CHAPTER 1 A Brief Introduction to Clinical Audiology and This Handbook 第一章：临床听力学及本手册简介

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CHAPTER 1 A Brief Introduction to Clinical Audiology and This Handbook
第一章：临床听力学及本手册简介

Audiology is the study of hearing and hearing disorders, a field devoted to helping those with auditory and vestibular dysfunctions. This work may involve evaluation, re/habilitation, counseling, education, research, and/or screening/ prevention.
听力学是一门研究听力和听力障碍的学科，致力于帮助那些有听力和前庭功能障碍的人。这项工作可能涉及评估、康复、咨询、教育、研究、和/或筛查/预防。

Audiology combines aspects of science and art with techniques that are based on both basic and clinical research. We use sophisticated equipment to provide precision in determining the type and extent of the problems. But audiology is also an art. It involves the ability to perform the various tasks precisely and to provide information and maximum support to the individuals affected and their families. Because of these intellectually and emotionally gratifying aspects, it makes audiology an exciting career.
听力学基于基础研究与临床研究将科学与艺术结合起来。我们使用精密的设备来确定问题的类型和程度。但听力学也是一门艺术。它包括准确执行各项任务的能力，以及向受影响的个人及其家庭提供信息和最大限度支持的能力。由于这些智力和情感上的满足，它使听力学成为一个令人兴奋的事业。

In my more than 50 years in this field, audiology has continued to be interesting and rewarding work. It is a comparatively new field that emerged in the aftermath of World War II (WWII) to aid service members who suffered hearing impairments. It brought together speech-language pathologists, deaf educators, psychologists, and ear, nose, and throat (ENT) physicians. This interdisciplinary cooperation was responsible for the excellent services that were provided to the injured military personnel. At the same time these multidisciplinary activities helped to lay the groundwork for the field of audiology. Indeed this interdisciplinary aspect of the field of audiology remains one of its great strengths even today. Initially, audiologic work was carried out in military hospitals and then spread to universities and university clinics, afterward to hospitals and community clinics.
在我50多年的职业生涯中，听力学一直是一项有趣而有意义的工作。这是一个相对较新的领域，出现在二战后，用于帮助听力受损的军人。它汇集了言语病理学家、聋人教育学家、心理学家以及耳鼻喉科医生。这种跨学科合作向受伤的军事人员提供了出色的服务。同时, 这些多学科活动为听力学领域奠定了基础。事实上，即使在今天，听力学领域的跨学科方面仍然是它的一大优势。最初，听力工作是在军事医院进行的，然后传播到大学和大学诊所，后来传播到医院和社区诊所。

Presently there are about 12,000 members of the American Academy of Audiology and approximately 2,000 members of the International Society of Audiology. Also memberships continue to grow in local, state, and national associations around the world. Audiology has several peerreviewed journals and other publications, both printed and digital, that report on research and clinical developments. The field of audiology is constantly expanding its horizons and developing deeper understandings of both normal and abnormal processes.
目前，美国听力学学会约有12,000名会员，国际听力学学会约有2,000名会员。此外，世界各地的地方协会、州协会和国家协会的会员人数也在不断增长。听力学领域的相关杂志和其他出版物，包括印刷版和电子版，都对研究和临床发展进行了报道。听力学不断拓展它的范围，加深了人们对正常和异常听力过程的认识。

AUDIOLOGY FROM 1940s TO TODAY
20世纪40年代至今的听力学

As mentioned above, the field of audiology was founded during WWII. Prior to that time hearing testing was carried out using tuning forks and whispered speech by medical doctors, although some puretone audiometers that provided repeatable stimuli were also in use. The combined efforts of the different disciplines fostered the variety of procedures we have to address the problems caused by hearing impairment. Bone-conduction testing and speech audiometry were soon added to the clinical tools. Aspects such as lip reading/speech reading, auditory training, and counseling were borrowed from deaf education, psychology, and speech-language pathology. An important adjunct for the service members was the fitting of hearing aids which were quite limited by today’s standards. Nevertheless for years after the war these veterans were still using and benefiting from the amplification and training that they had received from those early audiologists when the profession was in its infancy.
如上所述，听力学是在二战期间创立的。在此之前，听力测试是由医生使用音叉和耳语来完成的，尽管一些提供可重复刺激的纯音听力计也在使用。在不同学科的共同努力下，我们有了各种各样的程序来解决听力障碍造成的问题。骨导测试和言语测听很快应用于临床。诸如唇读/言语阅读、听觉训练和心理咨询等借鉴于聋人教育、心理学和言语病理学。对从业人员来说，一个重要的辅助设备是助听器的装配，这在今天的标准下来看是相当有限的。尽管如此，战后多年来，这些退伍军人仍然在使用助听器，并从早期听力学家的训练中获益。

