Perceived lateral position of narrow-band noise in hearing-

impaired and normal-hearing listeners under conditions

of equal sensation level and sound-pressure level
Helen J. Simon and Inna Aleksandrovskya)
Smith–Kettlewell Eye Research Institute, 2232 Webster Street, San Francisco, California 94115
~Received 19 October 1995; revised 23 March 1997; accepted 24 March 1997!
The perceived lateral position of narrow-band noise ~NBN! was studied in a graphic pointer task as
a function of the method of compensation for interaural threshold asymmetries in hearing-impaired
and normal-hearing subjects. The method of compensation consisted of equal sensation level
~EqSL! or equal sound-pressure level ~EqSPL! at the two ears within the same subject. The NBN
signals were presented at 11 center frequencies with interaural intensity differences ~IIDs! that
varied from 220 to 120 dB. When equalizing by SL, the perceived lateral position is essentially
linearly dependent on the degree and direction of asymmetry in asymmetric normal-hearing and
hearing-impaired listeners. Equalizing by SPL shows no such dependency but produces images that
are lateralized close to the midline. These results reveal that subjects may have adapted to their
threshold asymmetries. These results will be discussed in terms of the fitting of binaural hearing
aids. © 1997 Acoustical Society of America. @S0001-4966~97!03809-5#
PACS numbers: 43.66.Pn, 43.66.Qp @RHD#

INTRODUCTION and SNHL listeners. Generally, interaural time delay ~ITD!

The purpose of this paper is to report the results of a
study that systematically investigated the relation between
lateralization performance in subjects with normal hearing
and sensorineural hearing loss ~SNHL! when signals with
interaural intensity differences ~IIDs! were presented with
equal sensation level ~EqSL! or equal sound-pressure level
~EqSPL! at the two ears. Previous work with normal-hearing
listeners that assumed left–right symmetry ~Hershkowitz and
Durlach, 1969; Domnitz, 1973! showed reduced perfor-
mance in certain binaural discrimination and detection tasks
with imbalanced as compared to balanced intensity input.
With the notable exception of Koehnke et al. ~1995!, there
has not been compensation for threshold asymmetries in bin-
aural experiments with SNHL listeners ~Durlach et al., 1981;
Colburn et al., 1987!. It is assumed that degradation in bin-
aural performance in asymmetric subjects might be due to
loudness or SL imbalances as occurs with input imbalances
in normals. Durlach et al. ~1981! suggested that some
method of equating interaural stimulus amplitude might be
needed to restore the binaural performance and discussed
four methods: ~a! EqSPL, ~b! EqSL, ~c! equal loudness
~EqL! at the two ears, and ~d! a centered image. They argued
that, for normal-hearing listeners ~and we assume for sym-
metric thresholds!, all four methods would ‘‘roughly’’ equal
0 dB IID. However, for asymmetric SNHL, the interaural
stimulus amplitude for EqSL and EqSPL would differ from
each other. Further, EqSPL would be the closest to and EqSL
would be the furthest from a centered image due to, in the
former, the correlation of auditory, visual, and tactile percep-
tion and sensorimotor feedback ~Durlach et al., 1981!.
Hawkins and Wightman ~1980! and Smoski and Trahi-
otis ~1986! utilized EqSPL and EqSL with normal-hearing
a!
Now at Dept. of Psychology, University of California, Berkeley, Califor-
nia.
thresholds for narrow-band noise ~NBN! centered on 500 Hz
revealed better performance in the EqSPL condition than in
the EqSL condition, with SNHL listeners only slightly less
sensitive than normal-hearing listeners. Thresholds were
higher for both groups for the 4000-Hz signals than for the
500-Hz signals. At 4000 Hz, normal-hearing listeners again
showed superior performance in the EqSPL condition while
performance for the SNHL subjects was approximately equal
in the EqSL and EqSPL conditions.
Smoski and Trahiotis ~1986! noted that the degradation
of ITD thresholds in the high frequencies at EqSL may be
the result of the change in the overall intensity level of the
stimulus. Especially for the normal-hearing listeners, the in-
tensity level varied as a function of EqSPL and EqSL:
EqSPL was presented at a higher intensity level ~always 80
dB SPL! than EqSL ~25 dB SL!.
The present study investigates the perceived lateral po-
sition of NBN as a function of balancing the inputs to both
ears by EqSPL or EqSL in normal-hearing and SNHL sub-
jects. Subjects were tested at 25 dB SL ~EqSL! re: NBN
threshold. However, with threshold asymmetries between the
two ears, the results at EqSL would be unbalanced or un-
equal ~UnEq! in SPL. Thus at those frequencies where inputs
presented in the EqSL condition were asymmetrical in the
two ears ~UnEqSPL!, the subjects were retested with ‘‘bal-
anced’’ SPL inputs achieved by bilaterally presenting an in-
tensity level corresponding to 25 dB SL at the poorer ear.1
This balanced condition resulted in EqSPL ~UnEqSL!.2 The
decision to balance in this manner was made to insure that
the signal in the poorer ear was at 25 dB SL, thus allowing a
direct comparison with the EqSL condition.
Thus this study extends current knowledge in that the
intensity levels for EqSL and EqSPL are consistent within
the same subject, interaural asymmetries are documented and
tested, and the interaural asymmetries in the EqSPL condi-
tion are ‘‘balanced.’’

