Attenuation provided by four different audiometric earphone systems

The attenuation provided by TDH earphones in MX-41/AR and P/N 51 cushions, Audiocup earphone enclosures and ER-3A insert earphones with ER3-14 foam earplugs was determined for 30 normally hearing subjects using a real-ear attenuation at threshold paradigm. The MX-41/AR and P/N 51 cushions provided about the same amount of attenuation which was less than the attenuation provided by the Audiocup enclosures. The ER-3A/ER3-14 provided the highest amount of attenuation. The MX-41/AR and ER-3A/ER3-14 attenuation values were in agreement with other studies using similar methodology. However, the attenuation provided by the Audiocup enclosures was considerably less, in the lower frequencies, than reported in two other studies. ANSI S3.1-1977 supra-aural earphone cushion attenuation values, which were determined using pure-tones presented in a free-field, should be replaced by earphone cushion attenuation values determined with 1/3 octave bands of noise presented in a diffuse sound field.     

The influence of RECD transducer when deriving real-ear sound pressure level

OBJECTIVE: The main aim of the present study was to compare the derived and directly measured real-ear hearing instrument performance for a range of commonly used hearing instruments. A secondary aim was to compare the real-ear to coupler difference (RECD) measured using the ER-3A insert earphone and a selection of hearing instruments. DESIGN: The real-ear SPL was measured for four models of hearing instrument in 20 adult participants using an Audioscan RM500 real-ear system. This was compared with the derived real-ear SPL obtained by adding the RECD (measured using the ER-3A insert earphone) to the 2-cc coupler response of each hearing instrument. Measurements were made at 1/12 octave intervals from 0.2 to 6 kHz, using both the HA1 and HA2 2-cc coupler. In addition, the RECD was measured using four models of hearing instrument for comparison with the ER-3A insert earphone values. RESULTS: The procedures were very reliable with mean differences on retest of less than 1 dB. Repeated-measures analysis of variance revealed statistically significant differences between the measured and derived real-ear SPL (p < 0.001) for several models of hearing instrument. The derived responses using the HA1 coupler yielded good accuracy, whereas the HA2 yielded less accuracy. For three models of hearing instrument, the maximum difference was between 5 and 10 dB when using the HA2 coupler. The mean RECD measured with the ER-3A insert earphone and HA2 coupler was not always equivalent to the RECD measured with the hearing instruments. CONCLUSIONS: The accuracy of the derived real-ear response obtained using an RECD, measured with an ER-3A insert earphone, is very good when an HA1 is used for the coupler component of the RECD. The accuracy diminishes somewhat with the HA2 coupler, especially for undamped hearing instruments. The accuracy of the derived real-ear response is very good when the RECD is measured using the hearing instrument and the HA1 or the HA2 coupler.     

Is the real-ear to coupler difference independent of the measurement earphone?

Direct measurement of real-ear hearing aid performance can be obtained using a probe tube microphone system. Alternatively, it can be derived by adding the real-ear to coupler difference (RECD) to the electroacoustic performance of the hearing instrument measured in a 2-cc coupler. Inherent in this derivation is the assumption that the RECD measured with one transducer can be applied to a coupler measurement performed with a different transducer. For the RECD procedure to be valid, it should be independent of the measurement transducer. The Audioscan RM500 is an example of a commercially available real-ear measurement system that incorporates a clinical protocol for the measurement of the RECD. The RECD can be measured on the Audioscan RM500 using a standard EAR-Tone ER-3A insert earphone or the Audioscan's own RE770 insert earphone. The aim of this study was to compare the RECDs obtained with these two earphones. The Audioscan RM500 was used to measure the RECD from the right ears of 18 adult subjects ranging in age from 22 to 36 years (mean 25 years). Measurements were made with the EAR-Tone ER-3A and RE770 insert earphone and three earmould configurations: (1) the EARLINK foam ear-tip; (2) a hard acrylic shell earmould with the same length of acoustical tubing as the foam ear-tip (25 mm); and (3) the shell ear mould with the appropriate length of tubing for a behind-the-ear (BTE) hearing aid fitting (approximately 35-45 mm). The results show that the mean RECD was around 3 dB higher at 1.5 kHz with the foam ear-tip when measured with the RE770 earphone than when measured with the ER-3A earphone. The same magnitude of difference was obtained with the shell earmould and 25-mm tubing; however, this increased to 9 dB when the tubing was increased to around 40 mm for a BTE fitting. The difference in mean RECD with the two earphones was statistically significant on a repeated-measures ANOVA for every earmould configuration (p<0.001). The results of this study demonstrate that the RECD procedure that uses an HA2 coupler and earmould is not independent of the measurement earphone. This has important implications for clinical practice.     

