SYSTEM FOR MOUNTING AUDIOMETRIC TRANSDUCERS TO A USER'S HEAD AND CONFIGURATED CALIBRATION SYSTEM FOR IT

Description

[0001] The present invention relates to the field of auditory stimulation systems usable in audiometry for performing hearing tests. More specifically, it relates firstly to a method for calibrating an audiometric transducer device for air and vibration stimulation attached to the user's head for performing audiometry, and secondly to a system for holding on the head the various devices, vibrators and earphones, used in clinical audiometry to bilaterally test a patient's hearing in air and vibration stimulation, without moving the headset during the examination.In other words, it concerns a system for attaching transducers to the user's head for air conduction and bone conduction audiometry, as well as a calibration method for the transducer(s) using vibratory stimulation to enable their use with such a fixation system. Finally, the fixation system reliably eliminates the contribution of air stimulation from the vibrator occurring at high frequencies when only vibratory conduction testing is desired.

[0002] A pure-tone audiogram, the quintessential hearing test, comprises two types of audiometry that allow for a sufficiently precise assessment of a person's auditory system: air-stimulation audiometry, which tests all the structures of the ear (outer, middle, and inner ear), and vibration-stimulation audiometry, which directly tests the inner ear using vibrations. Performing both of these tests is essential to determine the type of hearing loss (sensorineural, conductive, or mixed).

[0003] Generally, this type of audiogram is performed manually by an operator using an audiometer connected to a binaural headset for air stimulation and a monaural headset for vibration stimulation using exclusively bone conduction (placed on the forehead or mastoid bone). In some cases, contralateral masking of the untested ear is necessary to avoid potentially erroneous responses, for example, in the case of a significant interaural difference, or in the case of vibration stimulation where transcranial transfer is virtually nil. To perform the tests, the operator places each headset on the patient's head either successively when masking is not required, or both headsets simultaneously when masking of the contralateral ear is necessary for the vibration stimulation test.In the present invention, as will be seen in more detail later, a comfortable attachment and fixing system is provided, which allows for the correct and easy positioning on the head of all the transducers necessary for carrying out binaural audiometry in air and / or vibratory stimulation without repositioning of the transducers and without human intervention.

[0004] Patent applications WO 2008 / 139404 A1 (KOEKEMOER, 2008-11-20), US 2015 / 358745 A1 (RIX ET AL, 2015-12-10) and JP S56 139740 A (YAMASHITA ET AL, 1981-10-31) are relevant to understanding the scope of the invention.

[0005] The choice of positioning of the transducer vibrator in vibratory stimulation and / or the type of headset used in air stimulation impose a particular requirement for the calibration of the transducers, due to a modification of the occlusion of the ear induced by the cohabitation between the different transducers since, unlike existing solutions, there is simultaneous wearing of the transducers of the air and vibratory stimulation on the ear being tested.

[0006] The invention therefore relates to a calibration method for an audiometric transducer device for air and vibration stimulation attached to the user's head for performing audiometry by emitting signals at frequencies below 20 kHz towards the head, comprising at least one bone conduction vibrator-type vibration transducer and an air stimulation device equipped with at least one transducer, in a headset or in the form of a hearing insert, the calibration method consisting of: the placement of the bone conduction vibrator(s) on the patient's head; the placement of the air conduction headset / inserts on the patient; the selection of the following parameters: ● one or more tests to be performed from among the air conduction or vibration stimulation tests and, for each of said tests, ● the ear or ears to be tested ●the presence or absence of contralateral masking; the selection of the type of transducer used and their positioning; the modification of the calibration of the transducers according to the transducer and the parameters selected, by applying an overall frequency weighting of the signals; the generation by the transducers of the frequency signals, constituting the stimuli of the vibratory and / or airborne stimulation.

