Unit 1

Clinical Masking and Calibration

H M Apoorva
 Part A – Clinical Masking - Objectives
Sl.n Topic SLOs
o The student should be able to
1. Clinical Masking – a) define masking
Introduction b) define the terminologies related to masking
c) discuss the purpose and rationale for masking
d) illustrate the necessity for masking in clinical practice using examples
2. Stimulus employed in a) describe the different stimuli used for clinical masking
masking b) explain critical band concept
3. Criteria for masking a) define inter-aural attenuation (IA), describe its importance and discuss factors affecting IA
b) define the criteria for AC masking, BC masking and speech masking
4. Effective masking a) define effective masking
b) discuss the purpose for calculating effective masking level
c) define minimum and maximum effective masking level for AC, BC and speech masking
d) discuss the factors to be considered while calculating minimum effective masking level.
5. Procedure for masking a) describe the different procedures used for clinical masking
b) discuss Hood’s plateau method for obtaining masked thresholds
c) describe the concept of Naunton’s dilemma
d) discuss Fusion Inferred threshold and its clinical implications
e) discuss Rainville test and Sensory Neural Acuity Level (SAL) test
 Part B – Calibration - Objectives
Sl.no Topic SLOs
The student should be able to
1. Introduction to calibration a) define calibration
b) describe the rationale for calibration of audiometer
c) mention the different types of calibration
d) classify the types of calibration based on how frequently the equipment needs to be calibrated.
2. Daily listening check a) discuss daily listening check
b) Know when to perform and who should perform daily listening check
c) know the importance of daily listening check
d) describe the steps carried out during daily listening checks
3. Subjective calibration a) define subjective calibration
b) Know when to perform and who should perform subjective calibration
c) discuss the importance of subjective calibration
d) describe the procedure used for carrying out subjective calibration
4. Objective calibration a) define objective calibration.
b) Know when to perform and who should perform objective calibration
c) Know the importance of carrying out objective calibration
d) list the important tools used for objective calibration
e) describe the procedure used for objective calibration of headphones, bone vibrators, inserts and
speakers
f) describe the procedure for carrying out calibration of speech stimuli
g) describe the procedure for carrying out linearity check, frequency calibration, distortion
calibration and frequency response of the transducer
Part B - Calibration
Introduction to Calibration
 Objectives
The student should be able to

a) define calibration

b) describe the rationale for calibration of

audiometer

c) mention the different types of calibration

d) classify the types of calibration based on

how frequently the equipment needs to be
calibrated.
Introduction to
calibration
 Definition of Calibration
In general,
• Calibration is the process of making sure that an instrument is really doing what it is
supposed to be doing.
• It is a systematic procedure of setting and maintaining or correcting a precision measuring
equipment according to the reference standards and specifications to which it is
manufactured
W.r.t Audiometer,
• W.r.t audiometer, it is the process of making sure the audiometer is in compliance with the
applicable standards.
• It is a process by which we rectify the errors in the audiometric output based on national
and international standards
• The electroacoustic or psychoacoustic determination that an audiometer is performing
properly in terms of its acoustic output, attenuator linearity, frequency accuracy, harmonic
distortion, and so on.
 Rationale for calibration of audiometer

➢ The accuracy in measurement is an important component of hearing assessment.

➢ We need to know what sound is actually being presented to the patient.

➢ For example, when the frequency dial says “1000 Hz” and the attenuator says “40 dB HL,” the
audiometer should actually be producing a 1000 Hz tone at 40 dB HL.

➢ For this reason, there are national and international standards that specify the physical
characteristics of the sounds that are produced by an audiometer like American National
Standard Specifications for Audiometers (ANSI S3.6 2010).
 Rationale for calibration of audiometer
➢ These standards also specify the tolerances (deviations) for these characteristics, which means
how far the actual sounds are allowed to deviate from the standard values.

➢ Thus, we must calibrate,

• as we are bound to meet such standards and regulations
• to make sure our results are within specified tolerances
 Rationale for calibration of audiometer
➢ Initial audiometric calibration provided by the manufacturer may be insufficient to guarantee
that the audiometer will function correctly over time.

➢ Even new audiometers can show variations in sound level, frequency or have distortion due
to problems in the transducers (earphones, bone vibrators, loudspeakers) or in any of the
electronic components in the audiometer resulting in audiometer failing to remain in
calibration.

➢ It is the responsibility of the user (i.e., the audiologist) to either check its calibration
personally or to arrange for regular calibration of the equipment by an outside service.

➢ The audiologist who has demonstrated that the clinic equipment is “in calibration” can then
feel confident in reporting the obtained results.
 Rationale for calibration of audiometer
Pure-tone audiometric results have significant influence on the medical, legal,
educational, occupational, social, and psychological outcomes, it is critical that
procedures be standardized and consistent among test providers which warrants
calibration.

Overall, calibration is important as it helps,

➢ to obtain accurate test results
➢ to ensure if an audiometer meets appropriate standards/ regulations
➢ to ensure the results fall within their specified deviations
➢ to keep in track if the instrument has changed over time
➢ to feel confident in reporting the obtained results
➢ to ensure uniformity in test findings across settings nationally and globally
 Types of calibration
I. Two main types of calibration
1.Subjective/ Real ear/ Biological calibration
2.Objective/ Electro-acoustic calibration

II Based on how frequently the audiometer is calibrated,

1.Daily listening check
2.Monthly calibration
3.Quarterly/ half yearly calibration
4.Annual/ Yearly calibration
 Types of calibration
III Based on the transducer being calibrated
1. AC calibration with headphones
2. BC calibration
3. AC calibration with insert earphones
4. Sound field calibration with loudspeakers
Types of calibration

Another way of classifying types of calibration

Daily listening Check
 Objectives
Daily listening The student should be able to…

a) define daily listening check

Check
b) Know when to perform and who should
perform daily listening check

c) know the importance of daily listening check

d) describe the steps carried out during daily

listening checks
 Daily listening Check
What is daily listening check ?

➢ Regular informal assessment of the output of an audiometer to ensure its

proper functioning

➢ Routine checks of the various parameters of an audiometer employing simple

tests or procedures without the help of any measuring instruments.
 Daily listening Check
When to perform ?
➢ Before using a new equipment - After the audiometer has been installed, plugged in, turned
on, and allowed to warm up, the operator should listen to the signal at different dial settings
through each transducer

➢ Perform everyday or at least every week on all audiometers in service, before

commencing the clinical examination.

