Lecture 8

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 Testing the electroacoustic performance of
hearing instruments serves two general
purposes:
 1] Hearing Aid Testing (HAT): To verify that an
instrument is functioning properly; that is,
according to the manufacturer’s specifications.

 2] Real Ear Measurement (REM): To verify that

an instrument is functioning appropriately;
that is, according to the auditory needs of the
wearer.
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Hearing Aid Testing (HAT)
Procedure:
 A test box (ex audioscan) generates sounds of a required
SPL at the hearing aid microphone.
 A test box includes a sound generator, an amplifier, a
loudspeaker, measuring microphone and a control
microphone.
 The control microphone or reference microphone is
calibrated or leveled.
 Place the measuring microphone at the reference position
in the sound chamber.
 Do not use a hearing aid or a coupler.
 Place the control microphone facing, and within 5±3 mm
of, the measuring microphone.
 Close the chamber and calibrate.
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Calibration

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 Hearing Aid Testing (HAT)

 The performance of hearing aids is most conveniently

measured when the hearing aid is connected to a
coupler.

 A coupler is a small cavity that connects the hearing

aid sound outlet to a measurement microphone.

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 Hearing Aid Testing (HAT)

 The standard coupler has a volume of 2 cubic

centimeters.

 This volume was chosen because it was an

approximation of the volume of the adult ear canal
past the earmold, i.e. the residual ear canal volume,
when a hearing aid is worn.

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2-cc couplers
ITE / ITC / CIC
The internal dimensions and coupling Putty
methods for several 2-cc couplers.

HA1

Microphone
2 mm dia
Insert
25 earphone

Earmold
simulator

18 18 mm
3 mm dia

HA2 HA2
2 cc
cavity
Microphone

Source: Dillon (2001): Hearing Aids

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Hearing Aid Testing (HAT)
 The hearing aid must be set to give the widest possible
frequency response range, the maximum gain, and the
maximum output.
 If it is not possible to achieve both the maximum
output and the maximum gain, set the aid for the
maximum output.
 An exception is an AGC instrument having
compression controls. Set the controls as indicated by
the manufacturer.
 If it is a directional hearing aid place it in
omnidirectional mode. The hearing aid is then
connected to a coupler.
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Hearing Aid Testing (HAT)
HA1 coupler for in the ear hearing aids which are connected
via putty, all vents must be sealed.
HA2 coupler for BTE and body worn, it has a tube to connect
to the BTE.
Then the coupler is connected to the measuring microphone.
The measuring microphone measures the output from the
hearing aid.
Next the control microphone is placed next to the hearing aid
microphone. The control microphone monitors the SPL
reaching the hearing aid from the loudspeaker.

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Hearing Aid Testing HA2 Coupler

13
Hearing Aid Testing HA1 Coupler

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 Choose either Linear or AGC Hearing aid:

 LINEAR HEARING AID:

A true linear hearing aid is a hearing aid whose gain and
frequency response remain the same, regardless of the
input signal.

 AUTOMATIC GAIN CONTROL (AGC) HEARING AID

An AGC hearing aid is an instrument whose gain is
controlled automatically as a function of the level of the
signal being amplified. This automatic control of gain is
usually designed to reduce the range of output levels as
compared to the range of input levels. Such AGC action is
called “compression.”

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Compression
 Two forms of compression:
 Input compression (dynamic-range compression)—
The extent of gain reduction is determined by the level of
the input to the hearing aid. This form of compression is
used to match the dynamic range of a hearing aid to the
reduced auditory dynamic range found in the recruiting
ear.

 Output compression (output-limiting compression)—

The extent of gain reduction is determined by the level of
the output of the hearing aid. This form of compression is
used to limit the maximum output of a hearing aid while
avoiding saturation distortion.
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 Input-output diagram

110

Output Level (dB SPL)

100
90
50
80 30
20
70 10
0
60
50
30 40 50 60 70 80 90 100
Input level (dB SPL)

Figure 4.7 Input-output diagram of a compression

hearing aid at 2 kHz (bold line) and lines of
constant gain (dotted lines).

Source: Dillon (2001): Hearing Aids

HAT

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Definitions of terms:
 ACOUSTIC GAIN —Acoustic gain (also called, simply,
gain) is the difference, in dB, between the output level and
the input level.

 FREQUENCY RESPONSE—In general, a frequency

response is a set of output levels, generated as a function of
frequency, for a fixed input level.

 FULL-ON POSITION—Full-on means the gain control of

the hearing aid is at its maximum position.

 GAIN CONTROL —Gain control is the technically correct

term for what is commonly called “volume control.”

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Definitions of terms:
 HARMONIC—A harmonic is an integral multiple of a
given frequency. For example, the first harmonic of a
frequency is the frequency itself; the second harmonic of a
frequency is twice the frequency; the third harmonic is
three times the frequency; etc.

