Short Course
Overviews and tutorials on important clinical and professional topics
Clinical Masking in Speech Audiometry: A
Simplified Approach
William S. Yacullo
Governors State University, University Park, IL
The optimal masking level during speech
audiometry is one that falls above the
minimum and below the maximum masking
levels. The goal is to select a masking level
that falls at the middle of the masking plateau.
This article presents a simplified approach to
selecting an appropriate level of contralateral
masking during suprathreshold speech
audiometry. The underlying theoretical
M ore than 25 years ago, Sanders (1972) wrote
the following introduction to his book chapter
on clinical masking:
Of all the clinical procedures used in auditory assess-
ment, masking is probably the most often misused and
the least understood. For many clinicians the approach
to masking is a haphazard, hit-or-miss bit of guess-
work with no basis in any set of principles. (p. 111)
Unfortunately, this statement probably still holds true today.
Martin, Armstrong, and Champlin (1994) stated that “despite
the large body of research regarding clinical masking, many
audiologists use improper determinations for the need to mask
and/or fail to mask using a logical method” (p. 26).
A strong foundation in the underlying theoretical and
experimental bases of clinical masking serves a twofold pur-
pose. First, it allows the clinician to make a well-informed
decision when selecting a specific approach to clinical mask-
ing. Second, it allows the clinician to apply and modify a
clinical masking procedure appropriately. A lack of under-
standing of the underlying theoretical concepts of masking,
however, can lead to misuse of clinical procedures.
This article presents a simplified approach to clinical
masking in suprathreshold speech audiometry. Stated sim-
ply, whenever it is determined that contralateral masking
is required, an effective masking level is used that is
equal to the presentation level of the speech signal at the
test ear minus 20 dB. According to the results of a recent
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concepts and prerequisite conditions are
reviewed. The advantages of insert earphones
when using the simplified approach are
discussed.
Key Words: clinical masking, speech
audiometry, acoustic masking procedures,
midplateau masking procedure, insert
earphones
survey of audiometric practices in the United States,
many audiologists “base their masking level for word-
recognition testing on the stimulus level presented to the
test ear and subtract a set amount, such as 20 dB” (Mar-
tin, Champlin, & Chambers, 1998, p. 100). This “short-
cut” approach to selecting an appropriate level of masking
during speech audiometry is based on the early work of
Jerger and associates (Jerger & Jerger, 1971; Jerger,
Jerger, Ainsworth, & Caram, 1966) and Studebaker
(1979). More recently, this procedure has been discussed
by Hannley (1986), Yacullo (1996), and Gelfand (1997).
Unfortunately, inappropriate use of this simplified ap-
proach can result in undermasking or overmasking.
The two purposes of this article are (a) to review the
underlying theoretical concepts of the simplified approach
to selecting an appropriate level of contralateral masking
during suprathreshold speech audiometry, and (b) to spec-
ify the prerequisite conditions for appropriate use of the
simplified procedure.
Background
The Need for Masking
One of the major objectives of the basic audiological
evaluation is assessment of auditory function of each ear
independently. There are situations during both air-con-
duction and bone-conduction testing when this may not
occur. Although a pure-tone or speech signal is being
presented through a transducer to the test ear, the nontest
● 1059-0889 © American Speech-Language-Hearing Association 1
 ear can contribute partially or totally to the observed re-
sponse. Whenever it is suspected that the nontest ear is
responsive during evaluation of the test ear, a masking
signal must be applied to the nontest ear in order to elim-
inate its participation.
Contralateral masking is indicated during speech audi-
ometry whenever the presentation level of the speech sig-
nal in dB HL at the test ear (PLT) minus interaural atten-
uation (IA) equals or exceeds the best pure-tone bone-
conduction threshold in the nontest ear (Best BCNT):
PLT 2 IA $ Best BCNT.
As with pure-tone air-conduction testing, the bone-con-
duction thresholds in the nontest ear must be considered
when making a decision about the need for masking dur-
ing speech audiometry. Because speech is a broadband
signal, it is necessary to consider bone-conduction hearing
sensitivity at more than a single pure-tone frequency.
There is some disagreement regarding the range of fre-
quencies that should be considered when determining the
need for contralateral masking during speech audiometry
(e.g., ASHA, 1988; Coles & Priede, 1975; Konkle &
Berry, 1983; Sanders, 1991). The most conservative ap-
proach, however, involves considering the best bone-con-
duction threshold in the 250- to 4000-Hz frequency range
(Coles & Priede, 1975).
Interaural attenuation refers to the reduction of sound
energy between ears. More specifically, it is the differ-
ence in decibels between the hearing level of the signal at
the test ear and the hearing level reaching the nontest co-
chlea. Interaural attenuation during air-conduction testing
is dependent on the type of earphone (e.g., supra-aural vs.
insert). According to the results of a recent survey of au-
diometric practices in the United States (Martin et al.,
1998), it appears that the majority of audiologists con-
tinue to use supra-aural earphones during clinical testing.
