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Abstract (summary)

The purpose of the present study was to determine the feasibility of reducing intersubject
variability of highf-requency hearing thresholds by using insert earphones and frequencymodulated (warble) tones. Forty listeners with normal hearing in the conventional
audiometric range (125-8000 Hz) participated in the study. Hearing thresholds were
measured at 10, 12, 14, 16, and 18 kHz with circumaural (HD-250) and insert (ER1)earphones using pure tones and 2% and 5% frequency-modulated FM (warble) tones.
Obtained results demonstrated significantly smaller intersubject variability of hearing
thresholds measured with insert earphones and 5% FM tones in comparison to all other test

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The purpose of the present study was to determine the feasibility of reducing intersubject
variability of highf-requency hearing thresholds by using insert earphones and frequencymodulated (warble) tones. Forty listeners with normal hearing in the conventional
audiometric range (125-8000 Hz) participated in the study. Hearing thresholds were
measured at 10, 12, 14, 16, and 18 kHz with circumaural (HD-250) and insert (ER1)earphones using pure tones and 2% and 5% frequency-modulated FM (warble) tones.
Obtained results demonstrated significantly smaller intersubject variability of hearing
thresholds measured with insert earphones and 5% FM tones in comparison to all other test
Audiometry, hearing threshold, high frequency
1. Introduction
High-frequency audiometry (HFA) refers to the hearing threshold measurements at
frequencies above 8 kHz. It complements conventional audiometric measurements
extending from low frequencies up to 8 kHz. Since frequencies in the order of 4-8 kHz are
considered the high frequency region of conventional audiometric measurements, the

audiometry above 8 kHz is also frequently referred to as extended high frequency

audiometry (EHFA). In this paper we refer to frequencies beyond 8 kHz as the HFA range.
The HFA range lies beyond the basic range of speech communication frequencies but this
range is important for acoustic signature recognition of many natural and military sources,
spatial orientation, and music perception. Therefore, the HFA range is of great interest to
human factors engineering. Human factors interest in HFA stems also from the fact that the
first symptoms of noise-induced hearing loss (NIHL) frequently develop in the high
frequency range before it spreads down toward lower frequencies. In addition, many nonNIHL hearing losses are progressive sensorineural high-frequency losses caused by various
pathological agents. In both cases an early detection of a high-frequency hearing loss is
important for prevention of more severe hearing loss affecting speech communication and
perception of acoustic warnings as well as for identification of populations at risk. There are
also studies indicating the importance of high-frequency hearing for speech perception and
for proper selection of aural rehabilitation strategies [1][2].
Since high frequency hearing is important for human auditory awareness of the environment
and general well-being it is important to determine normative values of high frequency
hearing thresholds for the general population. Such values are needed in order to determine
whether specific changes in high frequency sounds can be perceived by most of the
population or to determine what a change in high frequency signal needs to be made by a
signal designer in order to be detected and recognized under specific environmental
conditions. However, the normative HFA data that can be used across large populations are
very difficult to establish despite the fact that there are several documents and reports
proposing normative high frequency thresholds for specific testing conditions and specific
applications (e.g., [3]). The main factor making the development of general normative data
a very difficult task is the large intersubject variability of high frequency thresholds. This
variability results from large changes in high frequency hearing due to age, exposure and
susceptibility to noise, and the dimensions of the ear canal, which greatly affect the
behavior of high frequency acoustic waves. In addition, the proposed thresholds have been
developed for pure tone signals under rigorous and time-consuming procedures using
calibration equipment that is not easily available outside medical clinics and research
laboratories. Such signals emphasize rather than deemphasize differences in people and
require careful calibration of equipment. The medical community has limited interest of in
developing the HFA norms for the general population since medical use of HFA is limited to
serial measurements of the threshold of hearing in individual patients. The HFA is typically

