Multi-channel and multi-mode audiometer and method

Abstract

Improved audiometric methods and apparatus provide for assessment of the nature and / or extent of a subject's hearing loss or impairment. Embodiments include applying to the subject at least first and second test electrical stimuli, the first and second test electrical stimuli configured to stimulate hearing perception in the subject and distinct from one another. Identification of one or more characteristics of the perceived hearing produced by the at least first and second test electrical stimuli (e.g., location of origin of the perceived hearing) is received from the subject and recorded in association with the at least first and second test electrical stimuli. A clinician can improve the effectiveness of treatments for the hearing impairment based on the recorded information.

Description

[Technical Field]

[0001] FIELD OF THE DISCLOSURE The present disclosure relates generally to devices and methods for diagnosing hearing or sound perception in a subject. Embodiments include audiometers and audiometric methods. [Background technology]

[0002] Audiometry and instruments such as audiometers are used to assess hearing and sound perception in subjects. Audiometry results can be used by clinicians to evaluate and treat hearing disorders.

[0003] There is a continuing need for improved audiometric methods and devices. In particular, there is a need for methods and devices that can provide enhanced hearing assessments, e.g., more extensive and / or detailed information regarding a subject's hearing and / or sound perception. The information provided by such enhanced assessments can, for example, enhance a clinician's ability to assess the nature and / or extent of a subject's hearing impairment, which can lead to enhanced treatment. Summary of the Invention

[0004] In this disclosure, improved audiometric methods and devices are described that provide a richer assessment of the nature and / or extent of a subject's hearing loss or impairment. Using the richer assessment, clinicians may be able to improve the effectiveness of treatments for hearing impairments.

[0005] For example, audiometric methods and instruments allow clinicians to assess a subject's auditory system to determine the level of hearing loss and / or the location of lesions. This technology can be used to evaluate the function of the auditory system under a variety of applications. Applications include, but are not limited to, electrical speech and music perception using hearing protection, noise cancellation under earphones, frequency-filtered speech for improved speech perception, comparison of electrical and acoustic stimulus thresholds to determine lesion location with improved testing ranges over traditional bone conduction, evaluation of tinnitus suppression with electrical stimulation, ototoxicity monitoring of high frequencies, e.g., up to 20 kHz, tone and speech lateralization for asymmetric hearing loss, combined acoustic and electrical sound values for speech enhancement, and portable hearing aid functional gain testing for cochlear hearing loss. The ability to vary the timing and level of stimulation across multiple channels is provided, allowing for a richer assessment. Determination of sound delivery at various locations can be provided for evaluation. Enhanced central hearing testing and evaluation of time integrals, as well as masking by manipulating time / intensity interactions, are also possible.

[0006] A first example of an embodiment is an audiometric method that may include applying a first test electrical stimulus to a subject, the first test electrical stimulus configured to stimulate an auditory perception in the subject, applying a second test electrical stimulus to the subject, the second test electrical stimulus configured to stimulate an auditory perception in the subject and different from the first test electrical stimulus, receiving from the subject an identification of one or more characteristics of perceived hearing produced by the first test electrical stimulus and the second test electrical stimulus, the one or more characteristics including a location of origin of the perceived hearing, and recording the one or more characteristics of the perceived hearing identified by the subject in association with the first test electrical stimulus and the second test electrical stimulus.

[0007] In some embodiments of the first example, applying the first test electrical stimulus and the second test electrical stimulus includes applying the first test electrical stimulus and the second test electrical stimulus simultaneously.

[0008] In any or all embodiments of the first example, applying the first test electrical stimulus and the second test electrical stimulus includes sequentially applying the first test electrical stimulus and the second test electrical stimulus.

[0009] In any or all embodiments of the first example, applying the first test electrical stimulus and / or the second test electrical stimulus includes applying electrical stimuli corresponding to one or more of: (1) a tone, (2) a broad tone, (3) speech, or (4) background noise.

[0010] In any or all embodiments of the first example, applying the first test electrical stimulus and / or the second test electrical stimulus includes applying electrical stimuli corresponding to a wide range of intensities, and receiving from the subject an identification of the perceived hearing characteristic includes an identification of a threshold intensity at which the subject perceives hearing.

[0011] In any or all embodiments of the first example, applying the first test electrical stimulus includes applying a stimulus configured to at least primarily stimulate hearing on a first side of the subject, and applying the second test electrical stimulus includes applying a stimulus configured to at least primarily stimulate hearing on a second side of the subject that is different from the first side.

[0012] In any or all embodiments of the first example, applying the first test electrical stimulus includes applying the first electrical stimulus to a first lateral mastoid region of the subject, and applying the second test electrical stimulus includes applying the second electrical stimulus to a second lateral mastoid region of the subject.

