Real ear measurement | |
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Synonyms | In situ or Probe microphone measurement [1] |
Purpose | measure of sound pressure in ear |
Real ear measurement is the measurement of sound pressure level in a patient's ear canal developed when a hearing aid is worn. It is measured with the use of a silicone probe tube inserted in the canal connected to a microphone outside the ear and is done to verify that the hearing aid is providing suitable amplification for a patient's hearing loss. [2] The American Speech–Language–Hearing Association (ASHA) and American Academy of Audiology (AAA) recommend real ear measures as the preferred method of verifying the performance of hearing aids. [3] [4] Used by audiologists and other hearing healthcare practitioners in the process of hearing aid fitting, real ear measures are the most reliable and efficient method for assessing the benefit provided by the amplification. [5] Measurement of the sound level in the ear canal allows the clinician to make informed judgements on audibility of sound in the ear and the effectiveness of hearing aid treatment.
The use of real ear measurement to assess the performance of hearing aids is covered in the ANSI specification Methods of Measurement of Real-Ear Performance Characteristics of Hearing Aids, ANSI S3.46-2013 (a revision of ANSI S3.46-1997). [6]
The first commercially produced real ear measurement available was made by Rastronics. [7] Help soon arrived. In the early 1980s, the first computerized probe-tube microphone system, the Rastronics CCI-10 (developed in Denmark by Steen Rasmussen), entered the U.S. market (Nielsen and Rasmussen, 1984). This system had a silicone tube attached to the microphone (the transmission of sound through this tube was part of the calibration process), which eliminated the need to place the microphone itself in the ear canal. By early 1985, three or four different manufactures had introduced this new type of computerized probe microphone equipment, and this hearing aid verification procedure became part of the standard protocol for many audiology clinics.
First, the clinician will examine the ear canal with the use of an otoscope to ensure no wax or other debris will interfere with the positioning of the probe tube. The probe tube is placed with the tip approximately 6 mm (1/4 inch) from the tympanic membrane. Next the hearing aid is put in place. The REM system will typically produce a test stimulus from a loudspeaker situated 12–15 inches (30–38 cm) from the patient's head and simultaneously measure the output in the ear canal to determine how much amplification the hearing aid is providing. [8]
The traditional method of real ear measurement is known as insertion gain, which is the difference between the sound pressure level measured near the ear drum with a hearing aid in place, and the sound pressure level measured in the unaided ear. First a measurement is made with the probe tube in the open ear (Real Ear Unaided Response, or REUR), then a second one is made using the same test signal with the hearing aid in place and turned on (Real Ear Aided Response, or REAR). The difference between these two results is the insertion gain. This gain can be matched to targets produced by various prescriptive formula based on the patient's audiogram or individual hearing loss. [9]
Speech mapping (also known as output-based measures) involves testing with a speech or speech-like signal. The hearing aid is adjusted so that the speech is amplified to the approximate middle of the patient's residual auditory area (the amplitude range between the patient's hearing threshold and upper limit of comfort) while observing a real-time spectrum display of the speech in the patient's ear canal. Many multi-channel hearing aids allow each frequency channel to be adjusted separately. The aim is to find a good compromise between intelligibility and loudness discomfort. [10] This approach to hearing aid testing is implemented in most current real ear systems and there has been a significant increase in audiologists selecting to verify using the output method. [11] Using a real speech signal to test a hearing aid has the advantage that features that may need to be disabled in other test approaches can be left active, and the effects of these features in normal use are included in the test. [12]
A hearing aid is a device designed to improve hearing by making sound audible to a person with hearing loss. Hearing aids are classified as medical devices in most countries, and regulated by the respective regulations. Small audio amplifiers such as personal sound amplification products (PSAPs) or other plain sound reinforcing systems cannot be sold as "hearing aids".
A hearing test provides an evaluation of the sensitivity of a person's sense of hearing and is most often performed by an audiologist using an audiometer. An audiometer is used to determine a person's hearing sensitivity at different frequencies. There are other hearing tests as well, e.g., Weber test and Rinne test.
