Technical University of Denmark

Audiometry and middle ear

measurements

1st semester project

Ørsted•DTU
Acoustic Technology
Fall semester 2007

Group 6
Troels Schmidt Lindgreen – 073081
Kristoffer Ahrens Dickow – 071324
Reynir Hilmisson – 060162

Instructor
Torben Poulsen
 Technical University of Denmark Ørsted • DTU
Ørsteds Plads Bygning 348
2800 Lyngby
Denmark
Telephone +45 4525 3800
http://www.oersted.dtu.dk

Title:
Audiometry and middle ear mea-
surements
Synopsis:
Course:
31230 Acoustic Communication
In this report different aspects of hear-
Fall semester 2007
ing are investigated. Experiments are
conducted for both audiometry, tympa-
Project group: nometry and middle ear reflex.
6
Theory of audiometry and middle
Participants:
ear measurements is presented, with focus
Troels Schmidt Lindgreen
on areas directly related to the conducted
Kristoffer Ahrens Dickow
experiments. Calibration of equipment is
Reynir Hilmisson
taken into consideration when discussing
measured results, which show that all
Supervisor: three test subjects are within the range of
Torben Poulsen normal hearing persons.

Instructor:
It is concluded that there are varia-
Torben Poulsen
tions among individual normal hearing
Date of exercise: October 22nd persons, regarding both hearing thresh-
olds, middle ear reflex and mobility of the
tympanic membrane.
Pages: 27

Copies: 4

No part of this report may be published in any form without the consent of the writers.
Introduction
Audiology is the study of hearing, but the profession of audiology is so much more than
that. Often audiologists are concerned with designing equipment such as hearing aids
because of the great importance our hearing has in daily life. In order to understand what
a hearing impairment is, one has to understand the function of a ear, which is what this
report is concerned with.

Audiometry is the testing of hearing ability. Typically, audiometric tests determine a

subject’s hearing levels with the help of an audiometer. Audiometry is used to diagnose
the extent of hearing loss in a person suffering from suspected hearing loss, or other dis-
orders of the ear.
Audiometry and middle ear measurements are investigated in this report.

To carry out the analysis of audiometry and middle ear measurements, four different
experiments will be conducted:

• Check of audiometer calibration

• Pure tone audiometry of both air- and bone-conduction threshold

• Compliance of the tympanic membrane

• Measurement of the middle ear reflex

Technical University of Denmark, December 2, 2007

Troels Schmidt Lindgreen Kristoffer Ahrens Dickow Reynir Hilmisson

Contents

1 Theory 1
1.1 The ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Acoustic admittance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.3 Acoustic Reflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.4 Tympanometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.5 Equivalent ear canal volume . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.6 Pure tone audiometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.7 Hearing loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

2 Measuring setup and measuring procedure 11

2.1 Calibration of equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.2 Audiometry setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.3 Middle ear measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.4 Otoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

3 Results 17
3.1 Pure tone audiometry measurement results . . . . . . . . . . . . . . . . . . 17
3.2 Tympanometric measurement results . . . . . . . . . . . . . . . . . . . . . . 18
3.3 Middle ear reflex measurement results . . . . . . . . . . . . . . . . . . . . . 19

4 Discussion 21
4.1 Pure tone audiometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4.2 Tympanometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
4.3 Middle ear reflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

5 Conclusion 25

Bibliography 27
November 2007 Chapter 1. Theory

Chapter 1
Theory

In this chapter the basic theory behind the measurements and results presented in this
report is introduced.

1.1 The ear

The ear is divided into three main areas. The outer ear (pinna), the middle ear and the
inner ear. The function of the outer ear is to collect sound energy and to transmit this
energy through the ear canal to the ear drum.

Figure 1.1: Schematic drawing of the outer, middle and inner ear. Modified from [Hain, 2006]

The sound pressure arriving at the outer ear, sets the tympanic membrane (ear drum)
into motion. This motion is then picked up by the inner ear, which consists of fluid, via

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Chapter 1. Theory Technical University of Denmark

the ossicles bones in the middle ear. On figure 1.1 these small bones can be seen. These
are the smallest bones in the human body, and are the malleus (hammer), incus (anvil)
and the stapes (stirrup). These bones constitute a lever function, that has the purpose
to match the impedances og two fluids, air outside and water inside. This impedance
matching is to avoid large losses of energy through reflections.

The tympanic membrane operates over a wide frequency range as a pressure receiver.
The stapes footplate, together with a ring shaped membrane called the oval window,
forms the entrance to the inner ear. In addition to the lever ratio of about 2, produced by
the different lengths of the arms of the malleus and incus, the middle ear also produces
a transformation depending on the ratio of the area of the large tympanic membrane to
that of the small footplate. This ratio is about 15. This ratio acts as an amplifier of
sound. [Zwicker and Fastl, 1999]

In normal circumstances, the middle ear is a closed cavity. The tympanic membrane
on one side and the Eustachian tube on the other (see figure 1.1). This tube is connected
to the upper throat region. Usually it is a closed tube, making the pressure inside at
atmospheric level. When we swallow or yawn the tube opens, and the pressure at the
two sides of the tympanic membrane is equalized. When the tube is blocked, which is
usually the case when we have a cold, this equalization is not possible. This causes an
under-pressure to build up in the middle ear, which again causes the tympanic membrane
to be pressed inwards, and as a result the hearing sensitivity is reduced. [Poulsen, 2005]