A comparison of inter-aural attenuation with the Etymotic ER-3A insert earphone and the Telephonics TDH-39 supra-aural earphone.

One of the many reported advantages of the insert earphone over the supra-aural earphone is increased inter-aural attenuation (IA). Minimum values of IA determine the need for masking of the non-test ear in air-conduction audiometry. The aim of the present study was to measure inter-aural attenuation for the Etymotic Research ER-3A insert earphone (with deep and shallow insertion of the ear plug within the ear canal) and compare this with the supra-aural Telephonics TDH-39/MX41-AR earphone/cushion combination. Subjects were 18 adults ranging in age from 38 to 68 years (mean 50 years). Each subject had no hearing in one ear following translabyrinthine surgery for removal of an acoustic neuroma. The opposite ear had hearing thresholds better than 40 dB HL and an air-bone gap of less than 10 dB at any audiometric frequency. Pure tone air-conduction thresholds were obtained in the range 0.25-8 kHz. Deep insertion of the insert earphone was deemed to occur when the outside edge of the ear plug was flush with the entrance of the ear canal. Shallow insertion was deemed to occur when half of the ear plug (6 mm) was inside the entrance of the ear canal. IA was defined operationally as the difference between the good-ear and poor-ear not-masked air conduction threshold for a given audiometric frequency and earphone. The results show that the TDH-39/MX41-AR combination provides a median IA of approximately 60 dB with a lower limit of approximately 45 dB. Greater IA was obtained with the ER-3A insert earphone but this depended on the depth of insertion. With a deep insertion, the 1A values were some 15-20 dB greater than with the supra-aural earphone. Although frequency-specific IA values are provided, a simple rule of thumb is to apply masking to the non-test ear when the pure tone airconduction signal from the ER-3A insert earphone exceeds the bone conduction threshold of the non-test ear by 55 dB HL or more. If it is not possible to obtain a deep insertion depth this value should be reduced by 5 dB.     

A comparison of three HA-1 couplers

The use of 2-cm3 couplers for measuring the output of an ER-3A earphone has been recommended. The purpose of this study was to compare the acoustic output of three commonly available couplers and to study the intra- and inter-examiner reliability with which those measurements may be performed. While the repeatability of measurements, at least for clinical purposes, was good even for hand-held coupling of the earphone to the couplers, differences between couplers were observed. These differences were influenced by the positioning of the sound-outlet orifice relative to the interior, top wall of the couplers' cavities. A recommendation for 2-cm3 coupler calibration of the ER-3A earphone using a commonly available adapter was made.     

Interaural attenuation for tubephone insert earphones

Interaural attenuation of pure tone and speech signals was evaluated for a new audiometric insert earphone, the ER-3A tubephone, and a conventional TDH-49P supra-aural earphone in seven unilaterally deaf adult subjects. These results validate and extend the interaural attenuation data reported by the manufacturer of the ER-3A and his associates. At frequencies of 0.5 to 1 kHz, mean interaural attenuation for the deeply inserted ER-3A decreased from 94+ dB to 81 dB, with the lowest value for any subject, 75 dB. Interaural attenuation for speech approximated that of the 1 to 2 kHz frequency range. The ER-3A tubephone provides significantly greater acoustic isolation between the two ears in the low-mid frequency audiometric range than the conventional supra-aural earphone.     