[0007] The principle of frequency weighting is that a modification of the sound intensity value, which depends on the frequency, is applied to a given value. Noise is measured in dB, with 0 dB representing the threshold of audibility. For example, if the measurement gives an unweighted value of dB for different frequencies (e.g., 1000, 2000, 4000 Hz...), with a frequency weighting of 10 dB at 1000 Hz, 20 dB at 2000 Hz, and 30 dB at 4000 Hz, the intensity level AFTER weighting will therefore be 10 + 10 = 20 dB at 1000 Hz; 10 + 20 = 30 dB at 2000 Hz; and 10 + 30 = 40 dB at 4000 Hz.

[0008] The purpose of weighting is to adapt the intensity level of the sound signal according to the actual examination conditions, which may differ from the norm (for example, due to the creation of an occlusion effect, or other factors: see examples below). The overall weighting therefore depends on the type of transducers, their positioning, their coupling, etc.

[0009] It is further specified that overall weighting refers to the sum of different weightings that may be applied depending on the test context: for a given situation, it is sometimes necessary to sum the weighting coefficients to take into account the situation being tested (see detailed explanations below). The sum of the different weightings is applied to the reference value, provided by the standard, which specifies only one experimental measurement condition (0 dB reference, dependent on the type of transducer used for a given positioning, with the tested ear not occluded).

[0010] The side of the head to be tested first for a vibration stimulation test is determined by performing a Weber test that includes bilateral or frontal bone conduction stimulation at a suprathreshold intensity at different audiometric frequencies, for example, 0.5 kHz, 1 kHz, 2 kHz, 4 kHz. This allows the first test side to be determined based on the side on which the user perceives the stimulation. This determination is well-established.

[0011] In general, the vibration transducer is placed on at least one location on the head selected from the following: the forehead; the mastoid; an area covering a cartilaginous portion of the head.

[0012] So, more specifically: When vibratory transducer stimulation takes place on the forehead, the applied frequency weighting is between [-10 and +20] dB; when vibratory transducer stimulation takes place on a mastoid, the applied frequency weighting is between [-20 and +10] dB; when vibratory transducer stimulation takes place on an area covering a cartilaginous portion of the head, the applied frequency weighting is between [-40; 0] dB.

[0013] The additional frequency weighting applied is almost zero, i.e. between [-5 ; 5] dB if contralateral masking is performed via the air stimulation device placed on the contralateral ear only, the tested ear remaining free.

[0014] As a reminder, contralateral masking is achieved by presenting an acoustic message to one ear to prevent it from responding instead of the ear being tested.

[0015] The applied frequency weighting is between [-30 ; +10] dB if contralateral masking is performed via the air stimulation device placed simultaneously on both ears and the vibrating transducer is positioned on the forehead, on the mastoid(s) or on an area covering a cartilaginous portion of the head.

[0016] It is specified that the preceding weightings can be cumulative, meaning that, for a given situation, the weighting coefficients can be summed to take into account the situation being tested. For example, if the bone conduction examination is performed with the vibrator placed in a frontal position (A-weighting), in the presence of contralateral masking achieved by positioning the air-clamp headset over both ears simultaneously (B-weighting), the overall weighting will be the frequency-by-frequency sum of each of the individual weightings (frequency-by-frequency sum of the A-weighting, B-weighting, and C-weighting).

[0017] The overall weighting coefficient obtained previously aims to cancel the calibration and reference zero variations induced by a different positioning of the bone vibrator(s) and air transducer(s) than that prescribed in the standard.

[0018] The intensity level required for given experimental conditions during a hearing test using air conduction and bone conduction may be: The data is saved in memory as is, including a calibration table for each experimental condition. The target values ​​are determined by applying the ISO 389-3:2016 standard, to which the previously calculated global weighting is applied (multiple master calibrations). A master calibration is defined as the creation of a calibration table of size n, containing all possible experimental combinations (n ​​= occlusion x positioning x masking x...). In short, for each condition, a value is recorded and then calibrated. In other words, this amounts to creating as many calibration tables as there are experimental conditions, with the target values ​​for each table corresponding to the ISO 389-3:2016 value to which the global weighting is applied.This is calculated prior to stimulus generation, by calling the intensity level saved in the calibration (ISO 389-3:2016 standard, single parent calibration), to which the overall weighting is then applied (multiple daughter calibrations). A daughter calibration is defined as performing the calibration (ISO) only once, then calculating the desired output level from this single calibration by applying the weighting.