[0013] In any or all embodiments of the first example, applying the test electrical stimulus includes applying an electrical stimulus corresponding to a source of hearing perceived at a first side of the subject. In any or all embodiments of the first example, applying the test electrical stimulus includes applying an electrical stimulus corresponding to a source of hearing perceived at the second side of the subject.

[0014] In any or all embodiments of the first example, applying the test electrical stimulus includes applying an electrical stimulus corresponding to a perceived auditory source in the front of the subject. In any or all embodiments of the first example, applying the test electrical stimulus includes applying an electrical stimulus corresponding to a perceived source of hearing at the back of the subject.

[0015] In any or all embodiments of the first example, applying the test electrical stimulus includes applying an electrical stimulus that corresponds to a source of auditory sensation perceived by the subject. In any or all embodiments of the first example, applying the test electrical stimulus includes applying an electrical stimulus that corresponds to a source of auditory sensation perceived by the subject.

[0016] In any or all embodiments of the first example, applying the test electrical stimulus includes applying an electrical stimulus that corresponds to a stationary source of perceived hearing. In any or all embodiments of the first example, applying the test electrical stimulus includes applying an electrical stimulus that corresponds to a moving source of the perceived hearing.

[0017] In any or all embodiments of the first example, the method further includes applying at least a third test electrical stimulus to the subject, the third test electrical stimulus being different from the first test electrical stimulus and the second test electrical stimulus; receiving from the subject identification of perceived auditory characteristics produced by the first test electrical stimulus, the second test electrical stimulus, and the third test electrical stimulus; and recording the perceived auditory characteristics identified by the subject in association with the first test electrical stimulus, the second test electrical stimulus, and the third test electrical stimulus.

[0018] In any or all embodiments of the first example, applying the first test electrical stimulus and the second test electrical stimulus includes applying the first stimulus and the second stimulus with a timing change between the first stimulus and the second stimulus, for example, a timing difference between multiple electrodes affects sound lateralization and provides a complex auditory stimulus for evaluation of the central auditory pathway.

[0019] In any or all embodiments of the first example, applying the first test electrical stimulus and the second test electrical stimulus includes applying the first test electrical stimulus and / or the second test electrical stimulus that correspond to increasing intensity with changing frequency.

[0020] A second example embodiment is an audiometric method according to any or all of the embodiments of the first example embodiment, further comprising applying one or more of a test bone conduction stimulus to the subject, the test bone conduction stimulus configured to stimulate an auditory perception in the subject, or a test air conduction stimulus to the subject, the test air conduction stimulus configured to stimulate an auditory perception in the subject; receiving from the subject identification of perceived auditory characteristics produced by the first test electrical stimulus, the second test electrical stimulus, and one or more of the test bone conduction stimulus and the test air conduction stimulus; and recording the perceived auditory characteristics identified by the subject associated with the first test electrical stimulus, the second test electrical stimulus, and one or more of the test bone conduction stimulus or the test air conduction stimulus.

[0021] A third example embodiment is an audiometric method according to any or all of the embodiments of the first and second examples, wherein applying the first test electrical stimulus and the second test electrical stimulus includes applying stimuli to at least primarily stimulate the hearing on a first side of the subject, and applying stimuli to mask the hearing on a second side of the subject, different from the first side, produced by the stimulation on the first side.

[0022] Any or all embodiments of the third example may further include attenuating the subject's air-conduction hearing while performing the method. In any embodiment of the third example, attenuating air-conducted hearing includes applying earplugs, earmuffs, or other physical sound-attenuating structures to one or both ears of the subject.

[0023] In any embodiment of the third example, attenuating air-conducted hearing includes applying an attenuated air-conducted stimulus to one or both ears of the subject. A fourth example embodiment is a method according to any or all of the first, second, and / or third examples, wherein the method is performed while the subject's ears are protected from ambient sounds, for example by earmuffs, earplugs, or noise cancellation.

[0024] In a fourth example embodiment, the method is used to diagnose tinnitus. In a fourth example embodiment, the method is used to diagnose a lesion in a subject's ear organ, for example the outer ear, middle ear, or inner ear. [Brief explanation of the drawings]

[0025] [Figure 1] FIG. 1 is a schematic diagram of an audiometric system according to an embodiment. [Figure 2A]FIG. 1 is a schematic diagram of a headset including a multi-channel and multi-mode stimulation device placed against a subject's head, according to an embodiment. [Figure 2B] FIG. 1 is a schematic diagram of a headset including a multi-channel and multi-mode stimulation device placed against a subject's head, according to an embodiment. [Figure 3] FIG. 1 is a schematic diagram of functional components of a multi-channel and multi-mode audiometer according to an embodiment. [Figure 4] 4 is a schematic diagram of components of a computer system that may be used to implement the audiometer shown in FIG. 3, according to an embodiment. DETAILED DESCRIPTION OF THE INVENTION

