New course dates announced for Audiology training by @TracyJamesAudiologist

Our 4th of December @ The British Society of Audiology  accredited course in impression-taking is set to go ahead as planned at @Newbury College as impression-taking comes under the category medical services. Making a good impression of the ear is a skill that develops with experience, but first and foremost must be safe. Our courses focus on safety to each other and our patients / clients as a priority and will follow the British Society of Audiology guidance for both the procedure and covid-19 safety. As a result, we are pleased to announce another date on the 29th of January 2020 for impression-taking and a course in February for Audiometry and Tympanometry.

BSA_PPC_RP_Impressions_FINAL_12Feb2013 (2)

#audiology #hearing #ears #hearingprotection #training #audiologytraining

Introducing Louise Hart

Louise Hart joins Tracy James to deliver tinnitus and hyperacusis services to adults and children from October 2020. She will also be providing her expertise in our training courses delivered to provide British Society of Audiology Certificates in impression-taking, hearing surveillance and audiometry and tympanometry.

Louise says ‘ I am excited to be providing more independent work, alongside my NHS work. I really enjoy training and have pride in helping individuals enable their skills to the recognised standard of the British Society of Audiology. We will be training GPs, teachers of the deaf, assistant audiologists and any professional who works in the hearing industry, and I look forward to meeting our new delegates at the next course in Newbury.’

‘With regards to tinnitus, I will be providing the only independent tinnitus and hyperacusis management service in West Berkshire at Tracy James Hearing. We know the earlier we intervene in helping people manage their tinnitus and hyperacusis the more successful the outcome for them’

Despite research on drug or physical interventions on tinnitus, at present none seem to consistently reduce tinnitus well enough; this is why management techniques are used to combat tinnitus.  For over 20 years chronic pain sufferers have successfully been using cognitive behavioural techniques to manage pain, and we now have more studies showing the same success with tinnitus.

Louise will tailor a programme to you to help your tinnitus and/or hyperacusis; these can be provided face to face or through video consultation. For further information on tinnitus and or to book an appointment, go to Tracy’s website

For further information on audiology training courses, go to


OTIS Simulation software

Audiometry Simulation Software


Otis the virtual patient (from can be used to practise basic audiometry and tympanometry and masking. We use it in our classes and its a great way of developing your skills in audiometry without having the pressure of time or the client’s ability to focus, while getting used to the controls and techniques required. If you’re learning how to carry out masking, it is an invaluable learning and evaluation tool and you don’t need to rely on your supervisor to explain results.


Otis is a little bit like a real person, for example, your client can fall asleep if you take too long or shout if you present sounds that are too loud. You can view your otoscopy, history and tymp data as part of the assessment. There is reference data for masking and symbols. You have real-time evaluation and assessment of your procedure as you do the audiometry – it tracks your accuracy, time and errors. You can also progress from easier audiograms, to more difficult cases.


For further information please see our course guide to Audiometry & Tympanometry

Covid-19 and Online Audiology Training

Unfortunately, due the closing of colleges as a result of the coronavirus pandemic, audiology courses at Newbury College will not resume until government advice changes and you will be informed with further notice regarding new dates.

We will let you know as soon as new dates for courses are possible again.

If you wish to update your skills while you are working from home, then Tracy James provides online tutorials, training courses and refreshers – for all your audiology training needs.

Keep safe everyone.

Rule 3 explained? Masking Training with Tracy

In this post I would like to share some thoughts about rule 3.

This is the rule that many people scratch their head over, mainly because it can be difficult to see, but also because it doesn’t come up that often (and generally only in more complex cases). Therefore, if you’re used to testing routine cases you may not have to think about rule 3 very much. That’s why it’s good to refresh your knowledge so that you don’t miss it when it does come along. Completing rule 3 means that your hearing test will be more accurate; the end result may affect your diagnosis and also your hearing aid prescription.

How does Rule 1 differ to Rule 3 in masking?

We know that Rule 3 is only needed when Rule 1 has not been carried out and that both involve air conduction masking. But why?

Masking is carried out when there is a difference of 40dB between cochleae when using headphones. When we look at Rule 1 the difference between the two cochleae are obvious:

Masking 1

We mask the air conduction, and find the following:

Masking 2

Rule 1 was carried out at all the frequencies as there was a difference of >40 dB  at all the frequencies between the 2 ears. Headphones were used and the left ear was the test ear, and the right ear was the non-test ear, to be masked.

However, the difference between the two cochleae can be hidden when the non-test ear has a conductive component. Say for example the same patient as above comes back a few weeks later with a hideous cold that has affected his right ear.

Masking 3

There was no need to do air conduction masking in this scenario (Rule 1 not required).

Bone conduction was carried out on the worse ear:

Masking 4

As the there was an air bone gap of >10dB between the air and bone conduction thresholds (Rule 2), bone conduction masking needed to be carried out at 0.5, 1, 2 and 4 kHZ. The left ear was the test ear using bone conduction, and the right ear was the non-test ear, to be masked.

Once bone conduction was completed, we could see an asymmetry once again:

Masking 5

In this case we could only see that the right cochlea was >40dB better than the left cochlea because bone conduction had been completed. So we went back to using headphones again and masked the air conduction, with the masking noise in the right ear (non-test ear), and retested the hearing thresholds on the left ear (test ear). This revealed the following:

Masking 6

Moderate to severe sensorineural hearing loss on the left. Mild conductive hearing loss on the right.