1.2 Acoustic admittance

When acoustic signals arrive at the tympanic membrane, it vibrates with a characteristic
amplitude and phase depending upon the acoustic admittance, and energy begins to flow
toward the inner ear. Part of the acoustic signal reaching the tympanic membrane is trans-
mitted into the middle ear, and part of the signal is reflected back down the ear canal. The
part of the acoustic signal that is transmitted into the middle ear is directly proportional
to the acoustic admittance at the tympanic membrane. Admittance is the opposite of
impedance and therefore the inverted value. High admittance meas low impedance and
vice versa. This admittance is defined by the complex ratio of volume velocity to sound
pressure. It is complex due to phase shifts between the volume velocity and the sound
pressure. Sometimes the term immittance is used as a general term, referring to both
impedance and admittance. Immittance is therefore not a physical characteristic but only
a term, which is used in clinical applications. In any acoustic system, the measured acous-
tic admittance varies with the frequency at which it is measured and with the physical

Page 2 Audiometry and middle ear measurements

November 2007 Chapter 1. Theory

properties. [Weily and Stoppenbach, 2002]. Acoustic admittance is used in two general
areas, tympanometry and acoustic reflex measures.

1.3 Acoustic Reflex

Besides functioning as a mechanical amplifier, the middle ear also provides protection for
the hearing system from the effects of loud sounds. This occurs as a result of the action of
two muscles in the middle ear. The tensor tympani and the stapedius. These two muscles
are attached to the bones and will be activated by the so-called middle ear reflex. These
muscles act automatically in response to high sound pressure levels, approximately 75 dB,
and they have the effect of increasing the impedance of the middle ear by stiffening the
ossicular chain. This stiffening reduces vibrations transmitted from the tympanic mem-
brane to the inner ear and thus protecting it to some extend from loud sounds. [Howard
and Angus, 2001]

The reflex takes about 25 to 150 ms to react, and thus it has no effect on impulsive
sounds. Futhermore the reduction in sound pressure caused by the middle ear reflex is
somewhat more significant at lower frequencies (∼ 20 dBSPL at 125 Hz) than at higher
frequencies (∼ 5 dBSPL at 2000 Hz and above). [Poulsen, 2005, p. 9]

Acoustic reflex measures are based on changes in acoustic admittance in the ear canal
with contraction of the stapedius muscle during the presentation of an acoustic signal.
This acoustic reflex will result in a decrease in admittance due to stiffening of the ossicular
chain caused by the stapedius muscle contraction. This characteristic is referred to as the
acoustic compliance. In figure 1.2 idealized reflex responses are shown.

Figure 1.2: Idealized representations of the (a) activating stimulus, and reflex response time courses that
are (b) monophasic, (c) biphasic at onset only, and (d) biphasic at onset and offset. From [Fowler and
Shanks, 2002, p. 208]

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Chapter 1. Theory Technical University of Denmark

1.4 Tympanometry

Tympanometry is a measurement of admittance in the ear canal as the air pressure within
the canal is varied. These measurements provide useful information regarding middle ear
and eustachian tube function, which are of great interest when investigating conductive
hearing disorders. The graphic displays of such measurements are called tympanograms,
and are obtained using a probe inserted in the ear canal. Tympanograms can be very
useful for some applications but vary with individual ear canal characteristics, such as
shape and volume. [Weily and Stoppenbach, 2002]

The normal value of middle ear pressure for adults is within ±25 daPa relative to atmo-
spheric pressure [Poulsen, 2006, Appendix B]. Different possible results of tympanometric
measurements can be seen on figure 1.3. Figure 1.4 shows a distribution of the middle ear
compliance measured from 979 ears.

Figure 1.3: Classification of common tympanogram types. From [Poulsen, 2006, Appendix B]

If the tympanogram shows an abnormally low pressure in the middle ear it is often be-
cause of some kind of disorder in the Eustachian tube, since this is supposed to equalize
the pressure on both sides of the tympanic membrane.
If the tympanogram is flat, it means that the compliance measured does not change as
the pressure is varied. This could either indicate that the tympanic membrane is broken,
and thus allowing the pressure to equalize on both sides of it, or that the middle ear is

Page 4 Audiometry and middle ear measurements

 Tympanometry
Select tympanometry on the audiometer. Find a probe that fits into the ear canal. Keep the
probe at a fixed position. Don’t move, don’t talk. When the seal is tight the instrument will
start the measurement automatically. See the display (Status, Figure 10) for any ‘LEAKAGE’
indication.