[0019] In both cases, the result obtained is rigorously identical (the overall weighting is applied either during the material calibration phase or during the stimulus generation phase).

[0020] In practice, various implementation solutions are possible and are offered as non-limiting examples. They can be used separately or in combination to ensure the reliability of the audiometric thresholds obtained during measurements.

[0021] Thus, the final stimulation level can be applied either by modifying the intensity level of the emitted signal, i.e., the target bone stimulation provided by ISO 389-3:2016, and applying the global weighting (daughter calibration), or by directly selecting the corresponding calibration from the table (parent calibration). For example, if the ISO standard stipulates that a level of 78.9 dB SPL at 500 Hz corresponds to 40 dB HL, and the global weighting from the test configuration is -16 dB at this frequency, then the stimulation intensity will be 78.9 - 16 = 62.9 dB SPL. The value displayed on the user interface remains 40 dB HL. The target signal presentation level is lowered.

[0022] Alternatively, the intensity level of the airborne masking stimulation produced in the contralateral ear can be modified to prevent the contralateral ear from detecting the target bone tone signal. As a reminder, the intensity of the contralateral masking must be between the effectiveness criterion (the minimum masking intensity required to prevent the contralateral ear from detecting the target sound) and the interference criterion (the maximum masking intensity beyond which the masking sound presented in the contralateral ear begins to interfere with the detection of the target sound presented in the tested ear). In the present invention, the intensity level of the masking stimulation can be modified by setting the level of the masking noise at the interference threshold (provided that the interference criterion is greater than the effectiveness criterion, minus the overall weighting coefficient).For example, if the resonance threshold sets the intensity level of the masking noise at 60 dB HL, and the overall weighting is -16 dB at the tested frequency (meaning that the bone conduction detection threshold under the test conditions improves by 16 dB compared to the standard), the masking noise will then be 60 - (-16) = 76 dB HL. Upon resonance, the generated masking noise level will constrain the detectability of the target sound presented in the tested ear and will therefore modify the threshold obtained by a value equal to the overall weighting.

[0023] Finally, the displayed value can be modified after the measurement result by presenting a stimulation intensity level for the target tone and the masking tone in accordance with ISO 389-3:2016. The patient's response is simply recorded by taking the target tone value and adding the global weighting. For example, if the patient responds at 40 dB HL and the global weighting for the experimental condition tested at the tested frequency is -16 dB, then the patient's response will be recorded as 40 - 16 = 24 dB HL.

[0024] It is possible to use any combination of at least two of the three application types to achieve the same result. For example, if the weighting factor is -16 dB, it is possible to apply -8 dB to the intensity level of the target sound and +8 dB to the intensity level of the masking sound.

[0025] As a reminder, dB HL stands for "Decibel Hearing Level," and dB SPL stands for "Decibel Sound Pressure Level." Sound pressure level is expressed in physical decibels (dB SPL). Zero dB SPL is the reference hearing threshold at 1 kHz, obtained in a group of normal subjects. This means that the acoustic decibel scale would not exist without the human ear. This zero corresponds to a pressure of 20 µPa, the unit of pressure being the Pa (Pascal). Zero Pa can only exist in a vacuum and therefore cannot be used as an audiometric zero. Since the ear is not equally sensitive to all frequencies, audiometric zeros (hearing thresholds for each frequency) had to be expressed in dB SPL. In pure-tone audiometry, the measurement of hearing thresholds, i.e., threshold audiometry, is therefore done by reference to audiometric zeros.The measurement results are then expressed in dB HL.

[0026] As mentioned, the corrective factors or new calibrations are dependent on the acoustic coupling of the transducers, and may vary depending on the type of transducer used and their positioning, impacting the occlusion effect created by the cohabitation of the different transducers, made possible by the fixing system of the invention.

