J Am Acad Audiol 2022; 33(01): 045-056
DOI: 10.1055/s-0041-1735803
Research Article

Ambient Noise Monitoring during Pure-Tone Audiometry

Robert H. Margolis
1   Audiology Incorporated, Arden Hills, Minnesota
2   Division of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe, Arizona
George L. Saly
1   Audiology Incorporated, Arden Hills, Minnesota
Richard H. Wilson
2   Division of Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe, Arizona
› Author Affiliations
Funding This project was supported by DGS Diagnostics A/S.


Background There is an increasing need to administer hearing tests outside of sound-attenuating rooms. Maximum permissible ambient noise levels (MPANLs) from published in standards (Occupational Health and Safety Administration [OSHA] 1983; American National Standards Institute [ANSI] S3.1–1999 (R2018)) can be modified to account for the additional attenuation provided by circumaural earphones (relative to supra-aural earphones) that are used for pure-tone audiometry. Ambient noise can influence the results of pure-tone audiometry by elevating thresholds by direct masking and by producing distractions that affect the accuracy of the test. The effects of these distractions have not been studied in relation to pure-tone audiometry in adult listeners.

Purpose In Part I MPANLs provided by ANSI and OSHA standards are extended to account for the greater attenuation provided by circumaural earphones. Rules (“alerts”) were developed taking into account the listeners' thresholds. In Part II effects of distracting noise on pure-tone thresholds are reported.

Methods and Results In Part I MPANLs two standards were modified for circumaural earphones by adding the additional attenuation provided by three circumaural earphones (relative to supra-aural earphones). A set of rules (“alerts”) is provided for identifying masking effects from ambient noise in a variety of conditions (earphone type, threshold elevation, uncovered ear). In Part II the distracting effects of an industrial noise sample on thresholds obtained from five listeners with normal hearing are described. Pure-tone thresholds were measured in quiet and in distracting noise presented at various levels. The effects of the distracting noise on the following variables were measured: time per trial, number of trials required to measure threshold, threshold shift, and perceived distractibility of the noise. Time per trial was unaffected by distracting noise. Number of trials required for threshold, threshold shift, and perceived distractibility increased with distracting noise level.

Conclusion Part I: The modified MPANLs provide more relevant determinations of the potential effects of ambient noise on pure-tone thresholds than the values in the standards. Part II: Distracting noise affects pure-tone threshold measurements in a manner that is different from direct masking. The potential contaminating effect of distracting noise can be measured and reported.

Statement of Protection of Human Subjects

This research was conducted by Audiology Incorporated and does not meet the requirements for adherence to the Department of Health and Human Services regulation of human subjects research (29 CFR Title 45, Subtitle A, Subchapter A, Part 46). However, informed consent was obtained from all subjects and the research was conducted in accordance with the World Medical Association Declaration of Helsinki (https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki).


Any mention of a product, service, or procedure in the Journal of the American Academy of Audiology does not constitute an endorsement of the product, service, or procedure by the American Academy of Audiology.