➢ When transducer falls down

➢ Anytime during the day when there is reason to suspect that the audiometer is not performing
properly. Ex: when inconsistent responses noted between patients, and or not
correlating with results
 Daily listening Check
Who performs ?
The person (clinician/ audiologist) with primary responsibility for the audiometric testing
should perform listening checks.

Precautions/ pre-requisites for daily listening check

Care should be taken that,
➢ the operator with normal hearing, at least in one ear, should perform the checks.
➢ checks should be performed in sound treated room or in satisfactory ambient noise
conditions.
 Importance of Daily listening Check
Daily listening check helps,
➢ to ensure that the audiometer is performing in a proper manner overall thus ensuring
accurate diagnosis.
➢ to detect problems if any prior to obtaining clinical data. It is far better to find out that
the left earphone is intermittently dead during a five-minute listening check in the
morning than to figure out you have a problem in the middle of a clinical evaluation
➢ to ensure that the audiometer's attachments, leads and accessories are free from
any defect that may adversely affect safety. This is to make sure that there is no static,
extraneous noises, broken wires, or other apparent problems.
➢ to ensure that the audiometer calibration has not noticeably altered
➢ to monitor the status of the equipment
Steps carried out during daily listening check
1. Check the cords:
• Check the power, attenuator, earphone, and vibrator cords for signs of cracking.
• Listen to the tone through the transducer at a comfortable level while twisting and jiggling the cords.
• A defective cord will usually produce tone to be intermittent.
2. Check for loose dials:
• Check for loose dials on the audiometer or for dials that are out of alignment..
• Inspect the front panel, if there are such faults present, the dial readings will not be meaningful.
• Defective dials should be repaired immediately and the audiometer should be recalibrated to
determine the outputs at new dial settings.
3. Check for noises:
• Check for static or other noises on the earphone by flexing the earphone cords while a continuous
tone is on at 1000 Hz at 40 dBHL.
• Do this first for one earphone and then the other.
• Then do this for the bone vibrator cord as well.
Steps carried out during daily listening check
4. Check for hum:
• Check for hum or other noises in the earphones by listening to the tone through one of the earphones
at 1000 Hz at 90 dB. Also listen to the tone to check for distortion in tonal quality.
• Interrupt the signal and listen again for hum when the signal is absent
• Click on other noises. Do the same thing at 50 and 0 dB HL.
• Repeat for the other earphone and then the bone vibrator using 70 dBHL as the highest intensity for
the check.

5. Check for the ear cushions:

• The earphone cushions should be checked.
• They should not be hard and they should be free of cracks.

6. Check for the tension of the transducer:

• Check that the tension in the bone vibrator and earphone headband is adequate.
Steps carried out during daily listening check
7. Check for linearity:
• Also check for gross linearity at 1000 Hz, for example, by setting the attenuator at 10 dBHL and
then increasing in 10 dB steps upto 90 dBHL.
• The listener should determine whether the increases in loudness are roughly equivalent from
one 10 dB increment to the next. This should be done for both earphones and bone vibrator.
8. Check for noise in the attenuator:
• Noise in the attenuator should be checked at 1000 Hz, for example, by setting the attenuator, at
the lowest level and then increasing slowly from minimum to maximum with the tone
continuously on.
• The listener should check for noise or interruptions in the signal or decreases in loudness.
9. Check for cross-talk:
• “Cross-talk” may occur between earphones, that is, the signal that is sent to one earphone may be
heard in the contralateral earphone.
• Check for cross-talk by disconnecting the earphone plug for the right earphone applying a signal at
1000 Hz at 60 dBHL to the right earphone and listening through the left earphone.
Steps carried out during daily listening check

• The procedure should be repeated for the other

earphone by disconnecting the plug for the left
earphone.

10. Check for output through the transducer

• Place the earphone over your ears and listen to
the just audible tones by sweeping through at
10-15dBHL.
• This should be done at all appropriate
frequencies and for both earphones and bone
vibrator.

Form/ checklist for daily listening check

Subjective Calibration
 Objectives
Subjective The student should be able to…

a) define subjective calibration

Calibration
b) Know when to perform and who should
perform subjective calibration

c) discuss the importance of subjective

calibration

d) describe the procedure used for carrying out

subjective calibration
 Subjective calibration
Other terms:
Biological calibration / Real ear calibration

What is subjective calibration?

➢ Calibration process where there is active involvement of the human subjects

➢ A procedure to check and ensure if there is agreement between the intensity dial
reading and the actual output of the earphone or bone vibrator using human
subjects

➢ It is called as real ear calibration as the auditory system of an individual is used

to calibrate the audiometer
 Subjective calibration
When to perform ?

➢ Threshold check as a part of listening check may be performed everyday or at least every
week on all audiometers in service, before commencing the clinical examination.

➢ Detailed procedure of subjective calibration is done once in a month also (Monthly calibration)
when we don’t have facility for objective calibration (calibration measuring tools)

➢ When transducer falls down

➢ Anytime during the day when there is reason to suspect that the audiometer is not performing
properly. Ex: when inconsistent responses noted between patients, and or not correlating with
results
 Subjective calibration
Who performs ?
The person (clinician/ audiologist) with primary responsibility for the audiometric testing
should perform listening checks.

Precautions/ pre-requisites for subjective calibration

Care should be taken that,
➢ the operator with normal hearing, at least in one ear, should perform the checks.
➢ checks should be performed in sound treated room or in satisfactory ambient noise
conditions.
 Importance of Subjective calibration
Subjective calibration helps,

➢ to ensure that the audiometer is performing in a proper manner in terms of its

output through the transducer thus ensuring accurate diagnosis.

➢ to detect calibration errors if any prior to obtaining clinical data.

➢ to ensure that the audiometer calibration has not noticeably altered

➢ to monitor the status of the equipment

Procedure used for subjective calibration

• Procedures for AC
A subjective calibration

• Procedures for AC
B subjective calibration
 Procedure used for subjective calibration

A. Procedures for AC subjective calibration

There are 4 different methods for ai r conduction subjective calibration:

1. Method I
2. Method II
3. Method III – Loudness balance method
4. Method IV – objective biological calibration
 Procedure used for subjective calibration

Method 1
• The clinician should have their thresholds obtained from a calibrated audiometer --- This
record serves as reference thresholds (R)
• Then check the thresholds of the clinician with the audiometer to be calibrated (0)
• The threshold obtained at a particular frequency may be better or poorer than the reference
threshold level --- Thus, giving any gross deviations in audiometer output for different
frequencies.