 HARMONIC DISTORTION —An instrument exhibits

harmonic distortion when the instrument produces
harmonics in the output signal that are not present in the
input signal.

 HIGH-FREQUENCY AVERAGE (HFA) —The HFA is the

average of the decibel values at 1000, 1600, and 2500 Hz.
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Definitions of terms:
 INPUT-OUTPUT (I/O) CHARACTERISTIC —An input-output
characteristic is a set of output levels, generated as a function of
input level, for a fixed input frequency (or frequency band). I/O
testing is done only on AGC instruments.

 INPUT SOUND PRESSURE LEVEL —The input sound pressure

level (also called input level) is the SPL at the inlet of the hearing
aid microphone.

 OUTPUT SOUND PRESSURE LEVEL—The output sound

pressure level (also called output level) is the SPL measured by
the coupler microphone.

 OUTPUT SOUND PRESSURE LEVEL FOR 90 dB INPUT SPL

(OSPL90) —the OSPL90 is the output level of a hearing aid
when the input level is 90 dB SPL and the gain control is full-on.
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 REFERENCE TEST SETTING (RTS) —The reference-
test setting is the position of the gain control necessary
to yield the reference-test gain.

 REFERENCE TEST GAIN - The reference-test gain is

the gain of the hearing aid when the gain control is set
so that a 60 dB SPL input signal yields an HFA value
that is 17 dB below the HFA OSPL90 value.

 Exceptions: If the actual HFA output level for the full-

on position is already lower than 17 dB below the
OSPL90 level, then the full-on gain is considered the
reference-test gain (As in some AGC).
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 The average level of normal, conversational speech in
quiet is 65 dB SPL. Typically, speech levels vary over
time by +12 dB and –18 dB relative to the average level.

 Therefore, the typical maximum level of

conversational speech in quiet is 77 dB SPL. For testing
hearing aids under simulated normal-use conditions,
ANSI prescribes a gain setting such that the range of
amplified speech levels would fall at or below the
hearing-aid saturation level.

 Because the typical maximum speech (input) level is

77 dB SPL, the reference-test gain is the hearing aid
saturation level (HFA OSPL90 level) minus 77 dB.
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 To set the gain control to the reference-test position,
you must first determine a target HFA output level.

 The input level used to set the gain control to the

reference-test position is 60 dB SPL (50 for AGC).

 In general, the output level is the input level plus the

gain. Therefore, the target HFA output level would be
60 dB SPL plus the reference-test gain. This level is
also equal to the HFA OSPL90 level minus 17 dB.

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 HAT
 Test boxes use two different types of measurement
signals.

 The traditional signal is a pure tone that automatically

sweeps fq over the desired fq range, 125 Hz to 8000 Hz
and a broadband signal.

 The measurements most commonly performed on

hearing aids are the gain frequency response and
OSPL90- frequency response.

 HFA gain & Internal Noise is also measured

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 Gain-frequency response

120 60
90
110 50

Coupler Output Level (dB SPL)

100 40

Coupler Gain (dB)

90 30
60
80 20

70 10

60 0

50 -10
125 250 500 1,000 2,000 4,000 8,000
Frequency (Hz)
Gain-frequency response (measured with a 60 dB SPL input level) and
OSPL90-frequency response of a BTE measured in a 2-cc coupler with a
swept pure tone. The 60 dB curve can be read against either axis; the
OSPL90 curve must be read against the left hand axis.

Source: Dillon (2001): Hearing Aids

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HAT

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Tolerances:
 The maximum OSPL90 reading has to be no more than 3
dB higher than the manufacturer’s specification.

 The HFA OSPL90 has to be within ±4 dB of the

manufacturer’s specification.

 HFA Full on gain has to be within ±5 dB of the

manufacturer’s specification.

 The frequency response curve: The low-band portion of

the frequency response curve (<2 kHz) must fall within ±4
dB of the specified curve.
The high-band portion of the frequency response curve (>2
kHz) must fall within ±6 dB of the specified curve.
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Tolerances:

 Total harmonic distortion (%THD): The measured

%THD values have to be less than or equal to the pub-
lished values plus 3%.

 EQUIVALENT INPUT NOISE: The EIN level has to be

less than or equal to the highest value specified by the
manufacturer plus 3 dB.

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Real-Ear Measurements
 If you want to know how a specific hearing aid is
performing on a specific patient, you need to do real-
ear measurements.

 What are Real-Ear Measurements?

 Allows one to measure:
 1. Ear canal resonance (no HA) (REUR)
 2. Aided responses (HA in, and ON) (REAG)
 3. Occlusion effect (HA in, and OFF) (REOR)

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REM Acronyms
If the term ends in a 'G' it refers to Gain, it is a
difference measure (e.g., REUG). That is, the input
level used to generate the response has been
subtracted from the absolute output level across
frequencies.