An earplug is a device that is inserted in the ear canal to protect the user's ears from loud noises, intrusion of water, foreign bodies, dust or excessive wind. Since they reduce the sound volume, earplugs may prevent hearing loss and tinnitus, in some cases.
Audiology is a branch of science that studies hearing, balance, and related disorders. Audiologists treat those with hearing loss and proactively prevent related damage. By employing various testing strategies, audiologists aim to determine whether someone has normal sensitivity to sounds. If hearing loss is identified, audiologists determine which portions of hearing are affected, to what degree, and where the lesion causing the hearing loss is found. If an audiologist determines that a hearing loss or vestibular abnormality is present, they will provide recommendations for interventions or rehabilitation.
Conductive hearing loss (CHL) occurs when there is a problem transferring sound waves anywhere along the pathway through the outer ear, tympanic membrane (eardrum), or middle ear (ossicles). If a conductive hearing loss occurs in conjunction with a sensorineural hearing loss, it is referred to as a mixed hearing loss. Depending upon the severity and nature of the conductive loss, this type of hearing impairment can often be treated with surgical intervention or pharmaceuticals to partially or, in some cases, fully restore hearing acuity to within normal range. However, cases of permanent or chronic conductive hearing loss may require other treatment modalities such as hearing aid devices to improve detection of sound and speech perception.
Audiometry is a branch of audiology and the science of measuring hearing acuity for variations in sound intensity and pitch and for tonal purity, involving thresholds and differing frequencies. Typically, audiometric tests determine a subject's hearing levels with the help of an audiometer, but may also measure ability to discriminate between different sound intensities, recognize pitch, or distinguish speech from background noise. Acoustic reflex and otoacoustic emissions may also be measured. Results of audiometric tests are used to diagnose hearing loss or diseases of the ear, and often make use of an audiogram.
Auditory neuropathy (AN) is a hearing disorder in which the outer hair cells of the cochlea are present and functional, but sound information is not transmitted sufficiently by the auditory nerve to the brain. The cause may be several dysfunctions of the inner hair cells of the cochlea or spiral ganglion neuron levels. Hearing loss with AN can range from normal hearing sensitivity to profound hearing loss.
An audiometer is a machine used for evaluating hearing acuity. They usually consist of an embedded hardware unit connected to a pair of headphones and a test subject feedback button, sometimes controlled by a standard PC. Such systems can also be used with bone vibrators to test conductive hearing mechanisms.
A bone-anchored hearing aid (BAHA) is a type of hearing aid based on bone conduction. It is primarily suited for people who have conductive hearing losses, unilateral hearing loss, single-sided deafness and people with mixed hearing losses who cannot otherwise wear 'in the ear' or 'behind the ear' hearing aids. They are more expensive than conventional hearing aids, and their placement involves invasive surgery which carries a risk of complications, although when complications do occur, they are usually minor.
Adaptive feedback cancellation is a common method of cancelling audio feedback in a variety of electro-acoustic systems such as digital hearing aids. The time varying acoustic feedback leakage paths can only be eliminated with adaptive feedback cancellation. When an electro-acoustic system with an adaptive feedback canceller is presented with a correlated input signal, a recurrent distortion artifact, entrainment is generated. There is a difference between the system identification and feedback cancellation.
A contralateral routing of signals (CROS) hearing aid is a type of hearing aid that is used to treat a condition in which the patient has no usable hearing in one ear and minimal hearing loss or normal hearing in the other ear. This is referred to as single sided deafness.