Note: If both diodes on the button are lit the instrument will start to measure tympanometry
and immediately after the middle ear reflex (se section below). This may be an advantage. If
needed, press the Tymp/Reflex button again to select the two measurements separately.
November 2007 Chapter 1. Theory
The pressure pump will produce a slight over-pressure in the ear canal and then a slight
under-pressure. The result may be like in Figure 10.

filled with fluid, since fluid is not as easily compressed as air and thus makes
Figure 10 the tympanic
membrane less mobile. In the case of a flat tympanogram, a lowExample
maximum compliance
of tympanometry
(upper part of the display)
points toward fluid in the middle ear, whereas a flat tympanogram with higher compliance
The lower part of the figure
indicates a broken membrane. shows the result of a reflex
In the case of low maximum compliance, some kind of conductive determination
disorder would be sus-
pected, whereas an extremely mobile membrane (high maximum compliance) could be
caused by either some luxation of the ossicular chain or by a scarred (and thus more
sloppy) tympanic membrane. [Poulsen, 2006, Appendix B]

As always the fact that large individual differences occur, must be taken into consideration
before concluding anything from a tympanogram.
In order to evaluate your results, the following two ‘reference’ figures are given.

Figure 10 Distribution of
middle ear compliance for 979
ears.

Figure 1.4: Distribution of middle ear compliance. From [Poulsen, 2006, Appendix B]

TORBEN POULSEN: 45 25 39 40 (office), e-mail: tp@oersted.dtu.dk 7

1.5 Equivalent ear canal volume

The equivalent ear canal volume, obtained from a tympanogram, is an acoustic admit-
tance estimate of the volume between the probe tip and the tympanic membrane. The
term equivalent is used because it is not the direct volume measured, but the estimated
value of admittance measured offered by the air between the probe tip and the tympanic
membrane. The measure is based on the principle that under specified conditions, a given
volume of air has a specific admittance. A one cubic centimeter of air at sea level under
reference conditions, has an acoustic admittance of approximately 1 acoustic mmho for a
226 Hz probe tone. [Weily and Stoppenbach, 2002]

The approximate volume of the ear canal can be calculated under the assumption that the
ear canal is shaped like a tube with length 25 mm and diameter 7 mm. [Poulsen, 2005, p. 7]

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Chapter 1. Theory Technical University of Denmark

With a tube with length 25 mm and diameter 7 mm the approximation is:

Vear canal ' π · 3.52 · 25 ml = 0.96 ml (1.1)

This number is of course very approximate since the ear canal is not a perfect tube shape,
and since the size of it varies from person to person.

1.6 Pure tone audiometry

Pure tone audiometry is used to determine hearing sensitivity in terms of clarifying whether
or not a person has a hearing loss. The measure involves the peripheral and central au-
ditory systems. Pure tone thresholds indicate the softest sound audible to an individual
at least 50 % of the time. The hearing level (HL) is plotted on an audiogram, which is a
graph displaying intensity as a function of frequency, see figure 1.5.
Hearing level [dB HL]

-10
0
10
20
125 250 500 1000 2000 4000 8000
Frequency [Hz]

Figure 1.5: Audiogram for the right ear of test subject TL.

In pure tone audiometry, hearing is measured at frequencies varying from low pitches (125
Hz) to high pitches (8000 Hz). For threshold testing intensity, decibels are measured in HL,
which is based on the standardized average of individuals with normal hearing sensitivity.
HL is not equivalent to sound pressure level (SPL), but ANSI has defined a relationship
between SPL and HL for each audiometric frequency from 125-8000 Hz.

The HL is quantified relative to ”normal” hearing in decibels (dB HL), with higher num-
bers of dB HL indicating a higher hearing threshold. To describe the hearing threshold
with a single number, an average of the most important pure tone frequencies for speech
intelligibility is derived. Pure tone average (PTA) is the average of pure tone hearing
thresholds at 500 Hz, 1000 Hz, and 2000 Hz. In a given situation the PTA consisting of
500 Hz, 1000 Hz, and 2000 Hz can be rather useless and more frequencies are often taken
into account when calculating a detailed pure tone average.

Depending on the PTA HL, normal hearing and hearing loss is normally defined as:

Page 6 Audiometry and middle ear measurements

November 2007 Chapter 1. Theory

Normal hearing (adults) < 25 dB HL

Normal hearing (children) < 15 dB HL
Mild hearing loss 25 - 40 dB HL
Moderate hearing loss 41 - 65 dB HL
Severe hearing loss 66 - 90 dB HL
Profound hearing loss > 90 dB HL

Table 1.1: Definitions of hearing. From [Hain, 2006]

When a person has a hearing loss, the next step is to try and determine whether the loss is
caused by a sensory problem (sensorineural hearing loss) or a mechanical problem (conduc-
tive hearing loss). This distinction is made by using a bone vibrator. The vibrations of the
bones of the skull elicits auditory sensation. At least three bone-conduction mechanisms
can transmitt sounds and cause the same activity in the cochlea. Bone conduction can
be used as a way to bypass the outer and middle ear and to stimulate the cochlea. Bone
conduction works because the cochlea is housed within the temporal bone. The bones of
the skull are all connected , which allows energy applied to one part of the skull to radiate
throughout the entire skull, including the temporal bone. If hearing is better using bone
conduction than air conduction, a conductive hearing loss might be the case.

1.6.1 Determining the hearing threshold

Pure tone audiometry is standardized in ISO 8253-1. The standard describes the general
expression for determining the hearing threshold as the lowest level at which responses
occur in more than half of the ascents.

The hearing threshold determination consists of a sequence of threshold determination

tests, where each test determines the threshold for one frequency for one ear. The tested
frequency sequence is 1 kHz followed by frequencies above 1 kHz in increasing order. Then
frequencies below 1 kHz are tested in decreasing order.

