Audiometric Masking

Febryanti P Sari

Supervisor : Dr. Yussy Afriani Dewi,dr., M.Kes.,

SpTHT-KL(K)
.,FICS
Department of Otorhinolaryngology Head & Neck Surgery
Faculty of Medicine Universitas Padjadjaran
RS Hasan Sadikin
Bandung
2016

Audiometry(fromLatin:audre, "to
hear" andmetria, tomeasure") is a
branch ofAudiologyand the science of
measuring hearing acuity for variations
in sound intensity and pitch and for tonal
purity, involving thresholds and differing
frequencies.
audiometric tests determine a subject's
hearing levelswith the help of an
audiometer
Patrick J. Willems (2004). Genetic hearing loss. CRC Press. pp. 34. ISBN 978-0-8247-4309-3. Retrieved23 June 2011.

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AUDIOGRAM

Masked Air

Definition

The process by which the threshold of

hearing for one sound is raised by the
presence of another (masking) sound
and the amount by which threshold of
hearing for one sound is raised by the
presence of another (masking) sound
expressed in decibels
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
Thieme Medical Publishers,Inc., New York.2000

Why do we mask?

To prevent the non-test ear (NTE) from

participating in the test (cross-hearing)
to make sure that when we are testing the
right ear, that we are getting the true
threshold of the test ear (TE) and that the
NTE is not helping out
This is necessary because of BONE
CONDUCTION!
Our ears are housed in a bony skull, which

vibrates BOTH cochleae when sound is present at

a certain level
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
Thieme Medical Publishers,Inc., New York.2000

2/18/16

WHY? Cross Hearing!

Key Concept=Interaural
attenuation! The amount of sound
required to bridge across the head and
stimulate the opposite cochlea by BC.
Unmasked thresholds trace out a
shadow curve displaced from the nontest ear by the size of IA.
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
Thieme Medical Publishers,Inc., New York.2000

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Interaural Attenuation

Interaural attenuation (IA) is the

amount of sound that is
attenuated/reduced when crossing
from one ear to the other
The IA varies:
Depending on the frequency
From patient-to-patient (skull thickness)
Depending on the transducer used

(phones, inserts, bone)

Interaural Attenuation value based on

frequency and type of transducer (Stach)
Frrequen Supraaural
cy

Insertphone
(ER-3A)

Vibrator
BC

(TDH 49)

10

(Hz)
250

(dB)
40

500
1000
2000
4000
8000

40
40
45
50
50

(dB)
75
75
60
55
65
65

(dB)
0
0
0
0

IA minimum by Goldstein and Newman

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IA of Air Conduction - Headphones

The minimum IA of headphones is 40 dB

HL
If we present 80 dB to the test ear, 40 dB
of that sound is reaching the cochlea of
the non-test ear

Image from:
wikipedia.org

IA of Air Conduction - Inserts

The minimum IA of inserts is 70 dB HL

If we present 80 dB to the test ear, 10 dB of that
sound is reaching the cochlea of the non-test ear
You are less likely to mask for air-conduction

testing when you use inserts

Image adapted from:

wikipedia.org

IA of Bone Conduction
The minimum IA of bone

conduction is 0 dB HL
If we present 30 dB to
the test ear, 30 dB of
that sound is reaching
the cochlea of the nontest ear
You must mask for bone-

conduction testing in
conductive losses and
asymmetrical losses

Image from:
wikipedia.org

When to Mask-Air
Conduction

Headphones: when there is a 40 dB or

more difference between the air
conduction threshold of the test ear and
the bone conduction threshold of the
non-test ear.
Inserts: when there is a 70 dB or more
difference between the air conduction
threshold of the test ear and the bone
conduction threshold of the non-test ear.

Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn. Thieme Medical Publishers,Inc., New York.2000

When to Mask - Bone

Conduction

When there is a 10 dB or more

difference between the air conduction
threshold of the test ear and the bone
conduction threshold of the same ear
aka: Mask for BC when there is an air-bone

gap

Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn. Thieme Medical Publishers,Inc., New
York.2000

Type of masking noises

Effectiveness and efficiency of masking

critical bandwith signal to be
masked and type of masking noise
used
White noise
Narrow band noise
speech noise
Audiology: Diagnosis. Edited by Roeser, Valente, and HosfordDunn. Thieme Medical Publishers,Inc., New York.2000

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TYPES OF MASKING NOISES

white noise or broad band
random energy distribution (the average is
almost the same at all frequencies) are
analogous to the distribution of light white
color. Because spectrum is broad and flat,
WN have limitations for masking pure tones

