Appendix C: Answer Form for the MAPA 1.0 — Form A
Name
Date:
DOB
Age
500
1000
Sex
2000
Examiner
4000
OAE
Pressure
Volume
Comp
Right
Left
Note: Set audiometer to 50 dB HL or at patient’s MCL. Tape A = Right; Tape B = Left
Monaural Separation Closure (MSC)
mSAAT Non-competing (3)
NC-R (4)
NC-L (5)
Please _____ Bad
_____
Great
_____ Such
_____
Sled
_____ Need
_____
Pants
_____ Five
_____
Rat
_____ Rag
_____
Total
_____ Total
_____
mSAAT Competing
Instructions (6)
Instructions (8)
C-R (7)
C-L (9)
School _____ Broom _____
Ball
_____ Bowl
_____
Smoke _____ Coat
_____
Floor
_____ Door
_____
Fox
_____ Socks
_____
Hat
_____ Flag
_____
Pan
_____ Fan
_____
Bread
_____ Red
_____
Neck
_____ Desk
_____
Stair
_____ Bear
_____
Eye
_____ Pie
_____
Knee
_____ Tea
_____
Street
_____ Meat
_____
Wing
_____ String _____
Mouse _____ Clown _____
Shirt_____ Church _____
Gun
_____ Thumb _____
Bus
_____ Rug
_____
Train
_____ Cake
_____
Arm
_____ Barn_____
Chick
_____ Stick
_____
Crib
_____ Ship
_____
Wheel _____ Seal
_____
Straw
_____ Dog
_____
Pail
_____ Nail
_____
Total
____/25 Total
____/25
Auditory Pattern Temporal Ordering (APTO)
Tap Test Instructions: (10)
If they answer with anything but a
number, prompt them with “think back
and tell me how many you heard”.
Practice (11)
1. _____(5 Taps)
2. _____(7 Taps)
Test (12)
Tap 1: _________ (8 Taps)
Tap 2: _________ (12 Taps)
Tap 3: _________ (10 Taps)
Total for Tap 1,2,3 _____/30
Pitch Pattern Instructions: (13)
Binaural (14)
“You try…”__________
LHHH _________
HHLL _________
LHLL _________
HHLH _________
HHHL _________
LHHL _________
HLLL _________
LLLH _________
HLHH _________
LLHH _________
HLHL _________
LHLH _________
HLLH _________
LLHL _________
HHHL _________
LLLH _________
HLHH _________
HHLL _________
HHLH _________
LHHH _________
Total _________/20
Name:
Binaural Integration Binaural Separation (BIBS)
Dichotic Digits
Right Ear 1st (16)
3 …5 …2 / …1 …8 …6
4 …1 …8 / …6 …2 …5
2 …1 …9 / …5 …4 …8
2 …5 …4 / …6 …3 …1
5 …4 …8 / …2 …6 …3
4 …1 …9 / …3 …2 …6
3 …8 …1 / …6 …9 …4
2 …9 …6 / …1 …3 …8
9 …6 …1 / …4 …8 …3
9 …2 …4 / …5 …8 …1
Instructions (15)
Left Ear 1st (17)
2 …5 …3 / …8 …6 …9
8 …4 …9 / …5 …2 …6
9 …1 …2 / …8 …4 …5
3 …5 …2 / …1 …4 …6
8 …1 …5 / …3 …9 …2
9 …1 …4 / …6 …5 …3
1 …9 …4 / …6 …3 …2
5 …6 …2 / …8 …3 …9
9 …4 …6 / …1 …2 …8
4 …2 …9 / …6 …8 …5
Competing Sentences Instructions (18)
Rt Ear First (19) - Circle L/R of correct sentences
1. R - The caboose is always last.
L - This is a long freight train.
2. R - Recess is my favorite time.
L - I don’t like to go to school either
3. R - Put gas in the tank.
L - My car is very fast.
4. R - I do not like to eat dinner alone.
L - They say candy is bad for your teeth
5. R - That scratch may get infected.
L - Put a clean bandage on that cut.
6. R - I saw it when it was a play.
L - That movie was on TV.
7. R - There are lions and tigers in the zoo.
L - I saw lots of different kinds of animals.