When the pure tone hearing threshold is determined for all necessary frequencies for the
first ear, a 1 kHz threshold determination test is conducted again. Only if the two obtained
thresholds for 1 kHz differ by 5 dBSPL or less, the test is completed. If the difference is
greater; further audiometry tests must be conducted to prevent determining a higher hear-
ing threshold than the real threshold for the test subject due to non familiarisation with
the test method. The control test at 1 kHz is only needed on the first ear since the test
subjects is expected to be familiar with the test method when measuring the threshold for
the second ear.

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Chapter 1. Theory Technical University of Denmark

Pure tone audiometry can be performed with one of two methods: The ascending method
and the bracketing method, that differ only in the specific threshold determination proce-
dure.

1.6.2 Ascending method

The ascending method begins by presenting a level that is well above the expected thres-
hold and reducing the level by 10 dBSPL until the signal is inaudible to the test subject.
This is to familiarize the method so the test subject know which signal to listen for.
When hitting a negative response, the ascending series starts, and the level is increased
by 5 dBSPL until a positive response is obtained.

After each positive response the level will be reduced by 10 dBSPL and a new ascending
series is started. The procedure is repeated until three ascends have resulted in positive
response at the same level which is defined as the threshold, see figure 1.6. If five ascending
series are performed without three ascends have resulted in positive response at the same
level, the threshold determination must be started from the beginning.

30
TL (r)
Level [dB HL]

20
10
0
-10
-20
5 10 20
Stimulus no.

Figure 1.6: The ascending method for the right ear of test subject TL. The threshold is 0 dB HL. ”+”
corresponds to a positive response, ”o” corresponds to no response.

After a threshold determination the frequency is changed to the next according to the
frequency sequence described in the previous section. The ascending method is used again
starting with an introductory descending series for that frequency.

In audiological clinics a faster version of the ascending method is used where only two
ascends have resulted in positive response at the same level out of maximum three as-
cends.

1.6.3 Bracketing method

Like the ascending method an introductory series is used in the Bracketing method, but
this method uses both ascending and descending series contrary to the Ascending method.

Page 8 Audiometry and middle ear measurements

November 2007 Chapter 1. Theory

After a positive response the level is increased by 5 dBSPL and a decreasing series is
started by decreasing in steps of 5 dBSPL until no response is obtained. The level is de-
creased by further 5 dBSPL and a increasing series is started. The procedure is continued
until three ascending and three decreasing series has been performed. If the lowest levels
with response in the ascending and/or decreasing series deviate by more than 10 dBSPL
among themselves the test has be to repeated from the beginning.

The threshold is determined by calculating the average of the lowest levels with response
in the ascending series and calculating the average of the lowest levels with response in the
decreasing series. The threshold for the tested frequency is the mean of the two averages,
rounded to the nearest integer in dBSPL .

1.7 Hearing loss

Hearing loss can be divided into three subcategories:

• Sensorineural hearing loss; bone- and air-conduction thresholds within 10 dBSPL of

each other, and thresholds are higher than 25 dB HL.

• Conductive hearing loss; normal bone-conduction thresholds, but air-conduction

thresholds are poorer than normal by at least 10 dBSPL .

• Mixed hearing loss; conductive and sensorineural components.

The definition of the three subcategories is from [Mullin and Campbell, 2006].

1.7.1 Sensorineural hearing loss

Sensorineural hearing loss is secondary to cochlear abnormality and/or abnormality of the
auditory nerve or central auditory pathways. Both air- and bone-conducted signals are
effective in stimulating the cochlea because the outer ear and middle ear do not reduce the
signal intensity of the air-conducted signal. Pure tone air- and bone-conduction thresholds
are within 10 dBSPL . [Mullin and Campbell, 2006]

1.7.2 Conductive hearing loss

Conductive hearing loss is secondary to outer ear or middle ear abnormality, which can
include abnormalities of the tympanic membrane. The abnormality reduces the effec-
tive intensity of the air-conducted signal reaching the cochlea, but it does not affect the
bone-conducted signal that does not pass through the outer or middle ear. Examples of

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Chapter 1. Theory Technical University of Denmark

abnormalities include perforated tympanic membranes, fluid in the middle ear system, or
scarring of the tympanic membrane. Pure tone air-conduction thresholds are poorer than
bone-conduction thresholds by more than 10 dBSPL . [Mullin and Campbell, 2006]

1.7.3 Mixed hearing loss

This type of hearing loss has both sensorineural and conductive components. Pure tone
air-conduction thresholds are poorer than bone-conduction thresholds by more than 10
dBSPL , and bone-conduction thresholds are less than 25 dBSPL . [Mullin and Campbell,
2006]

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November 2007 Chapter 2. Measuring setup and measuring procedure

Chapter 2
Measuring setup and measuring procedure

2.1 Calibration of equipment

Calibration of sound level meter
In order to calibrate a audiometer to the ISO 389 standard, the sound level meter that
is used for this calibration must first be calibrated itself. The sound level meter in this
case consists of an artificial ear (IEC 318 standard) connected to a measuring amplifier.
A calibrator used produces a 1 kHz tone at a sound pressure level of 94 dB when fitted on
the artificial ear. A signal received by the artificial ear is passed through an 1/1-octave
band filter (around 1 kHz) in order to reduce unwanted noise, and a measuring amplifier
is set to show exactly 94 dB at the sound level meter. Figure 2.1 shows the calibration
setup.

