International Conference on Mathematics and Natural Sciences (ICl'viNS)

November 29-30, 2006, Bandung-lndonesia

Self-Created Software for Air Conduction Pure-Tone Audiometer

and Its Test at Dr. Hasan Sadikin Hospital (RSHS)

l'raswutllya Astagt n rusttj :;, .sm iVuna if.ilotmrah :;, amt. Katlla Anggraem Agu stWJI :;
IJ Student at Physics Study Program JTB
lJ Research group : Nuclear Physics and Biophysics
11
Otolaryngology Specialist Consultant Doctor ofdr. Hasan Sadikin Hospital

Abstract
The jimdamental test of audiological evaluations is the pure tone test because it can define the
hearing threshold of several important ji-equencies in conversational speech. A personal computer (PC)
based pure-tone audiometer was made using MATLAB program that offers two choices, automatic and
manual testing. This was tested to 23 research subjects (18 patients and 5 controls) in Ear and Speech Clinic
dr. Hasan Sadikin Hospital Bandung. All the research subjects were tested twice, firstly with standard
audiometer and secondly with this PC-based audiometer. Each research subjects have two audiograms that
contain data of hearing threshold intensity at several speech frequencies. The comparison between the two
audiograms is summarized into 4 groups that depend on the several factors of the device and the research
subjects.

Keywords: Hearing impairment, Hearing threshold, Pure-tone, PC-based pure-tone audiometer, dr.
Hasan Sadikin Hospital

I. Introduction II. Theory

The hearing ability has an important role
in the social interaction. If hearing impainnent
occurs, it will lessen the communication ability.
Therefore the hearing tests are required to
diagnose the type and degree of hearing loss and
to determine the intensity levels at threshold.
There are several devices for hearing tests; one of
them is pure tone audiometer that requires
responses from research subjects. Therefore this
test is subjective. This test is an initial test for
patient (more than 6 years old) to find general
diagnoses before giving the next medical
treatment.
The standard pure tone audiometers are
heavy, expensive, and always require an examiner
to opcratl': the device. To obtain the best results
which reflect the real hearing condition of the
research subjects, the examiner should know
about audiology and have experiences in
operating audiometer.
In this research, personal computer (PC)-
based Pme Tone Audiometer is made to clo auto-
screening threshold intensity as well as to do
Human ear gives responses for freque ncy
range between 20 and 20,000 Hz that includes
speech frequency range between 300 and 3,000
Hz. Pure tone test examines the threshold hearing
at several important frequencies between 125 and
8,000 Hz [1, 2, 3].
Sound intensity in decibel scale is
defined as logarithmic scale of the ratio intensity
(I) to the threshold hearing intensity (10) . There
are two decibel scales having different fo . First,
the decibel sound pressure level (dB SPL) uses 10
= 10·12 watt/m2 at frequency 1000Hz so that /(dB
SPL) = 0 at 1000 Hz. The curve /(dB SPL) as a
function of frequency (Hz) is shown in Figure-I n
(4].
v
co I ~
~
-.; '~
o>
>
"
...l

manual-screening threshold intensity (by

examiner). Therefore research subject is off.:red to "0
c
test his hearing sensitivity without the help of an ::>
0
If)
examiner or a doctor. The results are audiograms
of air conduction thresholds for right and left ears
as wel l as general diagnose for the degree of
hearing loss.
Figure- Ia. Equal loudness contours (4]