Correction Rule:
• If the threshold obtained from calibrated audiometer is R
• If the threshold obtained from an uncalibrated audiometer is O.
• Then, the correction factor (C.F. ) is given by the formula:
C.F. = R - O
 Procedure used for subjective calibration

Method 1

C.F = R – O

For example,
a) if a person's reference threshold is O dB and the value obtained on the audiometer is 10 dB,
C.F.= 0 - 10
C.F = -10 dB

b) if a person's reference threshold is 5 dB and the value obtained on the audiometer is 0 dB,
C.F.= 5 - 0
C.F = +5 dB
Note:
If CF is negative --- output is less
If CF id positive --- output is more
 Procedure used for subjective calibration

Method 1

Limitations:

1. Variations in the placement of earphones will have effect on the thresholds to vary within
10 dB particularly at low frequencies.

2. Since threshold is not a fixed point it may vary within the range of 10 dB from day to day
(Carhart and Jerger 1959)

3. Everywhere we may not have two audiometers (where one is calibrated)

 Procedure used for subjective calibration

Method II
• Select about 10 normal hearing adults without any history of familiar hearing loss, otological
problems or noise exposure.
• Test one ear of each subject at all frequencies with the audiometer to be calibrated
• Then find out the average threshold at each frequency
• Whatever average value is got is the correction factor (w.k.t, CF = R-O)
Ex: 250 Hz 500 Hz 1000 Hz 2000 Hz 4000 Hz 8000 Hz
Average 0 -10 +5 +10 -5 +10
threshold
C.F 0 +10 -5 -10 +5 -10
Note:
• Here, the assumption is that the Reference threshold (R) is 0
• If for the patient, threshold obtained is 35 dB at 1000 Hz,
His actual threshold will be --- 25 dB
 Procedure used for subjective calibration

Method II

Limitations:
1. Number of subjects required is more ---- It is time consuming and laborious.
2. If we get -10 dB as average, we really don’t know whether it is -10dB or still lower than that
 Procedure used for subjective calibration

Method III – Loudness balance method

• In this method, the output from a calibrated audiometer is matched against the
output of an audiometer to be calibrated.
• The method is more practical with no serious limitations. The steps are as follows:

Requirements:
• A calibrated audiometer known to be accurate
• At least three young subjects with normal hearing with negligible difference in hearing
sensitivity between ears.
 Procedure used for subjective calibration

Method III – Loudness balance method

Procedure:
• Detach one earphone of the known audiometer (Calibrated audiometer) and fix it to
the headband of the unknown audiometer (audiometer to be calibrated), after
removing one of its earphones.
• Instruct the subject to match the loudness of the tones.
• Place this headset on the ears of the subject.
• Set the frequency selector of each audiometer to 1 kHz and intensity dial of known
audiometer to 40 dBHL and present the tones alternatively from both the
audiometers.
• When the signal is 'off in the 'known earphone', then signal should be presented in
the 'unknown' earphone.
 Procedure used for subjective calibration

Method III – Loudness balance method

• While this presentation of signals continues; without looking at the intensity dial,
adjust the hearing level of the unknown audiometer until the subject tells you that
loudness of the tones are equal, or approximately equal.

• Stop presentations and then note down the intensity dial reading of the unknown
audiometer.

• Similarly, get loudness balance at the other hearing levels.

• Repeat the procedure at other frequencies. Also perform for other subjects.
 Procedure used for subjective calibration

Method III – Loudness balance method

Note:
• Avoid simultaneous presentation of the signals from both audiometers
• The sensitivity of this procedure can be increased by training the subjects to listen
carefully and match the tones.

Example:
• Suppose the dial is set 40 dBHL (AHL) at 1 kHz and the subject matches the tone of
the unknown audiometer when the intensity dial reads at 45 dB (BHL),
then, the CF = AHL - BHL
i.e., 40 dB - 45 dB = - 5 dB.
 Procedure used for subjective calibration

Method III – Loudness balance method

Correction Rule
• The correction values are positive, if the hearing level of the tone matched is lesser
than the hearing level of the known audiometer.
• The correction is negative if the hearing level of the tone matched is greater than the
hearing level of the unknown audiometer.

CF = AHL - BHL
Limitations:
• It does not permit to find out the attenuator linearity of the intensity dial of the
audiometer.
• It requires two audiometers, one of which is calibrated.
• It requires the task of loudness balance which is not easy – very subjective.
• Very time consuming
 Procedure used for subjective calibration

Method IV – Objective biological calibration

• Given by Vyasmurthy, M.N.,1977
• This method can be done even in the absence of the calibration instruments in a
centre.
• This procedure is both objective and biological in its approach.
• It makes use of an electronic instrument to elicit the response with out the co-
operation of the subject; hence it is called objective method and employs human
subjects for calibration, hence called biological calibration.

Requirements:
• An impedance bridge
• A few subjects with normal hearing
• Audiometer to be calibrated
 Procedure used for subjective calibration

Method IV – Objective biological calibration

Procedure:
• Determine the subject's acoustic reflex thresholds (ART1), at different frequencies using
impedance bridge. Note down the ART1
• Detach the ear phone of the impedance bridge and replace it by a ear phone of the
audiometer, to be calibrated.
• Now, determine the acoustic reflex thresholds (ART2 ) for the same ear, same subject for
different frequencies.
• Find out the correction factor by subtracting ART2 from ART1 for each frequency.
• Determine the reflex threshold (ART3 ) for the same ear, same subject, placing the other ear
phone of the audiometer to the head set of the impedance bridge.
• Then find out the correction factor by subtracting ART3 from ART1 for each frequency.
 Procedure used for subjective calibration

Method IV – Objective biological calibration

Correction Rule:
• Similar to the procedure used in method I that is R-O.
500 Hz 1000 Hz 2000 Hz 4000 Hz
Reference ART1 90 90 95 100
Rt Headphone ART2 90 90 105 100
Lt Headphone ART3 100 95 95 100

CF for Rt headphone R – O (ART1 - ART2)