Rising-frequency chirps and earphones with an extended high-frequency response enhance the post-auricular muscle response

The purpose of this study was to determine whether rising-frequency chirps presented via earphones with an extended high-frequency response would optimize the post-auricular muscle response (PAMR). The PAMR was recorded in adults using three different stimuli (a click, a rising-frequency chirp, and a truncated speech stimulus, /t/). Conventional ER-3A insert earphones were compared to ER-2 insert earphones to determine whether the PAMR is enhanced by the ER-2's extended highfrequency response. There were significant stimulus and earphone effects on PAMR amplitudes. The PAMR was largest for the chirp stimulus and the ER-2 earphones. The poorest responses were obtained using the /t/ stimulus and conventional ER-3A earphones. The results support previous ABR studies that have demonstrated a significant advantage of chirps over clicks for evoked response audiometry, and indicate that the PAMR is enhanced by inclusion of additional high-frequency stimulus energy.     

Hearing aid coupler output level variability and coupler correction levels for insert earphones

HA coupler type SPLs were independently determined by two experimenters for five repeated measurements with and without replacement of two ER-3A and two EARTONE 3A insert earphones. Measurements were made using a B&K DB-0138 coupler configured as an HA-1, HA-2 earphone coupler and HA-2 earphone coupler with entrance through a rigid tube referred to as the DB-0138 coupler. The HA-1, HA-2, and DB-0138 SPLs were found to be very stable (+/- 0.2 dB) for all intra- and interexperimenter measurements for each insert earphone and coupler type from 125 to 8000 Hz. Averaged across both experimenters and all repeated measurements, the mean HA-1 and HA-2 coupler SPLs were similar for each insert earphone from 125 to 8000 Hz. The mean HA-1, HA-2, and DB-0138 coupler SPLs were similar for each insert earphone from 125 to 2000 Hz; however, from 3000 to 8000 Hz the DB-0138 coupler SPLs were higher than the HA-1 and HA-2 coupler SPLs for each insert earphone. This occurred because of the geometrical differences between the insert earphone to coupler connections and coupler types. The HA-1 minus DB-0138 and HA-2 minus DB-0138 coupler SPL differences, or coupler correction levels, could be explained by quarter-wave resonances and stepped-diameter tubing systems creating acoustic horn effects.     

Three studies comparing performance of the ER-3A tubephone with the TDH-50P earphone

Three studies compared the performance of the ER-3A Tubephone insert earphone and the TDH-50P-MX41/AR supra-aural earphone. The three factors addressed were: threshold differences in children 7 to 10 yr old compared to adults, differences in real ear attenuation, and threshold differences in the presence of high background noise levels. The influence of insertion depth of the ER-3A Tubephone was also investigated. Findings showed no significant threshold differences between children and adults, significantly better real ear attenuation for the ER-3A Tubephone, and significantly better thresholds for the ER-3A in the presence of high background noise levels. Most critically, there was a significant change in attenuation characteristics of the ER-3A Tubephone, which was dependent on the insertion depth of the ear-tip.     

Test-retest variability in audiometric threshold with supraaural and insert earphones among children and adults

The effect of age and earphone condition on test-retest intrasubject variability in audiometric threshold was investigated. Ten subjects in each of the following age groups were investigated: 6-9 years, 10-13 years and young adults. Test-retest audiometric thresholds were collected at six frequencies (250, 500, 1,000, 2,000, 4,000 and 8,000 Hz) under three earphone conditions (Telephonics TDH-50P supraaural and Etymotic Research ER-3A insert earphone coupled to an immittance probe cuff or a foam insert). No statistically significant differences were found in variability of test-retest differences as a function of age, earphone condition or test frequency (p greater than 0.05). The clinical application of the insert earphone is recommended with children and adults as it affords no greater test-retest variability and at the same time provides a solution to a number of limitations incurred with the use of the supraaural earphone.     

Comparison of Beyer DT48 and etymotic insert earphones: auditory brain stem response measurements

Click-evoked auditory brain stem responses (ABRs) were measured using a Beyer DT48 circumaural earphone and an Etymotic ER-3A insert earphone in a group of normal-hearing subjects. Comparisons were made between time waveforms and amplitude spectra for the two transducers. ABR waveforms, latencies, and thresholds were compared for the two transducers. Click-evoked ABR and behavioral thresholds were comparable for the two earphones. In addition, absolute response-component latencies differed by an amount that was equivalent to the travel time introduced by the insert earphone's sound-delivery tube. Inter-peak latency differences were virtually identical. These findings suggest that the insert earphone is a viable transducer for clinical ABR evaluations. Further, a temporal correction may be all that is necessary to account for the difference between the insert earphone and the circumaural earphone if other characteristics of the transducers are similar.     