Calibrator Measuring
Artificial ear 1/1-octave filter
94 dBSPL @ 1 kHz amplifier

Figure 2.1: Setup of calibration of the sound level meter. Inspired by [Poulsen, 2006, p. 2]

Calibration of audiometer
With the sound level meter being checked, a audiometer can be calibrated for use with
the HDA 200 headphones. In table 2.1 the results are shown. The used audiometer
can not actually be calibrated to remove the calculated deviations, but knowing them
makes it possible to take themArtificial
into account when looking at the Measuring
Audiometer ear 1/1-octave filterresults of the audiological
amplifier
measurements. The calibrations are done by placing an ear cup on the artificial ear and
measuring level of the desired frequencies by setting the audiometer at the levels shown

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 Calibrator Measuring
Artificial ear 1/1-octave filter
94 dBSPL @ 1 kHz amplifier

Chapter 2. Measuring setup and measuring procedure Technical University of Denmark

in table 2.1. The filter must be set so that the desired frequency is within the 1/1-octave
band. Figure 2.2 shows the calibration setup.

Measuring
Audiometer Artificial ear 1/1-octave filter
amplifier

Figure 2.2: Setup of calibration of the audiometer. Inspired by [Poulsen, 2006, p. 2]

Calibration results

It is seen in table 2.1 that deviations are no more than 1.5 dBSPL , and that deviation
between the left and right ear cup is at most 0.5 dBSPL . Considering the steps used for
the audiometry measurements in this report are 5 dBSPL the deviations can be disregarded
in the discussion of the results.

Measuring amplifier: BK 2636, LA 1113 Artificial ear: IEC 60318-2, with flat
Filter: BK 1617, LA 1115 plate and conical ring
Microphone: BK 4134
Calibrator: BK 4230, LA 1218 Left earphone Right earphone
Measured at AA 222 standard levels (dB HL)
Frequency ISO Measured Microphone Target Left Deviation Right Deviation
389-8 Correction value level level
[Hz] [dB] [dB HL] [dB] [dB] [dB] [dB] [dB] [dB]
125 30.5 50.0 0.0 80.5 81.5 1.0 81.5 1.0
250 18.0 70.0 0.0 88.0 89.0 1.0 88.5 0.5
500 11.0 80.0 0.0 91.0 92.0 1.0 92.0 1.0
1000 5.5 85.0 0.0 90.5 91.5 1.0 92.0 1.5
2000 4.5 80.0 0.0 84.5 85.5 1.0 86.0 1.5
3000 2.5 80.0 0.1 82.6 83.5 0.9 83.5 0.9
4000 9.5 80.0 0.2 89.7 91.0 1.3 90.5 0.8
6000 17.0 75.0 0.5 92.5 93.5 1.0 93.5 1.0
8000 17.5 80.0 0.9 98.4 99.5 1.1 99.0 0.6

Table 2.1: Interacoustics AA 222 Audiometer Calibration Report. From [Poulsen, 2006, Appendix A].

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November 2007 Chapter 2. Measuring setup and measuring procedure

Table of equipment

Model Description DTU number

Brüel og Kjær type 2636 Measuring amplifier 1113
Brüel og Kjær type 1617 Filter 1115
Brüel og Kjær type 4134 Michrophone –
Brüel og Kjær type 4230 calibrator 1218
Sennheiser HDA-200 Headphone –
Interacoutics Audio traveller AA222 Audiometer 1321
Brüel og Kjær type 4153 Artificial ear –

Table 2.2: Table of equipment used in the experiments.

2.2 Audiometry setup

A test subject is sitting in a audiometric booth wearing headphones or a bone conductor
depending on what is being measured. Outside the box is the operator controlling a
audiometer. When a test subject hears a test tone he/she is asked to push a button,
which for practical reasons is also placed in the audiometric booth. When the button is
pushed it shows on the audiometer so the operator knows if the subject heard the test
tone or not.

2.2.1 Measurement procedure

The goal is to measure hearing thresholds of test subjects using both air- and bone con-
duction methods.

Audiometry measurements are done as manual audiometry using the ascending method
as described in section 1.6.2. The frequencies are 1 kHz, 2 kHz, 4 kHz, 6 kHz, 8 kHz, 500
Hz, 250 Hz, 125 Hz tested in the order mentioned. Results are stored in the audiometer
and printed out after testing both ears of the test subject at all frequencies.

During measurements, the operator(s) use paper and pencil to keep track of responses
of the test subject, in order to know when to store the result and move on to the next
frequency in the sequence. When air conducted measurements are finished, audiometry
using a bone conductor is carried out.

The bone conductor is placed on the mastoid (the bone just behind the outer ear). Bone
conduction measurements are done for only one ear, because results can be assumed to
be very similar for the other ear (cf. the exercise instructor). The audiometer only goes
down to 250 Hz when doing bone conduction measurements, so 125 Hz is not tested in this

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Chapter 2. Measuring setup and measuring procedure Technical University of Denmark

case – otherwise frequencies and the order of the sequence is identical to that of the air
conducted audiometry. It is noticed that calibration of the bone conductor is not checked,
since no means of doing this are given.

