Chapter 9

Masking
for Pure-Tone and
Speech
Audiometry

From Audiology: Science to Practice, Fourth Edition By Steven Kramer and David
K. Brown. Copyright © 2023 by Plural Publishing, Inc. All rights reserved.
 Learning Objectives
At the end of this unit, you should be able to:
1. Understand why the non-test ear (NTE) needs to be masked in some
cases in order to obtain true thresholds in the test ear (TE).
2. Know what is meant by interaural attenuation (IA) and the minimum IA
values used for each transducer when making decisions about the
need to obtain masked thresholds.
3. Recognize, from the unmasked thresholds, when masked thresholds
must be obtained; apply the decision-making rules for masking when
testing by air conduction (AC) using supra-aural earphones or insert
earphones and by bone conduction (BC).
4. Describe the types of maskers used for pure-tone and speech testing.
 Learning Objectives
(continued)
At the end of this unit, you should be able to:
5. Define effective masking (EM) and how the maskers are calibrated
and used with the audiometer.
6. Describe the occlusion effect (OE) and why this needs to be
considered when masking for BC.
7. Describe two advantages of insert earphones over supra-aural
earphones as they relate to masking.
8. Define a masking plateau and how much of a plateau is
appropriate. Discuss why the width of the plateau is smaller when
there is a potential bilateral moderate conductive loss.
 Learning Objectives
(continued)
At the end of this unit, you should be able to:
9. Define overmasking and masking dilemma; recognize situations in
which these may occur.
10.Apply the specific steps for air conduction and bone conduction
masking using the plateau method for a variety of unmasked
audiograms.
11.Apply rules for determining if masking is needed for speech testing
and select adequate amounts of maskers for speech testing.
 Introduction
• The audiogram key has different
symbols for unmasked or masked
thresholds.
• Masking = process of putting noise
into the non-test ear (NTE) while
measuring responses in the test ear
(TE)
• Masker = noise presented to NTE
• Masked threshold = threshold of TE
when obtained in the presence of a
masker in the NTE
 Introduction
(continued)
• A two-channel audiometer is required
• Patient is instructed to ignore the noise and respond only to
the test tone (or speech)
• See next 2 slides from Chapter 7 as a review of why it is
important to obtain masked thresholds when necessary

• Masking is need in supraaural headphones -40

• Masking is needed in inserted earphone - 55
 Recognizing the Need for Masking
• Need for obtaining masked BC thresholds
• Testing with BC oscillator on one side can directly stimulate both
cochleae; patient will respond to better ear
• Need to put masking noise into non-test ear (NTE) by AC
 Recognizing the Need for Masking
(continued)
• Need for obtaining masked AC thresholds
• Testing with AC transducer at moderate levels can create
vibrations in skull and stimulate both cochleae; patient will respond
to better ear’s BC threshold
• Need to put masking noise into non-test ear (NTE) by AC
 Interaural Attenuation
• Interaural attenuation (IA): Term used to quantify the difference in the level of a
signal delivered to TE (by AC or BC) compared to the level of the signal that occurs
in the NTE (by BC)
• IA for BC = 0 (same level in both ears) – the cochlea are very close to each other
• IA is higher for insert earphones than supra-aural earphones; masking needed less
often with inserts
• Minimum IA values adopted for this textbook:
• IA for bone vibrator = 0 dB
• IA for supra-aural earphones = 40 dB
• IA for insert earphones = 55 dB
• IA for circumaural earphones = 40 dB
 Maskers
• Specifications are found in ANSI S3.6
• Narrowband noises
• Speech noise
• Effective masking level (EML)
• Maskers are always delivered by AC
• Overmasking occurs when minimum level of masker exceeds the IA and
can cross back over to the test ear (likely to occur with moderate bilateral
conductive loss
• Central masking
 General Rule for When to Mask
• If the presentation level of the signal to the TE exceeds the minimum IA and
could be audible by BC in NTE, masking of the NTE is needed

• Compare the presentation level in the TE (AC or BC) to the measured or

presumed unmasked BC threshold in the NTE

• If the difference is equal or greater than the IA, you must mask the NTE (by
AC)