After leaving military service, the early audiologists began to train others at colleges and universities. Audiologists began to research the clinical problems that they faced and many of these approaches and solutions are still in use today. These procedures also led the way to important innovations. Because it was clear that we did not have enough diagnostic information to accurately measure and categorize hearing disorders, early on, there was a heavy emphasis on developing new diagnostic procedures. For a number of years the area of diagnosis was the primary focus in audiologic research and practice.
退伍后, 早期的听力师开始在高校培训其他人。听力学家开始研究他们面临的临床问题, 其中许多方法和解决方案至今仍在使用。这些程序也引领了重要创新。因为很明显，当时没有足够的诊断信息来准确测量和分类听力障碍，早期我们就大力重视开发新的诊断程序。多年来, 诊断领域一直是听力研究和实践的主要焦点。

When audiologists began dispensing hearing aids, this caused an expansion of attention, from just evaluation and identification of hearing loss to include providing means of managing hearing difficulties and therapy to address the communication problems. Hearing aid fitting was also a major impetus for audiologists to go into private practice. At the same time there were major breakthroughs in physiological measurements. This began with what we now refer to as cortical responses, but after a few years, earlier responses were identified from the auditory nerve and even the cochlea. The field of audiology has expanded to include the assessment of more complex functions at all levels of the peripheral and central auditory nervous system. Immittance measurements enabled audiologists to assess mechanical properties of the auditory system of the outer and middle ears, as well as middle-ear muscle responses that rely on auditory nerve and brainstem activity. Specialties such as auditory processing disorders, educational audiology, vestibular function, and interoperative monitoring have added to the breadth and depth of the field.
当听力师开始验配助听器时，这引起了广泛的关注，从仅仅评估和识别听力损失，到提供处理听力障碍的手段和治疗来解决沟通问题。助听器验配也是听力师进入私人诊所的一个主要动力。与此同时，生理性测量方面也取得了重大突破。这开始于我们现在所说的皮层反应，但几年之后，从听觉神经甚至耳蜗中发现了早期的反应。听觉学的领域已经扩大到包括评估周围和中央听觉神经系统各级更复杂功能。导抗测量使听力师能够评估外耳、中耳听觉系统的力学特性，以及依赖听觉神经和脑干活动的中耳肌肉反应。诸如听觉处理障碍、教育听力学、前庭功能和术间监测等专业增加了该领域的广度和深度。

The growing sophistication and understanding of auditory functions and development can be seen in the lowering of the target ages for various services. In the mid-1950s it was taught that we should wait until deaf children are perhaps 10 years of age before testing them and presumably provide amplification after that. Given our current state of knowledge, in retrospect, this seems absurd and counterproductive. At that time we did not understand that developmental problems should be identified at the earliest possible time. Otherwise, the person could miss critical periods and lose plasticity, as well as fall further behind with reduced learning and more acquired misconceptions. Now, neonatal hearing screening is widespread and we strive to begin habilitation by 6 months of age. In fact, in the past, one audiologist was ridiculed when she advocated that audiologists fit hearing aids for children as young as 1 year of age. Once we realized the critical importance of the early years for later development, early identification and assessment procedures, as well as training procedures were targeted and developed.
听觉功能及发育认识和理解的提高可以从越来越低的就诊患者年龄中看出来。在20世纪50年代中期，人们教导我们应该等到失聪儿童10岁左右再进行测试，之后再进行助听器验配。考虑到我们目前的知识水平，回想起来，这似乎是荒谬和适得其反的。当时我们不理解应尽早查明发育问题。否则，该人可能错过关键时期并失去可塑性，并且随着学习减少和更多误解而进一步落后于人。如今，新生儿听力筛查非常普遍，我们努力在6个大的时候开始进行康复训练。事实上，在过去，有一位听力学家曾因主张听力学家应该为1岁儿童验配助听器而遭到嘲笑。一旦我们认识到早期阶段对今后发展的重要性，就有针对性地制订早期识别、评价以及培训。