CF for Lt headphone R – O (ART1 - ART3)

Example:
CF for Rt headphone at 1000 Hz is 90-90 = 0
CF for Lt headphone at 1000 Hz is 90-95 = -5
 Procedure used for subjective calibration

Method IV – Objective biological calibration

Limitations:
• Does not permit to find out the attenuator linearity of the intensity dial of the audiometer.
• Calibration of output levels at 4kHz and 8 kHz may not be possible as reflex is usually absent
at these frequencies.
• Calibration of output levels at 250 Hz may not be possible as reflex are not genrally elicited at
this frequency
 Procedure used for subjective calibration

B. Procedures for BC subjective calibration

Some of the subjective calibration methods discussed for AC calibration can also be
employed for BC subjective calibration

➢ Method I – can be employed

➢ Method II – can be employed
➢ Method III – cannot be employed (because IA is 0 ---- Loudness matching become questionable)
➢ Method IV – cannot be employed (as bone vibrator cannot be used with impedance bridge)
 Procedure used for subjective calibration

B. Procedures for BC subjective calibration

In the absence of artificial mastoid for BC calibration, audiologist can keep check on the
calibration by employing the below 2 methods for BC subjective calibration:

1. American Medical Association method (AMA method) 1951

2. Roach and Carhart’s method (1971)
 Procedure used for subjective calibration

Subjective calibration for bone conduction

1. AMA method (1951)

This method compares BC output with AC thresholds

Requirement:
➢ At least 6 normal hearing subjects
➢ Audiometer to be calibrated should have accurate AC thresholds
 Procedure used for subjective calibration

Subjective calibration for bone conduction

Steps involved:
➢ Find AC thresholds at all frequencies from all the subjects and find the average threshold at
each frequency
➢ Find BC thresholds at all frequencies from all the subjects and find the average threshold at
each frequency
➢ The difference between the average AC threshold and average BC threshold will be the
correction factor

Assumption:
➢ AC and BC threshold are same for that group of individuals
➢ AC is calibrated
 Procedure used for subjective calibration

Subjective calibration for bone conduction

Correction rule:
C.F = AC ThAvg - BC ThAvg

Limitations:
• Most commonly BC is better atleast by 10 dB in normal individuals
• Dependent on the accuracy of the AC thresholds of the subject
 Procedure used for subjective calibration

Subjective calibration for bone conduction

2. Roach and Carhart’s method:

This method also compares BC output with AC thresholds

Requirement:
➢ 10 subjects with typical bilateral moderate sensorineural loss (Hearing loss need not be
equal in all ears).

➢ Audiometer to be calibrated should have accurate AC thresholds

 Procedure used for subjective calibration

Subjective calibration for bone conduction

Steps involved:
➢ Determine the air conduction thresholds of both ears of each subject at 250, 500, 1000, 2000,
& 4000 Hz using well calibrated air conduction system.
➢ Then determine the bone conduction thresholds for some ear using the bone vibrator to be
calibrated.
➢ Find out the average AC thresholds and average BC thresholds at each frequency.

Assumption:
➢ A typical sensorineural hearing loss subject, the AC and BC thresholds are equal. The
difference is considered as error in the bone vibrator output.
➢ AC output is calibrated and accurate
 Procedure used for subjective calibration

Subjective calibration for bone conduction

Correction rule:
C.F = AC ThAvg - BC ThAvg

Limitations:
• A slight conductive component might add to the air - bone differences in thresholds.
Hence to that extent, accuracy of this method is limited.
• Dependent on the accuracy of the AC thresholds of the subject
 Procedure used for subjective calibration

To summarize so far…
➢ Introduction to calibration – Definition, rationale and types
➢ Daily Listening Check – what? / when? / who ? / why ? / How ?
➢ Subjective calibration - what? / when? / who ? / why ? / How ?

AC calibartion – 4 methods
BC calibration – 2 methods
Objective Calibration
 Objectives
Objective
The student should be able to…

a) define objective calibration.

Calibration
b) Know when to perform and who should perform
objective calibration
c) Know the importance of carrying out objective
calibration
d) list the important tools used for objective calibration
e) describe the procedure used for objective calibration
of headphones, bone vibrators, inserts and speakers
f) describe the procedure for carrying out calibration of
speech stimuli
g) describe the procedure for carrying out linearity
check, frequency calibration, distortion calibration and
frequency response of the transducer
 Objective calibration
Other terms:
Electro-acoustic calibration / Internal calibration

What is objective calibration?

➢ A procedure to check and ensure if there is agreement between the intensity dial
reading and the actual output of the earphone or bone vibrator using various
measuring tools

➢ The electroacoustic or psychoacoustic determination that an audiometer is

performing properly in terms of its acoustic output, attenuator linearity, frequency
accuracy, harmonic distortion, and so on.

➢ It is called as electro-acoustic calibration as various electro-acoustic and

electronic instrumentation are used during the process of calibration
 Objective calibration
When to perform ?
➢ Should be performed compulsorily once in a year

➢ Can be performed (depending on the need),

• Once in 3 months (quarterly)
• Once in 6 months (half-yearly)
• Once in a year (annually)

➢ Whenever there is a difference greater than 20dB among three successive subjective
calibrations

➢ Anytime when there is sudden breakdown in the audiometer/ fall of the transducer / new
transducer is placed
 Objective calibration

Who performs ?

➢ Sound engineers, biomedical engineers and audiometric technicians perform

this type of calibration since it requires specialized tools.

➢ Trained audiologist may also perform the procedure

 Importance of Objective calibration
“Audiometer calibration is the key to accurate diagnosis”
Objective calibration helps,
➢ to ensure that the audiometer is performing in a proper manner thus ensuring accurate
diagnosis.