1821 J. Acoust. Soc. Am. 102 (3), September 1997 0001-4966/97/102(3)/1821/6/$10.00 © 1997 Acoustical Society of America 1821

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 TABLE I. Narrow-band noise ~NBN! presentation levels ~dB SPL! at the 11 center frequencies for the left/right
ears. These levels were obtained by adding 25 dB to the NBN thresholds. An asterisk indicates those frequen-
cies where hearing thresholds are not within normal limits for pure tones ~re: ANSI, 1969!. A double asterisk
indicates those frequencies not tested experimentally since the subject could not tolerate the EqSPL condition.

Center Normal Hearing impaired

frequency
~Hz! LP LT SA AB JD EG LAH

250 40/45 35/40 40/50 45/40 60/55 65/75* 50/50

300 45/40 35/40 40/50 45/40 55/55 70/80* 45/50
400 45/40 40/35 40/45 35/35 50/55 70/75* 50/50
500 45/50 35/35 35/35 35/35 50/50 70/75* 45/40
750 40/40 30/25 30/35 30/35 45/40 70/70* 45/45
1000 25/35 35/30 25/35 40/35 40/50 65/70* 50/45
1250 25/25 25/35 25/25 35/30 45/45 65/70* 75/65*
1500 30/25 30/30 30/25 40/40 50/45* 70/70* 100/85*
2000 35/35 35/40 40/40 65/55* 60/60* 80/80* 90/90*
3000 30/25 25/25 60/75* ** 90/85* 75/80* 75/80* 85/75*
4000 25/30 45/30 80/90* ** 90/90* 85/90* 75/75* 85/75*