As the field of audiology expanded so did the academic demands on the practitioners. Initially, a bachelor’s degree was required to practice and then a master’s degree was the entry level along with basic clinical certification. As in the past a Ph.D. was generally desired for university teaching and research. In more recent years (in the United States) the Doctorate of Audiology (Au.D.) degree was introduced to provide even broader clinical teaching and training experiences. Also, higher levels of competency and certification are generally required today to practice audiology. Students interested in a career that includes independent research continue to pursue a Ph.D. in audiology, hearing science, or related areas. Now many of the top university programs in audiology have both Ph.D. and Au.D. trained professors to provide the student the best of both worlds. We also see combined Au.D./Ph.D. programs that offer students excellent ground for both clinical and research endeavors.
随着听力学领域的发展，对听力学工作者的学术要求也在不断提高。最初，学士学位需要实习，然后硕士学位是基础临床认证的初级水平。和过去一样，哲学博士学位通常是大学教学和研究所需要的。近年来（在美国）引进了听力学博士学位，以便提供更广泛的临床教学和培训经验。此外，今天听力实践通常需要更高水平的能力和认证。对独立研究的职业感兴趣的学生继续攻读听力学、听力科学或相关领域的听力学博士学位和哲学博士学位。现在许多顶尖大学的听力专业都有听力学博士学位和哲学博士学位。训练有素的教授在两个领域为学生提供优质的服务。我们也看到听力学博士/哲学博士课程结合在一起，为学生的临床和研究提供了良好基础。

We owe a debt of gratitude to those early audiologists who helped to form this vibrant and vital health profession. Although we cannot mention the many important contributors, it is perhaps appropriate to mention Raymond Carhart (1912 to 1975) who is generally recognized as “The Father of Audiology.” He was an important contributor to the developing field of audiology and an excellent teacher. Many of his students from Northwestern University in Evanston, Illinois went on to contribute significantly to the field of audiology in their own right.
我们应该感谢那些早期的听力学家，他们帮助形成了这个生机盎然的健康行业。虽然我们不能提及全部重要的贡献者，但也许应该提及雷蒙德•卡哈特（1912 – 1975），他被公认为“听力学之父”。他对听力学的发展做出了重要贡献，也是一名优秀的教师。他的许多学生来自伊利诺斯州埃文斯顿的西北大学，他们后来凭借自己的能力在听力学领域做出了重大贡献。

ABOUT THIS HANDBOOK
关于这本书

The first edition of the Handbook of Clinical Audiology was published in 1972 and subsequent editions have served several generations of audiologists in the United States and increasingly throughout the world. It is used widely as both a text and reference book by students and professionals in various fields.
《临床听力学》第一版于1972年出版，随后的版本哺育了美国的几代听力学家，并逐渐遍及世界各地。它作为教科书和参考书被多个领域的学生和专业人士广泛使用。

Currently, for this edition, we have five editors who have diverse areas of specialization in clinical, research, and teaching aspects for which they are responsible. To broaden our horizons and to be as inclusive as possible, in this edition we have tried to include more international voices and procedures.
目前, 本版有五位编辑, 他们负责临床、科研和教学方面的不同领域。为了拓宽我们的视野, 尽可能具有包容性, 我们在本期试图纳入更多的国际观点和程序。

We have squeezed in as much information in 1,000 pages as we could. The more than 90 contributors are highly regarded audiologists who also have clinical, research, and teaching experience. This makes the chapters authoritative, well organized, and geared for sharing our knowledge in a field that we love. We have always considered readability an important feature of this book and especially now that it is used by many people whose first language is not English.
我们尽可能把更多信息压缩到1000页里。超过90位撰稿者都是非常受尊敬的听力学家，他们均有临床、科研和教学经验。这使得这些章节具有权威性，组织良好，适合于在热爱的领域分享我们的知识。我们一直认为可读性是这本书的一个重要特点，尤其是现在许多母语不是英语的人都在使用它。