Pure-tone audiometry is the main hearing test used to identify hearing threshold levels of an individual, enabling determination of the degree, type and configuration of a hearing loss and thus providing a basis for diagnosis and management. Pure-tone audiometry is a subjective, behavioural measurement of a hearing threshold, as it relies on patient responses to pure tone stimuli. Therefore, pure-tone audiometry is only used on adults and children old enough to cooperate with the test procedure. As with most clinical tests, standardized calibration of the test environment, the equipment and the stimuli is needed before testing proceeds. Pure-tone audiometry only measures audibility thresholds, rather than other aspects of hearing such as sound localization and speech recognition. However, there are benefits to using pure-tone audiometry over other forms of hearing test, such as click auditory brainstem response (ABR). Pure-tone audiometry provides ear specific thresholds, and uses frequency specific pure tones to give place specific responses, so that the configuration of a hearing loss can be identified. As pure-tone audiometry uses both air and bone conduction audiometry, the type of loss can also be identified via the air-bone gap. Although pure-tone audiometry has many clinical benefits, it is not perfect at identifying all losses, such as ‘dead regions’ of the cochlea and neuropathies such as auditory processing disorder (APD). This raises the question of whether or not audiograms accurately predict someone's perceived degree of disability.
Electric acoustic stimulation (EAS) is the use of a hearing aid and a cochlear implant technology together in the same ear. EAS is intended for people with high-frequency hearing loss, who can hear low-pitched sounds but not high-pitched ones. The hearing aid acoustically amplifies low-frequency sounds, while the cochlear implant electrically stimulates the middle- and high-frequency sounds. The inner ear then processes the acoustic and electric stimuli simultaneously, to give the patient the perception of sound.
The occlusion effect occurs when an object fills the outer portion of a person's ear canal, causing that person to perceive echo-like "hollow" or "booming" sounds generated from their own voice.
An earmold is a device worn inserted into the ear for sound conduction or hearing protection. Earmolds are anatomically shaped and can be produced in different sizes for general use or specially cast from particular ear forms. Some users specify how hard or soft they want their mold to be, an audiologist can also suggest this. As a conductor, it improves sound transmission to eardrums. This is an essential feature to diminish feedback paths in hearing aids and assure better intelligibility in noisy-environment communication. The main goal in wearing earmolds is to attain better user comfort and efficiency. Earmolds often turn yellow and stiff with age, and thus need replacement on a regular basis. Traditionally, the job of making earmolds is very time-consuming and skillful; each one is made individually in a molding process. However, new digital ear laser scanners can accelerate this process.
Hearing, or auditory perception, is the ability to perceive sounds through an organ, such as an ear, by detecting vibrations as periodic changes in the pressure of a surrounding medium. The academic field concerned with hearing is auditory science.
In live sound mixing, gain before feedback (GBF) is a practical measure of how much a microphone can be amplified in a sound reinforcement system before causing audio feedback. In audiology, GBF is a measure of hearing aid performance. In both fields the amount of gain is measured in decibels at or just below the point at which the sound from the speaker driver re-enters the microphone and the system begins to ring or feed back. Potential acoustic gain (PAG) is a calculated figure representing gain that a system can support without feeding back.
The first hearing aid was created in the 17th century. The movement toward modern hearing aids began with the creation of the telephone, and the first electric hearing aid was created in 1898. By the late 20th century, the digital hearing aid was distributed to the public commercially. Some of the first hearing aids were external hearing aids. External hearing aids direct sounds in front of the ear and block all other noises. The apparatus would fit behind or in the ear.
Personal Sound Amplification Products, also known as "Personal Sound Amplification Devices," or by the acronym PSAP, are defined by the U.S. Food and Drug Administration as wearable electronic products that are intended to amplify sounds for people who are not Deaf or Hard of Hearing. They are not hearing aids, which the FDA describes as intended to compensate for hearing loss. According to Dr. Mann of the FDA, choosing a PSAP as a substitute for a hearing aid can lead to more damage to your hearing.
Hearing protector fit-testing is a method that measures the degree of noise reduction obtained from an individual wearing a particular hearing protection device (HPD) - for example, a noise canceling earplug or earmuff. Fit testing is necessary due to the fact that noise attenuation varies across individuals. It is important to note that attenuation can sometimes score as zero due to anatomical differences and inadequate training, as to the proper wear and use. Labeled HPD attenuation values are average values that cannot predict noise attenuation for an individual; in addition, they are based on laboratory measurements which may overestimate the noise reduction obtained in the real world.
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