If the time intervals between test signals are kept the same, the test subject might convince
him/herself that a tone is heard even though he/she can not actually hear the tone. To
avoid this kind of bias the operator must vary the intervals slightly, especially around the
hearing threshold of the test subject.

2.3 Middle ear measurements

In figure 2.3 the principle behind a middle ear analyzer is shown. A loudspeaker generates
a pure tone that is sent into the ear, while a microphone measures the sound pressure level
in the ear canal. An air pressure pump makes it possible to control the static pressure in
the ear canal. A balance meter, shown in figure 2.3, is used to compare the output from
the microphone to the output of the tone generator. By changing phase and amplitude of
the signals the instrument can adjust itself so that the signals from the microphone and
the tone generator cancel each other. This of course requires a tight seal of the earplug.
When increasing or decreasing the pressure in the ear canal, the tympanic membrane will
move and thus change the volume of the ear canal. When doing so the balance between
the microphone signal and tone generator, signal changes. These changes are detected by
the measuring device, and can be used to calculate the acoustic compliance of the middle
ear. [Poulsen, 2006, p. 5 + Appendix B]

When conducting the actual experiment the middle ear analyzer is implemented in the
audiometer which is used for the measurements.
Tone Loudspeaker
generator

Ear plug

Air pressure pump

Tympanic
membrane
Balance Microphone
Meter

Figure 2.3: Middle ear analyzer. Modified from [Poulsen, 2006, p. 5]

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November 2007 Chapter 2. Measuring setup and measuring procedure

2.3.1 Tympanometry
In this part of the measurements the audiometer is used to measure compliance and pres-
sure of the middle ear. First the measuring device must be fitted with an appropriate
rubber plug, that makes a tight fit in the ear of a test subject. The probe is then placed
into the ear, and held in place by the test subject while he/she is resting the elbow on a
steady surface, to ensure as little movement of the probe during measuring as possible.
The audiometer will then do both tympanometry and middle ear reflex measurements. If
the probe detects a leakage the measurements will be aborted and must be restarted with
a better fitting ear plug. The tympanometry is done using a 226 Hz pure tone. When an
over- or under pressure is created in the ear canal, the tympanic membrane will be pressed
inwards or outwards. This usually reduces its mobility. When the air pressure in the ear
canal corresponds to that in the middle ear cavity, the tympanic membrane has its highest
mobility. This corresponds to maximum compliance, which is the sum of the compliance
of the middle ear and the air volume between the tympanic membrane and the probe.

When the air pressure in the ear canal differs alot from the pressure inside the middle
ear cavity, the tympanic membrane becomes almost immoblie. The acoustic compliance
recorded, expressed as equivalent volume, then corresponds approximately to the physical
volume of the ear canal. The middle ear compliance can then be determined by subtract-
ing this compliance value for the ear canal from the total compliance measured when the
middle ear and the ear canal pressure are equal, i.e. the maximum value recorded [Poulsen,
2006, Appendix B]. Tympanometry and middle ear reflex measurements are done for both
left and right ears.

2.3.2 Middle ear reflex

The middle ear reflex is tested with different frequencies: 500 Hz, 1 kHz, 2 kHz and 4 kHz.
Levels of the test tones are 80 dB HL, 90 dB HL and 100 dB HL. The testing is controlled
by the audiometer as described in section 2.3.1.

2.4 Otoscopy
By using an otoscope connected to a TV the ears of a subject can be examined. The goal
is to see the tympanic membrane. This can also be done using a smaller otoscope which
is not connected to a TV.

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Chapter 2. Measuring setup and measuring procedure Technical University of Denmark

Page 16 Audiometry and middle ear measurements

November 2007 Chapter 3. Results

Chapter 3
Results

3.1 Pure tone audiometry measurement results

Hearing level [dB HL]

Hearing level [dB HL]

-10 -10
0 0
10 10
20 20
125 250 500 1000 2000 4000 8000 125 250 500 1000 2000 4000 8000
Frequency [Hz] Frequency [Hz]

Figure 3.1: Air-conduction threshold for test subject Figure 3.2: Air-conduction threshold for test subject
TL, measured on left ear. TL, measured on right ear.
Hearing level [dB HL]
Hearing level [dB HL]

-10 -10
0 0
10 10
20 20
125 250 500 1000 2000 4000 8000 125 250 500 1000 2000 4000 8000
Frequency [Hz] Frequency [Hz]

Figure 3.3: Bone-conduction threshold for test sub- Figure 3.4: Air-conduction threshold for test subject
ject TL, measured on right ear. KD, measured on left ear.
Hearing level [dB HL]
Hearing level [dB HL]

-10 -10
0 0
10 10
20 20
125 250 500 1000 2000 4000 8000 125 250 500 1000 2000 4000 8000
Frequency [Hz] Frequency [Hz]

Figure 3.5: Air-conduction threshold for test subject Figure 3.6: Bone-conduction threshold for test sub-
KD, measured on right ear. ject KD, measured on right ear.