The 46 chapters are divided into four sections. Section I deals with basic tests and procedures that are used by most audiologists for most of the people with whom they work. This involves puretone air and bone conduction, as well as standard speech audiometry. Calibration and case history chapters are also important components for any audiologic assessment. The Diagnostic Audiology chapter helps the reader to combine all of the previous information into a coherent diagnosis.
46章被分为四个部分。第一部分介绍大多数听力师所使用的基本测试方法和程序。这涉及纯音空气传导和骨传导，以及标准的言语测听。校准和病史章节也是任何听力评估的重要组成部分。诊断听力学章节帮助读者将所有先前的信息组合成一个连贯的诊断。

Section II introduces the various physiological and electrophysiological procedures used by audiologists at this time. These include immittance measures that primarily reveal the status of the middle ear. Electrocochleography and Otoacoustic Emissions provide detailed information about the responses from the cochlea, the end organ of hearing. Five chapters in this section discuss the electrophysiological responses from the auditory nerve, brainstem, and various areas of the brain. The chapter on intraoperative monitoring describes the analysis of the auditory system during surgery that informs the surgeons about the status and possible adverse effects of their manipulations of the auditory system. The final three chapters in this section deal with the vestibular system. They begin with the study of vestibular neurophysiology and end with vestibular rehabilitation.
第二部分介绍了当前听力学家使用的多种生理和电生理程序。包括主要反映中耳状态的导抗测量。耳蜗电图和耳声发射提供了有关听觉的最终器官耳蜗反应的详细信息。本节有五章讨论来自听觉神经、脑干和大脑不同区域的电生理反应。关于术中监测的章节描述了对手术中听觉系统的分析，该分析将告知外科医生手术期间听觉系统的状态和可能的不良影响。本节的最后三章讨论前庭系统。从前庭神经生理学研究开始，至前庭康复结束。

Section III is called Special Populations. This recognizes that certain groups often require modifications in audiometric procedures or accommodations. Evaluation of young children offers a special challenge to the audiologist because they do not have the auditory or cognitive development needed for some of the tests, and it is sometimes difficult to have them perform in the expected fashion. This chapter describes ways to obtain the desired results. Hearing, screening, and educational audiology generally involve the work carried out in schools with those who have normal hearing as well as those with auditory impairments. This section also includes chapters that deal with those who have multiple disabilities, hereditary hearing loss, and the elderly. Other special groups are those with noise-induced hearing loss, those who have tinnitus, and individuals who have “nonorganic” hearing loss. Four of the other chapters involve auditory processing disorders, which include the bases of central auditory problems, diagnostic procedures, and subsequent remediation. This section concludes with a chapter on tele-practice in which audiologists can work with people at far distances via communication systems.
第三部分称为特殊群体。要认识到是，特定群体往往需要在听力测量程序或调节方面作出修改。幼儿评估对听力学家来说是一个特殊的挑战，因为测试所需的听觉或认知还没有发育完全，有时很难让他们按照预期的方式进行测试。本章介绍了获得预期结果的方法。听力、筛查和教育听力学一般涉及在学校进行的工作，对象既有听力正常的人，也有听力障碍的人。这部分也包括处理那些有多重残疾，遗传性听力损失，和老年人群等章节。其他特殊人群包括噪音性听力损失、耳鸣和“非器质性”听力损失。其他四章涉及听觉处理障碍，包括中央听觉问题，诊断程序，和随后的矫正的一些基础知识。本节以一个关于远程实践的章节结束，在这个章节中，听力学家可以通过通信系统远程与人一起工作。

Section IV deals with the management of hearing disorders. It begins with acoustical environments and technologies that are used to aid the hard-of-hearing person in reducing the influence of noise and other factors that can compromise communication. This is followed by four chapters related to various aspects of hearing aids and hearing aid fittings. Another chapter, which deals with implantable hearing devices, is a rapidly expanding area. The chapter discusses cochlear implants and other devices that are surgically imbedded into the person with a hearing loss. Two other chapters deal with management of those with hearing problems in the classroom and with rehabilitation of adults. There is also a chapter in this section that advises audiologists on how to start an effective audiologic practice.
第四部分讨论听力障碍的管理。它从声学环境和技术开始，这些技术被用来帮助听力困难的人以减少噪音和其他影响交流因素的影响。接下来是与助听器和助听器验配各方面有关的四章。另一章是关于植入式听觉装置，这是一个正在蓬勃发展的领域。这一章讨论了人工耳蜗和其他通过手术植入到失聪患者体内的设备。另外两章论述了有听力问题的学龄儿童的管理与成年人康复的管理。本节还有一章是关于指导听力师如何开始有效的听力学实践。