[0026] FIG. 1 is a schematic diagram of an audiometric system 10 according to an embodiment. As shown, the system 10 includes a multi-channel and multi-mode audiometer 12 and a multi-channel and multi-mode stimulation device 14. The audiometer 12, which may be operated by a clinician, generates multi-channel and optionally multi-mode stimulation signals that are coupled to the stimulation device 14. The stimulation signals cause the stimulation device 14 to generate multi-channel and optionally multi-mode stimuli that are applied to a subject 16 for the purpose of stimulating and eliciting hearing and / or the perception of hearing by the subject. The subject 16 may describe auditory or sound information that describes characteristics such as the nature, amplitude or level, location, and / or origin or direction of the source of the sound produced by the stimuli or the perceived hearing. The sound information provided by the subject 16 may be recorded, for example, to or by the audiometer 12, typically in association with a corresponding stimulus. In embodiments, the multi-channel stimulation includes a first channel electrical stimulation and a second channel electrical stimulation (e.g., electrical mode stimulation), where the first electrical stimulation and the second electrical stimulation are different. The embodiments optionally include one or more channels of one or more additional stimulation modes, such as bone conduction stimulation and / or air conduction stimulation or auditory stimulation. Recorded sound information provided by the subject 16 in response to the multi-channel and any multi-mode stimulation can be used by a clinician to provide an effective assessment of any hearing impairment of the subject 16. The recorded sound information can also be used to determine an effective approach for providing sound or auditory perception to the subject 16, for example, in situations where the subject is unable to perceive air conduction hearing via the ear.

[0027] 2A is a schematic diagram of a structure such as a headset 110 that includes a multi-channel stimulation device 14 and can be used to position the stimulation device 14 relative to a head 112 of a subject 16, according to an embodiment. The illustrated embodiment of the headset 110 is configured for multi-channel and multi-modal stimulation and includes multiple (eight shown for purposes of example) electrodes 1141-1148 for electrical stimulation, one bone conduction transducer 116 for bone conduction stimulation, and multiple (two shown for purposes of example) air conduction, pressure wave, or audio transducers 1181-1182 for air conduction stimulation, all attached to a band 122 configured to be attached to or positioned relative to the head 112 of the subject 16. The lateralization, or location or direction, of the perceived sound caused by stimulation produced by electrodes 1141-1148, bone conduction transducer 116, and / or audio transducers 1181-1182 may depend on factors such as the number and / or location of the electrodes, bone conduction transducers, or audio transducers. Accordingly, other embodiments include other combinations of number and / or location of electrodes such as 1141-1148, bone conduction transducers such as 116, or audio transducers such as 1181-1182. For example, embodiments may include only two or only four electrodes such as 1141-1148, and in such embodiments, the two or four electrodes may be placed near the cochlea (e.g., on the mastoid process) on the subject's head 112.

[0028] 2A , for example, electrodes 1141-1148 are positioned on band 122 at locations such that they are placed adjacent positions corresponding to 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00, and 10:30 on subject's head 112. Electrodes 1143 and 1147 may be placed adjacent the right and left mastoid processes of subject's head 112 to optimize or otherwise enhance the ability of the electrical stimulation provided by the electrodes to stimulate the subject's right and left cochlea, respectively. Electrodes 1141 and 1145 are shown placed in locations that would be adjacent the anterior and posterior portions of subject's head 112 (e.g., at the ends of medial midline 124 through the subject's head). As described in more detail below, electrodes 1141-1148 generate electrical signals (shown schematically at 126 in FIG. 2A ) that stimulate the cochlea of subject 16 to cause hearing or the perception of sound. Electrodes 1141-1148 may be conventional or otherwise known devices suitable for the functions and applications described herein. Non-limiting examples include surface electrodes typically used for stimulating and recording electrical signals. While described in this disclosure as a device providing transcutaneous electrical stimulation, it will be understood that electrodes such as 1141-1148 may be utilized in devices in other embodiments.

[0029] The bone conduction transducer 116 is shown positioned adjacent to a front portion of the subject's head 112 (e.g., on the medial midline 124 of the subject's forehead). As described in more detail below, the bone conduction transducer 116 generates physical movement or other vibratory motion (shown diagrammatically at 128 in FIG. 2A ) that vibrates and stimulates the skull and / or other anatomical structures of the subject's head 112 to produce an auditory or sound perception. The bone conduction transducer 116 may include conventional or otherwise known devices suitable for the functions and applications described herein. Non-limiting examples include devices that generate mechanical oscillations or vibrations.