Measuring the real-ear to coupler difference transfer function with an insert earphone and a hearing instrument: are they the same?

OBJECTIVE: The purpose of the study was to compare the real-ear to coupler difference (RECD) measured with an insert earphone and two models of hearing instrument. DESIGN: The RECD was obtained from one ear of 18 normal-hearing subjects by subtracting the 2-cc coupler (HA1 and HA2) response from a real-ear aided response, using a conventional probe-tube microphone system. The measurements were made with a conventional ER-3A earphone and two models of behind-the-ear hearing instrument (Unitron US80, Unitron, Kitchener, Canada; and Widex Diva, Widex, Vaerloese, Denmark). RESULTS: The procedures were very reliable, with mean differences on retest of less than 1 dB. There were statistically significant differences between the mean RECDs obtained using an insert earphone compared with those obtained with each hearing instrument (p < 0.05). The differences were greatest when using the HA2 2-cc coupler. For example, the maximum difference in mean RECD between the insert earphone and the Widex Diva was 6 dB and 11 dB when using the HA1 and the HA2 2-cc coupler, respectively. CONCLUSIONS: The RECD is dependent on the acoustic impedance of the sound source, the coupling system, and the coupler and ear. The acoustic impedance may be different for an insert earphone and a given hearing instrument. Therefore, the RECD measured with an insert earphone may not always accurately represent the difference in performance of a hearing instrument measured in the real ear and the 2-cc coupler.     

Equivalent hearing threshold levels for the Etymotic Research ER-10C otoacoustic emission probe

Objective: To determine the equivalent threshold sound pressure levels (ETSPL) for a commercially available distortion product otoacoustic emission (DPOAE) probe, and to study the impact of probe fitting and eartip size on the calibration. Design: Twenty-eight otologically normal test subjects participated in the ETSPL determination for the Etymotic Research ER-10C probe. Study sample: ETSPLs were determined up to 16 kHz and were compared to the reference hearing thresholds associated with the ER-3A insert earphone. Both ‘regular’ and ‘baby’ foam eartips were used. Results: At most frequencies, no significant threshold differences were observed between the insert earphone and the DPOAE probe. However, at 1 kHz and 4 kHz, the mean thresholds for the insert earphone were generally lower than those for the DPOAE probe, suggesting systematic differences at those frequencies. Repeated calibration runs resulted in deviations of about 0.6 dB. Similar deviations were noticed when using foam eartips of different sizes up to 10 kHz. Conclusions: Knowing the reference thresholds for DPOAE probes enables measurements of (subjective) hearing thresholds and (objective) otoacoustic emissions using the same probe. Probe fitting and eartip size had negligible effect on the determination of ETSPLs. The obtained data may be proposed for inclusion in future audiometry standards.     

How does the sound pressure generated by circumaural, supra-aural, and insert earphones differ for adult and infant ears?

OBJECTIVE: To determine how the ear canal sound pressure levels generated by circumaural, supra-aural, and insert earphones differ when coupled to the normal adult and infant ear. DESIGN: The ratio between the sound pressure generated in an adult ear and an infant ear was calculated for three types of earphones: a circumaural earphone (Natus Medical, ALGO with Flexicoupler), a supra-aural earphone (Telephonics, TDH-49 with MXAR cushion), and an insert earphone placed in the ear canal (Etymoup and down arrow tic Research, ER-3A). The calculations are based on (1) previously published measurements of ear canal impedances in adult and infant (ages 1, 3, 6, 12, and 24 months) ears (Keefe et al., 1993, Acoustic Society of America, 94:2617-2638), (2) measurements of the Thévenin equivalent for each earphone configuration, and (3) acoustic models of the ear canal and external ear. RESULTS: Sound-pressure levels depend on the ear canal location at which they are measured. For pressures at the earphone: (1) Circumaural and supra-aural earphones produce changes between infant and adult ears that are less than 3 dB at all frequencies, and (2) insert earphones produce infant pressures that are up to 15 dB greater than adult pressures. For pressures at the tympanic membrane: (1) Circumaural and supra-aural earphones produce infant pressures that are within 2 dB of adult ears at frequencies below 2000 Hz and that are 5 to 7 dB smaller in infant ears than adult ears above 2000 Hz, and (2) insert earphones produce pressures that are 5 to 8 dB larger in infant ears than adult ears across all audiometric frequencies. CONCLUSIONS: Sound pressures generated by all earphone types (circumaural, supra-aural, and insert) depend on the dimensions of the ear canal and on the impedance of the ear at the tympanic membrane (e.g., infant versus adult). Specific conclusions depend on the location along the ear canal at which the changes between adult and infant ears are referenced (i.e., the earphone output location or the tympanic membrane). With circumaural and supra-aural earphones, the relatively large volume of air within the cuff of the earphone dominates the acoustic load that these earphones must drive, and differences in sound pressure generated in infant and adult ears are generally smaller than those with the insert earphone in which the changes in ear canal dimensions and impedance at the tympanic membrane have a bigger effect on the load the earphone must drive.     