New Chapters in This Edition
本版本的新章节

a. Diagnostic Audiology serves an important purpose in bringing together the information from the basic evaluation procedures in this book to form an audiologic interpretation and an understanding of the patient’s needs. This chapter will also discuss some procedures that are not covered in the preceding chapters, as well as mentioning what our tests do not tell us.
诊断听力学的一个重要目的是汇集本书基本评估程序中的信息以形成听力学解释和对患者需求的理解。本章还将讨论一些在前面的章节中没有涉及的程序，并且提到测试没有告诉我们什么。

b. The Dizzy Patient and Vestibular Rehabilitation chapter is an extension of a former Handbook chapter, applying diagnostic information to enable appropriate treatment decisions for patients with vestibular problems. It will describe audiologic procedures designed to relieve patient’s symptoms, as well as the role of physical therapy and the necessity of collaboration among healthcare professionals.
“眩晕患者和前庭康复”章节是上版本章节的延伸，应用诊断信息来为前庭问题患者作出适当的治疗决策。它介绍了用于减轻患者症状的听觉程序，以及物理疗法的作用和卫生保健专业人员之间协作的必要性。

c. Hearing Screening discusses newborn hearing screenings, school screenings, and other screening procedures using universal approaches and targeted population approaches. The specific procedures, their value, and outcomes of screening programs will be discussed.
听力筛查讨论新生儿听力筛查、学校筛查和其他筛查程序，使用通用方法和目标人群方法。特定的程序及其评估，和筛选程序的结果将被讨论。

d. Hereditary Hearing Loss describes much-needed information for audiologists related to genetic aspects of hearing loss that may be nonsyndromic or part of a known syndrome. Since audiologists are often the first professionals to suspect a genetic basis for a hearing loss, it is important to have current information available as well as the knowledge of resources.
遗传性听力损失描述了与听力损失的遗传方面相关的听力学家亟需的信息，这些可能是非综合征型或已知综合征的一部分。由于听力学家通常是第一个怀疑听力损失与遗传因素有关的专业人员，因此获得最新信息及对信息的了解都非常重要。

e. Audiology Tele-practice follows the global trend to provide appropriate services at a distance from the professional. Using a range of communication technologies and appropriate training of para-professionals, audiologists can treat individuals in remote places who might otherwise not receive care. Tele-practice also provides convenience to patients who live relatively close by, but nonetheless find it challenging to visit the clinic for routine problems. By making oneself available using teletechnology, the audiologist helps patients conserve their physical energy, time, and travel expenses, while keeping abreast of the patient’s challenges as they develop.
听力远程实践遵循全球趋势, 在没有专业人员的地方提供适当的服务。利用一系列通信技术和对专业人员的助手进行适当培训, 听力专家可以治疗那些在偏远地区可能得不到治疗的个人。远程实践也为住在附近的患者提供了便利, 尽管如此，因为常规问题而访问诊所也是比较困难的。通过使用远程技术，听力专家帮助患者节省了体力、时间和差旅费, 同时了解患者在成长过程中面临的挑战。

f. The topic of Infection Control relates to every aspect of audiology, because it is important not to harm the people whom we are here to help. Infection control is part of every aspect of our work and for this reason it is the first of many chapters, in the future, that will be available from the Point on internet.
感染控制的话题涉及听力学的各个方面，因为重要的是不要伤害我们在这里帮助的人。感染控制是我们工作的各个方面的一部分，正因如此，它是许多章节的第一章，在未来，这些章节将在Point网站上发布。