I. PROCEDURE
A. Subjects
Three female and two male subjects with SNHL and one
female and one male with normal hearing participated in this
study. Audiometric evaluations, using the Method of Limits,
were performed using pure tones and NBN signals. Table I
shows the 25 dB SL level ~in dB SPL! for the NBN signals.
As shown in this table, asymmetries for both groups of sub-
jects were between 5 and 15 dB. In order to be insensitive to
daily fluctuations, thresholds were determined in 5-dB steps
and NBN thresholds were established immediately prior to
the experiment. Six of the subjects had previous experience
in psychoacoustic experiments in this laboratory and in ad-
dition, all subjects underwent extensive practice using this
paradigm. The training was completed when at least one
stimulus sequence at all frequencies was completed and per-
formance was considered stable ~usually 6–12 sessions!.
B. Stimuli
Using the ‘‘quadrature’’ noise method described by
Amenta et al. ~1987!, 100-Hz bandwidth NBN Gaussian
pseudorandom noise stimuli were digitally generated off-
line. One bandwidth value was used in order to keep the time
envelope fluctuations constant at different frequencies, even
though the resulting bandwidths differ in critical band units.
Stimuli consisted of NBNs with center frequencies of
0.25, 0.3, 0.4, 0.5, 0.75, 1, 1.25, 1.5, 2, 3, and 4 kHz. Ten
tokens at each center frequency were created. Each token
was a 100-ms sample of an NBN including 20-ms on/off
raised cosine function ramps. Tokens were digital-to-analog
converted at a 32 000-Hz sampling rate with 16 bits of reso-
lution using two separate channels. Both the overall presen-
tation level and the magnitude of the IID were controlled as
needed in 0.3-dB steps with a digitally controlled two-
channel attenuator. The IIDs were created symmetrically by
increasing one channel and decreasing the other. After digi-
tization, the signal was low-pass filtered using a Chebyshev
fourth-order reconstruction filter, with 10.5 kHz as the corner
frequency, that yielded 90-dB attenuation at 16 kHz.
C. Methods
Signals were presented binaurally through ER 3-A insert
earphones3 to individual subjects seated in an IAC sound-
attenuated room. Subjects were tested at 25 dB SL re: NBN
threshold at EqSL and EqSPL.
If the stimuli were reported as diffuse ~e.g., Domnitz and
Colburn, 1977!, subjects were instructed to locate the per-
ceived center of the intracranial image associated with the
stimulus. Each one and one-half hour session began with a
minimum of six practice trials preceding the experimental
runs.
D. Experimental paradigm
The experimental paradigm was a modification of a psy-
choacoustical mapping method such as that used by Blauert
and Lindemann ~1986!. The IIDs of the stimuli were varied
randomly in 4-dB steps over a range of 620 dB at each of 11
frequencies. Each trial consisted of three 100-ms stimuli with
50-ms interstimulus intervals. Each triplet was followed by a
400-ms pause. These triplets, repeated until the subject re-
sponded, constituted one trial. The subjects indicated where
they heard the stimulus by pointing a mouse-controlled cur-
sor to the position on a schematic of the front of a head
depicted on the computer screen. The computer program
converted the mouse position units to a range of 200 arbi-
trary units, with 0 calibrated as midline and 6100 at the two
ears.
An experimental run consisted of eleven trials, one trial
at each of the 11 IIDs at one frequency. Center frequency
and condition of balance were held constant over an experi-
mental run. Each subject completed a minimum of ten runs.
Each condition took several sessions to complete, thus insur-
ing that data for each frequency and balance condition were
gathered on more than one day.
II. RESULTS
A repeated measures analysis of variance ~ANOVA!
was carried out to examine the effects of subjects, group,
center frequency, balance, degree of asymmetry, better ear,

1822 J. Acoust. Soc. Am., Vol. 102, No. 3, September 1997 H. J. Simon and I. Aleksandrovsky: Perceived lateral position 1822

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 TABLE II. Repeated measure analysis of variance for EqSPL versus EqSL
data. Only the results of the main effects and significant three-way interac-
tions pertaining to the balancing conditions are shown. An asterisk indicates
the results significant at a criterion level of p,0.05.

Degrees of Sum of
Source of variance freedom squares F ratio

Subject 5 18 847.98 10.48*

Group ~hearing impaired and normal! 1 1358.13 0.36
Balance 1 18.23 0.05
Degree of asymmetry 1 1050.85 2.92
Center frequency 1 926.83 2.58
IID 1 9608.34 26.71*
Better ear 1 741.80 2.06
Degree of asymmetry*balance*better ear 1 4526.82 12.59*
IID*degree of asymmetry*balance 1 1761.89 4.90*