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Chapter 3. Results Technical University of Denmark

Hearing level [dB HL]

Hearing level [dB HL]

-10 -10
0 0
10 10
20 20
125 250 500 1000 2000 4000 8000 125 250 500 1000 2000 4000 8000
Frequency [Hz] Frequency [Hz]

Figure 3.7: Air-conduction threshold for test subject Figure 3.8: Air-conduction threshold for test subject
RH, measured on left ear. RH, measured on right ear.
Hearing level [dB HL]

-10
0
10
20
125 250 500 1000 2000 4000 8000
Frequency [Hz]

Figure 3.9: Bone-conduction threshold for test subject RH, measured on right ear.

3.2 Tympanometric measurement results

Figure 3.10: Typnanogram for TL.

Figure 3.11: Typnanogram for KD.

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November 2007 Chapter 3. Results

Figure 3.12: Typnanogram for RH.

3.3 Middle ear reflex measurement results

Figure 3.13: Middle ear reflex measure for TL.

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Chapter 3. Results Technical University of Denmark

Figure 3.14: Middle ear reflex measure for KD.

Figure 3.15: Middle ear reflex measure for RH.

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November 2007 Chapter 4. Discussion

Chapter 4
Discussion

As mentioned in section 2.2.1 the bone vibrator used for audiometry has not been cali-
brated, but it is assumed that the results are reliable.

The measurements are done using three test subjects; TL, KD and RH. They are 23,
26 and 27 years of age respectively and are all male.

In the following sections the results presented in chapter 3 are discussed.

4.1 Pure tone audiometry

By looking at the audiograms presented in chapter 3 (figures 3.1 to 3.9), it is seen that
none of the test subjects deviate more than 20 dBSPL from normal hearing (0 dB HL).
Thus all the test subjects are considered normal hearing. This can also be seen by looking
at the calculated PTA’s listed in table 4.1.
Test Left ear Right ear Right ear
subject air-conduction air-conduction bone-conduction
TL 10 dB HL 7 dB HL 2 dB HL
KD 3 dB HL 0 dB HL 12 dB HL
RH -3 dB HL -3 dB HL -3 dB HL

Table 4.1: Calculated PTA (500 Hz, 1kHz, 2 kHz) for the three test subjects.

Test subject TL has a 20 dBSPL dip at 1 kHz on his left ear (figure 3.1) and 10 dBSPL
on his right ear (figure 3.2). When looking at those dips it is interesting to see whether
he also has a 1 kHz dip when measuring with the bone vibrator. If this is not the case it
could actually be that test subject TL just need to clean his ears, as a higher threshold in
air conducted audiograms than bone conducted audiograms could indicate a conductive

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Chapter 4. Discussion Technical University of Denmark

hearing loss (see section 1.6). In figure 3.3 it is seen that TL has a 0 dB HL threshold at
1 kHz when testing with a bone conductor. A conductive hearing loss could be caused by
an ear wax plug, but could also be more serious problems in the middle ear. However it
must be emphasized that with deviations less than 20 dBSPL it is not considered a hearing
loss.

Figure 3.5 shows that test subject KD has an audiogram for his right ear, that is al-
most identical to that of an average normal hearing person (0 dB HL), but in figure 3.4
a dip at 4 kHz and above is seen. Again this is not considered a hearing loss, but if the
dip was greater a noise induced hearing loss could be suspected, since this type of hearing
loss typically is centered at 4 kHz.

Since the right ear of test subject KD has pretty much average normal hearing, it is
not suspected that his audiogram measured with a bone vibrator (behind the right ear)
would have any dips. Therefore the dip seen at 2 kHz in figure 3.6 is probably a measuring
mistake which could be caused by tiredness of the test subject or noise from the surround-
ings. When using the bone vibrator there is no padding around the ears to block out
unwanted sound, which makes it more difficult to focus on listening for sound produced
by the bone vibrator. Training could minimize the bias caused by unwanted sound from
the surroundings by making the test subject better at focusing on the tones produced by
the bone vibrator.

Regarding the 4 kHz dip at the left ear of test subject KD (figure 3.4), this could in-
dicate a beginning hearing loss, perhaps caused by gunshots, where the left ear (KD is a
right hand shooter) is the one pointing toward the end of the barrel of the gun, but again
when calculating the hearing threshold of an average normal hearing person, some will
have a higher threshold and some will have a lower threshold – that is why everything
within 25 dBSPL of 0 dB HL is considered normal hearing.

Figures 3.7 to 3.9 show the audiograms for test subject RH. It is seen that RH has a
very good hearing, which is slightly better than that of an average normal hearing person.
The audiometer is not able to go below -10 dB HL when testing, so it was actually not
possible to determine the hearing threshold for RH at certain frequencies, since he had no
trouble detecting the tone at -10 dB HL at those frequencies.

After being tested all the test subjects mentioned the impact that breathing has on the
results. When trying to detect very faint sounds and at the same time wearing closed
headphones, the tone can be completely drowned by heartbeats or by breathing. It is

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November 2007 Chapter 4. Discussion

possible that the test subjects are capable of getting better scores by training, as they
adapt and find out when to breathe and how to keep their pulse down in order to have
less disturbance from pumping veines and other body sounds.