Other New Features in This Handbook
本书的其他新特点

In this edition of the Handbook we have reduced the number of references provided in each chapter, but there are extensive lists of references for the interested students, professors, and researchers on the Point. In this way the reader is not encumbered with reading through or skipping over many references when trying to understand the concepts and to remember the facts in this book. At the same time there are thousands of references organized by chapters online for those who are interested in research or for greater depth on the topics covered in this book.
在本手册的这个版本中，我们减少了每一章所附参考文献的数量，但对于感兴趣的学生、教授和研究人员, 我们在Point网站上列出了大量的参考资料。这样，当读者试图理解本书的概念并记住书中的内容时，就不会因为阅读或跳过许多参考文献所累。与此同时，在线章节组织了数千个参考资料，供那些对研究感兴趣或想更深入了解本书所涉主题的人。

Another new feature is the thought questions at the end of each chapter. They will ask how and what you would do in dealing with, or solving, problems associated with the information in the chapter. This is not another hoop to jump through but a valuable exercise. The student must take what they have learned from the chapter and combine it with their other knowledge to figure out a good solution to a problem/question. In this way they take what was on page and internalize it, while it is fresh in their minds, and put the information to a practical use. This will help you to internalize the information and make the material your own.
另一个新特性是每章末尾的思考问题。他们会问你在处理或解决与本章内容相关的问题时，你会怎么做，会做些什么。这不应跳过，而是一个有价值的练习。学生必须把从这一章中学到的知识与其他知识结合起来，找出好的解决问题的办法。通过这种方式，他们把纸上的内容所消化，将他们留在脑海里，并将信息用于实际用途。这将帮助你理解信息并为我所用。

Terminology
术语

Most of the terms used in this edition are standard in the field at this time. However, when a change is made it should be for a worthwhile purpose and not one that creates important problems. For example, this writer was pleased to see a recent change back to a previous term. What was once called Central Auditory Processing was changed to Auditory Processing and recently was changed back to the clearer and more specific Central Auditory Processing again (American Academy of Audiology, 2010).
本版本中使用的大多数术语都是当时该领域的标准术语。然而，当进行更改时，应该是为了有价值的目的，而不要产生重大问题。例如，本文作者很高兴看到最近又变回上一个术语。曾经“中央听觉处理”被改为“听觉处理”，最近又被改回更清晰、更具体的“中央听觉处理”。（美国听力学会，2010）。

SENSORY/NEURAL
感音/神经

A conductive loss is a mechanical impairment of hearing, associated with the outer and/or middle ears. For many years a nonconductive loss had been called a “nerve loss.” After WWII it was changed to “sensory-neural loss” when ENT doctors and audiologists were then able to separate sensory (cochlear) from neural (acoustic nerve or brainstem) disorders. For example, cochlear problems (such as Meniere’s disease) were demonstrated by a rapid growth of loudness when a sound was presented above the person’s threshold of hearing. On the other hand with retrocochlear losses (e.g., auditory nerve or brainstem) there was no accelerated growth of loudness with sounds above the neural hearing level (as with a person who had an auditory nerve tumor). However, after a number of years the term sensory-neural was changed to “sensorineural.” There was little reaction to this minor change.
传导性损失是听力的机械性损伤，与外耳和/或中耳有关。多年来，非传导性的损失被称为“神经性损失”。二战后，耳鼻喉科医生和听力学家能够将感音（耳蜗）和神经（听觉神经或脑干）疾病分开时，它就变成了“感觉-神经性损失”。例如，耳蜗问题（如梅尼埃病）表现为当声音超过人的听觉阈值时，其响度迅速增加。另一方面，对于耳蜗后损伤（如听觉神经或脑干），当声音高于听觉阈值时（如患有听觉神经肿瘤的人），响度没有快速增加。然而，若干年后，“感音-神经性”一词改为“感音神经的”。这一小小的变化几乎没有引起什么反应。

I was shocked, however, to receive an angry phone call from a doctor who claimed that I made a mistake which caused him to delay surgery for his patient’s auditory nerve tumor. From a review of my report it was abundantly clear that the patient had retrocochlear characteristics that are consistent with an “eighth nerve or brainstem involvement” and not cochlear involvement. How could that have been misinterpreted? The physician only had read up to the first test result, that puretone testing showed a “sensorineural loss in the right ear.” On seeing the term “sensorineural” he incorrectly concluded that it was a cochlear problem and not a very dangerous auditory nerve tumor. He did not know that the term sensorineural could represent two importantly different types of hearing loss. Puretone thresholds distinguish conductive from both sensory and neural disorders.
然而，当我接到一个愤怒的医生打来的电话时，我震惊了，医生说我犯了一个错误，导致他推迟了为病人的听神经瘤做手术。从我的报告中可以清楚地看到，患者的蜗后特征符合“第八对脑神经或脑干受累”，而不是耳蜗受累。这怎么可能被误解呢？医生只读了第一个测试结果，纯音测试显示“右耳感音神经性损失”。在看到“感觉神经性”这个词时，他错误地认为这是一个耳蜗问题，而不是一个非常危险的听觉神经肿瘤。他不知道“感音神经性”一词可以代表两种重要的不同类型的听力损失。纯音阈值可以区分传导性与感音性神经性障碍。