More specifically, only 24% of responding audiologists
indicated that they are using insert earphones in “some
clinical capacity” (p. 97). Because supra-aural earphones
are the typical configuration used in audiometric testing,
they will be the focus of discussion in this paper. How-
ever, the advantages of insert earphones when using the
simplified approach during speech audiometry will also be
discussed.
Interaural attenuation for speech is typically measured
experimentally by obtaining speech recognition thresholds
(SRT) in individuals with unilateral, profound sensorineu-
ral hearing impairment. Specifically, the difference in
threshold between the normal ear and impaired ear with-
out contralateral masking is calculated:
IA 5 Unmasked SRTImpaired Ear 2 SRTNormal Ear.
The smallest reported value of interaural attenuation for
spondaic words when measured with conventional supra-
aural earphones (e.g., TDH-39, -49, or -50 transducers
encased in MX-41/AR or Telephonics Model 51 cush-
ions) is 48 dB (e.g., Martin & Blythe, 1977; Snyder,
1973). When making a decision about the need for con-
tralateral masking during clinical practice, a single value
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defining the lower limit of interaural attenuation is most
useful (Studebaker, 1967). The majority of audiologists
measure SRT using a 5-dB step size (Martin et al., 1998);
therefore, the interaural attenuation value of 48 dB is typ-
ically rounded down to 45 dB.
There is some evidence that it may be appropriate to ap-
ply a more conservative estimate of interaural attenuation
when making a decision about the need for contralateral
masking during assessment of suprathreshold speech recog-
nition. Although interaural attenuation remains constant dur-
ing assessment of threshold and suprathreshold speech rec-
ognition, fundamental differences in performance criteria
must be taken into account when selecting a clinically ap-
propriate value of interaural attenuation. The speech recogni-
tion threshold is specified relative to a 50% performance
criterion; suprathreshold speech recognition performance,
however, can range from 0 to 100%. Konkle and Berry
(1983) and Yacullo (1996) provide further discussion of in-
teraural attenuation and speech recognition.
The majority of audiologists use an interaural attenua-
tion value of 40 dB for all air-conduction measurements,
both pure-tone and speech, when making a decision about
the need for contralateral masking (Martin et al., 1998).
The use of a single interaural attenuation value of 40 dB
for both threshold and suprathreshold speech audiometric
measurements is suggested by Martin (1997). Although a
value of 40 dB is somewhat too conservative during mea-
surement of SRT, it should prove adequate in most cases
during assessment of suprathreshold speech recognition.
For the purpose of this discussion, 40 dB will be used as
the estimate of interaural attenuation for speech.
Clinical Masking Procedures
There are many different approaches to clinical mask-
ing. However, all procedures address two basic questions.
First, what is the minimum level of noise that is required
to just mask the cross-hearing signal in the nontest ear?
Stated differently, this is the minimum masking level that
is needed to prevent undermasking (i.e., the test signal
continues to be perceived in the nontest ear). Second,
what is the maximum level of noise that can be presented
to the nontest ear that will not shift or change the true
threshold in the test ear? Stated differently, this is the
maximum masking level that can be used without over-
masking. For this discussion, it is assumed that the
masker is speech spectrum noise (i.e., weighted random
noise for speech) calibrated in effective masking level
(i.e., dB EM). The reader is referred to the most current
American national standard specification for audiometers
(ANSI S3.6-1996) for further discussion of the calibration
of weighted random noise for the masking of speech.
Minimum Masking Level. The concept of minimum
masking level (MMin), originally described by Liden, Nil-
sson, and Anderson (1959), can be summarized using the
following equation:
MMin 5 PLT 2 IA 1 Max AB GapNT.
PLT represents the presentation level of the speech signal
in dB HL at the test ear, IA is the interaural attenuation
 value for speech, typically 40 dB (Coles & Priede, 1975;
Liden et al., 1959), and Max AB GapNT is the maximum
air-bone gap in the nontest ear in the 250- to 4000-Hz
frequency range. PLT 2 IA, an estimate of the hearing
level of the speech signal that has reached the nontest ear,
represents the minimum masking level required. However,
the presence of air-bone gaps in the nontest (i.e., masked)
ear will reduce the effectiveness of the masker. Conse-
quently, the minimum masking level must be increased
by the size of the air-bone gap.
One modification of the original formula described by
Liden et al. (1959) should be noted. Liden and associates
recommended that the average air-bone gap in the nontest
ear, calculated using frequencies of 500, 1000, and 2000
Hz, be accounted for when determining the minimum
masking level. Because speech is a broadband signal, it is
no longer appropriate to consider bone-conduction thresh-
old at only a single frequency as is the case during pure-
tone audiometry. Coles and Priede (1975) suggested a
more conservative approach and recommended that the
maximum air-bone gap at any frequency in the range from
250 through 4000 Hz be considered. There is the assump-
tion that the largest air-bone gap will have the greatest
effect on masking level. Following the recommendation
of Coles and Priede (1975), the maximum air-bone gap in
the nontest ear should be considered when determining
minimum masking level.
Maximum Masking Level. The concept of maximum
masking level (MMax), originally described by Liden et al.