If the term ends in an 'R‘ which refers to Response, it

is an absolute measure of output in SPL (e.g., REUR).
That is, there is no consideration given to the input
level used to generate the response.

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R or G

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Why do Real-Ear Measurements?
 Is the HA output what you think it is?
 Evaluate performance of advanced hearing aid features, such as
noise reduction technology.

 Is the patient’s subjective report consistent with the

HA output?

 REM characterize the performance of a HA as worn as opposed

to in a 2cc coupler

 2cc coupler has greater volume and impedance relative to

the real ear.

 2cc coupler under-predicts the output of a HA in the ear.

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REM
 Where a fitting rationale contains an acoustic target,
each hearing aid should be verified by REM.

 Tolerances to the prescription rationale +/- 5 dB at

frequencies of 250, 500, 1000 and 2000 Hz

 +/- 8 dB at 30000 and 4000 Hz

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Probe Tube Calibration
 Most real-ear measurement systems require you to
calibrate the probe tube prior to conducting REM.

 Probe tube calibration accounts for the acoustic

effects the probe tube introduces as sound travels
through it to the probe microphone during actual
use conditions.

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Probe Tube Calibration
 In effect, calibration removes the acoustic effects the
probe tube and microphone introduce during real-ear
measurement, thereby making the probe tube and the
microphone 'acoustically invisible.'

 As the probe tube calibration values will be applied to

all probe microphone readings via a mathematical
correction, careful and accurate probe tube calibration
is particularly important.

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Probe Tube Calibration
 Hold the headset .5m from the loudspeaker

 Microphone and probe should be facing the

loudspeaker

 Your hand should not be placed between the

microphone and loudspeaker

 Run calibration

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Prepare Patient
 The patient should be instructed to sit as still as
possible during recording, in particular to maintain
the same head position.

 They should also be informed that they may interrupt

the test at any time in the case of discomfort

 Otoscopic Examination must always precede REM.

Examine the ear canal for obstruction.

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Prepare Patient
 The patient should be seated so that the ear under test
is:

 At a distance of 0.5 m from the loudspeaker,

 level with centre of loudspeaker itself

 placing the patient directly in front of and facing the

speaker (0 degrees azimuth)

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 Insertion of probe tube
Always use a new probe tube for each patient

 As the typical length of the adult ear canal is 25 mm and

the typical distance from the ear canal opening to the
intertragal notch is 10 mm,

 Using an insertion depth of 28 mm past the tragus should

result in placement within 5 mm of the eardrum for the
average adult

 Mark the probe tube the appropriate distance (e.g. 28 mm)

from its open end

 Insert the probe tube into the ear canal until the mark
approaches the intertragal notch 40
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Insertion of probe tube
 The probe tube should be placed within 5mm of the
eardrum.

 The guidelines regarding how far to insert the probe tube

can vary depending on the age and gender of the patient.

 This length should be modified for shorter or longer-than-

average earcanals [children’s ear canals are typically
between 20mm and 25mm in length (0.8 to 1 inch)

 Adult males ear canals are approximately 30mm in length

and females 28 mm.
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To perform a REM:

 Adjust the length of the blue probe module cord on

the client’s ear until the probe module is snug against
the head directly below the client’s earlobe (cheek
level).

 The reference microphone should face outwards.

Establishing a consistent position for the reference
microphone can be facilitated by running the cable
from the RM probe module across the front of the
client and clipping it to the clothing on the side
opposite the test ear.

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To perform a REM:

 A small amount of “otoferm” (or similar lubricant) can

be applied to the probe tube to help it remain along
the bottom of the ear canal during insertion.

 Otoferm will also help to reduce friction between the

probe tube and earmold, and to assist in providing a
good acoustic seal.

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Measurments:
1. REUR/REUG
 Real-Ear UNAIDED Response/Gain

 The level, in dB SPL, as a function of frequency,

measured in an open (unaided) ear canal.

 Normal variations in length and diameter of EAC

change center frequency and level of resonant peak.

 Use a 65dB SPL broad band stimulus

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2. REAR/REAG
 Real-Ear AIDED Response/Gain
 The level, in dB SPL, as a function of frequency, measured
in the ear canal with the hearing in place, and turned on.

 1. Fit the hearing aid (or custom earmold with aid attached)
into the client’s ear while holding the REM probe tube so
that its position in the ear canal is not disturbed. Turn the
hearing aid on and set the volume control wheel to the
desired test position.

 2. Ensure that the client is as close as possible to the

position that was used for the REUR measurement.