Later on similar mistakes, with the term sensorineural, were made by knowledgeable audiologists in two separate publications. This convinced me that the term sensorineural can create serious problems that should be less problematic with the original term sensory-neural.
后来，有经验的听力师在两份不同的出版物中犯了类似的错误，使用了“感音神经性”一词。这使我相信，“感音神经性”这个术语可以产生严重的问题，最初的术语“感音-神经”就不会产生这么严重的问题。

Since the second edition of the Handbook we have used the term sensory-neural to avoid the errors caused by sensorineural (Katz, 1978). If those who coined the term sensorineural originally did not try to combine two auditory components that we try hard to distinguish from one another, it is likely that fewer problems would have occurred. Other authors have recognized the problem with the term sensorineural. Jacobson and Northern (1991) suggest using just sensory or neural, when it is clearly one or the other. Martin and Clark (2012) avoid the confusion by using the term sensory/neural which is also a good way to clarify the term. For this edition we will combine both the Jacobson and Northern and the Martin and Clark approached as this seems to be better than sensory-neural and avoids the problems that ‘sensorineural’ has caused.
自手册第二版以来，我们使用了“感音-神经性”这个术语来避免由“感音神经性”引起的错误（Katz, 1978）。如果那些发明“感音神经性”这个词的人最初并没有试图将我们难以区分的两种听力损失类型结合起来，那么很可能发生的问题就可能会减少。其他作者已经认识到“感音神经性”这个词的问题。雅各布森和诺森（1991）建议当能明显分别的时候只使用感音性或神经性。马丁和克拉克（2012）通过使用“感音/神经性”这一术语避免了混淆，这也是一种澄清术语的好方法。在本版中，我们将综合雅各布森和诺森以及马丁和克拉克的方法，因为这似乎比“感音-神经性”更好，避免了“感音神经性”引起的问题。

PURETONE
纯音

The reader might infer that the writer does not like compound words (two words that are combined to form a composite of the two, e.g., flashlight, textbook). We rarely combine opposites (e.g., dogcat, daynight, or even sensorineural). But when two words are frequently spoken together (e.g., base and ball) often the first step is to hyphenate them (base-ball) and when people get used to this expression, they are often combined and made a compound word (baseball).
读者可能会推断作者不喜欢复合词（两个词组合在一起构成一个复合词，如手电筒（flashlight），教科书（textbook））。我们很少把对立的事物结合在一起（例如，狗猫（dogcat），白天黑夜（daynight），甚至是感音神经性（sensorineural））。但是，当两个词经常要一起说时（如base和ball），通常第一步是使用连字符（base-ball），当人们习惯这个表达时，它们经常被组合成一个复合词（baseball）。

The term “pure tone” is shown one or more times on every audiogram and appears in almost every report and is a very common type of audiometer (but in that case it might be hyphenated because it is followed by a noun, e.g., pure-tone audiometer). Because (1) we have to explain this to students and often have to decide if it needs a hyphen when we are writing, and (2) it is surely time to graduate from pure-tone to puretone, this change seems appropriate. In this case there is no compelling reason for doing so (as it would be in the case of sensorineural) but it seems that it is time for “pure” and “tone” to be officially married and to be a compound word forever more.
“pure tone纯音”一词在每个听力图上出现一次或多次，并在几乎每一份报告中出现，这是一种非常常见的听力计类型（但在这种情况下，它可能是连字符，因为它后面跟着一个名词，例如，pure-tone audiometer纯音听力计）。因为（1）我们必须向学生解释这一点，并且在我们写作时常常必须决定它是否需要连字符；（2）是时候从pure-tone转向puretone了，这一改变似乎是可行的。在这种情况下，没有不可抗拒的理由这样做（就像“感觉神经性”的例子），但似乎是时候让“pure”和“tone”正式结合并永远成为复合词了。