(1959), can be summarized using the following equation:
MMax 5 Best BCT 1 IA 2 5 dB.
Best BCT represents the best bone-conduction threshold in
the test ear in the frequency range from 250 through 4000
Hz, and IA is equal to the interaural attenuation value for
speech. If Best BCT 1 IA is just sufficient to produce over-
masking, then a slightly lower masking level than the calcu-
lated value must be used clinically. Because masking level is
typically adjusted using a 5-dB step size, a value of 5 dB
subsequently is subtracted from the calculated value.
Liden et al. originally suggested that the average pure-
tone bone-conduction threshold in the test ear, calculated
using frequencies of 500, 1000, and 2000 Hz, should be
considered when estimating maximum masking level.
Martin (1997), however, states that overmasking occurs
when effective masking level in the nontest ear minus the
patient’s interaural attenuation is equal to or greater than
the best bone-conduction threshold in the test ear. There
is the assumption that the best bone-conduction threshold
is most susceptible to the effects of overmasking. There-
fore, it is recommended that the best bone-conduction
threshold in the test ear should be considered when esti-
mating maximum masking level.
Selection of Appropriate Masking Levels. The optimal
masking level during speech audiometry is one that falls
above the minimum and below the maximum masking
levels (Konkle & Berry, 1983; Liden et al., 1959; Stude-
baker, 1979). Minimum and maximum masking levels
represent respectively the lower and upper limits of the
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masking plateau. Acoustic masking procedures are “those
based on calculating the approximate acoustic levels of
the test and masker signals in the two ears under any
given set of conditions and on this basis deriving the re-
quired masking level” (Studebaker, 1979, p. 82). One of
the goals of the acoustic or “formula” method is to use
rules that will place the masking level at the middle of
the range of correct values (i.e., the middle of the mask-
ing plateau). This concept was originally discussed by
Luscher and König in 1955 (cited by Studebaker, 1979).
Although Studebaker (1962) originally described an equa-
tion for calculating midmasking level during pure-tone bone-
conduction testing, the basic principles underlying the mid-
plateau method also can be applied effectively during speech
audiometry. A direct approach to calculating the midmasking
level (MMid) involves determining the arithmetic mean of the
minimum and maximum masking levels:
MMid 5 (MMin 1 MMax) / 2.
For example, if MMin is equal to 30 dB EM and MMax is
equal to 70 dB EM, then the masking level that occurs at
the middle of the range (i.e., MMid) is 50 dB EM. Stude-
baker (1962) states that, at midmasking level, the risk of
undermasking or overmasking is minimized. It is impor-
tant to note that the midplateau represents a small range
of values surrounding the midmasking level. Depending
on the particular case, the use of a slightly higher or
lower masking level can be justified.
There are two important advantages of the midplateau
masking procedure. First, the midplateau method elimi-
nates interaural attenuation as a source of error when se-
lecting an appropriate masking level. Interaural attenua-
tion has equal yet opposite effects on minimum and
maximum masking levels. Although the value of interau-
ral attenuation affects the width of the masking plateau,
the midmasking level remains the same.
Second, the midmasking level can be predicted for both
threshold and suprathreshold measures by using the same
formula (Konkle & Berry, 1983). Specifically, the midpla-
teau method avoids a potential problem inherent in suprath-
reshold speech recognition testing that is related to calibra-
tion of effective masking level and percent-correct response
criterion. Effective masking level for speech is specified rel-
ative to 50% correct recognition of spondaic words (i.e., the
SRT). However, suprathreshold speech recognition perfor-
mance can range from 0 to 100%. Konkle and Berry (1983)
state that one of the primary advantages of the midplateau
procedure is that the midpoint of the masking plateau is not
affected by different listener response criteria (e.g., threshold
vs. suprathreshold speech recognition). The reader is referred
to Studebaker (1979) and Konkle and Berry (1983) for fur-
ther discussion.
Studebaker (1979) has described an alternate acoustic
masking procedure for use during speech audiometry that
is consistent with the goal of selecting a masking level
that occurs at the middle of the masking plateau. He
states that the recommended effective masking level is
simply equal to the presentation level of the speech signal
in dB HL at the test ear, adjusted appropriately for air-
bone gaps in the test and nontest ears.
Yacullo: Clinical Masking in Speech Audiometry 3
 It should be noted that effective masking level is equal
to the hearing level of the speech signal in those cases
where there are no air-bone gaps in either ear. Conse-
quently, very high levels of masking can result, particu-
larly during suprathreshold speech recognition testing.
Assuming that there are no air-bone gaps in the nontest
ear, Studebaker (1979) states that it is permissible to re-
duce the level of the masker by 20 to 25 dB below the
presentation level of the speech signal. More specifically,
effective masking level can be reduced by the smallest
expected interaural attenuation value; a value of 20 dB is
subsequently added to the effective masking level as a
safety factor. If we assume that a conservative estimate of
interaural attenuation for speech is 40 dB, then Studebak-
er’s procedure can be simplified as follows.
dB EM 5 PLT 2 IA 1 20 dB safety factor
5 PLT 2 40 dB 1 20 dB safety factor
5 PLT 2 20 dB
A Simplified Approach
A simplified approach, based on the underlying con-
cepts of both the midplateau and Studebaker acoustic pro-
cedures, can be derived when selecting contralateral
masking levels during speech audiometry. Although this
approach proves most effective during assessment of su-
prathreshold speech recognition, it also can be applied
during threshold measurement. Stated simply, effective
masking level is equal to the presentation level of the
speech signal in dB HL at the test ear minus 20 dB:
dB EM 5 PLT 2 20 dB.