and IID on perceived lateral position. Individual subject data

points that were more than three standard deviations from the
group mean at each IID were considered outliers and were
removed for statistical calculation. A type III sum-of-squares
was used since the number of observations behind each data
point was not always identical. It can be noted that not all
subjects had asymmetries or unbalanced data at each fre-
quency. A criterion level of p,0.05 is used throughout to
assess statistical significance. The results of the main effects
and significant three-way interactions pertaining to the bal-
ancing conditions are shown in Table II.
The only significant main effect is IID indicating that for
larger IIDs the position of the signal is perceived farther
away from the center of the head ~see Fig. 1!. There were
other significant two- and three-way interactions observed,
however, only the interactions pertaining to the balancing
conditions will be discussed since the other interactions do
not affect the significant effects detected with respect to bal-
ance. FIG. 1. The effect of IID and degree of asymmetry on perceived intracranial
Figure 1 illustrates the significant three-way interaction position in EqSL and EqSPL. The ordinate represents the perceived lateral
@ F (1,360)54.90; p50.0271# as a function of the degree of position of the IID stimulus, with 0 calibrated as perceived midline and
6100 perceived at the two ears. Positive values are to the right of midline
asymmetry, IID, and balance. The ordinate represents the and negative values to the left. IID in dB is shown on the abscissa with 0
perceived mean position of the intracranial image, with 0 indicating equal intensitive stimuli, positive values indicating stimuli more
calibrated as perceived midline and 6100 perceived at the intense in the right ear, and negative values indicating stimuli more intense
two ears. Positive values are to the right of midline and nega- in the left ear. The parameter is the degree of asymmetry in dB SPL @panel
~a!# or dB SL @panel ~b!#. Each point represents the mean for the seven
tive values to the left. IID in dB is shown on the abscissa subjects. Error bars indicate the standard deviation of the mean.
with 0 indicating equal intensitive stimuli, positive values
indicating stimuli more intense in the right ear, and negative
values indicating stimuli more intense in the left ear. The position of the signal is perceived farther away from the
parameter is the degree of asymmetry in the two balance center of the head. In the EqSPL condition, the perceived
conditions, dB SPL @panel ~a!# or dB SL @panel ~b!#. Each lateralization is relatively unaffected by the degree of asym-
point represents the mean for the seven subjects. There was metry. However, in the EqSL condition, the dependency on
no significant difference between the two groups of subjects the degree of asymmetry is more notable, especially with the
when a group was added in a four-way interaction and thus 10- and 15-dB asymmetries.
the data were combined in this and the following figure. Figure 2 illustrates the perceived mean position of the
Error bars indicate the standard deviation of the mean. intracranial image as a function of the significant three-way
Threshold differences favoring right or left ears were com- interaction of degree of asymmetry, better ear, and balance
bined for this graph, i.e., each point combined the conditions for the EqSPL and EqSL conditions @F (1,360)512.59; p
where right ear input was 5 ~10, 15! dB greater or 5 ~10, 15! 50.0004#. Note that although this effect is represented as a
dB less than the left ear input. The resultant mean position of three-way interaction in the ANOVA, the figure combines
the intracranial image was shifted towards the ear where ‘‘better ear’’ and ‘‘degree of asymmetry’’ into one signed
more subjects had poorer thresholds. variable for salience of interpretation. The interaural input
This figure shows that in general, for larger IIDs, the asymmetry is shown on the abscissa, with 0 indicating no

1823 J. Acoust. Soc. Am., Vol. 102, No. 3, September 1997 H. J. Simon and I. Aleksandrovsky: Perceived lateral position 1823