used to monitor to what extent specific pathologies, medications, and noise levels affect the
threshold of hearing over time. In these applications patients serve as their own baselines.
For that reason most of the efforts to develop appropriate methods to calibrate HFA
equipment and to determine related normative hearing threshold values for the medical
community was concerned with minimizing the intrasubject variability than intersubject
variability of the data.
There are several studies reporting very good intrasubject variability of the HFA data that is
comparable to that of conventional audiometry. Good intrasubject reliability reported in
these studies also indicates that the random errors related to calibration procedures
and earphones fitting in HFA can be kept relatively small especially when the threshold of
hearing is determined by measuring sound pressure in the ear canal using a probe tube
microphone. The probe microphone technique is an excellent method for determining the
normative HFA values and for general HFA measurements. However, this is a clinical and
laboratory technique that is time consuming and requires medically trained personnel. In
addition, while pure tones are important frequency-specific test signals for medical
assessment of hearing, they are inappropriate signals for human factors and audio
applications where more general information about the hearing threshold is needed. Thus,
for all the above reasons, the existing HFA normative data and test procedures are not well
suited for human factor applications.
In order to compare a person's hearing to established norms, the procedure and
instrumentation used for testing must be compatible with the procedure and
instrumentation that was used to determine the norms. Thus, in order to establish the
normative HFA thresholds that can be used across wide ranges of medical, research, audio,
and human factors applications it is important to first develop a procedure that is easily
repeatable, can be used in various environments, and provides some averaging of the
threshold values to provide more robust estimates of the HFA thresholds. This paper
presents a description and an initial validation of a new HFA procedure that results in
relatively small intersubject variability and could be used across both medical and nonmedical applications of HFA. The signals proposed in this procedure are frequencymodulated tones that have never been reported before to be used for hearing threshold in
high frequency range (HFA).
2. Method

2.1 Listeners
Forty listeners, 20 males and 20 females, ranging in age from 20 to 30 years (mean = 26.2
years, SD = 2.6 years) participated in this study. Each participant had bilateral air
conduction hearing thresholds less than 20 dB HL at all audiometric frequencies within the
0.25 to 8 kHz frequency range (ANSI S3.6-1989 [4]), normal bilateral tympanograms, no
history of recent otologic pathology, and no history of any prolonged noise exposure.
2.2 Instrumentation
All hearing screening and subsequent experimental testing were conducted in an
audiometric test booth (Suttle, SEB1) complying with ANSI S3.1-1991 [5] noise
requirements for open ear testing. The test signals were high frequency pure tones and 2%
and 5% FM tones at 10, 12, 14, 16 and 18 kHz produced by a Beltone 2000 audiometer. All
signals were presented for 1.5 s with a 25 ms rise/fall time. The FM tones were obtained by
linear (triangular) frequency modulation with a 5 Hz modulation rate. The audiometer
calibration was verified before and after the collection of the data. The test stimuli were
delivered to the subject's ears monaurally through either an insert earphone (Etymotic
Research ER-1; 10 ohms) or circumaural earphone (Sennheiser HD-250; 50 ohms). A
custom-built impedance matching device was inserted between the 50 ohms Beltone 2000
output and the ER-1 10 ohms insert earphone during both calibration and testing.
The ER-1 insert earphone is a shoulder-mounted transducer coupled to the ear via plastic
tubing ending with a foam eartip surrounding the internal plastic tube. Each ER-1 insert
earphone was calibrated using an ANSI S3.25-1989 [6] occluded ear simulator (Knowles
DB-100 Zwislocki Coupler) with the nipple of the ER-1 sound tube attached to the coupler
through ER1-08 adapter. The Sennheiser HD-250 circumaural earphones were calibrated
with a flat-plate configuration of the IEC 318-2 (1998) [7] artificial ear (B&K 4153).
Both earphonesused in this study had gradual frequency response roll-offs above 15 kHz
and steep roll-offs above 17 kHz. Therefore, the high-frequency FM tones at 16, and 18 kHz
were actually modulated in both frequency (FM) and amplitude (AM). Consequently, the
additional amplitude modulation of FM signals might have influenced threshold data
reported in the study. This situation, however, is common for reproduction of FM signals by
the transducers with non-ideal frequency responses and was not accounted for in this study.
2.3 Procedures

Each listener participated in two, 1.5-hour long, experimental sessions: test session
(Session 1) and retest session (Session 2). Each session included six test conditions
presented as the test blocks: (1) insert earphones with pure tone stimuli; (2) insert
earphones with 2% FM tone stimuli; (3) insert earphones with 5% FM tone stimuli; (4)
circumaural earphones with pure tone stimuli; (5) circumaural earphones with 2% FM tone
stimuli; and (6) circumaural earphones with 5% FM tone stimuli. In each test block, both
ears were tested and the test signals were always presented in the 10 to 18 kHz sequence.
The order of test blocks as well as ears tested were counterbalanced in Session 1 and
reversed in Session 2. There was a minimum interval of two and a maximum of seven days
between the test and the retest session for each listener.
The HD-250 circumaural earphones were fitted on each listener by an experimenter to
ensure that eachearphone diaphragm was centered over the opening of the ear canal. Then
the headband assembly was tightened. After the earphones had been placed, the subject
was not allowed to touch or reposition theearphones. In the case of the ER-1 insert
earphones, the foam eartips were inserted by an experimenter into the listener's ear canal.
This was done by compressing the foam eartip and inserting it into the ear canal so that the
outer edge of the earplug was flush with the floor of the subject's concha (12 mm insertion
depth). The eartip was then held in place for 30 seconds to allow it to expand. The eartip
was checked for insertion depth and reinserted if necessary. These fitting procedures are
common in HFA testing [8]. .
During the experiment, each listener was seated comfortably and provided with a response
button. Instructions for responding at threshold were identical to those routinely given for
conventional audiometry. The listener's task was to press the response button every time
the signal was heard even if the signal was very faint. In each test block, all test stimuli
were initially demonstrated at suprathreshold level to familiarize the listener with the type of
stimuli used in this block. During testing, the stimulus was initially presented at a
subtreshold level and increased gradually in 2 dB steps until the listener responded. Once an
initial response occurred, the level was decreased in 10 dB steps until no response occurred
and then increased in 2 dB steps until the subject responded again. This procedure (10 dB
down and 2 dB up) was continued until six ascending thresholds were obtained. Threshold
was defined as the mean of the six ascending thresholds [9].
3. Results and Discussion