Audiology: Diagnosis. Edited by Roeser, Valente, and HosfordDunn. Thieme Medical Publishers,Inc., New York.2000
2/18/16

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TYPES OF MASKING NOISES

Narrow band noise / NBN
The most efficient is to produce a shift in the
hearing threshold of the greatest intensity is
the smallest sound masking
The results of the research of the most effective
masking is around the frequency of the sound
in masking
NBN intensity is lower than WN
NBN can produce a shift in the threshold
without causing disruption due to masking
intensity is too hard
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
Thieme Medical Publishers,Inc., New York.20002/18/16

19

Effective masking level

The amount of intensity noise that

should be given to prevent cross
hearing
Minimum masking
Maximum masking
Over masking

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Undermasking

Not using enough noise in the non-test

ear
The obtained threshold is really the
response of the non-test ear

Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.

Thieme Medical Publishers,Inc., New York.2000

Overmasking

Using too much noise

The obtained threshold is exaggerated
when the masker crosses the head and
shifts the threshold of the test ear.
Traditionally, we use the plateau
method to ensure that we have
obtained a true threshold and are not
undermasking or overmasking.
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
Thieme Medical Publishers,Inc., New York.2000

PROBLEM IN MASKING
Central masking
the increase in the threshold of hearing ear
being tested at the time of masking test
starts (not yet achieve effective masking)
central masking between 5 15 dB (usually
around 5 dB)
oclussion effect
Raising the threshold of hearing in the closed
ear due to the occlusion effect
Commonly bone conduction with masking
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
Thieme Medical Publishers,Inc., New York.20002/18/16

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TRANSDUSER TYPES

Headphone / earphone
Insertphone
vibrator

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MASKING METHOD

Plateau method

formula method

step masking method

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PLATEAU (HOOD) METHOD

Widely used in the United Kingdom
Less desirable because the long test time
It is recommended if the minimum and
maximum masking area is very narrow
Provide
sound
masking
intensity
increased gradually until it reaches a
plateau which indicates that the threshold
is actually in the ear being tested has
been reached
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
Thieme Medical Publishers,Inc., New York.20002/18/16

26

PLATEAU METHOD

Finding the threshold of the ear being

tested (without masking)
Then the masking noise of 10 dB SL give
to the ear not being tested and the
hearing threshold test is repeated
Each time the masking sound intensity is
raised 10 dB, the ear hearing threshold
test is repeated

Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.

Thieme Medical Publishers,Inc., New York.20002/18/16

27

PLATEAU METHOD

During the masking intensity is still under

masking, any increase in the intensity of
10 dB will shift the hearing threshold of 10
dB
At a certain intensity, the increase in 10dB
masking is no longer shifting threshold
Two increases masking noise by 10 dB, no
longer shifting threshold reach plateau
Effective masking has been reached
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
Thieme Medical Publishers,Inc., New York.2000 2/18/16

28

FORMULA METHOD
Air conduction
Masking
minimum
(Mmin)
=
threshold in TE IA + A-B gap in NTE

AC

Masking maximal (Mmax) = threshold

BC in TE + IA

Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.

Thieme Medical Publishers,Inc., New York.20002/18/16

29

FORMULA METHOD
Bone conduction
Masking minimum (Mmin) = BC TE +
A-B gap NTE
Masking maximum (Mmax) = BC TE +
IA
note: Mmaks < UCL

Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.

Thieme Medical Publishers,Inc., New York.20002/18/16

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INITIAL INTENSITY MASKING

(Sataloff)

Avoid under masking

Easing achieve effective masking

Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.

Thieme Medical Publishers,Inc., New York.20002/18/16

31

MASKING INITIAL INTENSITY (Sataloff)

Air conduction tests

effective initial intensity is the intensity of
the initial masking as a guide at the start
of the hearing threshold shift in the ear
being tested
Sataloff performed on the intensity of
the air conduction threshold of the ear not
being tested + 30 dB

Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.

Thieme Medical Publishers,Inc., New York.20002/18/16

32

Condition need masking for AC AS

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MASKING INITIAL INTENSITY

(Sataloff)
Bone conduction test
Bone conduction starts at the air conduction
threshold of the non test ear + 20 dB
If the masking threshold ear in normal or
sensorineural deafness, should be added to
15dB at 250-500hz,and 10dB at 1000 Hz, which
is the correction factor occlusion effect on the
closed ear headphones
Above 1000 Hz occlusion effect is very minimal
Conductive deafness not need the added value
occlusion effect
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
2/18/16
Thieme Medical Publishers,Inc., New York.2000

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>

>

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STEP MASKING method(Katz dan

Lezynsky)