Jerger and associates (Jerger & Jerger, 1971; Jerger et
al., 1966) appear to be the first investigators to report the
use of a masking procedure that involved presenting con-
tralateral masking noise at a level 20 dB less than the
presentation level of the speech signal at the test ear. Spe-
cifically, it was reported that “whenever the speech level
to the test ear was sufficiently intense that the signal
might conceivably cross over and be heard on the nontest
ear, the latter was masked by white noise at a level 20 dB
less than the speech presentation level on the test ear”
(Jerger & Jerger, 1971, p. 574). A rationale for the se-
lected masking level was not provided. It is important,
however, to note the following. First, Jerger and associ-
ates used white noise rather than the typically used
speech spectrum noise. White noise (or more specifically,
broadband noise with a spectrum characterized by the
frequency response of the earphone) and speech spectrum
noise presented at equivalent sound pressure levels will
not produce comparable masking effects on speech
(Konkle & Berry, 1983). Second, the white noise was not
calibrated in effective masking level for speech. Conse-
quently, the contralateral masking procedure first de-
scribed by Jerger and associates is not truly comparable
to the currently described short-cut approach.
More recently, Hannley (1986) and Gelfand (1997) have
very briefly discussed the simplified masking procedure.
Assuming that interaural attenuation for speech is equal to
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40 dB, then contralateral masking presented at an effective
masking level 20 dB less than the hearing level of the
speech signal should result in masking noise that is at least
20 dB higher than the cross-hearing signal reaching the non-
test ear. It is important to note, however, that the desired
outcome will not occur if there are significant air-bone gaps
in the nontest ear. In fact, Gelfand indicates that this ap-
proach generally proves most effective in cases of bilateral,
sensorineural hearing loss.
The short-cut masking procedure when used appropri-
ately can simplify the calculations required for the deter-
mination of midmasking level. It proves effective given
the following two conditions: (a) There are no significant
air-bone gaps (i.e., $15 dB) in either ear, and (b) speech
is presented at a moderate sensation level (i.e., 30 – 40 dB
SL) relative to the measured or estimated SRT. Given
these two prerequisites, the selected masking level will
occur approximately at midplateau.
It is important to note that audiometric configuration
can influence the effectiveness of the short-cut approach.
For example, the procedure may prove most effective
when the audiometric configuration in the test ear is rela-
tively flat rather than rising or sloping (or more generally
when the SRT correlates with the best pure-tone thresh-
olds from 250 through 4000 Hz). In fact, there is a basic
underlying assumption that the SRT, which typically
serves as a reference level for suprathreshold speech rec-
ognition tests, confirms the pure-tone findings.
The following case reports illustrate the uses of the
simplified approach to selecting contralateral masking
levels during speech audiometry. The use of both supra-
aural and insert earphones will be discussed.
Case Reports
Case 1
The example presented in Figure 1 illustrates the ap-
propriate use of the simplified masking procedure during
assessment of suprathreshold speech recognition. Pure-
tone testing reveals a moderate, sensorineural hearing loss
of flat configuration in the right ear. There is a mild, sen-
sorineural hearing loss of flat configuration in the left ear.
SRTs were obtained at 50 dB HL and 35 dB HL in the
right and left ears, respectively, a finding consistent with
the pure-tone results. Suprathreshold speech recognition
will be assessed at 40 dB SL using NU-6 (Northwestern
University Auditory Test No. 6) monosyllabic word lists.
Assuming that traditional supra-aural earphones are being
used, contralateral masking will be required only when
evaluating suprathreshold speech recognition in the right
ear. The presentation level of 90 dB HL (i.e., SRT of 50
dB HL 1 40 dB SL) minus a conservative estimate of
interaural attenuation for speech (i.e., 40 dB) exceeds the
best bone-conduction threshold of 30 dB HL in the non-
test ear.
PLT 2 IA $ Best BCNT
90 dB HL 2 40 dB $ 30 dB HL
50 dB HL $ 30 dB HL
 FIGURE 1. Case report illustrating the appropriate use of the simplified masking procedure during assessment of suprathreshold
speech recognition.

Yacullo: Clinical Masking in Speech Audiometry 5

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 The use of the simplified approach to selecting an ap-
propriate contralateral masking level will prove efficient
in this case because both criteria have been met. Specifi-
cally, (a) there are no significant air-bone gaps in either
ear, and (b) speech will be presented at a moderate sensa-
tion level (i.e., 40 dB SL). Stated simply, effective mask-
ing level is equal to the presentation level of the speech
signal in dB HL at the test ear minus 20 dB.
dB EM 5 PLT 2 20 dB
5 90 dB HL 220 dB
5 70 dB EM
We will use the midplateau masking procedure to ver-
ify the appropriateness of the selected masking level of
70 dB EM. Recall that the midplateau method involves a
three-step process: Calculation of minimum masking level
(MMin), maximum masking level (MMax), and midmask-
ing level (MMid).