[0030] The audio transducers 1181-1182 generate audible and air-conducted pressure waves (shown schematically at 130 in FIG. 2A ) that vibrate the eardrum, tympanic membrane, and / or other anatomical structures of the ear or auditory system within the subject's head 112 to produce hearing, or the perception of hearing or sound. The audio transducers 1181-1182 can be positioned adjacent the subject's ear canal to optimize the hearing they produce. The audio transducers 1181-1182 can be conventional or otherwise known devices suitable for the functions and applications described herein. Non-limiting examples include audio speakers, such as the type used in hearing aids.

[0031] 2B is a schematic diagram of an exemplary alternative embodiment of a headset 110'. As shown, the headset 110' includes a plurality of electrodes 1141'-1148', two bone conduction transducers 1161' and 1162', and a plurality of audio transducers 1181'-1182', all attached to a band 122' configured to be attached to or positioned relative to the head 112 of the subject 16. In the embodiment shown in FIG. 2B, the two bone conduction transducers 1161' and 1162' are shown positioned on the band 122' such that they are adjacent to positions corresponding to 3:00 and 2:00, respectively, on the head 112 of the subject 16. Other than these different numbers and locations of bone conduction transducers 1161' and 1162', headset 110', including electrodes 1141'-1148' and audio transducers 1181'-1182', may be the same or similar to those described in connection with FIG. 2A and may be located in or adjacent to the same or similar locations. Like reference numbers are used to indicate like features in FIGS. 2A and 2B. Throughout this disclosure, the terms "stimulation device" or "stimulation transducer" may be used to refer to one or more or all of the stimulation devices, such as, for example, one or more of stimulation devices 1141-1148, 1141'-1148', 116, 1161', 1162', 1181-1182, or 1181'-1182'.

[0032] 3 is a schematic diagram of the functional components of an audiometer 12 that can be used in conjunction with a stimulation device 14, such as those described above in connection with FIGS. 2A and 2B, to provide multi-channel and optionally multi-modal diagnostic auditory sensory stimuli in accordance with embodiments. The illustrated embodiment of audiometer 12 includes a test routine controller 200 coupled to an electrical stimulus generator 202, a bone conduction stimulus generator 204, and an air conduction or audio stimulus generator 206. Information characterizing audiometric diagnostic routines or tests that may be performed by audiometer 12 may be stored in a test routine storage device 208 coupled to test routine controller 200. A user interface 210 coupled to test routine controller 200 may be used by a clinician or other user to control the operation of audiometer 12. Non-limiting examples of physical and / or functional components of user interface 210 include knobs, buttons, switches, or graphical user interface (GUI) components, including, for example, a display for selecting and controlling functions, audiometric testing routines and parameters and related information, controlling levels, and providing information (e.g., visually) to a clinician or other operator or user of audiometer 12. Information contained in responses from a subject to audiometric testing routines provided by audiometer 12 may be stored in subject response storage 212. The embodiment shown in FIG. 3 includes a subject response input 214, through which information in subject responses to testing routines may be received by audiometer 12. In embodiments, for example, subject response input 214 may include a user input, including components such as a keypad and display that may be operated by the subject or clinician to enter subject responses. Alternatively or additionally, the subject response input section 214 may be a communications interface (e.g., a wired or wireless interface) that can be coupled to another device (not shown) operated by the subject or clinician and that receives information representing the subject responses provided via the other device.Alternatively or additionally, the user interface 210 may be used by a clinician to input subject responses and other information.

[0033] Audiometer 12 supports several different diagnostic test modes, including one or more of an electrical stimulation test mode, a bone stimulation test mode, and an air conduction test mode. As described in more detail below, a useful feature of embodiments of audiometer 12 is its ability to support multi-mode diagnostic test modes, such as, for example, an electrical and bone stimulation test mode, an electrical and air conduction stimulation test mode, and an electrical, bone, and air conduction stimulation test mode. An operator can select the desired test mode, for example, using user interface 210.

[0034] The audiometric test routines stored by test routine storage device 208 include an electrical stimulation routine, a bone stimulation routine, and an air conduction stimulation routine. Depending on the selected test mode, audiometer 12 operates according to one or more of the test routines stored by test routine storage device 208, and optionally in response to control parameters provided by a clinician (e.g., via user interface 210). In embodiments, an operator can use user interface 210 to select the desired test routine to be executed during the selected test mode. Alternatively, or additionally, audiometer 12 may be configured with predetermined test routines for one or more of the test modes. During a multi-mode test mode, two or more of the electrical stimulation routine, bone stimulation routine, or air conduction stimulation routine may be executed simultaneously and / or sequentially by audiometer 12.