[0027] The introduction of multiple calibration of bone conduction transducers according to the type of air transducers used must be implemented in order to normalize the thresholds obtained in the different experimental conditions that may be encountered (binaural headset in vibratory stimulation worn alone, or alternatively with addition of the binaural headset in air stimulation, whether headset or ear insert).

[0028] It should be noted that at high frequencies, the occlusion effect can be negative; that is, occlusion of the external auditory canal degrades the "vibratory" perception of high frequencies. In reality, canal occlusion degrades the perception of the acoustic field radiated by the vibrator, which is audible to the subject (airborne stimulation emitted involuntarily by the vibrator). The support system described below, with its combination of airborne and vibratory stimulation devices, prevents the subject from perceiving the airborne radiation emitted by the vibrator. The quality of the diagnosis is thus improved, as the thresholds measured by vibratory stimulation then reflect only the response of the inner ear, including at high frequencies.

[0029] Currently, vibratory stimulation transducers used in audiometry all have the same attachment system: a headband to which a single transducer is attached. No binaural vibratory stimulation audiometry system is currently available, likely due to various technical issues mentioned above, which naturally impact the devices worn by patients, including: i) Current audiometry systems offer only one calibration for each transducer, whether for air conduction or vibration. The references from ISO 389-3:2016 allow for the calibration of the vibrator for an open ear (not occluded by headphones). Creating occlusion through the simultaneous use of air and vibration headphones, even partial, significantly alters the sound level perceived by the patient (and therefore the 0 dB reference used), thus negating the benefit of the calibration. ii) The headband is calibrated to provide "sufficient" pressure for audiometry purposes. More precisely, an application force of between 4.9 and 5.9 Newtons is normally applied to allow this type of test, although in practice this force varies from one individual to another depending on their head circumference.In existing devices, the headband clamping force is never adjusted and is not adjustable. Furthermore, the current device quickly becomes uncomfortable after a few minutes of wear, making it unsuitable for the longer duration required to complete a full audiometric examination.

[0030] However, the clamping pressure of the transducers in vibratory stimulation is an important parameter for the physical transmission of signals. Each transducer has a flat, circular surface of 150 to 200 mm² that rests on the patient's head, generally on the mastoid process. When the full clamping force of current monaural headsets (for example, when the headband is rigid metal) is applied, it causes significant pressure on the mastoid, making wearing the headset extremely uncomfortable and even painful. Therefore, applying the headsets can be delicate and unstable, and the operator must possess considerable expertise, especially since it is necessary to reposition the headset several times to test each ear for all the tests.Since vibratory conduction tests must be performed with the ear open, the vibrator (ossivibrator on the mastoid and support cushion on the mandible) and the air headset should be positioned simultaneously in a crossed manner (i.e., one earphone on the ear to be masked and the other on the cheek, to leave the tested ear open).

[0031] The need to leave one ear open, the rudimentary comfort, and the requirement to switch the headset to the other side during vibratory stimulation mean that all tests cannot be performed without removing the headset. This necessitates the presence of an operator on-site to ensure the repositioning of the transducers throughout the different phases of the test. While a frontal positioning of the vibrator, suggested by some authors (e.g., Studebaker 1962), could allow the examination to be performed without external intervention or modification of the headset positioning, the results obtained under such circumstances for vibratory stimulation would be erroneous, particularly due to the vibrator being calibrated for open-ear stimulation rather than an open or semi-occluded ear, unless the headset is moved to the untested ear to leave it open.

[0032] These various problems have remained unresolved until now, primarily due to a lack of need, as examinations are conducted in person and the positioning of the headphones can be easily adjusted by the examiner. However, the advent of artificial intelligence and telemedicine would now allow for the automation of some audiometric tests and their potential remote performance. At least some of the potential benefits of automation and telemedicine (saving time for human intervention) are therefore not feasible due to the aforementioned constraints, particularly the need for a person to be present to handle the application and replacement of the headphones on the patient's head, or the significant acoustic impact of any change in the positioning of the vibrators.