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FIG. 2. Mean position of the intracranial image as a function of degree of
asymmetry in SL and SPL. The vertical axis indicates the mean perceived
horizontal ~lateral! position of the intracranial position; the horizontal axis
indicates the degree of interaural input asymmetry with 0 indicating no
difference between the ears and positive and negative values indicating
greater intensity ~consistent with the poorer ear! to the left and right ears,
respectively. The parameters are conditions EqSPL and EqSL.
difference between the ears and positive and negative values
indicating greater intensity ~consistent with the poorer ear! to
the left and right ears, respectively. The ordinate indicates
the mean perceived horizontal ~lateral! position of the intrac-
ranial image. Positive and negative values indicate percepts
to the right and left of midline, respectively. The parameters
are conditions EqSPL and EqSL. Each data point represents
one of the six values of asymmetry ~615, 610, 65 dB!, the
mean of at least 1500 repetitions for the normals and a mini-
mum of 264 ~maximum 1243! for the SNHL.4 Figure 2 dem-
onstrates that for EqSL, lateral position is essentially linearly
dependent on the degree of asymmetry. For EqSPL, again
there is essentially no dependency of lateralization position
on the degree of asymmetry.
III. DISCUSSION
This study confirms the assumptions of Durlach et al.
~1981! for SNHL listeners and the results of Simon et al.
~1994! for normal-hearing listeners: EqSPL is closest to, and
EqSL is the furthest from a centered image. In addition, this
result appears to be independent of the degree of asymmetry
~to 615 dB! for EqSPL and is similar for normal and SNHL
listeners.
These findings are also consistent with those of Hawkins
and Wightman ~1980! and Smoski and Trahiotis ~1986!5
where subjects generally show superior performance at
EqSPL. The present results augment a previous report from
this laboratory. In an acoustic pointing task ~Simon et al.,
1994!, when slight asymmetries at the two ears produced
signals of EqSL ~UnEqSPL!, lateralization was towards the
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ear with the greater SPL signal, regardless of the ear to
which the signal was delayed by ITD. The result with the
acoustic pointing task and the present study suggest that
people with asymmetric normal hearing have adapted to their
asymmetry for IID and ITD lateralization tasks at individual
frequencies.
The role of adaptation in lateralization experiments
whether positioned by ITD or IID has also been documented
by Bauer et al. ~1966! and Florentine ~1976!. In studies of
real and simulated asymmetrical hearing loss, Bauer et al.
~1966! and Florentine ~1976!, respectively, found that at the
onset of the hearing loss ~or occlusion! subjects used EqL to
center the image. After a period of time, the subjects in the
former study used EqSPL to center the image while subjects
in the latter study used a setting somewhere between EqSPL
and EqL at the two ears. Nabelek et al. ~1980! and Byrne and
Dermody ~1975! tested subjects with balanced ~EqSPL! and
unbalanced ~UnEqSPL! gains in hearing aids. Both found
that to produce a centered image, some of their subjects ig-
nored the imbalance between the aids, an example of adap-
tation in hearing aid fitting.
An important issue as a result of these studies and the
present findings concerns the current practices of fitting
‘‘binaural’’ hearing aids. The common assumption that two
optimally fit monaural hearing aids constitute an optimum
binaural fit is not necessarily true ~Braida et al., 1979; Col-
burn et al., 1987; Koehnke and Zurek, 1990!. The impor-
tance of the true ‘‘binaural,’’ and insufficiency of simply
‘‘bilateral’’ hearing aid fitting has been recently emphasized
~Sandlin, 1994!. Some interaction between both hearing aids
is necessary to access the binaural advantage. However, what
constitutes this interaction is unclear. Kimberly et al. ~1994!
suggest that adjustments of the interaural amplitude ratio are
necessary to compensate for an asymmetrical loss. Sch-
weitzer ~1993! and Jerger et al. ~1993! consider the phase
relationships between the two hearing aids to be important
and suggest variable phase adjusters for varying phase rela-
tionships to reflect individual differences. Thus some rela-
tionship between the two hearing aids in either time or in-
tensity is being advocated.
However, no prescriptive procedures to date specifically
document the appropriate method of adjusting the interaural
levels in binaural hearing aids. In the traditional hearing aid
fitting, the amount of real-ear gain prescribed by the pre-
scription formulas ~the actual gain provided by the hearing
aid for an individual! in specific frequency regions is deter-
mined by data from one of two sources, threshold or com-
fort. If threshold procedures are used ~i.e., Byrne and Cotton,
1988; McCandless and Lyregaard, 1983! asymmetries be-
tween the ears may result in unequal gain prescribed to each
ear. If most comfortable loudness ~MCL! procedures are
used, even bilaterally symmetrical thresholds would not nec-
essarily produce equal MCL in the two ears ~cf. Lee, 1995!
and in those instances the formulas also would prescribe bi-
laterally asymmetrical gain. To the extent that lateralization
performance can predict localization abilities, the resultant
SPL imbalance using these prescription formulas would dis-
rupt the previously adapted system and impair localization
and binaural release from masking. Presently in clinical prac-
H. J. Simon and I. Aleksandrovsky: Perceived lateral position 1824