1033

Second, the decibel hearing level (dB
HL) uses 10 as the threshold hearing intensity for
normal hearing so that the curve J(dB SPL) at
hearing thresholds is 0 dB HL (shown in Figure-
! h' n ...r.ihel 1-ll . i<: n~ed in pnre. tone
II l(dH HL) IS more than zero then 1t md1cates the
deviation from the normal hearing [1].
~~ r .45- - _________ - - - - - - - · - -- - - --- · --~
40 1
35 1 ' OdBHL
25.5
it30 t :
UJ25 1 :
~ 20 I 1 13.5
L'
15 . : :
10 I '
5 : : : : t
0 -:--:~-- '---~~ +-7-·-~-:-. -~
125 250 500 1k 1k5 2k
frequency (Hz)
Figure- I b. The equivalent dB-SPL is for supra-aural earphone [I]
The threshold sensitivity in hearing test
for air conduction in pure tone audiometer is
evaluated using earphone. This test is capable to
determine the degree of hearing loss (e.g. mild,
moderate, severe, or profound) but it is not to
determine the type of hearing loss (e.g.
conductive, sensorineural, or mix) [3].
Pure tone air conduction test procedures
are: ( 1) case history I patient information, (2) test
environment, (3) listener position, (4) instruction
to the patient, (5) ear examination, (6) earphone
placement, (7) ear selection, (8) frequency
sequencing, (9) threshold procedures, and ( 10)
false negative and positive responses [I].
III. Experimental Method
A. Self Created PC-Based Pure Tone
Audiometer
Pure tone threshold are regularly assessed
at octave and sometimes at half-octave intervals
between the range of 125 and 8000 Hz. The
output pure tones from standard audiometer at
RSHS were recorded (in l(dB-comp) scale) by
using a PC to be analyzed their maximum
intensity and wave characteristics [5].
The valid recorded maximum intensity was
written to Microso ft Excel. At each frequency, a
chart of l(dB-comp) as a function of l(dB-HL) was
made to determine the conversion (regrl!ssion)
function from d13-HL to dB-comp to obtain the
next d13-comp [5].
International Conference on Mathematics and Natural Sciences (ICMNS)
November 29-30, 2006, Bandung-lndonesia
PC-based
Pure Tone
Audiometer
(~L\1LAB)
~n dioJlleter
Interactive graphic display
Figure-2.Biock Diagram Self Created PC-Bascd Pure
15.5 13 Tone Audiometer
The PC based audiometer software was
made using MATLAB 6.5 and run with Notebook
Compaq Presario (Prosesor Intel® Pentium
3k 4k 6k ek
Mobile 1,73 GHz, 512 DDR SDRAM), and used
Windows XP Professional as the operating
system. Figure-2 shows that the subject interacts
with PC monitor, listens sound stimulus via
earphone, and responses the sound by clicking the
mouse button.
PC-based audiometer programming and
standard audiometers use Modified Hughson-
Westlake Technique as follows: ( I) frequency
sequence started at I 000 Hz, then increased to
2000, 4000, 8000 Hz, and finall y decreased to
500, 250, and 125 Hz. (2) initial intensity is 40 dB
for each frequency, (3) if subject gives a response,
then intensity is decreased in I 0-15 dB steps until
there is no response, (4) if subject gives no
response, then intensity is increased in 20 dB
steps until there is a response. Then, intensity is
decreased in 10 dB steps until there is no
response, (5) determination the threshold by
increased in 5 dB steps until subject gives a
response, then decreased in I0 dB steps until
subject gives no response, then increased in 5 dB
steps until subject gives a response, (6) if a fal se-
positive or false-negative response occurs then the
subject must be re-instructcd, (7) a respons..: is
valid only if the time latency is con si st~.:nt. (S) the
thresho ld is the lowest intensity which subjc:ct
gives 2 valid responses from 3 stimu lus.
B. PC-based Audiometer Test at RSHS
The tests were done at !!caring and
Speech Impairment Clin ic at dr. Hasan Sadikin
Hospital Bandung on i'vlay 16m to 27 1h 2006. PC-
based audiometer tests for patients were done with
assistance of an examiner, however lor controls
were done automatically (without an examiner).
Patients and controls were tested twice using
standard audiometer at RSHS ami then PC-based
audiometer.
103-1
 International Conference on Mathematics and Natural Sciences (ICMNS)
November 29-30, 2006, Bandung-lndonesia

IV. Results
Table- I lists the results ofthreshold intensity as fu nction of frequency of8 patients from total 18 patients and 2 controls
from total5 controls (this is done because of space limitation). The s~~bject code P 16-1 means the subject is the fi rst
!·~·•;•l.l '"'h" n ... Jr-,1 ~~~ ~. , .,.! .,,,t.

Right Ea r Left Ear

Subj ect Audiometer Frequencv (Hz) Frcqucncv (liz)
125 250 : 500 , 1k ~ 2k , .Jk Sk 125 . 250 : 500 : 1k 2k .Jk ; 8k
p 16- J