[0033] The present invention aims to overcome the aforementioned drawbacks by providing a comfortable attachment and fixation system that allows for the correct and easy positioning on the head of all the transducers necessary for performing binaural audiometry with air and / or vibration stimulation, without repositioning the transducers or human intervention (without moving the system during the test) during the examination. To further achieve this objective, the invention also presents a more secure transducer retention system, better adapted to the individual shape of the head and ears. This results in improved comfort, allowing the user to keep the device in place throughout the entire examination without any movement.The proposed system works in particular with the method of the invention, which is in reality a method of adjusting the initial calibration of the ossivibrator, which makes it possible to compensate for the variations linked to the differences between the real measurement conditions and the conditions from the standard setting the 0dB reference (occlusion of the external auditory canal in practice versus open auditory canal in the standard).

[0034] In other words, it is necessary to be able to test both ears binaurally and simultaneously with air and / or vibration stimulation, with or without contralateral masking, after simultaneous or near-simultaneous placement of the necessary transducers (i.e., at least one transducer for vibration stimulation and two transducers for air stimulation) so as to allow the entire examination to be performed without external intervention. In the case of a single transducer for vibration stimulation, the excellent transmission properties of vibration stimulation in bone (very low transcranial transfer around 0 to 10 dB, see Appendix 1) or in soft tissues are used to transmit sound bilaterally.

[0035] In the case of a single transducer for vibratory stimulation, the vibrator can, for example, be positioned on the skull equidistant from both ears (for a patient viewed from the front: azimuth 0°, i.e., on the frontal bone in line with the frontal suture, or 180° on the occipital bone, in line with the sagittal suture and below the lambdoid suture). In the case of two transducers for vibratory stimulation, the positioning of the vibrators can, for example, be carried out precisely opposite the mastoid process on either side of the skull. Regardless of the number of transducers used for vibratory stimulation, two air-stimulation transducers are added to the previous device, either intra-auricularly (ear inserts) or supra-auricularly (headphones).

[0036] To fulfill these objectives, and others which will be apparent from reading this text, the system of the invention, ensuring the attachment to the head of a user of transducers for the performance of audiometry in air stimulation and in vibratory stimulation, is such that it comprises support means for two audiometric transducers in air conduction each positionable at the level of one of the auditory pinnae or of the external auditory canal and at least one audiometric transducer in vibratory stimulation.

[0037] The system of the invention therefore comprises at least three transducers enabling binaural stimulation for both air conduction and vibration (bone conduction and / or soft tissue). It is thus designed to stimulate the auditory system for both types of stimulation, thereby allowing for a functional auditory assessment that provides comprehensive information for a definitive diagnosis. It differs from current vibration-based audiometry solutions that allow for monaural bone conduction in accordance with the NF EN ISO 389-3 standard or binaural stimulation, but for which modifying the experimental conditions leads to a substantial change in the equivalent reference levels of threshold vibrational force for pure-tone vibrators when the ear is occluded.

[0038] Current audiometry solutions using vibratory stimulation do not allow for binaural bone conduction stimulation without moving the different headsets. As previously mentioned, the support devices for the two types of transducers allow the entire test to be performed without needing to remove them after initial installation. These support devices must therefore be designed so that, once installed, they guarantee the correct positioning of the transducers and their stability over time. Finally, a calibration compensation algorithm eliminates the occlusion effect created by the simultaneous use of the different audiometric headsets.

[0039] In one scenario, the support system comprises a combination of primary support elements for the audiometric transducers in air stimulation and secondary support elements for the audiometric transducer(s) in vibration stimulation. The user is responsible for initially positioning them, if necessary relative to each other, without any need for repositioning until the end of the tests.

[0040] In fact, according to one possible configuration, the first support means for the audiometric transducers in air stimulation and the second support means for the audiometric transducer(s) in bone stimulation are fixed together, so that there is no need to position them relative to each other. The headset, with at least three transducers, is indeed a single unit that should be fixed to the head, adjusting the positions of the transducers relative to the ear canal or the auricles for air conduction, and to the mastoids and forehead for vibratory conduction.