Rising-frequency chirps and earphones with an extended high-frequency response enhance the post-auricular muscle response

The purpose of this study was to determine whether rising-frequency chirps presented via earphones with an extended high-frequency response would optimize the post-auricular muscle response (PAMR). The PAMR was recorded in adults using three different stimuli (a click, a rising-frequency chirp, and a truncated speech stimulus, /t/). Conventional ER-3A insert earphones were compared to ER-2 insert earphones to determine whether the PAMR is enhanced by the ER-2's extended high-frequency response. There were significant stimulus and earphone effects on PAMR amplitudes. The PAMR was largest for the chirp stimulus and the ER-2 earphones. The poorest responses were obtained using the /t/ stimulus and conventional ER-3A earphones. The results support previous ABR studies that have demonstrated a significant advantage of chirps over clicks for evoked response audiometry, and indicate that the PAMR is enhanced by inclusion of additional high-frequency stimulus energy.

Sumario

El propósito de este estudio fue determinar si los gorjeos de frecuencia ascendente presentados con auriculares de respuesta extendida en las frecuencias agudas, optimizan la respuesta del músculo post-auricular (PAMR). El PAMR se registró en adultos que usaron tres estímulos diferentes (clic, gorjeo de frecuencia ascendente y estimulo truncado de lenguaje, /t/). Se compararon auriculares de inserción convencionales ER-3A con auriculares de inserción ER-2 para determinar si el PAMR mejora con las respuestas de alta frecuencia extendida del ER-2. Se apreciaron efectos significativos en el estímulo y en los auriculares sobre las amplitudes del PAMR. EL PAMR fue más grande para los estímulos con gorjeo y con los auriculares ER-2. Las respuestas mas pobres se dieron usando el estimulo /t/ y los auriculares convencionales ER-3A. Estos resultados apoyan estudios previos de ABR que demostraron una ventaja significativa de los gorjeos sobre los clics en la audiometría de respuestas evocadas e indican que el PAMR se incrementa con la inclusión adicional de la energía de estímulos de altas frecuencias.     

Use of the 'real-ear to dial difference' to derive real-ear SPL from hearing level obtained with insert earphones

The electroacoustic characteristics of a hearing instrument are normally selected for individuals using data obtained during audiological assessment. The precise inter-relationship between the electroacoustic and audiometric variables is most readily appreciated when they have been measured at the same reference point, such as the tympanic membrane. However, it is not always possible to obtain the real-ear sound pressure level (SPL) directly if this is below the noise floor of the probe-tube microphone system or if the subject is unco-operative. The real-ear SPL may be derived by adding the subject's real-ear to dial difference (REDD) acoustic transform to the audiometer dial setting. The aim of the present study was to confirm the validity of the Audioscan RM500 to measure the REDD with the ER-3A insert earphone. A probe-tube microphone was used to measure the real-ear SPL and REDD from the right ears of 16 adult subjects ranging in age from 22 to 41 years (mean age 27 years). Measurements were made from 0.25 kHz to 6 kHz at a dial setting of 70 dB with an ER-3A insert earphone and two earmould configurations: the EAR-LINK foam ear-tip and the subjects' customized skeleton earmoulds. Mean REDD varied as a function of frequency but was typically approximately 12 dB with a standard deviation (SD) of +/- 1.7 dB and +/- 2.7 dB for the foam ear-tip and customized earmould, respectively. The mean test-retest difference of the REDD varied with frequency but was typically 0.5 dB (SD 1 dB). Over the frequency range 0.5-4 kHz, the derived values were found to be within 5 dB of the measured values in 95% of subjects when using the EAR-LINK foam ear-tip and within 4 dB when using the skeleton earmould. The individually measured REDD transform can be used in clinical practice to derive a valid estimate of real-ear SPL when it has not been possible to measure this directly.     