MMin 5 PLT 2IA 1 Max AB GapNT
5 90 dB HL 2 40 dB 1 5 dB
5 55 dB EM
MMax 5 Best BCT 1 IA 2 5 dB
5 45 dB HL 1 40 dB 2 5 dB
5 80 dB EM
MMid 5 (MMin 1 MMax)/2
5 (55 1 80)/2
5 135/2
5 67.5 dB EM.
Note that the masking level of 70 dB EM calculated
using the short-cut approach is in good agreement with
the value determined using the midplateau procedure (i.e.,
67.5 dB EM). A masking level of 70 dB EM is appropri-
ate for three reasons. First, it occurs approximately at
midplateau. Second, it occurs at least 10 dB above the
minimum masking level. Ideally, a safety factor of 10 dB
or greater should be added to the calculated minimum in
order to account for intersubject variability with respect to
effectiveness of masking levels (Martin, 1974; Stude-
baker, 1979). Finally, it does not exceed the maximum
masking level.
Insert earphones are sometimes substituted for the tra-
ditional supra-aural arrangement during audiometric test-
ing. The short-cut procedure can be applied effectively
when using either type of earphone. The ER-3A “tube-
phone” (Etymotic Research, 1991) is a commonly used
insert earphone that has been researched extensively since
its development by Etymotic Research in the 1980s (Kil-
lion, 1984).1 A major advantage of the 3A insert ear-
phone is increased interaural attenuation for air-conducted
sound, particularly in the lower frequencies (Killion, Wil-
ber, & Gudmundsen, 1985; Sklare & Denenberg, 1987;
Van Campen, Sammeth, & Peek, 1990). Unfortunately,
1
E-A-R Auditory Systems (1997) manufactures an insert earphone
known as the E-A-RTONE® 3A. The ER-3A and the E-A-RTONE 3A
insert earphones are considered functionally equivalent because they are
built to identical specifications (Frank & Vavrek, 1992).
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there are only limited data available about interaural at-
tenuation for speech when using insert earphones. The
smallest reported value of interaural attenuation for spon-
daic words is 20 dB greater when using 3A insert ear-
phones with deeply inserted foam eartips (Sklare &
Denenberg, 1987) than when using a supra-aural arrange-
ment (Martin & Blythe, 1977; Snyder, 1973). Conse-
quently, a value of 60 dB represents a very conservative
estimate of interaural attenuation for speech when using
3A insert earphones. This value is derived by simply add-
ing a correction factor of 20 dB to the interaural attenua-
tion value used with supra-aural earphones (i.e., 40 dB).
We will now take a second look at Case 1 and substi-
tute 3A insert earphones for the supra-aural arrangement.
Contralateral masking again will be required only when
evaluating suprathreshold speech recognition in the right
ear. The presentation level of 90 dB HL in the test ear
minus a conservative estimate of interaural attenuation for
insert earphones (i.e., 60 dB) equals the best bone-con-
duction threshold of 30 dB HL in the nontest ear.
The use of the simplified approach to selecting an ap-
propriate contralateral masking level will prove equally
effective when using insert earphones. In this case, effec-
tive masking level is equal to 70 dB EM (i.e., the presen-
tation level of the speech signal at the test ear minus 20
dB), the same value derived when using supra-aural ear-
phones. We will use the midplateau masking procedure to
verify the appropriateness of the selected masking level.
The calculations are the same for both supra-aural and
insert earphones with the exception that an interaural at-
tenuation value of 60 dB is substituted in the equations
for minimum and maximum masking levels when using
inserts. Masking levels are summarized as follows.
MMin 5 35 dB EM
MMax 5 100 dB EM
MMid 5 67.5 dB EM
It is important to remember that an increase in interau-
ral attenuation has equal yet opposite effects on minimum
and maximum masking levels. Because interaural attenua-
tion is increased by 20 dB when using insert earphones,
the width of the masking plateau will increase by 40 dB.
More specifically in Case 1, the width has increased from
25 to 65 dB when substituting insert earphones for the
supra-aural arrangement. However, the midmasking level
remains the same. As in the case when supra-aural ear-
phones are used, the masking level of 70 dB EM calcu-
lated using the short-cut approach is in good agreement
with the value determined using the midplateau procedure
(i.e., 67.5 dB EM).
The use of an earphone that yields increased interaural
attenuation for air-conducted sound provides three major
advantages. First, the need for contralateral masking is
significantly reduced during air-conduction audiometry.
Second, there is reduced risk of overmasking when con-
tralateral masking is required. Finally, the range between
minimum and maximum masking levels is increased,
thereby increasing the width of the masking plateau and
the range of permissible masking levels.