[0035] The electrical stimulus generator 202 generates a multi-channel electrical stimulation signal based on a multi-channel electrical stimulation routine stored in the test routine memory 208 and control parameters provided by an operator. The multi-channel electrical stimulation signal is configured to be coupled to two or more of the electrodes, such as 1141-1148 or 1141'-1148', of the stimulation device 14. The electrical stimulus generator 202 generates an electrical stimulation signal in a form and having characteristics configured to cause the electrodes to electrically stimulate the cochlea in the head 112 of the subject 16, thereby producing a perception of sound or hearing in the subject.

[0036] The multi-channel stimulation provided by the electrical stimulation generator 202 can provide a lateralized (e.g., directional) auditory perception within the subject 16. In embodiments, the electrical stimulation generator 202 can generate multi-channel electrical stimulation signals applied to transducers such as 1141-1148 such that sounds perceived by the subject 16 are perceived to originate from one or more locations or directions and at levels corresponding to the locations or directions in a sphere surrounding the subject's 16's head 112. For example, the multi-channel electrical stimulation signals can have morphologies and characteristics (e.g., levels and phases) and can be applied to particular electrodes to cause hearing to be perceived as originating from particular locations or directions around the subject's 16's head 112 (e.g., 12:00, 3:00, 6:00, and / or 9:00 positions, above, below, or other locations or directions relative to the sphere around the subject's head). The electrical stimulation generator 202 can be configured to generate the electrical stimulation (simulation) signals by conventional or otherwise known techniques. These types of electrical stimulation techniques are sometimes referred to as galvanic vestibular stimulation (GVS) or cochlear stimulation. For example, U.S. Patent No. 3,267,931 to Puharich, U.S. Patent No. 3,766,331 to Zink, and a 1984 paper by Tonndorf et al. entitled "High Frequency Audiometry" describe techniques for modulating a carrier signal to generate an electrical stimulation signal that, when applied to the cochlea via electrodes, produces an electrical signal that induces auditory perception. The Puharich and Zink patents and the Tonndorf et al. paper are incorporated herein by reference for all purposes. These types of electrical stimulation modalities generally can stimulate sounds perceived over a relatively wide frequency range, corresponding to most or all of the full range of typical hearing, such as 100 Hz to 20,000 Hz.

[0037] An embodiment of bone conduction stimulus generator 204 generates a mono-channel or single-channel bone conduction stimulus signal based on a bone stimulation routine stored in test routine storage device 208 and control parameters provided by an operator. For example, when used in conjunction with a headset such as 110, the mono-channel bone conduction stimulus signal is configured to be coupled to bone conduction transducer 116. For example, when used in conjunction with a headset such as 110', the mono-channel bone conduction stimulus signal is configured to be coupled to one or both of bone conduction transducers 1161' and 1162'. Bone conduction stimulus generator 204 generates a bone conduction stimulus signal in a form and having characteristics configured to cause the bone conduction transducer to vibrate the skull of head 112 of subject 16, thereby producing a perception of hearing within the subject. The bone conduction stimulation of the subject 16 provided by the bone conduction stimulation signal generated by the bone conduction stimulus generator 204, when provided simultaneously (e.g., simultaneously and / or sequentially, or in other combinations) with one or both of the multi-channel electrical stimulation generated through the electrical stimulus generator 202 or the audio stimulation generated through the audio stimulus generator 206, provides the ability to evaluate and diagnose relatively detailed and complex components of the subject's ability to perceive sound, including lateralization.

[0038] An embodiment of bone conduction stimulus generator 204 generates a multi-channel bone conduction stimulus signal based on a bone stimulation routine stored in test routine storage device 208 and control parameters provided by an operator. For example, when used in connection with a headset such as 110′, the multi-channel bone conduction stimulus signal is configured to be coupled to bone conduction transducers 1161′ and 1162′. Bone conduction stimulus generator 204 generates a bone conduction stimulus signal in a form and having characteristics configured to cause the bone conduction transducers to vibrate the skull of head 112 of subject 16, thereby producing a perception of hearing within the subject.