3.1 Intrasubject Reliability

Intrasubject reliability was assessed by comparing test and retest data at all experimental
conditions. Mean test-retest differences observed for both types of earphones, both ears,
and all test signals were all very small. For the HD-250 earphones they were in the range
from 0.1 dB for the 5% FM tone at 16 kHz to 1.4 dB for the pure tone at 10 kHz. These
values are similar to those reported by Frank [9] for HD-250 data measured across four test
sessions and agree with the data reported by Frank and Dreisbach [10]. The test-retest
differences observed for the ER-1 earphones were slightly smaller than those reported for
the HD-250earphones. Average left-right ear differences were below 3 dB for all conditions
tested and both earphones. To assess statistical significance of the observed differences, ten
three-factor repeated measures ANOVAs on SESSION (test, retest), EAR (left, right), and
STIMULUS (pure tone, 2% FM tone, 5% FM tone) were conducted for individual frequencies
(5) and earphone types (2). The ANOVA results did not reveal any significant effects at
p<0.05 for either SESSION or EAR factors across both earphones and all test frequencies.
These findings agree with number of other studies reporting good intrasubject variability of
HFA thresholds measured with careful fitting of the transducers. The STIMULUS factor was
always significant at p<0.002 level or better. Since there were no statistically significant
effects of either test session or test ear on collected data, further data analysis was limited
to the right ear data collected during the test session.
3.2 High Frequency Hearing Thresholds
All listeners (n = 40) responded to all the stimuli at each frequency in each ear. The mean
hearing threshold data combined across all listeners are shown in Table 1. The mean highfrequency thresholds reported in Table 1 increase with frequency regardless of the
differences in the transducer or stimulus. The threshold curves measured with ER-1 and HD250 earphones are both relatively flat in the frequency range of 10 to 12 kHz and rise
steeply beyond 12 kHz. For both earphones, the mean threshold values are the largest for
pure tones and the smallest fort 5% FM tones.
The threshold SPL values presented in Table 1 are the reference-equivalent threshold SPLs
(RETSPLs) measured in an IEC flat plate coupler (ER-250) and DB-100 Zwislocki coupler
(ER-1). The differences between the RETSPLs of both earphones, for the same signal and at
the same signal frequency, are due to both the differences in ear coupling and the
differences in frequency response of the couplers used for calibration of theearphones. Since

the acoustic loads provided by both couplers in the measured frequency range are not
equivalent, no absolute comparison of the threshold SPLs for both earphones was made in
this study and only differences across signals and frequencies are compared. The direct
comparison between both earphonescould be made if the SPLs were measured in the ear
canal of the listener during testing (e.g., [11]). Such comparison, however, was not the
object of this study.
For both tested earphones, the FM signals resulted in lower threshold values than those
obtained with pure-tone signals. The higher the frequency, the greater the difference. In
addition, larger frequency deviation resulted in a less steep slope of the threshold. These
results are different from the results of studies utilizing FM tones in conventional
audiometry. Several studies [12-14] reported no significant differences between thresholds
obtained for FM and pure tone signals in the conventional audiometric range. The different
findings of this study can be accounted for by the differences in the shape of the threshold
curves in conventional audiometry and HFA ranges. Hearing threshold at high frequencies
rises abruptly with frequency whereas it has a much flatter contour within most of the
conventional audiometry range. When FM tones sweep through the frequency range where
the hearing threshold raises quite steeply, the measured threshold is defined by the lowest
value of the hearing threshold within the modulation bandwidth rather than by the center
frequency of the band. In addition, the slope of the threshold results in additional amplitude
modulation of the signal that increases the audibility of the stimulus. Therefore, highfrequency hearing thresholds obtained with FM tones should be naturally lower than those
obtained with pure tones if the hearing threshold monotonically and steeply rises with
frequency. The difference should also increase with the increase in the frequency deviation
of the FM-tone signal.
Table 2 presents mean values of high-frequency pure-tone threshold levels obtained in the
present study and other studies using the same earphones. Normalized hearing threshold
data [3] for HDA-200 and ER-2earphones commonly used for medical purposes are also
included for comparison together with calibration coupler information. Presented data
indicate that though all the thresholds curves are similar in shape, our thresholds are
generally higher than those reported in previous studies. This difference is most likely
related to age differences between subjects participating in the studies. The mean age of
subjects in our study was greater by almost five years than the mean age of subjects
participating in the Frank's [9] and Tang and Letowski's [15] studies. Apart from the age
differences, the experimental conditions and the listeners' characteristics reported in these