 There are clear advantages to using the simplified ap-
proach with 3A insert earphones that relate to the presence
of a wider masking plateau. Specifically, there is greater
flexibility in deviating somewhat from the recommended
prerequisite conditions (i.e., no air-bone gaps in either ear,
the use of moderate sensation levels) while still remaining
within an acceptable range of midplateau and without signif-
icantly increasing the risk of overmasking. Consequently,
there is a greater margin for error when selecting an appro-
priate masking level. The reader is referred to Yacullo
(1996) for further discussion of clinical masking procedures
and the use of insert earphones.
Case 2
The example presented in Figure 2 illustrates the inappro-
priate use of the simplified masking procedure during assess-
ment of suprathreshold speech recognition. Pure-tone testing
reveals normal hearing in the right ear. There is a mild, con-
ductive hearing loss of flat configuration in the left ear.
SRTs were obtained at 0 dB HL and 30 dB HL in the right
and left ears, respectively, a finding consistent with the pure-
tone results. Suprathreshold speech recognition will be as-
sessed at 30 dB SL using CID (Central Institute for the
Deaf) W-22 monosyllabic word lists. Assuming that supra-
aural earphones are being used, contralateral masking will be
required only when evaluating suprathreshold speech recog-
nition in the left ear. The presentation level of 60 dB HL
(i.e., SRT of 30 dB HL 1 30 dB SL) minus a conservative
estimate of interaural attenuation (i.e., 40 dB) exceeds the
best bone-conduction threshold of 0 dB HL in the nontest
ear.
The use of the simplified approach to selecting an appro-
priate level of contralateral masking is not recommended in
this case. One of the prerequisite conditions has not been
met. Although suprathreshold speech recognition will be
assessed at a moderate sensation level (i.e., 30 dB SL), there
are significant air-bone gaps in the test ear.
Recall that midmasking level (MMid) is the midpoint
between the minimum (MMin) and maximum (MMax)
masking levels. These levels are summarized as follows.
MMin 5 20 dB EM
MMax 5 35 dB EM
MMid 5 27.5 dB EM
The width of the masking plateau is narrow (i.e., 15
dB) in this case. The presence of air-bone gaps in the
test ear has decreased the maximum masking level.
Consequently, there is an increased risk of overmask-
ing. An appropriate masking level is considered 30 dB
EM. In addition to falling in the vicinity of midplateau,
a value of 30 dB EM occurs at least 10 dB above the
minimum masking level. Also, the selected masking
level does not exceed the estimated maximum.
Let us confirm that the simplified masking procedure
is not appropriate in this case. Effective masking level
in the nontest ear is calculated as follows.
dB EM 5 PLT 2 20 dB
5 60 dB HL 2 20 dB
5 40 dB EM
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It is apparent that the masking level of 40 dB EM cal-
culated using the short-cut approach theoretically could
result in overmasking. The selected masking level ex-
ceeds the estimated maximum of 35 dB EM.
Case 3
The example presented in Figure 3 illustrates the appli-
cation of the simplified masking procedure during mea-
surement of SRT. Pure-tone testing reveals normal hear-
ing in the right ear. There is a moderate, sensorineural
hearing loss of relatively flat configuration in the left ear.
Based on the pure-tone threshold findings, it is predicted
that SRTs will be measured at approximately 10 dB HL
and 55 dB HL in the right and left ears, respectively.
Prior to the measurement of speech thresholds, we can
predict whether contralateral masking will be required.
Assuming that supra-aural earphones are being used, con-
tralateral masking will be required only when measuring
SRT in the left ear because the estimated speech thresh-
old of 55 dB HL minus a conservative estimate of inter-
aural attenuation (i.e., 40 dB) exceeds the best bone-con-
duction threshold of 5 dB HL in the nontest ear.
Although the simplified approach to selecting appropri-
ate masking levels proves most effective during assess-
ment of suprathreshold speech recognition, it also can be
applied during measurement of SRT. Regardless of the
procedure used, spondaic words are typically presented at
both threshold and suprathreshold levels. Consequently, a
masking level should be selected that is appropriate for
the highest presentation levels used.
ASHA (1988) recommends a standardized, descending
threshold technique for measuring SRT that is based on
the earlier work of several investigators (e.g., Hirsh et al.,
1952; Hudgins, Hawkins, Karlin, & Stevens, 1947; Till-
man & Olsen, 1973; Wilson, Morgan, & Dirks, 1973).
The first phase involves familiarizing the patient with the
test words at a comfortable, suprathreshold hearing level.
The test phase involves initially presenting spondaic
words at hearing levels approximately 10 dB higher than
the calculated SRT. ASHA recommends that the starting
level for the test phase can be determined by setting the
hearing level to 30 to 40 dB above the estimated SRT. In
fact, presenting the test words at this recommended hear-
ing level often results in a comfortable listening level for
most patients during the familiarization phase.
Consider again the case presented in Figure 3. If the
ASHA-recommended procedure is used to measure SRT,
then the highest hearing levels employed will be approxi-
mately 30 to 40 dB above the estimated SRT. Following
ASHA’s recommendation, we will familiarize the patient
with the spondaic words at a comfortable listening level.