4.2 Tympanometry
In this section a discussion of the results obtained from the tympanometry are covered.
Figures 3.10 to 3.12 show the results, where the ear canal volume (ECV), the static com-
pliance, the middle-ear pressure and the gradient are given. According to theory, there is
no one value indicating a right value (see figure 1.4). The ECV, does not tell much, as
this is the equivalent volume between the probe and the tympanic membrane. This value
varies much, as the probe fitting can have different sizes. However the EVC is important to
determine the compliance of the middle ear as it is used by the audiometer to calculate the
middle ear compliance printed on the tympanograms [Poulsen, 2006, Appendix B]. The
middle ear compliance, expressed in equivalent volume [ml] is very different from person
to person, as can be seen on these tympanograms. The results show that all values are
consistent with the theory, when comparing to figure 1.4.

The middle ear pressure is the pressure inside the middle ear at maximum compliance.
This actually means the normal pressure at normal conditions. Again the measured values
for all three test subjects are close to the expected. Test subject KD has -31 daPa relative
to atmospheric pressure on his left ear (figure 3.11) and RH has -34 daPa on his right
ear (figure 3.12), but otherwise all are within the normal limits, i.e. ±25 daPa relative to
atmospheric pressure.

The curves on figures 3.10 to 3.12 are seen to have different steepness and amplitude,
but when comparing to figure 1.3 it is seen that the curves for test subject TL have a
normal pressure, normal amplitude and a sharp form. The curves for test subject KD
has normal pressure and form, but a slightly lower amplitude than normal. Looking at
the curves for test subject RH it is clearly seen that he has normal pressure, high ampli-
tude and a sharp form. All three test subjects are within the limits of what is considered
normal.

4.3 Middle ear reflex

The results for test subject RH (figure 3.15) will be discarded, since they are too inconsis-
tent to draw any conclusions. It could be that leakage during measuring has caused the
measuring procedure to stop, or perhaps the probe was not held steady enough to give

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Chapter 4. Discussion Technical University of Denmark

useful results. The procedure was tried three times, but none of them gave useful results.

Figure 3.14 shows the test results for test subject KD. Generally it is seen that the middle
ear reflex is activated at 90 dB HL, but that it is more significant at 100 dB HL. At 500 Hz
a small reaction at 80 dB HL is seen on the right ear, whereas at higher frequencies there
is no reaction below 90 dB HL.

Figure 3.13 shows the results for test subject TL, and in comparison to those of test
subject KD, it can be seen that TL’s middle ear reflex is not as easily activated as that of
KD. At most frequencies TL has no reaction below 100 dB HL, and even at this level, the
effect of the middle ear reflex is seen to be rather small compared to the results measured
for KD.

It is unfortunate that the audiometer used to conduct these experiments does not in-
dicate when the pure tone was present, and when it was not, in the graphs from the
middle ear measurements. Such an indication would make it possible to investigate the
reaction time of the reflex, and also to see how long after the stimulus has stopped the
reflex is still active.

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November 2007 Chapter 5. Conclusion

Chapter 5
Conclusion

In this report different aspects of hearing has been investigated. Experiments were con-
ducted for both audiometry, tympanometry and middle ear reflex measurements. Besides
the actual measurement results, practical experience was achieved while doing the tests.

When conducting audiometry measurements results were obtained by using the ascending
method and with varying time intervals between stimuli. Tympanometry and middle ear
reflex measurements were done using automated procedures integrated in an audiometer.
Several test were executed to ensure correct probe fitting and thus reproducible results.
Calibration of equipment is taken into consideration when discussing measured results.

From the experiments which this report is based on, it is seen that the three subjects
tested all have normal hearing. Their audiograms show that they have hearing thresholds
within the range from -10 dB HL to 20 dB HL.

For tympanometry and middle ear reflex measurements, results similar to the expected
were seen.

It is concluded that there are variations among individual normal hearing persons, regard-
ing both hearing thresholds, middle ear reflex and mobility of the tympanic membrane.

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Chapter 5. Conclusion Technical University of Denmark

Page 26 Audiometry and middle ear measurements

November 2007 Bibliography

Bibliography

[Fowler and Shanks, 2002] Fowler, C. G. and Shanks, J. E. (2002). Clinical Audiology,
chapter 12 - Tympanometry. 5 edition.

[Hain, 2006] Hain, T. C. (2006). Hearing testing. http://www.dizziness-and-

balance.com/testing/hearing test.htm.

[Howard and Angus, 2001] Howard, D. M. and Angus, J. (2001). Acoustics and psychoa-
coustics.

[Mullin and Campbell, 2006] Mullin, G. and Campbell, K. C. (2006). Audiology, Pure-
Tone Testing. http://www.emedicine.com/ent/topic311.htm.

[Poulsen, 2005] Poulsen, T. (2005). Acoustic Communication, Hearing and Speech. 2.0
edition. Only available from DTU campusnet.

[Poulsen, 2006] Poulsen, T. (2006). Audiometry and middle ear measurements. 2.0 edition.
Only available from DTU campusnet.

[Weily and Stoppenbach, 2002] Weily, T. L. and Stoppenbach, D. T. (2002). Clinical Au-
diology, chapter 11 - Basic principles of acoustic immittance measures. 5 edition.

[Zwicker and Fastl, 1999] Zwicker, E. and Fastl, H. (1999). Psychoacoustics. Facts and
Models. 2 edition. Available at Ørsted DTU Library Building 352.

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