Three studies are reported assessing the validity of AMTAS, an automated method for obtaining an audiogram, including air- and bone-conduction thresholds (stimuli delivered by a forehead-placed transducer) with masking noise presented to the non-test ear. In Study 1, six subjects at each of three sites were tested using manual audiometry by two audiologists at each site. The mean differences between the audiograms for the paired audiologists provided a measure of the reliability of traditional audiometry. In Study 2, thirty subjects (5 normal hearing, 25 hearing impaired) were tested using AMTAS and manual audiometry. For air-conduction thresholds, AMTAS-manual differences were similar to inter-tester differences in Study 1, but for bone-conduction thresholds, the former were larger. Two possible sources of the greater differences were identified, (1) incorrect reference-equivalent threshold force levels for forehead bone conduction, and (2) a differential effect of middle-ear disease on forehead and mastoid bone-conduction thresholds. In Study 3, intersubject variability was studied for forehead and mastoid bone-conduction thresholds. The results indicate similar variability for the two placement sites.

Acoustic impedance/reflectance measurements were made at various ear-canal pressures in 20 subjects with a clinical acoustic immittance instrument and an experimental impedance/reflectance system. Measurements were made over a frequency range of 226-2000 Hz with the clinical system and 125-11,310 Hz with the experimental system. For frequencies < or = 2.0 kHz, tympanograms obtained with the two systems are similar, with patterns that progress through the same orderly sequence with increasing frequency. Eardrum impedance measurements were also similar. There are small gender differences in middle-ear impedance. Reflectance patterns (reflectance versus frequency) at ambient ear-canal air pressure are characterized by high reflectance at low frequencies, two district minima at 1.2 and 3.5 kHz, increasing reflectance to 8.0 kHz, and decreasing reflectance above that frequency. Ear-canal pressure increases reflectance at low frequencies, decreases reflectance in the region of the minimum, and increases reflectance slightly at high frequencies. Reflectance tympanograms (reflectance versus ear-canal pressure) progress through a sequence of three patterns. At low frequencies, reflectance tympanograms are "V" shaped, indicating that pressure increases reflectance. At frequencies near the minimum reflectance, the pattern inverts, indicating that pressure decreases reflectance. At high frequencies, the patterns are flat, indicating that ear-canal pressure has little effect. Results presented for one patient suggest that reflectance tympanometry may be useful for detecting middle-ear pathology.

No abstract

Although certain jobs could be affected, the gap between capacity and need is so great that automated audiometry will not significantly affect employment. Automation could increase the number of hearing impaired patients that could be served. The reallocation of personnel time would be a positive change for our patients and our profession.