ESPECIALLY FOR STUDENTS— SOME SUGGESTIONS
致学生——一些建议

As a student, it is most helpful to educate yourself broadly in your profession and related subjects. You may benefit from speech, psychology, and many other courses as much as from some of your audiology courses. The ability to take a broader view is certainly an advantage no matter how you plan to practice audiology.
作为一名学生，在你的专业和相关学科上进行广泛的自我学习是最有帮助的。你可能会从语言、心理学和许多其他课程中受益，就像从听力课程中受益一样。无论你打算如何练习听力学，能从更广泛的角度看待问题当然是一个优势。

When you have a choice in taking your first job, it is well to take one that covers a wider area of professional activity over one that is narrow. You may find that an area that previously did not seem too interesting is one that you realize is very interesting or gratifying. Also, if you have a broad experience you can qualify for more opportunities later on.
当你有选择第一份工作的机会时，最好选择一个涵盖广泛专业活动的领域，而不是一个狭窄的领域。以前看起来不太有趣的领域，你会意识到其实是非常有趣或令人兴奋的。此外，如果你有广泛的经验，可以在以后获得更多机会。

As you get deeper into your areas of major interest you will necessarily reduce how broadly you can practice. But having a prior background or learning can help you in what you are doing and perhaps provide variety in your professional activities. Later on, if you have specialized in one area then an exciting and enriching aspect is to carry out research to improve your success or simply to obtain a better understanding. One way to repay your profession for training you is to supervise students in your external practicum site. Mentoring students and sharing what you have learned can be most rewarding, but in addition you may learn some new concepts from the students that you may have missed or learn from having to answer their questions.
当深入到感兴趣的领域时，你会减少学习的广度。但是，拥有先前的背景或学习能够帮助你正在做的事情，也可能在你的专业活动中提供多种可能。此后，如果你专门从事一个领域，那么一个令人兴奋和充实的方面是进行科研以提高你的成功，或者只是为了获得更好的理解。回报你专业培训的一个方法是在你的外部实习场所监督学生。指导学生并分享你学到的知识可能是最有意义的，除此之外，你可以从学生那里学到一些你可能错过的新概念，或者从必须回答他们的提问中学到东西。

It is our pleasure to provide you with this book full of knowledge that was written by dozens of audiologists who have enjoyed sharing with you their hundreds of years of experience in this wonderful field. Finally, as professionals we should be committed to helping those we serve. We also need to follow the rules. Of course, in addition your work needs to provide you with the necessities of life. Despite these constraints, to a great extent, your profession is pretty much what you make of it.
我们很高兴为您提供这本满载知识的书，这本书是由几十位听力专家撰写，他们很高兴与您分享他们在这一奇妙领域的数百年经验。最后，作为专业人士，我们应该致力于帮助我们所服务的人。我们也需要遵守规则。当然，另外你的工作需要为你提供生活必需。尽管有这些限制，但在很大程度上，你的职业很大程度上取决于你对它的理解。

FOOD FOR THOUGHT
引人深思的事

1. What personal characteristics and experiences do you have that you think will be helpful to you as an audiologist?
   作为一名听力师，你认为你有哪些个人特征和经验对你有帮助？

2. You are the Director of an Audiology Department at a medical center. There is a need to establish guidelines for the audiologists to provide a degree of consistency (e.g., in reports). You have seen “sensorineural” spelled like that and also as sensory/neural. Consider the main reason for choosing each of them for your department.
   你是一家医疗中心的听力科主任。有必要为听力师建立指导方针，以提供一定程度的一致性（例如，报告中）。你见过这样拼写的“sensorineural”（感音神经的），也有sensory/neural感音/神经的。请考虑你的部门选择它们的主要原因。

3. If you were the editor of Handbook of Clinical Audiology and could only add one chapter to this edition, based on what you know or imagine, which of the six new chapters (see above) would you choose and why?
   如果你是《临床听力学》的编辑，根据你所知道或所想象，你只能在这个版本上增加一章，你会选择六篇新章节中的哪一章（见上面），为什么？