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Evaluation of an Aided TEN Test for Diagnosis of Dead Regions in the Cochlea

Marriage, Josephine1,2; Moore, Brian C. J.1; Ogg, Vivian3; Stone, Michael A.1

doi: 10.1097/AUD.0b013e3181690701
Research Articles

Objectives: To compare results for the original version of the threshold equalizing noise [TEN(HL)] test for diagnosis of dead regions (DRs) in the cochlea, using stimuli presented via headphones, with results for an aided version of the test, the ATEN test, in which subjects listened to stimuli presented in free field using their own hearing aids.

Design: The test tones were warble tones for both the TEN(HL) and the ATEN test. Twenty-five subjects (12 males and 13 females), aged between 12 and 19 yr, with severe or profound sensorineural hearing loss were tested. For each test, two levels of the TEN were used, chosen to fall within the comfortable range of levels for the individual subject. A DR was considered to be present when the TEN(HL) produced at least 10 dB of masking and when the masked threshold was at least 10 dB above the nominal TEN(HL) level. Measurements of the outputs of the hearing aids in response to the TEN(HL) plus the test tones were obtained using a KEMAR acoustic manikin to assess the extent to which distortion or compression might have influenced the outcomes.

Results: For the TEN(HL) test, the results were often inconclusive, because the TEN(HL) could not be made sufficiently intense to give at least 10 dB of masking. The incidence of these inconclusive cases was markedly reduced for the ATEN test. There were more positive diagnoses of DRs for the ATEN test than for the TEN(HL) test. The KEMAR measurements indicated that distortion, compression, and/or feedback cancellation probably influenced the outcomes in some cases, leading to a moderate incidence of false positives for the ATEN test, and also some “missed” cases.

Conclusions: The ATEN test leads to a lower incidence of inconclusive results than the TEN(HL) test in the diagnosis of DRs in people with severe to profound hearing loss. However, for some hearing aids the gain changed rapidly as a function of frequency, which undermined the validity of the ATEN test. Also, some hearing aids introduced distortion that probably affected the outcome of the test and gave misleading results. Hence, the ATEN test cannot be recommended for use in the clinic.

The TEN(HL) test is used for diagnosing dead regions in the cochlea. For people with severe hearing loss, the results of the test may be inconclusive because the available equipment cannot produce the required sound levels, or because the required sound levels lead to uncomfortable loudness. This study evaluated the possibility of administering the test via the client's own hearing aid(s). While the aided version of the test led to a reduced incidence of inconclusive results, it also led to false positives. Hence, the aided version of the TEN test is not recommended for use in clinical practice.

1Department of Experimental Psychology, University of Cambridge, Cambridge, UK; 2Chear Ltd, 30 Fowlmere Road, Shepreth, Royston, Herts SG8 6QS, UK; and 3Mary Hare School, Arlington Manor, Snelsmore Common, Newbury, UK.

This work was supported by the Medical Research Council (UK) and by Deafness Research UK.

Address for correspondence: Brian C. J. Moore, PhD, Department of Experimental Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK. E-mail:

Received April 23, 2007; accepted October 22, 2007.

© 2008 Lippincott Williams & Wilkins, Inc.