The results of AMTAS are data driven and evidence based. They are then used to calculate the overall accuracy and a number of other important markers that will basically give the audiologist an image of how the patient was acting during the test. It is important that you are familiar with these.
The Quality Indicators that are most impressive to audiologists and ENTs are as follows: Predicted Average Absolute Difference, Time Per Trial, False Alarm Rate, and QC Fail.
- Predicted Accuracy - Overall Quality - Good, Fair, Poor – based on the quality indicators.
- Predicted Average Absolute Difference – Difference between automated and manual thresholds based on a study where five expert audiologists tested patients manually and compared the results to AMTAS evaluations – based on research.
- Masker Alerts - These indicate thresholds where masking may have been too high or low.
- Time Per Trial - Measures the average time from stimulus to patient response.
- False Alarm Rate – The number of times patient responded with no stimulus presented is divided by number of trials when no stimulus was presented. When there is a false alarm, AMTAS displays a message to alert the patient that he responded yes when there was not a tone presented.
- Average Test-Retest Difference – Displays the average difference between 1 KHz test and retest in the right and left ears.
- Quality Check Fail Rate – When threshold is established, AMTAS presents a stimulus that is 5 dB above threshold. The patient should hear this tone. QC fail indicated the number of times patient did not respond to stimulus above threshold divided by the number of measured thresholds. If this is high, it can indicate malingering or that the patient is not a good candidate for AMTAS.
- Number of Air/Bone Gap > 35 dB – This is the number of air/bone gaps that exceed 35 dB.
- Number of Air/Bone Gap < -10 dB – This is the number of air/bone gaps that are less than 10 db
If the data and research is not convincing enough, patient care situations can help:
- If an ENT cannot find an audiologist but he has a patient that requires audiometric testing, he must end the appointment, send the patient across town to the audiologist he refers to, and then wait for the patient to come back. This adds a level of complexity that is inconvenient. The patient must then make an appointment, go to the appointment (pay the copay), and then make and go to a follow up appointment (copay again) with the ENT. If that office had AMTAS, they would still likely refer to audiology, but they would be able to complete the patient’s appointment more efficiently.
- If an audiologist is supporting an ENT clinic and has several patients who need audiometry at the same time, the patients will have to wait until the audiologist completes testing with the previous patients before they can be seen. This can add up to a long time in a waiting room for a hearing test. If that audiologist had AMTAS, one patient could be working through a basic air/bone/speech while other patients were undergoing middle ear testing, OAEs, or counseling.
- If a busy clinic has AMTAS, a walk-in patient with sudden hearing loss can be tested immediately and worked into the schedule for immediate treatment.
- A satellite office where an audiologist is not available every day can see more patients and be more effective by using AMTAS.
The biggest drawback to AMTAS (from an audiologist or ENT perspective) is the billing. Currently, there is not a billing code in place for this evaluation. GSI believes that in the next couple of years that will change. In the meantime, the small amount of money that is reimbursed for the air/bone/speech is made up for by the time and other testing that can be performed by the audiologist.
GSI AMTAS is a powerful automated audiometry tool that can benefit a clinic in many ways. For more information, visit www.grason-stadler.com to learn what AMTAS can do for you!