 3. The tube must extend 5 mm past the end of the mold or

aid, to avoid the transition region near the sound outlet.
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 Probe position for insertion gain

(a) (b)

(c) (d)

Probe positioning for measuring insertion gain: (a) noting a

landmark on the ear; (b) marking the probe; (c) measuring the
unaided response; (d) measuring the aided response.
Source: Dillon (2001): Hearing Aids
REAR
REIG
 Subtract the REUR from the REAR across frequencies
or subtract the REUG from the REAG across
frequencies

 Adjust hearing instrument characteristics so that the

REAG and thus the subsequent calculation of REIG
provides the best match to the target REIG values
across frequencies

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 REIG = REAG - REUG

Insertion Gain (dB) Real-Ear Gain (dB)

40
REAG
30
20 REIG
10
REUG
0
100 1000 10000

30
20
10
0
100 1000 10000
Frequency (Hz)

Real ear unaided and aided gains (top half). The difference between
Source: Dillon (2001): these curves is the insertion gain, shown as the shaded region in the
Hearing Aids
top half and as the curve in the lower half.
REIG
Occlusion Effect
 Occlusion effects are characterized by descriptions of
people with low frequency thresholds less than 40 dB
HL

 They complain that, when their ear canal is occluded

by an earmold, their voice sounds like it is hollow,
boomy, echoic, or coming from inside a tunnel.

 It is caused by bone-conducted sound vibrations

reverberating off the object filling the ear canal

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Occlusion Effect
 When talking or chewing, these vibrations normally
escape through an open ear canal; most people are
unaware of their existence.

 When the ear canal is blocked, the vibrations are

reflected back toward the eardrum.

 Compared to a completely open ear canal, the

occlusion effect can boost low frequency (usually
below 500 Hz) sound pressure in the ear canal by 20
dB or more

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Why measure REOR
 The primary purpose of the REOR measurement is to
determine venting characteristics.

 Specifically, it is reported that this measurement will

allow the audiologist to determine whether the vent is
performing as expected by allowing certain
frequencies to pass through it.

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REOR
 The REOR can be measured by placing a probe
microphone in the ear canal with their hearing aid in
the ear canal but turned off.

 Record using 65 dB SPL broad band stimulus

 A reduction of the peak around 2000-3000 Hz is

expected

 It is the natural resonance of the ear canal

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RECD
 RECD (Real-Ear-to-Coupler Difference)

 What is it?
 Formal Definition: Difference in decibels, as a
function of frequency, between the SPL at a specified
measurement point in the ear canal and the SPL in a
2cc coupler, for a specified input signal.

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RECD
 Informal Definition: Difference in dB across
frequencies, between the SPL measured in the real-ear
and in a 2cc coupler, produced by a transducer
generating the same input signal.

 Given the differences in volume and impedance

between the ear and the coupler, RECD values are
generally greater than or equal to 0 dB (i.e., greater
output in ear than coupler for same input signal level).

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RECD
 As can be expected, RECD values can vary
substantially across age groups (with children typically
having larger RECDs than adults) and even within age
groups (Feigin et al., 1989).

 A negative RECD value may indicate an inadequate

seal of the transducer to the ear (e.g., foam ear tip), a
larger than average ear, or a perforated eardrum.

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Why should you do it?
 The RECD allows you to accurately convert assessment
information collected with insert phones from dB HL to dB
SPL (Scollie et al., 1998b) by, in effect, adjusting the 2cc
coupler calibration values used with insert phones.

 This is helpful when using hearing instrument fitting

methods that use the SPL-O-GRAM format (e.g., DSL).

 RECD values can also be used to convert real-ear targets to

2cc coupler targets to assist with selection of hearing
instruments via manufacturers' specification sheets.
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 Arguably the most useful application of the RECD is in
the prediction of real-ear output when measuring
hearing instruments in the 2cc coupler.

 Given that the RECD allows us to know the difference

between output in the real-ear and the 2cc coupler,
real-ear hearing aid output (e.g., REAR, RESR) can be
accurately predicted to within approximately 2 dB
(Seewald et al, 1999).

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How is it done?
 Coupler Measure:

 1. Attach the transducer used to generate the signal to

the speaker jack if necessary.
 2. Attach the 2cc coupler (i.e., HA-2 coupler) to the
coupler microphone.
 3. Couple the transducer to the coupler.
 4. Introduce the signal.
 5. Store the coupler measurement (most equipment
will store this coupler response automatically).
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Real-Ear Measure:
 1. Conduct otoscopic examination.
 2. Place probe tube in the ear canal, with end of the tube at
appropriate distance from the intertragal notch (i.e., within
5 mm of the eardrum).
 3. Couple transducer to the standard foam ear tip (or
earmold tubing).
 4. Insert foam ear tip (or custom earmold) into the ear,
being careful not to move the inserted probe tube.
 5. Introduce the same signal as used with the coupler
measurement.
 6. Store the real-ear measurement.
 7. Subtract the stored coupler response from the real-ear
measurement to produce the RECD. (Most equipment will
calculate the real-ear-to-coupler difference for you).
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