➢ for a conditioned maintenance of the equipment for a longer duration

➢ to ensure uniformity in testing by maintaining the test instruments to their set standards

➢ once calibrated, you will be issued with a calibration certificate proving that the device is
suitable for use. This will include the date of calibration which determines the period of
validity – a mandate by regulatory bodies like RCI, NABH, NABL
 Objective calibration
Quarterly/ Half yearly calibration includes:
➢ Checking output SPL through different transducers for different inputs (PT/noise/Speech)
• Headphones
• Bone vibrator
• Insert receivers
• Speakers
Annual / yearly calibation includes:
➢ Output SPL through different transducers for different inputs (PT/noise/Speech) – as above
➢ Linearity check
➢ Frequency calibration
➢ Frequency response of the transducer
➢ Distortion calibration
 Objective calibration
Pre-requisites/ tools for objective calibration:
➢ Audiometer to be calibrated with respective transducers
➢ Sound level meter with Microphone
➢ Couplers (artificial ear/ artificial mastoid/ HA1 or HA2 coupler)
➢ Adaptor (optional)
➢ Octave filter set
➢ Piston phone/Quest/ Sound level calibrator
 Objective calibration

Pre-requisites/ tools
➢ Sound level meter with microphone
• A sound level meter is a measuring instrument used to
assess noise or sound levels by measuring sound
pressure.

• It is commonly a hand-held instrument with a

microphone.

• The best type of microphone for sound level meters is

the condenser microphone
 Objective calibration

Pre-requisites/ tools
➢ Sound level meter with microphone:

Analog
Digital
 Objective calibration

Pre-requisites/ tools
➢ Couplers
• Coupler is a tool that connects two things, especially mechanical
components or systems
• Couplers used during calibration of audiometer include:
1. Artificial ear
2. Artificial mastoid
3. HA1 or HA2 coupler
 Objective calibration

Pre-requisites/ tools - Coupler

1. Artificial ear
• It is a coupler used to calibrate air conduction ear phones

• Most commonly used is NBS 9A coupler which is also called as physical ear

• A standard convenient way of indicating the sound generated by an ear phone

is to measure, using a precision microphone, sound pressure produced in a
precisely machined cavity of specified dimensions.

• This is accomplished by "coupling" the ear phone to the measuring

microphone by an enclosed volume of air --- NBS 9A coupler
 Objective calibration

Pre-requisites/ tools - Coupler

1. Artificial ear
• In ear phone calibration for audiometry a 6cc coupler is used because it
approximates the volume of air enclosed between the earphone diaphragm and
the tympanic membrane of the ear when the ear phone is placed on the ear.

• The artificial ear is made of heavy steel body with the cavity at the center

• The cavity volume can be changed from 6cc to 4cc or 2cc by placing a steel cylinder.

• The whole steel body is mounted on a wooden base isolated from the table with a
mechanical suspension
 Objective calibration

Pre-requisites/ tools - Coupler

1. Artificial ear
 Objective calibration

Pre-requisites/ tools - Coupler

1. Artificial ear (NBS 9A coupler)
• The lower part has a provision to fix a 1" condenser microphone and
preamplifier.

• Head band tension is provided by a ebonite cup and spring loaded tension
with the scale from 0 to 1000 gms.

• Impedance characteristic simulates the impedance of human ear over a small

frequency range

• The size shape and the hard walls permit the possibilities of standing waves at
and above 6000 Hz
 Objective calibration

Pre-requisites/ tools - Coupler

2. Artificial mastoid
• It is a mechanical coupler used to calibrate bone conduction vibrators

• The output should be measured in a device resembling the average human head
with respect to its mechanical impedance characteristics.

• It mainly consist of a cylindrical mass of 6.5 kg by weight which corresponds to the

weight of the human head.

• The central part of the steel mass is provided with a layer of silicon butyl rubber

• A crystal bymorph is fixed to convert the vibration received from the bone vibrator in
to electrical signal.
 Objective calibration

Pre-requisites/ tools - Coupler

2. Artificial mastoid
 Objective calibration

Pre-requisites/ tools - Coupler

2. Artificial mastoid
• To provide the headband tension, arrangement is made with a spring load on
arm

• The tension on the arm can be adjusted using a spring balance

• The complete system is mounted on a steel base separated from the base
with a suitable suspension.
 Objective calibration

Pre-requisites/ tools - Coupler

3. HA1 or HA2 2cc coupler
• HA1 or the HA2 are the single piece steel couplers
• These couplers are usually used to calibrate output
through insert receivers
 Objective calibration

Pre-requisites/ tools - Coupler

➢ Adaptor (optional)

• The output terminal of the artificial ear/ artificial mastoid can be half inch or
one inch
• Input terminal of the SLM can be half inch or one inch
• Microphone of the SLM can be half inch or one inch

• So, depending on the size of the input and output terminals, the adaptor
requirement is considered

If all have one inch terminal ---- adaptor not required

If size variation ---- adapter is required
 Objective calibration

Pre-requisites/ tools - Coupler

➢ Octave filter set
• An additional accessory connected with the SLM that enables measuring
frequency specific output

➢ Piston phone/Quest/ Sound level calibrator

• All these 3 accessories will generate pure tone and are used to calibrate
the SLM
✓Piston phone generates 250 Hz, 124 dB tone
✓Quest generates 1000 Hz, 110 dB SPL tone
✓Sound level calibrator generates 1000 Hz, 90 dB SPL tone
 Objective calibration
1. Intensity calibration through headphone using Pure tone
2. Intensity calibration through Bone vibrator using Pure tone
3. Intensity calibration through insert receiver using Pure tone
4. Intensity calibration through loudspeakers using Pure tone (Sound field
calibration)
5. Calibration of speech stimuli
6. Linearity check
7. Frequency calibration
8. Frequency response of the headphone
9. Distortion calibration
 Objective calibration

1. Intensity calibration through headphone using Pure tone

Other descriptions:
➢ AC calibration for headphones for intensity
➢ Calibration of output SPL though headphones using pure tones
• Requirement
• Block diagram
Requirement: • Procedure

1. Audiometer to be calibrated with headphone

2. Artificial ear
3. Sound level meter with Microphone
4. Octave filter set
5. Piston phone/Quest/ Sound level calibrator
 Objective calibration

1. Intensity calibration through headphone using Pure tone

Block diagram:

Artificial ear with

Audiometer Earphone SLM + OFS
Microphone

Steps:
1. Calibration of SLM
2. Connections
3. Actual procedure/ Measurement of output
4. Adjustment of the output (Correction factor)
 Objective calibration

1. Intensity calibration through headphone using Pure tone

Steps:
1. Calibration of SLM
• Piston phone/ Quest/ sound level calibrator can be used to
check the output accuracy of the SLM

• The sound level meter’s microphone is inserted into the

depression at the end of the calibrator, which is then set to
produce one or more precisely known test signals.