studies were very similar. This observation seems to lend support to the five-year steps
postulated by Schechter et al. [16] as the basis for high-frequency threshold normalization.
3.3 Threshold Variability
Standard deviations (SDs) of high frequency hearing thresholds obtained under each test
condition are shown in Table 1. As expected, the larger the frequency deviation of the
signal, the smaller the variability of the threshold data for a given test frequency. In
general, the SDs increased as a function of frequency, reached a maximum value at 16 kHz
and decreased markedly at 18 kHz for both transducers and all signals except for 5% FM
tones. Lower variability of hearing threshold at very high frequencies conforms to other
reports [9] [17] and may be caused by the signal reaching the threshold of feeling at this
In order to examine whether the differences between SDs obtained under various test
conditions were statistically significant, the Morgan t-test [15] for related measures was
performed Due to multiple comparisons assessed by Morgan test, the Bonferroni-corrected
significance level for any single comparison was set to 0.01 level to maintain the
experiment-wide error rate at 0.05. The results of Morgan t-test indicated that all SDs
obtained with HD-250 were significantly higher than respective SDs obtained with ER1 earphones at 0.05 level (t>2.51). When the comparisons were made for the stimulus
factor within the same earphone all the differences between PT and 5% FM were significant
(p<0.05) with the exception of ER-1 at 16 and 18 kHz.
In general, data presented in Table 1 demonstrate that insert earphones yielded smaller SDs
than circumauralearphones for all the test frequencies except 18 kHz. Thus, by using the
ER-1 insert earphones in place of the HD- 250 circumaural earphones, the intersubject
threshold variability for pure tone signals can be reduced by 2.9 to 5.7 dB from 10 to 16
kHz. These data are consistent with our previous report [15]. The use of a 5% FM tone in
place of a pure-tone stimulus reduced the threshold SDs obtained with
circumaural earphones by an additional 1.0 to 3.7 dB depending on test frequency. The
combined effect of the insert earphone and 5% FM signal reduced variability (SD) of hearing
thresholds in the 10 to 16 kHz range by as much as 4.1 to 7.8 dB in comparison to HD250 earphones used with pure-tone signals. The actual SDs reported in this study for
frequency range up to 14 kHz (SD=5.68.7 dB) are not much greater than those observed

for pure tone signals in conventional audiometric range (4 to 6 dB) [8]. Intersubject
variability was 16.1 dB at 16 kHz and 15.6 dB at 18 kHz.
4. Conclusions
Even though the high frequency threshold levels have good intrasubject variability, the
specification of normative high frequency threshold levels also requires acceptable
intersubject variability. The results of the present study indicate that intersubject variability
of threshold of hearing in the high frequency range can be reduced substantially by
using insert earphones and FM (warble) signals. Resulting variability can be acceptable low
for both human factor and medical applications without a need to control sound pressure
level in the ear canal with a probe microphone. However, the determination of normative
threshold data and standardized variability for the proposed variant of HFA requires
validation of present findings on a much larger population. The research needs to be also
extended on other types of insert earphones to determine the normative thresholds needs
to be earphone specific.
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Institute (ANSI), New York.
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Houchin Tang
Camino Medical Group, Sunnyvale, CA 94086
Tomasz Letowski
Human Research and Engineering Directorate
U.S. Army Research Laboratory, APG, MD 21005
Word count: 3741
Copyright Institute of Industrial Engineers-Publisher 2007

Indexing (details)
Ears & hearing;
High-Frequency Hearing Threshold Measurements Using Insert Earphonesand Warble
Tang, Houchin; Letowski, Tomasz
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IIE Annual Conference. Proceedings
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Proceedings of the 2007 Industrial Engineering Research Conference
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Copyright Institute of Industrial Engineers-Publisher 2007
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