Publication History

Received: 19 September 2020

Accepted: 29 July 2021

Article published online:
11 July 2022

© 2021. American Academy of Audiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Meinke DK, Norris JA, Flynn BP, Clavier OH. Going wireless and booth-less for hearing testing in industry. Int J Audiol 2017; 56 (sup 1 Suppl 1): 41-51
  • 2 Swanepoel DW, Matthysen C, Eikelboom RH, Clark JL, Hall III JW. Pure-tone audiometry outside a sound booth using earphone attenuation, integrated noise monitoring, and automation. Int J Audiol 2015; 54 (11) 777-785
  • 3 Jerger JF, Tillman TW. Effect of earphone cushion on auditory threshold. J Acoust Soc Am 1959; 31 (09) 1264-1264
  • 4 Stein L, Zerlin S. Effect of circumaural earphones and earphone cushions on auditory threshold. J Acoust Soc Am 1963; 35 (11) 1744-1745
  • 5 Bug MU, Fedtke T. Equivalent threshold sound pressure levels (ETSPLs) for RadioEar DD65v2 circumaural audiometric headphones. Int J Audiol 2020; 59 (08) 624-630
  • 6 Smull CC, Madsen B, Margolis RH. Evaluation of two circumaural earphones for audiometry. Ear Hear 2019; 40 (01) 177-183
  • 7 Margolis RH, Madsen B. The acoustic test environment for hearing testing. J Am Acad Audiol 2015; 26 (09) 784-791
  • 8 Margolis RH, Bratt G, Feeney MP, Killion MC, Saly GL. Home hearing test: within-subjects threshold variability. Ear Hear 2018; 39 (05) 906-909
  • 9 Margolis RH, Killion MC, Bratt GW, Saly GL. Validation of the Home Hearing Test™. J Am Acad Audiol 2016; 27 (05) 416-420
  • 10 Mosley CL, Langley LM, Davis A, McMahon CM, Tremblay KL. Reliability of the home hearing test: implications for public health. J Am Acad Audiol 2019; 30 (03) 208-216
  • 11 Hawkins JE, Stevens SS. The masking of pure-tones and of speech by white noise. J Acoust Soc Am 1950; 22 (01) 6-13
  • 12 Berger EH, Killion MC. Comparison of the noise attenuation of three audiometric earphones, with additional data on masking near threshold. J Acoust Soc Am 1989; 86 (04) 1392-1403
  • 13 American National Standards Institute. Maximum Permissible Ambient Noise Levels for Audiometric Test Rooms. (ANSI S3.1–R2018). New York, NY: American National Standards Institute; 2018
  • 14 Werner LA, Bargones JY. Sources of auditory masking in infants: distraction effects. Percept Psychophys 1991; 50 (05) 405-412
  • 15 Occupational Safety and Health Administration. Occupational Noise Exposure: Hearing Conservation Amendment: Final Rule. Code of Federal Regulations (29 CFR 1910.95; 48. Fed Regist 1983; •••: 9738-9785
  • 16 American National Standards Institute. Specifications for Audiometers (ANSI S3.6–2018). New York, NY: American National Standards Institute; 2018
  • 17 Occupational Safety and Health Administration. Standard Interpretation Letter to Mr. David Croft Regarding the “Use of Insert Earphones for Audiometric Testing,” March 11, 2013. Accessed September 25, 2020 at: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=29255.
  • 18 Meister H, Schreitmüller S, Ortmann M, Rählmann S, Walger M. Effects of hearing loss and cognitive load on speech recognition with competing talkers. Front Psychol 2016; 7: 301
  • 19 Heinrich A, Ferguson MA, Mattys SL. Effects of cognitive load on pure-tone audiometry thresholds in younger and older adults. Ear Hear 2020; 41 (04) 907-917
  • 20 Dunn HK, White SD. Statistical measurements on conversational speech. J Acoust Soc Am 1940; 11 (03) 278-288
  • 21 Kryter KD, Licklider JC, Stevens SS. Premodulation clipping in AM voice communication. J Acoust Soc Am 1947; 19 (01) 125-131
  • 22 Hughson W, Westlake HD. Manual for program outline for rehabilitation of aural casualties both military and civilian. Trans Am Acad Ophthalmol Otolaryngol 1944; 48 (Suppl): 1-15
  • 23 Margolis RH, Saly GL, Le C, Laurence J. Qualind: a method for assessing the accuracy of automated tests. J Am Acad Audiol 2007; 18 (01) 78-89
  • 24 Margolis RH, Frisina R, Walton JP. AMTAS(®): automated method for testing auditory sensitivity: II. air conduction audiograms in children and adults. Int J Audiol 2011; 50 (07) 434-439
  • 25 Margolis RH, Glasberg BR, Creeke S, Moore BCJ. AMTAS: automated method for testing auditory sensitivity: validation studies. Int J Audiol 2010; 49 (03) 185-194
  • 26 Eikelboom RH, Swanepoel W, Motakef S, Upson GS. Clinical validation of the AMTAS automated audiometer. Int J Audiol 2013; 52 (05) 342-349
  • 27 Margolis RH, Moore BCJ. AMTAS(®): automated method for testing auditory sensitivity: III. sensorineural hearing loss and air-bone gaps. Int J Audiol 2011; 50 (07) 440-447
  • 28 Mahomed F, Swanepoel W, Eikelboom RH, Soer M. Validity of automated threshold audiometry: a systematic review and meta-analysis. Ear Hear 2013; 34 (06) 745-752
  • 29 Berger EH. Options in defining background noise during audiometric testing. Presented to the 30th Annual Conference of the National Hearing Conservation Association, December 20, 2005
  • 30 Frank T, Williams DL. Effects of background noise on earphone thresholds. J Am Acad Audiol 1993; 4 (03) 201-212
  • 31 Lankford JE, Perrone DC, Thunder TD. Ambient noise levels in mobile audiometric testing facilities: compliance with industry standards. AAOHN J 1999; 47 (04) 163-167