8. R - Don’t forget your father’s birthday.
L - My sister has a new boyfriend
9. R - I had to take a nap.
L - He is only resting.
10. R - He’s off for Easter week.
L - I had a wonderful Christmas.
11. R - Visit your grandmother on Sunday.
L - Make sure you call your brother this
week.
12. R - Summer is finally here.
L - The sun is finally shining.
13. R - Did your boss give you a raise?
L - Do you have to take many business
trips?
14. R - Goldfish are easy to keep.
L - That dog likes to run.
15. R - He doesn’t like his new boss.
L - Make sure you get to work on time.
Total ___/30: Note: Sentences must be exact to
be scored correct.
Right 1st Total _____/60
any order
Left 1st Total______/60
any order
R/L Total________/120
any order
Competing Sentences Instructions (20)
Lt Ear First (21) - Circle L/R of correct sentences.
1. L - It was a long ride by car.
R - I thought we would never get there.
2. L - He went to the South on his vacation.
R - I get two weeks off in the summer.
3. L - Make sure you deposit that check.
R - I need to borrow five dollars.
4. L - I put the letter in the mailbox.
R - You must write to her more often.
5. L - He drank all of the milk.
R - I like my coffee black.
6. L - When did your dog get sick?
R - Do you want to buy that cute puppy?
7. L - He was very late to class yesterday.
R - I went to the cafeteria at noon.
8. L - The airplane flew very low.
R - The jet took off smoothly.
9. L - I have the best teacher in school.
R - He was a student here before me.
10. L - I saw the funny clown.
R - The circus was very good.
11. L - What’s your address?
R - They bought a new house.
12. L - I never saw a bear.
R - Cats have whiskers.
13. L - How many of your brothers live at home?
R - How long have your parents been
married?
14. L - She has a fever.
R - See your doctor.
15. L - How much snow fell?
R - Has it started raining?
Total ___/30: Note: Sentences must be exact to
be scored correct.
Name:
Supplementary Tests
Duration Patterns
Binaural
Instructions (22)
Test (23)
“You try…” ______
LSSS _____
SSLL _____
LSLL _____
SSLS _____
SSSL _____
LSSL _____
SLLL _____
LLLS _____
SLSS _____
LLSS _____
SLSL _____
LSLS _____
SLSS _____
LLSL _____
SSSL _____
LLLS _____
SLLS _____
SSLL _____
SSLS _____
LSSS_____
Total _____/20
Comments:
SINCA
Instructions (24)
Right (25)
+20 dish teach pinch pink *(___)
+16 bead bath
tree shop _____
+12 five rat
mouth box _____
+8 fed
such need hunt _____
+4 ride class hit
scab _____
+0 great smile pond sled _____
Total number correct (*exclude +20)
____/20
Score: 18 - Total # correct = ____SNR
SINCA
Instructions (26)
Left (27)
+20 hot
please few cart *(___)
+16 bad pants slip law _____
+12 ways thank fold bus _____
+8 slice rag
put
did _____
+4 take beef
neck suit _____
+0 turn darn laugh clamp _____
Total number correct (*exclude +20)
____/20
Score: 18 - Total # correct = ____SNR
AFT-R
(Gap Detection Test)
Instructions (28)
Test items: (29)
Practice 1 ______
Practice 2 ______
5 _____
10 _____
40 _____
15 _____
20 _____
2 _____
30 _____
0 _____
25 _____
Lowest msec gap
detected (i.e. lowest
number w/2 ______
Appendix C: Answer Form for the MAPA 1.0 — Form B
Name
Date:
DOB
Age
500
1000
Sex
2000
4000
Examiner
OAE
Pressure
Volume
Comp
Right
Left
Note: Set audiometer to 50 dB HL or at Patient’s MCL. Tape A = Right; Tape B = Left
Monaural Separation Closure (MSC)
mSAAT Non-competing (31)
NC-R (32)
NC-L (33)
Please _____ Bad
_____
Great
_____ Such
_____
Sled
_____ Need
_____
Pants
_____ Five
_____
Rat
_____ Rag
_____
Total
_____ Total
_____
mSAAT Competing
Instructions (34) Instructions (36)
C-R (35)
C-L (37)
Moon
_____ Spoon _____
Bell
_____ Bow
_____
Coke
_____ Goat_____
Corn
_____ Horn
_____
Box
_____ Blocks _____
Bag
_____ Black
_____
Can
_____ Man
_____
Thread _____ Bed
_____
Nest
_____ Dress
_____
Chair
_____ Pear
_____
Fly
_____ Tie
_____
Key
_____ Bee
_____
Feet
_____ Teeth
_____
Spring _____ Ring
_____
Crown _____ Mouth _____
Dirt
_____ Church _____
Sun
_____ Gum
_____
Cup
_____ Bug
_____
Snake _____ Plane
_____
Car
_____ Star
_____
Dish
_____ Fish
_____
Bib
_____ Lip
_____
Queen _____ Green _____
Saw
_____ Frog
_____
Jail
_____ Tail
_____
Total
____/25 Total
____/25
Auditory Pattern Temporal Ordering (APTO)
Tap Test Instructions: (38)
If they answer with anything but a
number, prompt them with “think back
and tell me how many you heard”.