Rule 3 explained? (Some tips):

  • Rule 3 is usually required because the non-test ear has a conductive component
  • The asymmetry that is present between the 2 cochleae (as you would visibly see in Rule 1) is hidden until you carry out the bone conduction. That is why you only carry out Rule 3 if Rule 1 has not been carried out.
  • Rule 3 is often missed because the BC that relates to the better ear (non-test ear) is recorded on the side on which the BC is placed (worse ear). Therefore you have to think to which ear the not-masked BC belongs to.
  • Although you check the BC to ascertain an asymmetry, you don’t use the BC in your masking procedure – you are masking the AC thresholds only.
  • At frequencies where no b-c thresholds have been measured – if there is a possibility that a-c threshold at these frequencies (including 250 Hz and 8000 Hz) are not the true thresholds, they should be masked.

If you have any questions please send an email to and either myself or Louise will get back to you

Tracy James visits Estonia

Tracy James of TJ Audiology delivered a 3 day BSA certificate training course in Audiometry and Tympanometry at Medivar in Tallin, Estonia. Tallinn was fantastic, with a beautiful old town; cobbled streets, 14th Century buildings and lots of history. Estonians are also very exotic with only 1 million inhabitants. For those of you that don’t know – Estonians speak Estonian which has a lovely sing song lilt to it.

The training course was delivered to 5 employees in English and I was amazed at how those on the course (and Europeans in general) were able to use English in their day to day lives. Everyone took great assurance in having lots of practice time and as the group was small, there was lots of time to make sure that questions could be answered. Some of what we covered included anatomy and physiology, otoscopy images (possible abnormalities we may come across), contraindications, physics of sound as well as the practical procedure.

Feedback included: “Very thorough and in-depth. Informative, professional and gave consistent support and feedback to the practical assessments as well as to how we were progressing in general. Pace was perfect.”

I was pleased to have visited both Estonia and Medivar and to learn more about Estonian culture as well as Audiology Services. Medivar is a European distributor of health equipment, including Audiology equipment and supplies. I found the people I worked with there very professional and I was very well looked after. Thank you very much!


Tallinn Audiology Training Estonia Audiology Town Walls Estonia Audiology Training


HSE and Hearing Surveillance – Industrial Audiometry UK

The HSE indicates there is variation in practice and standard across practitioners in Hearing Surveillance Programmes. Does your occupational health worker attend a British Society of Audiology accredited course?

Tracy James MSc

The Health and Safety Executive (2013) carried out visits and questionnaires across a range of health surveillance programmes across the UK so that current practices across teams and individuals could be evaluated. Their key findings included that there was variation in practice across practitioners and health surveillance programmes. In particular, they noted that:

 ‘….some practitioners probably did not adopt sufficient measures to exclude the effects of prior exposure to noise and background noise when the test was being conducted’

…and with regards to training competency they noted:

If practitioners had undergone appropriate training there is an assumption that they would be competent to undertake otoscopy, but it was found that otoscopy was not always carried out before testing’

HSE (2013). Current Practice in Health Surveillance for Noise, pp iii


The Health and Safety Executive (HSE) outlines clearly what is required with regards to a health and surveillance programme under the Guidance on Regulations ‘Controlling Noise at Work’ 2005. In Appendix 5 it reports that a training syllabus for industrial audiometricians has been prepared by the British Society of Audiology (BSA) which has accredited a number of courses. The document is available at


Why choose a BSA accredited course? In order to be accredited, the provider has submitted the course content and assessment material to experts in the field to ensure that the training is accurate and according the recommended procedures published by the BSA. It also ensures that the minimum training guidelines are fulfilled and that the trainer has a suitable background knowledge/qualifications for providing the training. A representative of the BSA will also visit the course provider during their training programme.  In order to remain accredited, course providers are required to resubmit their training material every 3 years to ensure the course is up to date.

BSA industrial audiometry courses are designed to enable occupational health workers to:

  • Undertake a brief subject interview and/or administer a questionnaire regarding otological and noise history
  • Perform otoscopy and pure-tone a-c threshold audiometry without masking, both in accordance with BSA recommended procedures. Audiometry may be manual or automated
  • Interpret results and classify them in accordance with HSE guidelines
  • Relay information to subjects and, with consent, to the employer or other person with overall responsibility for that particular hearing test program.
  • Make appropriate 3rd party referrals

BSA (2008)

Has your occupational health worker completed a BSA accredited course in industrial audiometry? When you scroll online you can see many courses that quote their course is ‘BSA approved’ or  ‘based on’ BSA guidelines or ‘follows’ BSA recommended procedures – but they’re not actually accredited! The BSA lists the accredited courses available nationally on or you can check your course is accredited by contacting

A BSA accredited course may the key to enable consistency in training and competency levels across practitioners within a hearing surveillance programme. Choose your course and make sure it is accredited. The BSA (2008) recommends that the occupational health worker attends a refresher course in industrial audiometry every 3 years.



HSE (2013). Current Practice in Health Surveillance in Noise.

HSE (2005). Controlling Noise at Work. Guidance on Regulations

BSA 2008. Guidelines on the Training of Industrial Audiometricians.


Tracy James MSc is a Clinical Scientist and director of TJ Audiology Services, an Audiology Training Service. The next BSA accredited course in Industrial Audiometry is at PC Werth Headquarters, London on 18TH April 2016 and in-house or tailor-made course are available. See or email for details and booking.