt, refer.