Audiometers and hearing Aids

3.1 Hearing Aids

Mechanism of hearing

The ear has three sections viz.- the external auditory meatus, the middle ear and the
inner ear, as shown in Fig.1. The external ear is the area from the pinna (technically
called auricle) to the ear drum. The middle ear is from the ear drum to the cochlea, it
consists of the three small bones called ossicles which are placed in a closed space
(called tympanum) filled with air. The inner ear is the portion of the ear deeper to this
and it houses the transducer (called cochlea) and also the organ of balance (called
vestibular labyrinth).

Figure 1 The organ of hearing, consisting of the outer ear (auricle and pinna)

When sound reaches the inner ear through the eardrum, this phenomenon is called air
conduction. This is the usual path of sounds to reach the eardrum. Sound, particularly in
the low frequency range, may reach the inner ear via the bones in the head rather than
from the eardrum, this phenomenon being called bone conduction [6]. The normal
process via the ear canal is called air conduction. Wearing earplugs results in a greater
percentage of the sound heard coming from bone conduction. Normally only a small
fraction of sound is received in this way; however, deaf people whose inner ear still
functions normally may be able to hear sound conducted to the ear in this way, for
instance by holding between the teeth a wooden rod connected to a vibrating object.
Basic Audiometer

Audiometry is the technique to identify the nature of hearing loss and to determine the
threshold of hearing by recording responses of the patient after presenting him with
auditory stimuli with varying intensity levels.

It is essentially an oscillator driving a pair of headphones and is calibrated in terms of

frequency and acoustic output. Both the frequency and acoustic output are adjustable.
Some instrument is also provided with a calibrated noise source and bone-conductor
vibrators.

The figure below show the block diagram of a basic audiometer.

Figure 2: Block Diagram of basic audiometer

It consists of two channels, tone generator and noise generator and each channel has an
attenuator, equalizer and power amplifier.

The tone generator or oscillator has a controllable frequency range from 250 Hz to
8KHz.
The equalization circuit is required to provide frequency dependent attenuation in order
to calibrate the output sound level in dB HL and also to provide different amount of
attenuation for different output devices used.

The attenuator or the hearing/ tone level control should be capable of controlling the
output sound level over a desired range in steps of 5dB. The output sound should be
within 3dB of the indicated value.

For masking purpose the noise generator should provide wide band noise, which has
energy spectrum up to 8 KHz. There can also be a narrow band noise whose output
should be distribute around the test frequency.

The power amplifier determines the output power available, which determines the
maximum sound pressure level available from the headphones and the bone vibrator.
The amplifier must have low distortion and good SNR.

There are different audiometric techniques and procedures used for achieving this. For
air conduction testing, stimuli are presented to each ear independently with specialized
earphones. For bone conduction testing, a bone vibrator is placed onto the mastoid
process of either right or left temporal bone; external auditory canals are not usually
occluded. All equipment must be continually calibrated to conform to international
standards. This ensures that a gradual loss of hearing noted on serial testing is truly valid
and not due to machine error. Audiometry is performed in an isolated sound-dampened
environment. As with other psychoacoustic testing, all audiometric equipment is
discretely arranged so that visual (nonacoustic) cues are minimized.

Pure Tone Audiometres

Pure tone audiometry is a procedure for determination of the extent of hearing loss and
the cause, i.e. conduction or sensorineural loss. The subject s hearing thresholds for
acoustic stimuli of different frequencies are measured. The initial level of the stimuli is
selected by the audiologist. Pure tone audiometers usually generate test tones in
octave steps from 125-8000Hz. A pure tone is simplest type of auditory stimulus and it
can be specified accurately in terms of frequency and intensity.

Speech Audiometry

While pure tone threshold testing attempts to assess sensitivity, speech audiometry
testing attempts to address the integrity of the entire auditory system by assessing the
ability to here clearly and to understand speech communication. The main use of speech
audiometry is in the identification of neural types of hearing loss, in which both the
reception as well as the discrimination of speech is impaired more markedly than in
cochlear or conductive hearing loss. Speech audiometry generally incorporates a good
 quality CD player to play recorded speech and masking noise is supplied by the noise
generator.

Calibration of Audiometers

Audiometers are devices that are used for comparison of hearing of a subject to a normal
human being. The comparison may be between an individual’s present audiogram and one
previously taken audiogram or between his audiogram and the audiogram of other. Therefore
for valid comparison, the test conditions and reference levels must be universal.

Accurate calibration of audiometers is essential to ensure that the instrument produces a pure
tone at the specified level and frequency, and that signal is present only in the transducer to
which it is directed. For pure tone audiometer, the parameters that re checked are frequency
and intensity.

The frequency output is checked using either a counter-timer of an oscilloscope. It is connected

across one earphone, and the audiometer is set to give maximum output. The specification of
audiometer allows a tolerance of ±3% for frequency output. The sound pressure level is
checked by an “artificial ear” or a coupled with a sound level meter. The artificial ear consists of
a condenser microphone and a coupler.

The earphone is placed squarely on the coupler and it should be ensured that it forms a good
seal. The output on the sound level is directly measured in dB and compared with expected
frequency outcome. While the artificial ear is used as a standardize substitute for human ear
when making measurements using an air-conduction earphone, an artificial mastid is used as a
standardize substitute for the human mastoid. The artificial mastoid consists of mechanical
stimulation of the human one, incorporating a build-in force transducer to monitor the output
of the device to be calibrated.