[0041] In practice, various configurations can be implemented within the framework of the invention. For example, the second support means for the audiometric transducers in vibratory stimulation can consist of a headband that can be positioned on the forehead (a vibrator) or over the mastoid processes behind the auricles. This headband can be flexible or rigid, and its positioning, as well as the clamping force exerted on the skull, can be varied according to the user's preference, primarily based on their cranial morphology and the position of the auricles. In the present case, the attachment system for the vibrators can be achieved either by means of a clamping system, using notches provided for this purpose on either side of the vibrator, or simply by using the clamping force of the headband and sliding the vibrator under the headband.

[0042] Alternatively, these second support methods for vibratory stimulation audiometric transducers can consist of a semi-rigid headband encircling the nape of the neck, the ends of which are fitted with soft tips positioned above the auricles. Although semi-rigid, the headband can easily be moved to adapt to the patient's skull.

[0043] In general, according to the invention, the first support means for the air-stimulation audiometric transducers consist of a headset comprising an upper headband equipped with means for adjusting its length and either earphones placed on the auricles or inserts inserted directly into the ear canal. This headset is positioned in relation to the second support means for the vibration-stimulation audiometric transducers described above, for overall positioning of the various transducers.

[0044] In certain configurations, the headband of the headphones may include an arm extending towards the forehead or a mastoid bone (bone stimulation) or the pretragal region (soft tissue stimulation), to which an audiometric transducer is attached, enabling vibratory stimulation. This is the one-piece configuration.

[0045] In general, according to the invention, the transducers are attached to their supports via fastening means whose position is adjustable relative to said supports. It is easy for the user to move them to position them correctly, that is to say, in a manner adapted to their skull and, on each side, to the location of the auricle or the external auditory canal and the areas of vibratory stimulation (including, but not limited to, the mastoid bone, forehead, soft tissues of the skull, etc.).

[0046] The choice of positioning of the transducer vibrator in vibratory stimulation and / or the type of helmet used in air stimulation impose a particular requirement for the calibration of the transducers, due to a modification of the occlusion of the ear induced by the cohabitation between the different transducers - since there is, unlike existing solutions, simultaneous wearing of air and vibratory stimulation.

[0047] Other objects and advantages of the present invention will become apparent in the following description, relating to embodiments which are given only as indicative and non-limiting examples.

[0048] Understanding this description will be facilitated by referring to the attached drawings, in which: There [ Fig.1 [ ] represents a schematic profile view of a user equipped with support devices consisting of a headband for audiometric transducers in vibratory stimulation (bone conduction and soft tissue). The [ Fig.2 ] represents a schematic rear view of the user equipped with said support headband. The [ Fig.3 ] represents a schematic front view of the user wearing said support headband when only one vibrator is used, but positioned frontally. The [ Fig.4 [ ] represents a schematic profile view of a user equipped with support devices, also for audiometric transducers in vibratory stimulation, consisting of a semi-rigid headband surrounding the user's neck. The [ Fig.5 ]] represents a schematic rear view of the user equipped with said support hoop. The [ Fig.6 [ ] represents a schematic profile view of a user wearing a combination headset, equipped with a headband for the air-stimulation audiometric transducers (earbuds) and support arms for the vibration-stimulation audiometric transducers. The [ Fig.7 ] represents a schematic rear view of the user equipped with said combined helmet from the previous figure.

[0049] The configuration of [Fig.1] à [Fig.3] shows a flexible or rigid headband. This particular support is designed to leave the patient's ears free so that a headset or binaural air stimulation inserts can be attached to complement audiometric tests. Its nature and positioning allow it to be installed simultaneously with a traditional headset equipped with earphones or inserts. The headband 1 may, according to one embodiment, include fastening means 2 for the vibratory stimulation transducer(s) 3, which ensure that they remain stationary on the headband 1. The vibratory stimulation transducer(s) 3 may also be slid under the headband without any fastening system (see in [ Fig.3 ]), their retention being then ensured by the pressure force of the headband. These fixing means 2 can be adjusted / slid on the headband so as to modify, for the purpose of adjustment, the distance between the transducer(s) 3 so that they are well positioned, generally in relation to the stimulation area (for example the mastoid process of the temporal bone, the forehead or possibly soft tissues), and / or - in the case of a flexible headband - the clamping force exerted by the system.