In this case, we will use a sensation level of 30 dB rela-
tive to the estimated SRT (i.e., 55 dB HL 1 30 dB SL 5
85 dB HL) in the left ear.
The use of the simplified approach to selecting an ap-
propriate contralateral masking level will prove efficient
in this case because both prerequisite conditions have
been met. Effective masking level in the nontest ear is
calculated as follows.
Yacullo: Clinical Masking in Speech Audiometry 7
 FIGURE 2. Case report illustrating the inappropriate use of the simplified masking procedure during assessment of suprathreshold
speech recognition.

8 American Journal of Audiology ● Vol. 8

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 FIGURE 3. Case report illustrating the appropriate use of the simplified masking procedure during measurement of SRT.

Yacullo: Clinical Masking in Speech Audiometry 9

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dB EM 5 PLT 2 20 dB
5 85 dB HL 2 20 dB
5 65 dB EM
We will use the midplateau method to verify the ap-
propriateness of the selected masking level of 65 dB EM.
Masking levels are summarized as follows.
MMin 5 50 dB EM
MMax 5 85 dB EM
MMid 5 67.5 dB EM
The masking level of 65 dB EM calculated using the
short-cut approach is in good agreement with the value
determined using the midplateau procedure (i.e., 67.5 dB
EM). Although spondaic words will be presented at lower
hearing levels during the actual measurement of SRT, it
is not necessary to reduce the original masking level. It
already has been determined that the selected masking
level (a) does not exceed the maximum masking level,
and (b) is appropriate for the highest hearing levels used
during the threshold procedure.
Summary and Conclusions
In this paper a simplified approach to selecting appro-
priate contralateral masking levels in suprathreshold
speech audiometry was described. Specifically, effective
masking level is equal to the presentation level of the
speech signal in dB HL at the test ear minus 20 dB:
dB EM 5 PLT 2 20 dB.
This short-cut masking procedure proves very effective
given the following two conditions: (a) There are no sig-
nificant air-bone gaps (i.e., $15 dB) in either ear, and (b)
speech is presented at a moderate sensation level (i.e.,
30 – 40 dB SL) relative to the measured or estimated SRT.
Given these two prerequisites, the selected masking level
will occur approximately at midplateau. Although the
simplified approach proves most effective during assess-
ment of suprathreshold speech recognition, it also can be
applied during measurement of SRT.
The simplified approach to selecting contralateral
masking levels in suprathreshold speech audiometry ap-
pears to have wide clinical applicability. First, it can be
used with a large patient population, including those with
normal hearing and sensorineural hearing loss. Second,
the procedure can be applied effectively when using ei-
ther supra-aural or insert earphones. Finally, the majority
of audiologists continue to administer suprathreshold
word recognition tests at a specified sensation level refer-
enced to the SRT (Martin et al., 1994, 1998; Martin &
Morris, 1989), typically 30 dB or 40 dB (Martin et al.,
1994; Martin & Morris, 1989).
Whenever there is risk of overmasking, direct calcula-
tion of midmasking level is strongly recommended. Any
factor that either increases the minimum masking level or
decreases the maximum masking level will narrow the
masking plateau. The presence of significant air-bone
gaps in the nontest ear and/or the use of high sensation
levels (i.e., approximately 50 dB SL and greater) will
10 American Journal of Audiology ● Vol. 8
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increase minimum masking level. Conversely, the pres-
ence of significant air-bone gaps in the test ear will de-
crease maximum masking level. In cases where the mask-
ing plateau is narrow or nonexistent, knowledge about
minimum and maximum masking levels will permit the
clinician to make a well-informed decision when selecting
an appropriate level of contralateral masking.
Addendum
A preliminary version of the information presented in
this paper is published in Clinical Masking Procedures by
W.S. Yacullo, 1996, Needham Heights, MA: Allyn &
Bacon.
References
American National Standards Institute. (1996). American na-
tional standard specification for audiometers (ANSI S3.6-
1996). New York: Author.
American Speech-Language-Hearing Association. (1988).
Guidelines for determining threshold level for speech. ASHA,
30, 85– 89.
Coles, R. R. A., & Priede, V. M. (1975). Masking of the non-
test ear in speech audiometry. The Journal of Laryngology
and Otology, 89, 217–226.
E-A-R Auditory Systems. (1997). Instructions for the use of
E-A-RTONE® 3A insert earphones (Rev. ed.). Indianapolis,
IN: Author. [Available from: E-A-R Auditory Systems, 5457
W. 79th Street, Indianapolis, IN 46268.]
Etymotic Research. (1991). ER-3A TubephoneTM insert ear-
phone. Elk Grove Village, IL: Author. [Available from: Ety-
motic Research, 61 Martin Lane, Elk Grove Village, IL
60007.]
Frank, T., & Vavrek, M. J. (1992). Reference threshold levels
for an ER-3A insert earphone. Journal of the American
Academy of Audiology, 3, 51–58.
Gelfand, S. A. (1997). Essentials of audiology. New York: Thi-
eme Medical Publishers, Inc.
