Threshold Equalizing Noise (TEN) Page 1 of 3

Threshold Equalizing Noise (TEN) - Quick

Guide
This Quick Guide is based on a white paper that was written for Interacoustics by Brian C.J. Moore (2009).
The TEN test requires an additional license.

What is the TEN test?

The test consists of measuring pure tone thresholds in a special masking noise, called the TEN (Threshold
Equalizing Noise).The TEN test was developed to provide clinicians with a quick and easy way to identify
cochlear dead regions.

What is a dead region?

A dead cochlear region is defined as a region of the cochlea where there are no functioning inner hair cells
and/or neurons (Moore, 2001). When a pure-tone signal “falls” into a dead region, it can be heard by
neighbouring hair cells, if the intensity of the signal is loud enough. This is because the pure tone produces
sufficient basilar-membrane vibrations in neighbouring areas of the cochlea, where there are surviving IHCs
and neurons. This phenomenon is defined as “Off Frequency Listening”. Clinically, this will be presented as a
threshold on the traditional pure tone audiogram, but it may not be the real threshold. It is not possible to use
traditional pure tone audiometry to determine if there is a dead region present; the TEN test was developed
for this very purpose.

When to do the TEN test?

Characteristics that could indicate the presence of a dead region (Moore, 2009):
• Severe to profound hearing loss
• Absolute threshold at a specific (suspected) frequency is 70dB HL or greater
• Steeply sloping hearing loss
• Complaints of distortion
• Extremely poor speech discrimination

Test Procedure
The TEN test is performed ipsilaterally, meaning that the tone and the noise are presented in the same ear.
It can only be conducted with TDH39, DD45 and Insert earphones.

1. On the device press and hold the Tests button and use the black scroll wheel to select TEN:
Threshold-equalizing noise. The test is set to start with the stimulus for channel 1 and 2 directed to
the same ear. The tone is presented in channel 1 and TEN is presented in channel 2, with the
stimulus in channel 2 reversed (Rev) to have a continuous masking signal.

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If operating the audiometer from the PC the TEN noise will be available in channel 2 if licensed. To
enable the TEN noise press TEN (a). Ensure it is presented to the same ear as in channel 1 (b).
The decibel step size can be changed to 2dB (c).

2. Set the intensity levels:

• For frequencies where hearing loss up to 60dB HL: set the TEN level to 70dB
• For frequencies where hearing loss is 70dB or more: set the TEN level 10dB above the
audiometric threshold at that frequency (Moore, 2009). E.g., if the audiometric threshold is
75dB HL, set the TEN level to 85dB HL
• If the TEN is too loud, or if the maximum TEN level of 90dB HL is reached, then set the TEN
level equal to the audiometric threshold. This should still give a definitive result
3. Conduct a threshold search using the traditional method for air conduction
4. Repeat for each frequency where a dead region is suspected

Clinical Value of TEN test

Criteria for diagnosing a dead region (Moore, 2009):

A dead region at a particular frequency is indicated when:

A masked threshold is at least 10dB or more above the level of the TEN
AND
Masked threshold is at least 10dB above the non-masked threshold.

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The example below shows an example of a positive TEN test, with a masked threshold indicating a dead
region.

If dead regions are present, this may have important implications for fitting hearing aids and for predicting the
likely benefit of hearing aids. When a patient has a dead region, there may be little or no benefit from hearing
aid amplification for frequencies well inside the dead region (Moore, 2009).

Identifying a cochlear dead region can:

• Help counsel the patient and manage expectations regarding the potential benefit of hearing
aids
• Helps on choice of type of hearing aid
• Can help determine if a patient would be a good candidate for cochlear implants
o Patient might do better with an implant when there are extensive dead regions
o Helps determine insertion depth

References
Moore, B. C. J. (2001). "Dead regions in the cochlea: Diagnosis, perceptual consequences, and implications
for the fitting of hearing aids," Trends Amplif. 5, 1–34.
Moore, B. C. J. (2009). “Audiometer Implementation of the TEN (HL) Test for Diagnosing Cochlear Dead
Regions”.

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