PP1313 - Investigation of Bone-Conduction Thresholds with Three Different Head Coverings

No formal protocol currently exists for bone conduction testing for patients who wear head coverings. We recently surveyed hearing care professionals and found there is wide variety in bone conduction testing practices when patients wear a head covering. Here, we present data comparing bone conduction thresholds measured while wearing a baseball cap, a wig, and a hair scarf compared to baseline thresholds. Considering the cultural and religious diversity in the United States, the results of this study support the development of bone-conduction testing protocols for patients who wear head coverings.

Summary:

Rationale

Bone conduction threshold testing is a foundational component of a comprehensive audiologic evaluation. Inaccurate bone conduction thresholds negatively impact the management of the patient . It is not known whether testing bone conduction with a head covering (e.g., wig, cap, or hair scarf) in place affects the measured threshold. 

Currently, no formal protocol exists for testing bone conduction when patients are wearing head coverings. Current protocols for bone conduction testing address touching the pinna and recommend removal of earrings, hearing aids, glasses, etc. to minimize interference with proper placement of the bone oscillator. As far as we know, the only mention of removing any kind of head covering appears in an older work in the context of removing a wig before completing bone conduction testing via a tuning fork at the vertex of the skull (Turner, 1990). It is not known whether wigs or any head coverings need to be removed for accurate mastoid-placement bone conduction testing.

In preparation for the current research, a survey was developed to probe bone conduction testing protocols for various head coverings among licensed hearing care providers in the United States. We noted inconsistency amongst hearing care professionals about which head coverings are routinely removed for bone conduction testing. Further, results for each specific head covering show a range of practices was observed. 

Objective

Identify whether bone conduction thresholds and/or test-retest reliability are affected by a head covering worn during testing.

Design

Thirty participants will enroll in the study. Bone conduction thresholds are measured at audiometric frequencies from 250-4000 Hz in four conditions: uncovered (no head covering), wearing a wig, wearing a hair scarf, and wearing a baseball cap. We recognize that there is variety in style, type, and personal and cultural significance for each of these items. Rather than attempting to replicate a specific cultural application of any of these head coverings, we took a more general approach.

Results

Data collection is underway and will be completed by February 15, 2024. An Analysis of Variance (ANOVA) will be used with the factors of condition and audiometric frequency. For the analysis of test-retest variability, an intraclass correlation approach will be used.

Conclusions

The results of this study will support the development of a bone conduction testing protocol for patients who wear head coverings. Our research team considers this an important aspect cultural sensitivity.