Ex: if piston phone used, the SLM should read 124 dB

if sound level calibrator is used, SLM should read 90 dB
 Objective calibration

1. Intensity calibration through headphone using Pure tone

Steps:
2. Connections / Set-up
• Unscrew the coupler from the artificial ear
• Unscrew the protection grid from the microphone. Without touching the diaphragm fit
the microphone into the socket inside the artificial ear.
• Replace the coupler on the artificial ear
• Remove the earphone to be calibrated from its headband clamp. Place it on the
coupler so that the earphone perforations face the coupler cavity
• Unscrew the adjustable clamp on the artificial ear slightly and adjust the weight on
the earphone to 0.5 Kg or as per specification provided by the manufacturer.
• Connect the artificial ear and the octave filter set to the SLM
 Objective calibration

1. Intensity calibration through headphone using Pure tone

Steps:
2. Connections / Set-up

https://www.youtube.com/watch?v=eeTygVlkrrc
 Objective calibration

1. Intensity calibration through headphone using Pure tone

Steps:
3. Measurement of output/ Actual procedure
• Switch on the Audiometer

• Set the attenuator to 60 dB / 70 dB (depending upon the manufacturers

specifications) frequency dial to 250 Hz/ 1000 Hz as required.

• Set the output selector to right / left depending on the earphone placed on the
artificial ear

• The octave filter set is connected to the SLM. Set it to the required frequency i.e.,
the same frequency as that selected on the Audiometer.

• Switch on the SLM and set it to "slow response" and to "external filter"
 Objective calibration

1. Intensity calibration through headphone using Pure tone

Steps:
3. Measurement of output/ Actual procedure
• Adjust the tone switch on the audiometer so that the signal is continuously on

• Read the meter on the audiometer calibrator (or sound level meter) to measure the
actual sound pressure level that is produced by the earphone.

• Compare the actual sound pressure level to what it is supposed to be. Record any
difference.

• Repeat the procedure for each of the test frequencies. Remember to vary the
frequency setting on the octave filter set

• Repeat the entire procedure with the other earphone.

 Objective calibration

1. Intensity calibration through headphone using Pure tone

Steps:
4. Adjustment of the output (Correction factor)
• There is generally autocal switch (calibration switch) available on the audiometer

• If measured output is not as per expected level then turning the attenuator dial either
clockwise or anticlockwise adjust the output and press the mentioned switch to store
the changes in the memory.

• The difference should not exceed ± 3 dB at frequencies from 250 Hz to 4000 Hz , ±

5 dB at 6000 and 8000 Hz (IS9098 - 1979).

• For objective calibration,

C.F = Measured – Reference value
 Objective calibration

1. Intensity calibration through headphone using Pure tone

Steps:
4. Adjustment of the output (Correction factor)
The expected value reading on the SLM is based on the RETSPL values at that
particular frequency
 Objective calibration

1. Intensity calibration through headphone using Pure tone

Steps:
4. Adjustment of the output (Correction factor)

Thus, C.F = Measured (actual SPL measured) – Reference value (expected SPL)
 Objective calibration

Intensity calibration through headphone

Note:
Intensity calibration through headphones for other stimuli
1. Narrow band noise – No change (as it is)
2. Speech noise/ White noise/ wide band noise – OFS not required (as they are not
frequency specific signal)
3. Speech stimuli – will be discusses separately
 Objective calibration

2. Intensity calibration through Bone vibrator using Pure tone

Other descriptions:
➢ BC calibration for intensity
➢ Calibration of output SPL though bone vibrator using pure tones
• Requirement
• Block diagram
Requirement: • Procedure
1. Audiometer to be calibrated with bone vibrator
2. Artificial mastoid/ Mechanical coupler
3. Sound level meter
4. Octave filter set
5. Piston phone/Quest/ Sound level calibrator
6. Other accessories: Spring balance and level indicator
 Objective calibration

2. Intensity calibration through bone vibrator using Pure tone

Block diagram:

Audiometer Bone vibrator Artificial Mastoid SLM + OFS

Steps:
1. Calibration of SLM
2. Connections
3. Actual procedure/ Measurement of output
4. Adjustment of the output (Correction factor)
 Objective calibration

2. Intensity calibration through bone vibrator using Pure tone

Steps:
1. Calibration of SLM
• Piston phone/ Quest/ sound level calibrator can be used to
check the output accuracy of the SLM

• The sound level meter’s microphone is inserted into the

depression at the end of the calibrator, which is then set to
produce one or more precisely known test signals.

Ex: if piston phone used, the SLM should read 124 dB

if sound level calibrator is used, SLM should read 90 dB
 Objective calibration

2. Intensity calibration through bone vibrator using Pure tone

Steps:
2. Connections / Set-up
• Ensure that the artificial mastoid is placed on a horizontal plane
• Detach the BC vibrator from the headband and place it on the artificial mastoid
• Note the level, with the help of the level indicator and remove the BC Vibrator
• With the help of the spring balance, check the weight (500 gms) on the clamp / arm of
the artificial mastoid and readjust the level of the clamp with reference to the level
indicator
• Remove the spring balance and level indicator
• Connect the adaptor to SLM
• Plug in the output jack of the artificial mastoid to the adaptor and thus the artificial
mastoid is connected to the SLM
• Connect the OFS to the SLM
 Objective calibration

2. Intensity calibration through bone vibrator using Pure tone

Steps:
2. Connections / Set-up
 Objective calibration

2. Intensity calibration through bone vibrator using Pure tone

Steps:
3. Measurement of output/ Actual procedure

• Switch on the audiometer

• Set the intensity dial at 20 / 40 dB (depending upon the instructions in the manual)
and the frequency dial 250 Hz
• Set the output selector to bone
• Set the tone switch on the audiometer so that the signal is continuously on.
• Set the OFS to the required frequency
• Switch on the SLM and set it to slow response and to external filter
 Objective calibration

2. Intensity calibration through bone vibrator using Pure tone

Steps:
3. Measurement of output/ Actual procedure

• Read the meter on the audiometer calibrator (or sound level meter) to measure the
actual sound pressure level that is produced by the earphone.

• Compare the actual sound pressure level to what it is supposed to be. Record any
difference.