• With proper masking of the NTE, one is confident that the patient’s
responses are due to hearing in the TE
 When to Mask for AC Pure-Tone
Thresholds
•For insert earphones, look for > 55 dB difference between unmasked TE AC
threshold and the unmasked BC threshold
•For supra-aural earphones, look for > 40 dB difference between
unmasked TE AC threshold and the unmasked BC threshold.
In many cases, the decision is based on the presumed BC
threshold of the NTE
•Comparing unmasked AC threshold in the TE to the unmasked AC threshold in
the NTE can also be done; however, it is only appropriate if the difference is
greater than the IA; if not, one may need to reassess the need to mask after
finding BC threshold of NTE
Making Decisions on
When to Mask for AC
 When to Mask for BC Pure-Tone
Thresholds
• Since IA = 0, one would assume masking always needed;
however, there are two exceptions:
• Exception 1: No air-bone gaps (masking would not make any
difference)
• Exception 2: If you mask for poorer ear first and find that the BC
threshold shifts, then the original unmasked threshold can be
assumed to be an estimate of the other ear
Making Decisions on
When to Mask for BC
• Examples: Making decisions to
mask for AC and/or BC

• + indicates where masked

thresholds would be needed
 Other Things to Keep in Mind
• Undermasking stage (chase)

• Overmasking

• Masking dilemma
 How to Mask for AC Pure-Tone
Thresholds
• Plateau method
• General strategy:
• Initial masking level (IML) presented to the NTE = 10 dB HL above AC threshold
of the NTE (masker elevates the AC and BC threshold of NTE each by 10 dB HL)
• Present tone again in TE at level where you last obtained a response;
• If the patient does not respond, raise the level of the tone by 10 (or 5) dB and
retest
• If patient does respond, raise the level of the masker by 10 (or 5) dB
• Continue the above steps until there is no change in threshold to the tone in the TE
for increases in masker in the NTE by 15-30 dB HL (called the plateau)
Example of How to
Mask for AC Pure-
Tone Threshold
 How to Mask for BC Pure-tone
Thresholds
• For BC, there is a need to consider the occlusion effect (OE)
• OE is an increase in the level of the BC signal reaching the cochlea due to the
inclusion of some air-conducted vibrations of the cartilaginous part of external ear
canal of the NTE when covered (occluded) with the masking earphone (see next
slide)
• There is less OE with inserts (when properly inserted) than for supra-aural
• OE occurs only for BC tones below 2000 Hz
• The following amounts are used:
• For supra-aurals: 20 dB @ 250 Hz; 15 dB @ 500 Hz; 5 dB @ 1000 Hz
• For inserts: 10 dB @ 250 Hz and 500 Hz
• OE does not need to be added if there is a conductive component
 How to Mask for BC Pure-Tone
Threshold
• Plateau method
• General strategy:
• Similar to AC masking, except IML includes any OE; IML to the NTE = 10 dB HL above
AC threshold of the NTE + OE. AC and BC (with OE) each increase by the same
amount.
• Present tone again in TE at level where you last obtained a response;
• If the patient does not respond, raise the level of the tone by 10 (or 5) dB and retest
• If patient does respond, raise the level of the masker by 10 (or 5) dB
• Continue the above steps until there is no change in threshold to the tone in the TE for
increases in masker in the NTE by 15-30 dB HL (called the plateau)
Illustration of the
Occlusion Effect
(OE)
Example of How to
Mask for BC Pure-
Tone Threshold
Masking Example 1
Masking Example 2
Masking Example 3
Masking Example 4
 Masking for Speech Testing
• Principles of masking similar to pure-tone masking, except only
one level of masker is selected
• Compare presentation level of speech to the best BC threshold in
the NTE; if greater than the IA, then masking the NTE is needed
• As with AC pure-tone masking, speech masking is often done
before obtaining BC thresholds; therefore, one may use the
presumed BC threshold of NTE for making decisions about
masking
 Masking for Speech Testing
(continued)
• IA for speech for this text are same as for pure-tones (40 dB HL for
supra-aurals and 55 dB for inserts)
• Put enough speech masker in NTE that would elevate the presumed
best BC so that the speech presentation level in the TE compared to
the elevated (by masker) BC in the NTE is less than the IA
• A commonly used “rule of thumb” is to present masker to the NTE
that is at a level 20 (or 30) dB HL less than the presentation level in
the TE; be sure that it is sufficient and that it is not overmasking.
Example of
Masking for
SRT
Example of
Masking for
WRS