Practice (39)
1. _____(5 Taps)
2. _____(7 Taps)
Test (40)
Tap 1: _________ (8 Taps)
Tap 2: _________ (12 Taps)
Tap 3: _________ (10 Taps)
Total for Tap 1,2,3 _____/30
Pitch Pattern Instructions: (41)
Binaural (42)
“You try…”__________
LLHH _________
LHLH _________
LLHL _________
HHLH _________
HLLL _________
HLHH _________
LHHH _________
LLLH _________
HLLH _________
HHHL _________
HHLL _________
LHHL _________
HLHL _________
LHLL _________
HLLH _________
HLHL _________
HHLL _________
HHHL _________
LHHL _________
LHHH _________
Total _________/20
Name:
Binaural Integration Binaural Separation (BIBS)
Dichotic Digits Instructions (43)
Right Ear 1st (44)
6 …8 …1 / …2 …5 …3
5 …2 …6 / …8 …1 …4
8 …4 …5 / …9 …1 …2
1 …3 …6 / …4 …5 …2
3 …6 …2 / …8 …4 …5
6 …2 …3 / …9 …1 …4
4 …9 …6 / …1 …8 …3
8 …3 …1 / …6 …9 …2
3 …8 …4 / …1 …6 …9
1 …8 …5 / …4 …2 …9
Left Ear 1st (45)
9 …6 …8 / …3 …5 …2
6 …1 …5 / …9 …4 …8
5 …4 …8 / …2 …1 …9
6 …4 …1 / …2 …5 …3
2 …9 …3 / …5 …1 …8
3 …5 …6 / …4 …1 …9
2 …3 …6 / …5 …1 …8
9 …3 …8 / …2 …6 …5
8 …2 …1 / …6 …4 …9
5 …8 …6 / …9 …2 …4
Competing Sentences Instructions (46)
Rt Ear First (47) - Circle L/R of correct sentences
1. R – The children played tag for a long time.
L – I think hide and seek is a lot of fun.
2. R – I was able to go to the park.
L – They went to the zoo Sunday.
3. R – Your uncle is not over there.
L – My sister is older than I am.
4. R –I think I hear a radio playing.
L – There’s a color television over there.
5. R – I like to run my model train.
L – He’s too old to play with toys.
6. R – I had a sandwich for lunch.
L –There was fried chicken for dinner.
7. R – I put strawberries on my ice cream.
L – Dessert was a chocolate sundae.
8. R – I like maple syrup on my waffles.
L – Mother made pancakes for breakfast.
9. R – They won’t answer the phone.
L – Nobody is at home.
10. R – There’s a lot of snow on the ground.
L – It’s raining very hard.
11. R – We’re going to paint the guest bedroom
next week.
L – She just moved into a 3 room apartment.
12. R – She’s the one who gives singing lessons.
L – The free concerts are wonderful.
13. R – She wants to start buying some stock.
L – Do you think we should buy him a
savings bond?
14. R – How much is the bill?
L – Can I pay by check?
15. R – Practice the guitar.
L – Turn the radio off.
Total ___/30: Note: Sentences must be exact to
be scored correct.