• Repeat the procedure for each of the test frequencies. Remember to vary the
frequency setting on the octave filter set
 Objective calibration

2. Intensity calibration through bone vibrator using Pure tone

Steps:
4. Adjustment of the output (Correction factor)
• There is generally autocal switch (calibration switch) available on the audiometer

• If measured output is not as per expected level then turning the attenuator dial either
clockwise or anticlockwise adjust the output and press the mentioned switch to store
the changes in the memory.

• For objective calibration,

C.F = Measured – Reference value
 Objective calibration

2. Intensity calibration through bone vibrator using Pure tone

Steps:
4. Adjustment of the output (Correction factor)
The expected value reading on the SLM is based on the RETFL values at that
particular frequency
 Objective calibration

3. Intensity calibration through insert receivers using Pure tone

Other descriptions:
➢ AC calibration for intensity using insert earphones
➢ Calibration of output SPL though insert earohones using pure tones
• Requirement
• Block diagram
Requirement: • Procedure
1. Audiometer to be calibrated with insert earphone
2. HA2 coupler/ occluded ear simulators
3. Sound level meter with microphone
4. Octave filter set
5. Piston phone/Quest/ Sound level calibrator
 Objective calibration

3. Intensity calibration through insert receiver using Pure tone

Block diagram:

2 cc coupler with SLM + OFS

Audiometer Insert earphone
microphone

Steps:
1. Calibration of SLM
2. Connections
3. Actual procedure/ Measurement of output
4. Adjustment of the output (Correction factor)
 Objective calibration

3. Intensity calibration through insert receiver using Pure tone

Steps:
1. Calibration of SLM
• Piston phone/ Quest/ sound level calibrator can be used to
check the output accuracy of the SLM

• The sound level meter’s microphone is inserted into the

depression at the end of the calibrator, which is then set to
produce one or more precisely known test signals.

Ex: if piston phone used, the SLM should read 124 dB

if sound level calibrator is used, SLM should read 90 dB
 Objective calibration

3. Intensity calibration through insert receiver using Pure tone

Steps:
2. Connections / Set-up
• Insert earphones are connected to the 2 cc coupler with the help of a plastic
connector

• The other end of the coupler is connected to the microphone and the preamplifier

• The output terminal of the coupler is connected to the SLM

• SLM is connected to the OFS

 Objective calibration

3. Intensity calibration through insert receiver using Pure tone

Steps:
2. Connections / Set-up
 Objective calibration

3. Intensity calibration through insert receiver using Pure tone

Steps:
3. Measurement of output/ Actual procedure

• Switch on the audiometer

• Set the intensity dial at 60 / 70 dB (depending upon the instructions in the manual)
and the frequency dial 250 Hz / 1000 Hz
• Set the output selector to Insert (R/L)
• Set the tone switch on the audiometer so that the signal is continuously on.
• Set the OFS to the required frequency
• Switch on the SLM and set it to slow response and to external filter
 Objective calibration

3. Intensity calibration through insert receiver using Pure tone

Steps:
3. Measurement of output/ Actual procedure

• Read the meter on the audiometer calibrator (or sound level meter) to measure the
actual sound pressure level that is produced by the insert earphone.

• Compare the actual sound pressure level to what it is supposed to be. Record any
difference.

• Repeat the procedure for each of the test frequencies. Remember to vary the
frequency setting on the octave filter set

• Repeat the entire procedure for the other insert earphone

 Objective calibration

3. Intensity calibration through insert receiver using Pure tone

Steps:
4. Adjustment of the output (Correction factor)
• There is generally autocal switch (calibration switch) available on the audiometer

• If measured output is not as per expected level then turning the attenuator dial either
clockwise or anticlockwise adjust the output and press the mentioned switch to store
the changes in the memory.

• For objective calibration,

C.F = Measured – Reference value
 Objective calibration

3. Intensity calibration through insert receiver using Pure tone

Steps:
4. Adjustment of the output (Correction factor)
The expected value reading on the SLM is based on the RESPL values at that
particular frequency
 Objective calibration
1. Intensity calibration through headphone using Pure tone
2. Intensity calibration through Bone vibrator using Pure tone
3. Intensity calibration through insert receiver using Pure tone
4. Intensity calibration through loudspeakers using Pure tone (Sound field
calibration)
5. Calibration of speech stimuli
6. Linearity check
7. Frequency calibration
8. Frequency response of the headphone
9. Distortion calibration
 Objective calibration

4. Intensity calibration through loudspeakers using Pure tone

Other descriptions:
➢ Sound field calibration
➢ Calibration of output SPL through loudspeakers for pure tones
• Requirement
• Block diagram
Requirement: • Procedure

1. Audiometer to be calibrated with loudspeakers

2. Sound level meter with microphone (free field type)
3. Octave filter set
4. Piston phone/Quest/ Sound level calibrator for calibration of SLM
 Objective calibration

4. Intensity calibration through loudspeakers using Pure tone

Block diagram:

Audiometer Speakers SLM + OFS

Steps:
1. Calibration of SLM (same as explained earlier)
2. Connections
3. Actual procedure/ Measurement of output
4. Adjustment of the output (Correction factor)
 Objective calibration

4. Intensity calibration through loudspeakers using Pure tone

Steps:
1. Calibration of SLM (same as explained earlier)
2. Connections / Set-up
➢ Audiometer on the tester room and the two speakers on the patient room
➢ The SLM with mic is placed at a specific distance, angle and height w.r.t the
loudspeakers
• Distance – 1m away
• Height – Same as that of patient’s ears
• Angle – 450
 Objective calibration

4. Intensity calibration through loudspeakers using Pure tone

Steps:
2. Connections / Set-up
 Objective calibration

4. Intensity calibration through loudspeakers using Pure tone

Steps:
3. Measurement of output/ Actual procedure (similar to as explained for headphone calibration)
4. Adjustment of the output (Correction factor)
Same as explained for headphone calibration. But the RETSLP values for sound field neeeds
to be considered while calculating the expected value
C.F = Measured – Reference value
 Objective calibration

5. Calibration of speech stimuli

➢ As we know, speech audiometry can be done with all the different transducers.
➢ Depending on the transducer used for speech testing, the requirement and the set-
up varies.
➢ Ex: Headphone – Artificial ear
Bone vibrator – Artificial ear
Insert earphone – 2cc coupler
Loudspeaker – no coupler
➢ Please note that the octave filter set is not required for calibration of speech stimuli
➢ Depending on the transducer used for presentation of speech stimuli, the set
up/connections vary
 Objective calibration

5. Calibration of speech stimuli

➢ The procedure is same as that discussed

under each type of calibration (based on
transducer used)

➢ Ensure to select speech from the input

selector switch

➢ During the measurement and adjustment of

the output, RETSPL/ RETFL values for
speech needs to be considered depending on
the transducer used
 Objective calibration

6. Linearity check
➢The requirement is same as that for the AC calibration with headphones using pure tones

Artificial ear with

Audiometer Earphone SLM + OFS
Microphone

➢The procedure is similar to that followed for AC calibration with headphones using pure
tones.