tice, when threshold asymmetries exist, there is intuitive
knowledge that ‘‘asymmetrical’’ gain fittings will cause per-
ceptual ‘‘imbalance.’’ Therefore attempts are made to ‘‘un-
deramplify’’ the worst ear to bring the gain functions for
both ears as close to each other as the hearing loss permits.
At the same time, the patient is often asked to ‘‘balance’’ the
percept of the sound source or to adjust ‘‘user gain’’ by
manipulating the volume controls on both hearing aids.6 To
our knowledge, there has not been a systematic study of the
adjusted outputs in terms of the user gain relationship of
binaural hearing aids. A possibility exists that a patient will,
in effect, try to counterbalance the prescription-induced in-
teraural SPL differences, achieving some UnEqSL, mini-
mally UnEqSPL listening conditions to which he or she is
adapted. The procedure involves balancing the loudness per-
cept of a broadband signal like speech, leaving the interaural
intensity/loudness relationships of the individual frequencies
unaccounted for and possibly disrupted.
While the bilateral hearing aid user is likely to adapt to
these prescription-induced imbalances for subjective tasks
like perceptual centering, Colburn et al. ~1987! note that
long-term adaptation to the imbalance of the inputs does not
occur for sensitivity tasks. By applying different gain func-
tions to asymmetrical ears, a listener with SNHL could be at
a perceptual disadvantage, whether temporary or permanent.
Although listeners report better speech perception and local-
ization ability with binaural as compared to monaural ampli-
fication ~Koehnke et al., 1992!, the less-than-optimal im-
provement and acceptance of binaural amplification in some
cases may be the result of these imbalances.
In conclusion, balancing by SPL rather than SL pro-
duced more accurate lateralization performance in asymmet-
ric normal-hearing and SNHL listeners. Thus in binaural ex-
periments, compensation for threshold asymmetries by
equalizing SL between the two ears with SNHL listeners
may not be necessary. However, our results do indicate the
importance of testing thresholds in normal-hearing subjects
and balancing for dB SPL in binaural experiments. Clini-
cally, more attention and research is needed on the binaural
rather than the bilateral fitting of hearing aids.
ACKNOWLEDGMENTS
This research was supported by grants from NIDCD
~R29DC00468-04! and NIDRR ~H133G20048! as well as a
grant from the Smith-Kettlewell Eye Research Institute. Spe-
cial thanks to the memory of Carter C. Collins, Ph.D., who
helped develop the instrumentation and all the good ideas.
Thanks also to Brennan McBride for software development,
Albert B. Alden and Steven T. Chung for hardware develop-
ment, Judith Paton, M. A. for audiological evaluations, Lau-
ren Gee, M. P. H. for statistical analysis, and Elaine Goduti
for assistance during data collection and analysis. We also
wish to thank Pierre L. Divenyi, Ph.D., Suzanne McKee,
Ph.D., Raymond H. Dye, Jr., Ph.D., and two anonymous
reviewers for their helpful comments and suggestions and
Arthur Jampolsky, M. D. for his continued support.
1825 J. Acoust. Soc. Am., Vol. 102, No. 3, September 1997
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1
The decision to balance the ears for EqSPL by presenting an intensity level
corresponding to 25 dB SL at the poorer ear was done so that both ears
were at least at 25 dB SL. Presenting an intensity level corresponding to 25
dB SL in the better ear would reduce the sensation level in the poorer ear
below 25 dB. The manner of matching the ears will determine which sig-
nals are presented at the greater overall level.
2
EqSPL or balance could also occur naturally when the thresholds in the two
ears were equal at a particular frequency ~EqSPL and EqSL!. These differ-
ences will be discussed in relation to a different data set and paradigm in
subsequent publications.
3
These earphones were chosen because of their good intrasubject reliability
in comparison to supra-aural phones: they reduce the variability of the
volume of trapped air between the transducer and the eardrum ~Wilber
et al., 1988; Killion and Villchur, 1989! and eliminate variations caused by
earphone placement or collapsed ear canals, a common problem in the
elderly ~Olsho et al., 1985!. The insert earphones were positioned only
once during a session. The insert earphones were inserted 2 to 3 mm past
the canal entrance ~a deep insertion!, and visually checked by the investi-
gator. Little test variability between sessions was anticipated from earphone
placement ~Wilber et al., 1988!.
4
Since mean position of the intracranial image for the full-range IID yields
polar opposite results, variability statistics for the collapsed IID data are not
meaningful.
5
Hawkins and Wightman ~1980! tested three normal-hearing subjects with
reported asymmetries of 10 dB or less. At 500 Hz, three of their eight
SNHL subjects had 5-dB asymmetries and two had asymmetries of 40 dB
or greater. At 4000 Hz, four subjects had asymmetries of 5 dB and three
others had 10-, 35-, and 45-dB asymmetries. Smoski and Trahiotis ~1986!
did not report on the asymmetries of their two normal-hearing subjects.
However, three of the four hearing-impaired subjects tested had asymme-
tries of 5 and 10 dB at 500 Hz and 5 and 25 dB at 4000 Hz.
6
The validity of such a procedure is seldom discussed in the literature.
However, this clinical judgment is validated by our results.
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