Hannley, M. (1986). Basic principles of auditory assessment.
Needham Heights, MA: Allyn & Bacon.
Hirsh, I. J., Davis, H., Silverman, S. R., Reynolds, E. G., El-
dert, E., & Benson, R. W. (1952). Development of materi-
als for speech audiometry. Journal of Speech and Hearing
Disorders, 17, 321–337.
Hudgins, C. V., Hawkins, J. E., Jr., Karlin, J. E., & Stevens,
S. S. (1947). The development of recorded auditory tests for
measuring hearing loss for speech. Laryngoscope, 57, 57– 89.
Jerger, J., & Jerger, S. (1971). Diagnostic significance of PB
word functions. Archives of Otolaryngology, 93, 573–580.
Jerger, J., Jerger, S., Ainsworth, J., & Caram, P. (1966). Re-
covery of auditory function after surgical removal of cerebel-
lar tumor. Journal of Speech and Hearing Disorders, 31,
377–382.
Killion, M. C. (1984). New insert earphones for audiometry.
Hearing Instruments, 35, 28, 46.
Killion, M. C., Wilber, L. A., & Gudmundsen, G. I. (1985).
Insert earphones for more interaural attenuation. Hearing
Instruments, 36, 34 –36.
Konkle, D. F., & Berry, G. A. (1983). Masking in speech audi-
ometry. In D. F. Konkle & W. F. Rintelmann (Eds.), Princi-
ples of speech audiometry (pp. 285–319). Baltimore: Univer-
sity Park Press.
Liden, G., Nilsson, G., & Anderson, H. (1959). Masking in
clinical audiometry. Acta Oto-Laryngologica, 50, 125–136.
 Martin, F. N. (1974). Minimum effective masking levels in
threshold audiometry. Journal of Speech and Hearing Disor-
ders, 39, 280 –285.
Martin, F. N. (1997). Introduction to audiology (6th ed.). Need-
ham Heights, MA: Allyn & Bacon.
Martin, F. N., Armstrong, T. W., & Champlin, C. A. (1994).
A survey of audiological practices in the United States in
1992. American Journal of Audiology, 3, 20 –26.
Martin, F. N., & Blythe, M. E. (1977). On the cross hearing of
spondaic words. Journal of Auditory Research, 17, 221–224.
Martin, F. N., Champlin, C. A., & Chambers, J. A. (1998).
Seventh survey of audiometric practices in the United States.
Journal of the American Academy of Audiology, 9, 95–104.
Martin, F. N., & Morris, L. J. (1989). Current audiologic
practices in the United States. The Hearing Journal, 42,
25– 44.
Sanders, J. W. (1972). Masking. In J. Katz (Ed.), Handbook of
clinical audiology (pp. 111–142). Baltimore: Williams &
Wilkins.
Sanders, J. W. (1991). Clinical masking. In W. F. Rintelmann
(Ed.), Hearing assessment (pp. 141–178). Needham Heights,
MA: Allyn & Bacon.
Sklare, D. A., & Denenberg, L. J. (1987). Interaural attenua-
tion for Tubephone insert earphones. Ear and Hearing, 8,
298 –300.
Snyder, J. M. (1973). Interaural attenuation characteristics in
audiometry. Laryngoscope, 73, 1847–1855.
Studebaker, G. A. (1962). On masking in bone-conduction test-
ing. Journal of Speech and Hearing Research, 5, 215–227.
Downloaded From: http://aja.pubs.asha.org/ by a Northern Illinois University User on 08/23/2016
Terms of Use: http://pubs.asha.org/ss/rights_and_permissions.aspx
Studebaker, G. A. (1967). Clinical masking of the non-test ear.
Journal of Speech and Hearing Disorders, 32, 360 –371.
Studebaker, G. A. (1979). Clinical masking. In W. F. Rintel-
mann (Ed.), Hearing assessment (pp. 51–100). Baltimore:
University Park Press.
Tillman, T. W., & Olsen, W. O. (1973). Speech audiometry. In
J. Jerger (Ed.), Modern developments in audiology (2nd ed.)
(pp. 37–74). New York: Academic Press.
Van Campen, L. E., Sammeth, C. A., & Peek, B. F. (1990).
Interaural attenuation using Etymotic ER-3A insert earphones
in auditory brain stem response testing. Ear and Hearing, 11,
66 – 69.
Wilson, R., Morgan, D., & Dirks, D. (1973). A proposed SRT
procedure and its statistical precedent. Journal of Speech and
Hearing Disorders, 38, 184 –191.
Yacullo, W. S. (1996). Clinical masking procedures. Needham
Heights, MA: Allyn & Bacon.
Received November 16, 1998
Accepted July 3, 1999
First published (online) November 5, 1999
http://journals.asha.org
DOI: 10.1044/1059-0889(1999/019)
Contact author: William S. Yacullo, Ph.D., Governors State Uni-
versity, College of Health Professions, University Park, IL
60466-0975. Email: W-Yacull@govst.edu
Yacullo: Clinical Masking in Speech Audiometry 11