p 16-2

p 17-3

p 18-2

p 18-3 ~Sf IS--------- -- - ~-? ...-.: ..-~~---l----~_?___~__}9__ _L_;!~ ___;___~Q___;___ ?_9___ ----~,S. __l___7Q___ _;, __~_Q_ ___Ll_O_.:___ ?.9.. _; __?,5._.!.___1?._
PC-bascd 35 : 30 ' 30 · 30 ; 40 ' 45 : 60 20 : 25 ' 30 ; 25 · 45 ; 65 ; 70
__¥Sf~--------- __ ).?____: ___)~ ___ !_)2____ j_ __~_Q___L_.29____ l_ __ 2,5___!___?_Q___ ____!?. __.l __ )Q___l_ __?_L_~_;___ ?Q___!_ __~_s. ___'_ ~g_
p 19-1
PC-Imcd 25 25 30 · 40 ~ 60 80 ' 80 20 20 : 30 ' 45 65 85 ' 80
p 24- 1
_nsns ______ --~?--~-2?____:____~Q_ __,__}_9__ ,____~Q___L?Q....!._?..9___ ---~-_.__?Q___:___?_Q_ ___;_i_0_;__?.9___~___?Q_-'-·2Q...
1
PC-bascd 30 ' 25 ' 15 ' 25 ; 50 : 65 ' 80 45 ' 70 ' 45 ' 35 ' 45 ' 70 80
p 24-2

p 27-3 _13-..§!-!L_____ ---~~... L .\?....L .!!L.J____t_Q__ _L __.\?.... L ..!2__L _1_9_______!Q...L...!.~...l...!.!!....L2._ t...?.... L~ ...-L..?.Q__
PC-bascd 5 : 5 ' 10 i IS ; 20 l 0 l 0 0 ·. 5 ; 15 . IS 1 15 : IS . 10

c 27-1
c 27-2

both automatic and manual testing. The automatic

V. Conclusions and Discussions
testing was done very well by the student controls.
Audiograms from PC-based and standard The weaknesses of this PC-based audiometer are
audiometers arc summarized into four categories the intensity and frequency pure tone data at 0-20
as follows: dB SPL not yet produced precisely.
1. The two results are similar; the curves are VI. References
overlapping or the difference is about 5 dB
(Figure-3). [1] ROESER, ROSS J., MICHAEL VALENTE,
2. Patients have unilateral hearing loss; the HOLLY HOSFORD-DUNN. (2000). Audiology
intensity differences are more than 20 dB due Diagnosis. Thieme Medical Publishers, Inc.
to PC-based test did not do the masking New York.
technique (Figure-4). [2] S ILMAN, SHLOMO & CAROL A. SILYERMAN.
3. The two results are shifted (Figur·e-5). ( 1991). Auditory Diagnosis Principles and
Intensity thresholds from PC-based are larger Application. Academic Press. New York.
from standard audiometer, because of: [3] SKURR, BARBARA. ( 1991). Audiometri
• Using different earphone type. Klinis -Kumpulan Krt!iah pada Kursus
• Damaged pure tone data at 0-15 cii3-HL at Audiologi Praktis. LAH/UPF TI-lT Fakultas
1000, 2000, 4000 Hz clue to the limitation Kedokteran Unpad I Rumah Sakit Hasan
of program in producing very low Sadikin. Bandung.
intensity sounds (wave form is no longer (4) DAMASK, A.C. ( 1981). Medical Physics
sinusoidal). volume 11 : E"ternal Senses. Academic
• Increasing intensity threshold due to Press. New York.
computer fan turns on while the test is (5] YUSUF, PRASANDHYA A (2006).
running. Pembuatan Perangkat Lunak Audiometer
4. The two results have random differences Nada Mumi Hantaran Udara dan Uji
about 5 dB-HL (Figure-6). Coba Perangkat Lzmak tersebut di Rumah
Sakit dr. Hasan Sadikin. Thesis S- 1 FI-
The advantages of PC-based pure tone F!viiPA rm.
audiometer are cheaper, pot1ablc, and capable

1035
 '"•~~''"'' International Conference-on. .MathematicS-and Natural-Sc iences (ICMNS)
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RIGHT (P 2.<4-1~ LEFT (P 24-1)

Figure-3. The two results are similar or about5 dD difference. (P-24 I)

h equency(Ht)
100 I DOO 10000

.:; FC-ba~~- RGHT _,_RSHS RCHT

X ICbn ed : L£fT - x - RSHS LEFT p Z.4·2

Figure-4. Patients have unilateral hearing loss. (P-24 2)

trc quency(~l I lr.qu.~fHI:, ~
too 1000 toooo too . 1000 ~ I~ J

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L _ __ ·:~~~~~i;;;~;-~~~~~ RJGHT(C27-1 ) _: EFT{C27-1!_ ___ - L~-=-~i;;-::)1:::~~- ___ j

Figure-S. The two results arc shifted (C-27 I)
!rc quenq jlt-.)

0""'

ao !

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.... . ... L

RIGHT (C 27 -2) LEFT (C 27-2) --~~--""-"-

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Figun:-6. Random differences (C-27 2)

1036