Compensated active noise cancellation earphone for audiometric screening tests in noisy environments

Abstract

Objective: This study investigated hearing screening tests by using a custom-designed compensated hybrid active noise cancellation (ANC) earphone and compared it with TDH39 and Audiocups audiometric earphones under conditions of quiet, 45?dB HL masking narrowband, wideband speech-shaped, and white noise.

Design: The hearing screening tests were conducted to characterise the shifts of screening results under noisy conditions, and real-ear attenuations at thresholds were assessed to quantify real-ear noise reduction performance.

Study sample: Twenty-four normal-hearing adults, aged 20–25?years, participated in this study.

Results: The ANC earphone exhibited significantly lower/better mean screening results than those of the TDH39 earphone at 250 and 500?Hz and those of the Audiocups earphone at 250?Hz under conditions of narrowband, speech-shaped, and white noise. Compared with the TDH39 earphone at 250 and 500?Hz, applying a hybrid ANC earphone reduced the shifts in screening results by 14.2 and 12.3?dB, respectively, under the narrowband noise condition.

Conclusion: This study demonstrated that the compensated hybrid ANC earphone provided lower shifts of screening results than the TDH39 and Audiocups earphones and that it was capable of screening at 250 and 500?Hz from 20?dB HL under 45?dB HL masking narrowband and wideband noise.     

An initial investigation into the equivalence of the metal and plastic-cased TDH39 earphones.

Since the adoption of the Telephonics TDH39 pattern of earphone as the main audiometric earphone in use in Britain and elsewhere, there have been a number of superficial changes in its design. The most significant change was around 1980 when the metal-cased design was replaced by a plastic-cased version: the TDH39P. At that time it was assumed that the new earphone was equivalent to the metal-cased version since both types of earphone exhibited similar frequency responses as measured on the IEC 303 acoustic coupler. However, it has been found, through measurements taken during the course of routine audiometer calibration, that the two types of earphone appear to exhibit a significant difference in the measured SPL at 6 kHz when they are compared using an IEC 318 wide-band artificial ear.     

Variation of young normal-hearing thresholds measured using different audiometric earphones: implications for the acoustic coupler and the ear simulator

This paper questions the necessity for two calibration devices to measure the acoustic output from different types of audiometric earphones. International standards give the audiometric zero for TDH39 earphones on the IEC 60318-3 acoustic coupler; the IEC 60318-1 ear simulator is intended for other supra-aural earphone types. If hearing threshold samples from young, healthy ears were found to be more variable using TDH39 earphones, then that earphone and its coupler might be taken out of service. The audiological literature yielded threshold survey results for over 5100 otologically normal ears of subjects aged 31 years or less. These independent samples showed smaller variation for TDH39 samples than for samples using other earphones; this finding does not support abandoning the TDH39 and its coupler. Nevertheless, benefits accrue from calibrating TDH39 output to the audiometric zero as measured on the ear simulator.     

Variation of young normal-hearing thresholds measured using different audiometric earphones: Implications for the acoustic coupler and the ear simulator

This paper questions the necessity for two calibration devices to measure the acoustic output from different types of audiometric earphones. International standards give the audiometric zero for TDH39 earphones on the IEC?60318-3 acoustic coupler; the IEC?60318-1 ear simulator is intended for other supra-aural earphone types. If hearing threshold samples from young, healthy ears were found to be more variable using TDH39 earphones, then that earphone and its coupler might be taken out of service. The audiological literature yielded threshold survey results for over 5100 otologically normal ears of subjects aged 31 years or less. These independent samples showed smaller variation for TDH39 samples than for samples using other earphones; this finding does not support abandoning the TDH39 and its coupler. Nevertheless, benefits accrue from calibrating TDH39 output to the audiometric zero as measured on the ear simulator.