Right 1st Total ______/60
any order
Left 1st Total _______/60
any order
R/L Total_________/120
any order
Competing Sentences Instructions (48)
Lt Ear First (49) - Circle L/R of correct sentences.
1. L – Do you want gravy on your potatoes?
R – Do you want to have a BBQ this evening?
2. L – Visit your grandmother on Sunday
R –How long have your parents been married?
3. L – Will you go to the beach even if it’s still
cloudy?
R – Will you be going on vacation in the spring?
4. L – Did you remember to call you grandmother?
R – Does he still live with his parents?
5. L – Do you know of a good band for the party?
R – She’s the one who gives singing lessons.
6. L – How much did they charge you for the
alterations?
R – Buy that bathing suit because it fits you.
7. L – Pass the bread and butter.
R – Cake is sweet.
8. L – How many cats do you have?
R - Don’t let the dog off his leash.
9. L – Don’t try to run unless you have good shoes.
R – Bring your sneakers to the exercise class.
10. L – Wear a heavy sweater since it’s cold.
R – Take the dog out before it snows.
11. L – Have you eaten yet?
R – I want coffee.
12. L – Play that song.
R – Can you sing?
13. L – Bring your sneakers to the exercise class.
R – I don’t like to swim in an indoor pool.
14. L – Can she ice skate?
R – Throw me the ball.
15. L – Please turn on the coffee.
R – What do you want for lunch?
Total ___/30: Note: Sentences must be exact to be
scored correct.
Name:
Supplementary Tests
Duration Patterns –
Binaural
Instructions (50)
Test (51)
“You try…”______
LLSS _____
LSLS _____
LLSL _____
SSLS _____
SLLL _____
SLSS _____
LSSS _____
LLLS _____
SLLS _____
SSSL _____
SSLL _____
LSSL _____
SLSL _____
LSLL _____
SLLS _____
LSLS _____
SSLL _____
SSSL _____
LSSL _____
LSSS_____
Total _______/20
Comments:
SINCA
Instructions (52)
Right (53)
+20 tire
seed
room bug *(___)
+16 that sell
rich those _____
+12 black nest
had cost _____
+8 fit
bounce wide most _____
+4 thick them dad ship _____
+0 case choose white frog _____
Total number correct (*exclude +20)
____/20
Score: 18 - Total # correct = ____SNR
SINCA
Instructions (54)
Left (55)
+20 bush
+16 pass
+12 leave
+8 paste
+4 park
+0 knife
clown
grade
nuts
page
wait
turn
cab
blind
laugh
weed
fat
grab
hurt
drop
falls
gray
cage
rose
*(___)
_____
_____
_____
_____
_____
Total number correct (*exclude +20)
____/20
Score: 18 - Total # correct = _____SNR
AFT-R
(Gap Detection Test)
Instructions (56)
Test items: (57)
Practice ______
Practice ______
5 _____
10 _____
40 _____
15 _____
20 _____
2 _____
30 _____
0 _____
25 _____
Lowest msec gap
detected (i.e. lowest
number w/2 ______
MAPA SUMMARY SHEET
MAPA Summary
Name_____________________Age____
Domain
MSC
APTO
BIBS
Test
MSAAT RE
MSAAT LE
Tap Test
Pitch Pattern
DD
CS Rt Ear
CS Lt Ear
Raw
Score
If age 11, use mean
data based on closest
grade.
-1 SD
based on
age
*
*
*
*
*
*
*
-2 SD
based
on age
**
**
**
**
**
**
**
Circle 2 stars for
- 2 SD or 1 star for - 1 SD if raw
score is lower than mean data
from Appendix B which you fill
in above.
Severity
Domain
MSC
APTO
BIBS
Total Domains
________
Total Stars
________
(0-3)
(-2 SD only)
(only count stars if
there is at least one
domain at
-2 SD)
Supplementary Tests
Test
Raw
-1 SD
Score based on
age
SINCA RE
*
SINCA LE
*
# _______
*
DP
*
AFT-R (Gap
*
Detection Test)
## _______
*
###_______
*
###_______
*
# SCAN AFG or SCAN FW, QUICKSIN, BKB-SIN, etc.
## GIN, AFT-R, etc
### SCAN CW, SCAN CS, etc
-2 SD
based
on age
**
**
**
**
**
**
**
**