[0039] The multi-channel stimulation provided by the bone conduction stimulation generator 204 can provide a lateralized auditory perception within the subject. In embodiments, the bone conduction stimulation generator 204 can generate multi-channel bone conduction stimulation signals applied to transducers such as 1161'-1162' such that sounds perceived by the subject 16 are perceived to originate from one or more locations or directions and at levels corresponding to the locations or directions of a sphere surrounding the subject's 16's head 112. For example, the multi-channel bone conduction stimulation signals can have morphologies and characteristics that, when applied to particular transducers, cause hearing to be perceived as originating from particular locations or directions around the subject's 16's head 112 (e.g., 12:00, 3:00, 6:00, and / or 9:00 positions, above, below, or other locations or directions relative to the sphere around the subject's head). It has been observed that, in at least some instances, the lateralization (e.g., direction and level) capabilities provided by multi-channel bone conduction stimulation may be less than those provided by electrical or audio stimulation modalities. However, multi-channel bone conduction stimulation of subject 16 provided by bone conduction stimulation signals generated by bone conduction stimulus generator 204, when provided simultaneously with or otherwise in combination with either or both multi-channel electrical stimulation generated via electrical stimulus generator 202 or audio stimulation generated via audio stimulus generator 206, enhances the ability to assess and diagnose relatively detailed and complex components of the subject's ability to perceive sound, including lateralization.

[0040] The bone conduction stimulus generator 204 can be configured to generate the bone conduction stimulus signal by conventional or otherwise known techniques. For example, the bone conduction stimulus signal may have a varying frequency that corresponds to or is representative of a desired sound perception to be provided to the subject. The bone conduction stimulus signal may, in embodiments, be amplitude modulated, frequency modulated, and / or phase modulated. For example, the following papers describe various bone conduction stimulation techniques that may be used in connection with the bone conduction stimulus generator 204 and are incorporated herein in their entirety for all purposes: Shiraishi, K., "Sound Localization and Lateralization by Bilateral Bone Conduction Devices, Middle Ear Implants and Cartilage Conduction Hearing Aids," Audiology Research 2021, 11, 508-523; Stanley, R. et al., "Lateralization of Sounds Using Bone-Conducted Headsets," Proceedings of the Human Factors and Ergonomics Society 50 th Annual Meeting 2006; Daga, K. et al., "Bone-Conducted Sound Lateralization of Interaural Time Difference and Interaural Intensity Difference in Children and a Young Adult with Bilateral Microtia and Atresia of the Ears," Acta Otolaryngol. 2001, 121, 274-277. These types of bone conduction stimulation modalities are typically capable of providing auditory perception over a frequency range below the upper range of that provided by electrical and air conduction stimulation modalities. For example, the most effective frequency range for bone conduction stimulation in a particular subject may typically be in the range of about 250 Hz to about 6,000 Hz.

[0041] Embodiments of audio stimulus generator 206 generate mono-channel air-conducted stimulus signals based on audio stimulus routines stored in test routine storage 208 and control parameters provided by an operator. In certain embodiments, audio stimulus generator 206 generates multi-channel audio stimulus signals based on audio stimulus routines stored in test routine storage 208 and control parameters provided by an operator. For example, when used in connection with a headset such as 110 or 110′, the mono-channel audio stimulus signal or the multi-channel audio stimulus signal is configured to be coupled to one or both of audio transducers 1181-1182 or one or both of audio transducers 1181′-1182′. Audio stimulus generator 206 generates audio stimulus signals in a form and having characteristics configured to cause audio transducers 1181-1182 or 1181′-1182′ to generate audible sound via air-conducted pressure waves, thereby generating a hearing sensation in subject 16. The audio stimulation of the subject 16 provided by the audio stimulus signal generated by the audio stimulus generator 206, when provided simultaneously or at the same time (e.g., simultaneously and / or sequentially) with one or both of the multi-channel electrical stimulation generated by the electrical stimulation generator 202 or the mono-channel or multi-channel bone conduction stimulation generated by the bone conduction stimulation generator 204, enhances the ability to assess and diagnose relatively detailed and complex components of the subject's ability to perceive sound, including lateralization.

[0042] The multi-channel stimuli provided by the audio stimulus generator 206 can provide a lateralized auditory perception in the user. In embodiments, the audio stimulus generator 206 can generate multi-channel audio stimulus signals applied to transducers such as 1181 and 1182, or 1181′ and 1182′, such that sounds perceived by the subject 16 are perceived to originate from one or more locations or directions, and at levels corresponding to locations or directions in a sphere surrounding the subject's 16's head 112. For example, the multi-channel audio stimulus signals can have morphologies and characteristics and can be applied to particular audio transducers to cause hearing to be perceived as originating from particular locations or directions around the subject's 16's head 112 (e.g., 12:00, 3:00, 6:00, and / or 9:00 positions, above, below, or other locations or directions relative to the sphere around the subject's head).

[0043] The audio stimulus generator 206 can be configured to generate the audio stimulus signal by conventional or otherwise known techniques. For example, the audio stimulus signal may be frequency modulated, amplitude modulated, and / or phase adjusted to correspond to the frequency and / or level of the desired sound perception provided to the subject. Non-limiting examples include techniques used by conventional or otherwise known hearing aids. These types of audio stimulus modalities can stimulate sounds perceived over a relatively wide frequency range, typically corresponding to most or all of the full range of typical hearing, such as 100 Hz to 20,000 Hz.