[0050] In this regard, one or more systems for adjusting the clamping force applied can be implemented: these systems may, for example, consist of slides, snap fasteners, adjustment notches, etc. In practice, these adjustment systems allow the pressure exerted by the vibratory stimulation transducers on the patient's bone or soft tissues to be adjusted.

[0051] The headband size can be universal or adjustable, and in the case of a flexible headband, the pressure force can also be adjusted by measuring the patient's head circumference using a measuring tool. The measurement allows for finer adjustment of the headband diameter via adjustment systems and markings on the headband until the required pressure force, corresponding to the measured head circumference, is achieved. The headband may also include an opening system (slider, clips, hook-and-loop fastener, etc.) to facilitate its application to the patient.

[0052] The support methods illustrated in [ Fig.4 ] And [ Fig.5 ] feature a semi-rigid headband 10 designed to be positioned behind the patient's head. As with the headband configuration 1 of the [Fig.1] à [Fig.3] These support devices are designed to leave the recipient's ears unobstructed, allowing for the insertion of headphones or inserts, the latter serving as transducers for binaural air stimulation. The positioning of the rear headband (10) allows these secondary support devices to be installed simultaneously with a traditional air stimulation setup.

[0053] The fixation system consists of a semi-rigid, malleable headband 10, adjustable to the patient's morphology, to which various elements are added. This headband 10 may be available in different sizes. The headband 10 must be positioned just above the ears and follow the contour of the head. One or more fixation means 12 allow the vibrator(s) 13 constituting the vibratory stimulation transducers to be fixed to the headband 10. These fixation means 12 are movable along the axis of the headband 10 to allow their positioning opposite the mastoid process of the temporal bone or, optionally, the preauricular area for soft tissue stimulation. Two flexible tips 14 further secure the assembly in position. The soft tips 14 should rest slightly in front of the ear so as to be comfortable while maintaining pressure of the vibrators 13 on the stimulation area.

[0054] A third combined configuration appears in [ Fig.6 ] And [ Fig.7[ ], wherein the support means are based on a headset equipped with air stimulation earphones 21. The device of the invention consists of an upper headband 20, which effectively constitutes the support means and can be telescopic, i.e., include extendable arms for adaptation to the head size of each patient. The extendable arms of the upper headband 20 terminate at each end with a professional earphone 21 for air conduction and an audiometric vibrator 23 for bone conduction. Another example of the invention would be to have one or more additional extendable arms of the upper headband oriented towards the chosen stimulation areas (for example, forehead, mastoids, preauricular areas, etc.). The vibrators 23 constituting the vibration simulation transducers are placed on fastening means 22 arranged at the free end of branches 24 connecting them to the arms of the upper headband 20.

[0055] In all the cases mentioned, the transducers are intended to be connected to a conventional audiometer by wired connectors or by wireless signal transmission technology.

[0056] The above examples are not limiting to the invention, which on the contrary encompasses variants of form and configuration that are within the scope of the invention.

Claims

1. Method for calibrating an audiometric transducer device for air stimulation and vibratory stimulation attached to the user's head for performing audiometry by emitting signals at frequencies below 20 kHz in the direction of the head, comprising at least one vibratory transducer of the bone conduction vibrator type and an air stimulation apparatus provided with at least one transducer, in a pair of headphones or in the form of an auditory insert, the calibration method consisting of : - Placement of the bone conduction vibrator(s) on the patient's head; - fitting the air conduction headphone / inserts to the patient; - selection of the following parameters: • one or more tests to be carried out using air stimulation or vibratory stimulation and, for each of these tests • the ear(s) to be tested, • the presence or absence of contralateral masking; - selection of the type of transducer used and their positioning; - modification of the transducer calibration according to the transducer and the parameters selected, by applying a global frequency weighting to the signals; - generation by the transducers of frequency signals, constituting the stimuli for vibratory and / or aerial stimulation.