➢However, linearity needs be checked at only one frequency (1000 Hz), where the intensity
dial should be set at maximum level (120 dB)

➢Set the attenuator of the SLM at a level that corresponds to the maximum level on the
audiometer.
 Objective calibration

6. Linearity check
➢Decrease the attenuator setting on the audiometer in 5 dB step and note down
the corresponding reading on the SLM.

➢Continue this till the audiometer reads 30 or 40 dBHL . Record the level on the SLM
for each 5 dB decrease.

➢If with every decrease in the dial reading the SLM indicates a corresponding reduction,
then the intensity variation is said to be linear

➢The standard requires the linearity of an audiometer’s attenuator to be accurate within

± 1 dB per 5 dB step
 Objective calibration

7. Frequency calibration
Purpose:

To determine the deviation of the output frequency from that of the dial reading.

Requirement:

1. Audiometer to be calibrated
2. Patch cord
3. Digital Frequency Counter
(Note that no transducer is required as this is input calibration)

Block diagram:

Audiometer Patch cord Frequency counter

 Objective calibration

7. Frequency calibration
Steps:

➢ Remove one of the earphone jacks from the output socket

➢ Insert a spare ear phone jack in to the socket

➢ Connect the spare jack to the input terminals of the frequency counter with a wire

➢ Switch on the Audiometer and the Frequency counter

➢ Set the Audiometer frequency dial to 125 Hz, as the case may be

➢ Set the output intensity to maximum

 Objective calibration

7. Frequency calibration

Steps:

➢ Adjust the tone switch to continuously 'on' position

➢ Turn the function selector on the frequency counter to frequency

➢ Note down the reading on the frequency counter.

➢ Compute the deviation of the frequency generated by the audiometer from the
expected frequency

➢ Repeat the procedure for other test frequencies

 Objective calibration

7. Frequency calibration
Steps:
ANSI S3.6-2010 has given guidelines for tolerance limits for frequency accuracy based
on the type of the audiometer

For type 1 type 2 and extended HF audiometers ---- ± 1%

For type 3 type 4 audiometers ---- ± 2%
For sweep frequency audiometers ---- ± 5%

For example, if the dial is set to 1000 Hz,

• For type 1 type 2 and extended HF audiometers ---- frequency must actually be
between 990 and 1010 Hz
• For type 3 and type 4 audiometers ---- the frequency must actually be between 980
and1020 Hz.
• For sweep frequency audiometers ---- the frequency must actually be between 950
and 1050 Hz
 Objective calibration

8. Frequency response of the headphone

Headphone frequency response refers to the frequency-specific sensitivity of the output The
procedure is similar to that followed for AC calibration with headphones using pure tones.

Requirement:
1. Frequency generator/ Beat frequency oscillator (BFO) – generates pure tones
2. Headphones
3. Artificial ear
4. Frequency counter / Audio frequency analyzer
5. Graphic level recorder - An instrument that measures and provides a graphic
representation of the magnitude of an electrical signal and its time variation.
 Objective calibration

8. Frequency response of the headphone

Block diagram:

Frequency Frequency Graphic level

Headphones Artificial ear recorder
generator counter

Connections/ Set-up:
➢ The output terminal of the headphone is connected to frequency generator
➢ The headphone is placed on the artificial ear (within which there is a mic)
➢ The output terminal of the artificial ear is connected to frequency counter which in turn is
connected to the graphic level recorder
➢ The graphic level recorder shows the frequency response of the headphones
 Objective calibration

8. Frequency response of the headphone

Steps:
➢ Once the connections are ready, the frequency generator (BFO) is set to produce 50 Hz –
--- So 50Hz is the starting frequency.

➢ The speed at which the frequency needs to be changed has to be selected

➢ Select the corresponding frequency on the graphic level recorder (GLR) – This has to be
set to 50 Hz

➢ Switch on the BFO and GLR simultaneously

➢ The output will be plotted on the GLR.

 Objective calibration

8. Frequency response of the headphone

Note:
Frequency response of the bone vibrator can also be measured using artificial mastoid

Frequency Artificial Frequency Graphic level

Bone vibrator mastoid counter recorder
generator
 Objective calibration

9. Distortion calibration
Distortion calibration is similar to frequency calibration

Requirement:

1. Audiometer
2. Patch cord
3. Distortion factor meter – device which measures the output at different frequencies

Block diagram:

Audiometer Patch cord Distortion factor meter

 Objective calibration

9. Distortion calibration

Steps:

➢ Remove one of the earphone jacks from the output socket

➢ Insert a spare ear phone jack in to the socket

➢ Connect the spare jack to the input terminals of the distortion factor counter

➢ Switch on the Audiometer and the distortion factor counter

➢ Set a particular frequency and set the output intensity to maximum

 Objective calibration

9. Distortion calibration

Steps:

➢ Adjust the tone switch to continuously 'on' position

➢ Note down if the DFM is reading single frequency or multiple frequencies (these will
generally be the harmonics of fundamental frequency)

➢ The difference between the frequency under observation and the next harmonics
which has got maximum intensity, should be more than 30 dB.

➢ If there is such 30 dB difference, then there is no distortion

 Procedure used for subjective calibration

To summarize
➢ Introduction to calibration – Definition, rationale and types
➢ Daily Listening Check – what? / when? / who ? / why ? / How ?
➢ Subjective calibration - what? / when? / who ? / why ? / How ?
➢ Objective calibration
1. Intensity calibration through headphone using Pure tone
2. Intensity calibration through Bone vibrator using Pure tone
3. Intensity calibration through insert receiver using Pure tone
4. Intensity calibration through loudspeakers using Pure tone (Sound field calibration)
5. Calibration of speech stimuli
6. Linearity check
7. Frequency calibration
8. Frequency response of the headphone
9. Distortion calibration
Thank You