[0044] 3 includes drivers 222, 224, and 226 that couple electrical stimulation generator 202, bone conduction stimulation generator 206, and audio stimulation generator 208, respectively, to associated stimulation devices such as electrical stimulation electrodes 1141-1148 or 1141'-1148', bone conduction stimulation transducers 116 or 1161' or 1162', or audio stimulation transducers 1181-1182 or 1181'-1182'. Drivers 222, 224, and / or 226 convert signals generated by their respective signal generators 202, 204, or 206 to levels suitable for application to the associated stimulation devices. In embodiments, for example, drivers 222, 224, and 226 may include transformers or other components for converting signals generated by the respective stimulus generators 202, 204, or 206 into current and / or voltage levels and / or impedance levels suitable for application to a stimulation device.

[0045] The multi-channel electrical stimulation routines may include routines for generating electrical stimulation signals configured to provide several different types of predetermined or expected perceived auditory sensations in the subject 16 for the purpose of diagnosing the subject's perceived hearing abilities and limitations. In connection with these different types of electrical stimulation routines, the routines may generate electrical stimuli that, when applied to the electrical stimulation electrodes, produce current flow in several different directions through the head 112 of the subject 16. Generally, an increase in the amplitude of the current corresponds to an increase in the intensity (e.g., sound pressure level, or SPL) of the stimulated auditory sensation. These different current flow direction signals may be configured to produce sound perceptions from different locations relative to the head 112 of the subject 16. For example, using two electrodes such as 1143 and 1147 placed adjacent to the right and left mastoids of subject 16, respectively, a stimulation signal applied with a current flow direction from right to left (e.g., a first direction from anode to cathode) will generate a sound perception on the subject's right side, and a stimulation signal applied with a current flow direction from left to right (e.g., a second direction from anode to cathode) will generate a sound perception on the subject's left side. By this approach, two electrodes are used as both an anode and a cathode for different, e.g., consecutive, time periods. In other embodiments, these multiple current flow direction signals can be provided, e.g., simultaneously, by using four electrodes (e.g., one anode and one cathode at each of two locations). Stimulation routines using other combinations of electrical stimulation electrodes and / or different (e.g., first and second) directional current flow electrical stimulation signals can be configured to generate the expected perception of hearing from any of a wide range of source directions or locations relative to the head 112 of subject 16. For example, the electrical stimulation signals may be configured to primarily stimulate auditory perception in one or more of a first or right side, a second or left side, an anterior side, a posterior side, an posterior side, an posterior side, an posterior side, an posterior side, or ...

[0046] The electrical stimulation routine may be configured to generate electrical stimulation signals that provide perceptions corresponding to different types or qualities of sound, such as, for example, one or more of a tone, a range of tones, speech, or background noise. The electrical stimulation signals may be configured to provide perceptions corresponding to a wide range of amplitudes or intensities. For example, the intensity may increase or decrease. As another example, the electrical stimulation routine may be configured to provide each of a plurality of different types of qualities in sound occurring at each of a plurality of different locations, including moving locations, over a wide range of amplitudes or intensities, including levels below the threshold perceptible to the subject and levels above the threshold perceptible to the subject. For example, the electrical stimulation signals may be configured to increase or decrease in intensity as the frequency of the sound changes (e.g., increases or decreases). Any changing or dynamic characteristics of the perceived sound (e.g., source, type of sound, and / or intensity) may be set or predetermined by stored data characterizing the electrical stimulation routine, or may be controllable by the operator, for example, through use of the user interface 210.