Faster than methods plateau

The increase in the intensity of masking
methods plateau only 5-10 dB each time,
step masking using greater intensity =
20 dB
Masking begins with providing EML
(Effective Masking Level) of 30 dB SL
(Sensation Level)
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
Thieme Medical Publishers,Inc., New York.20002/18/16

36

METODE STEP MASKING (Katz

dan Lezynsky)

If the masking threshold after

administration shifted by 15 dB or more
required additional masking (subsequent
masking / submask) of 20 dB
If the administration of the initial masking
30 dB SL EML no threshold shift or just a
5-10 dB, the likelihood is that the actual
threshold (no cross-over hearing) so it
does not need to be supplemented
submask
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
2/18/16
Thieme Medical Publishers,Inc., New York.2000

37

STEP MASKING METHOD (Katz

dan Lezynsky)
CRITERIA AFTER INITIAL MASKING QUOTE FROM
Abiratno.2005
Threshold shifting
with EML 30dBSL

need/not submask

0-10 dB

No need

15 dB

possibly no need

20 dB

Possibly need to

25 dB

Need to

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STEP MASKING METHOD(Katz dan

Lezynsky)

If the threshold in the ear being tested

eased after the initial masking (30 dB SL
EML)
The number of shifts in the ear threshold
test showed indications of whether or not
an additional masking / submask
If after submask summed (20 db above
masking initial EML), an indication of the
need to shift the threshold / absence of
additional submask
Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.
Thieme Medical Publishers,Inc., New York.20002/18/16

39

METODE STEP MASKING (Katz

dan Lezynsky)
Criteria after giving subsequent masking by
Abiratno.2005
Threshold shifting
with EML 20dBSL

Need/not submask

0-10 dB

No need

15 dB

Possibly no need

20 dB

Possibly need

> 20dB

Need to

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Masking for Speech

Reception Threshold

Just like masking for puretones

Determine the need for masking and use

plateau method to determine effectively

masked threshold for speech
Minimum IA 45dB
Initial level masking 30dB
Subsequent mask is 20dB

Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.

Thieme Medical Publishers,Inc., New York.2000

Masking for word

recognition score(WRS)

Wrs doesnt count hearing

threshold,only using one level intensity
Using widely spectrum noise masking
Level masking of the non test ear 30dB

Audiology: Diagnosis. Edited by Roeser, Valente, and Hosford-Dunn.

Thieme Medical Publishers,Inc., New York.2000

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conclusion

Masking may be necessary if one normal

ear and one ear of a hearing loss, or if
there
is
an
asymmetrical
hearing
threshold
Inspection begins frequency 1000 Hz
The purpose masking to determine the
actual threshold of the ear suspected of
having hearing problems and avoid the
tested crossings from ear to ear not being
tested (cross hearing)
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Given the time needed to carry out the

masking procedure, then we need to
understand a clear indication when
required masking and masking effective
intensity for each frequency being tested
If we doubt the diagnosis of hearing,
whether conductive hearing loss (CHL),
nerve deafness (Sensorineural hearing
loss)
or
deafness
mixture
(SFM),
absolutely necessary masking
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With audiometric we can distinguish or

compare hearing threshold between
conduction and bone conduction
Masking air conduction is done when
there is a difference between AC and BC
on both ears IA and bone conduction
masking done in case A- B gap 10 dB
For masking procedure, in the field of
audiology known three methods, namely
methods plateau, method formula and
step masking method
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 Thank

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you

46

Contoh penggunaan formula untuk

menilai
masking
minimum
dan
maksimum
Telinga kanan: yang sedang dites
Telinga kiri : gangguan konduktif ringan
dengan A-B gap : 30 dB (dikutip dati
Hodgson 1980, Handbook of Clinical
Audiology)
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Contoh kasus:
Evaluasi
pendengaran
dengan
menggunakan metode step masking
Kasus dengan gangguan pendengaran
unilateral kiri. Telinga kanan: Normal
(AC dan BC rata-rata 10 dBHL). Telinga
kiri : ambang AC tanpa masking ratarata 55 dBHL tertera pada tabel 3.10

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METODE FORMULA
Formula Masking untuk tes hantaran
udara
Mmin = At 40 + (Am Bm)
Mmaks = Bt + 40 dengan catatan Mmaks
kurang dari UCL (uncomfortable loudness
level)
NB: Nilai IA minimum untuk semua
frekuensi yang dipakai dalam metode
formula : 40 dB
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Berdasarkan pada panduan besar IA

minimum
untuk
hantaran
udara,
semua frekuensi perlu di masking
kecuali 4000 Hz dan 8000 Hz (besar IA
lebih kecil dari IA minimum pada
masing-masing frekuensi)

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