2. A method of calibrating an audiometric transducer device according to the preceding claim, characterized in that the vibratory transducer is placed on at least one location of the head selected from the following: - the forehead or on the median axis of the skull; - the mastoid; - a zone covering a cartilaginous portion of the head.

3. Method of calibrating an audiometric transducer device according to one of the preceding claims, <b>characterized in that: - when stimulation by vibratory transducer takes place on the forehead, the frequency weighting applied is between [-10 and +20] dB; - when stimulation by vibratory transducer takes place on a mastoid, the frequency weighting applied is between [-20 and +10] dB; - when stimulation by vibratory transducer takes place over an area covering a cartilaginous portion of the head, the frequency weighting applied is between [-40 and 0] dB.

4. Method for calibrating an audiometric transducer device according to one of claims 1 to 3, characterized in that the additional frequency weighting applied is virtually zero, i.e., between [-5; 5] dB if contralateral masking is performed via the air stimulation device placed on the contralateral ear only, and the test ear is unoccluded.

5. Method for calibrating an audiometric transducer device according to one of claims 1 to 4, <b>characterized in that the frequency weighting applied is between [-30; +10] dB if contralateral masking is performed via the air stimulation device placed simultaneously on both ears and the vibratory transducer is positioned on the forehead, on the mastoid(s) or on a zone covering a cartilaginous portion of the head.

6. System for attaching transducers to the head of a user for performing audiometry using air stimulation by air conduction and vibratory stimulation by bone conduction or by conduction in soft cartilaginous tissues, characterized in that it comprises support systems (1, 10, 20, 24) for two audiometric transducers (21) for air stimulation, each of which can be positioned at one of the auditory pinnae or the external acoustic meatus, and at least one audiometric transducer (3, 13, 23) for bone stimulation, which can be positioned onto at least one desired stimulation zone selected from one of the mastoids of the skull, the forehead, and a zone covering a cartilaginous portion of the head.

7. Fixing system according to the preceding claim, characterized in that the support system comprises a combination of first support system (20) for the audiometric transducers (21) for air stimulation and second support system (1, 10) for the audiometric transducers for vibration stimulation (3, 13).

8. Fixing system according to the preceding claim, characterized in that the first support system (20) of the audiometric transducers (21) for air stimulation and the second support system (24) of the audiometric transducers (23) for vibration stimulation are connected to each other.

9. Fixation system according to one of claims 7 to 8, characterized in that the second support system for the audiometric transducer or transducers (3) in vibratory stimulation consist of a headband (1) which can be positioned above or below the auricles.

10. Fixation system according to one of claims 7 to 8, characterized in that the second support system for the audiometric transducer or transducers (13) in vibratory stimulation consist of a semirigid hoop (10) surrounding the nape of the neck and the ends of which are provided with flexible tips (14) placed above the auricular pinnae.

11. Fixation system according to one of claims 8 to 10, characterized in that the first support system for the audiometric transducers (21) for air stimulation consist of a headset comprising an upper headband (20) equipped with means for adjusting its length and earphones (21) placed on the auricular pinnae or in the external auditory canal.

12. A fastening system according to the preceding claim, characterized in that the headband (20) comprises, either in the vicinity of each earphone (21), or at its base, one or more branches (24) extending in the direction of the vibratory stimulation zones (for example, mastoid bone, forehead, soft tissues) to which an audiometric transducer (23) is attached for vibratory stimulation.

13. Fixing system according to one of claims 6 to 12, characterized in that the transducers (21, 3, 13, 23) are fixed to their support systems (20, 2, 12, 22) via fixing means whose position is adjustable relative to said support systems (20, 2, 12, 22).