[0047] Similarly, bone conduction stimulation routines and air conduction stimulation routines may include routines for generating bone conduction stimulation signals and / or air conduction stimuli configured to provide one or more different types of predetermined or expected perceived auditory sensations in the subject 16 for purposes of diagnosing the subject's perceived hearing abilities and limitations. In connection with these different types of bone conduction stimulation routines and air conduction stimulation routines, the routines may generate stimulation signals configured to be applied to stimulation transducers at one or more locations on the head 112 of the subject 16. The bone conduction stimulation and air conduction stimulation may be configured to generate sound perceptions from different locations relative to the head 112 of the subject 16. For example, a bone conduction stimulation signal applied to the transducer 116 of the headset 110 may generate a sound perception from a location along the medial midline 124 of the head 112 of the user 16 (e.g., in front of or above the user's head). When using a headset such as 110', the bone conduction stimulation can be configured to generate sound perceptions from locations on different sides of the head 112 of the user 16 (e.g., different sides of the medial midline 124) by controlling characteristics such as the relative amplitude or level and phasing of the bone conduction stimulation signals applied to the transducers 1161' and 1162' on either side of the user's head. For example, the bone conduction stimulation signal may be configured to primarily stimulate auditory perceptions on one or more of a first or right side, a second or left side, or an anterior side of the head 112 of the subject 16. Similarly, the air conduction stimulation signals applied to transducers 1181 and 1182 or 1181′ and 1182′ may be configured to generate sound perceptions from different locations relative to the head 112 of the subject 16, such as, for example, different sides of the head 112 of the user 16 (e.g., different sides of the medial midline 124), by controlling characteristics such as the relative amplitude or level and phasing of the air conduction stimulation signals applied to the transducers on either side of the user's head. For example, the air conduction stimulation signals may be configured to primarily stimulate auditory perceptions on one or more of a first or right lateral side, a second or left lateral side, or an anterior side relative to the head 112 of the subject 16.The bone conduction stimulation routine and / or the air conduction stimulation routine may be configured to generate the perception of a static or stationary source of perceived hearing and / or the perception of a dynamic or moving source of perceived hearing.

[0048] The bone conduction stimulation routine and the air conduction stimulation routine may be configured to generate stimulation signals that can be expected to provide perceptions corresponding to different types or qualities of sound, such as one or more of a tone, a range of tones, speech, or background noise. The bone conduction stimulation signal and the air conduction stimulation signal may be configured to provide expected perceptions corresponding to a range of amplitudes or intensities. For example, the intensity may increase or decrease. As another example, the bone conduction stimulation routine and / or the air conduction stimulation routine may be configured to provide each of a plurality of different types of qualities in sound occurring at each of a plurality of different locations, including moving locations, over a range of amplitudes or intensities, including levels below the threshold perceptible to the subject and levels above the threshold perceptible to the subject. Any desired changing or dynamic characteristics of the perceived sound (e.g., source, sound type, and / or intensity) may be set or predetermined by stored data characterizing the bone conduction stimulation routine or the air conduction stimulation routine, or may be controllable by the operator, for example, through use of the user interface 210.

[0049] In response to using audiometer 12 to stimulate the perceived hearing of subject 16 via stimuli provided by a test routine in a test mode, the subject can provide information describing or characterizing the hearing or sound perceived by the subject. The information provided by subject 16 can characterize, for example, the nature of the perceived hearing (e.g., whether it is a tone, a broad tone, speech, or background noise), the level or intensity of the perceived hearing, or the location of the source or origin of the perceived hearing (e.g., left or right, front, back, above or below, and / or whether it is moving). For example, the subject can identify when the perceived hearing of the stimulation routine crosses a threshold intensity level from imperceptible to perceptible. As described above, perceived hearing information can be received, for example, directly from the subject (e.g., via subject response input 214) or indirectly (e.g., verbally from the subject to an operator of audiometer 12, by the audiometer operator inputting response hearing information via user interface 210). Auditory information provided by subject 16 may be stored in subject response storage 212. In an embodiment, the subject-response auditory information is stored in association with, or registered with, corresponding information describing characteristics (e.g., nature, intensity, location) of the stimulus that generated the auditory information.

[0050] Embodiments of audiometer 12 are configured to generate an audiometric test report or other information characterizing the auditory information stored in subject response storage 212. The audiometric report may include information describing relevant characteristics of the stimuli that resulted in the auditory information from subject 16. For example, the audiometric report may be presented to a clinician or other user via user interface 210. Additionally or alternatively, the audiometric report may be communicated (e.g., via a wired or wireless communication interface) to a peripheral device, such as a monitor, printer, or mobile device, for review.

[0051] The audiometer 12 and audiometric test reports, such as those described above, can be used by a clinician or other user to evaluate the user's 16 auditory system and determine the nature and / or extent of any limitations in the user's auditory system. For example, a clinician can determine the level of hearing loss and / or the location of the disorder (e.g., whether the hearing loss is caused by a structural or other condition, disease, or damage to the middle and / or inner ear). Diagnosis can be performed according to any of several different applications. Such applications include, but are not limited to, electrical speech and music perception using hearing protection, noise cancellation using earphones, frequency-filtered speech for improved speech perception, and comparison of electrical conduction and air conduction thresholds to determine the location of the lesion. These and other diagnoses can be performed with improved ranges over conventional single-mode and / or single-channel diagnostic techniques. Suppression of tinnitus with electrical stimulation and ototoxicity monitoring at relatively high frequencies up to 20 kHz can be performed. To assess asymmetric hearing loss, for example, tone and speech lateralization can be used. The value of multiple stimulation modes, such as a combination of electrical stimulation with either or both bone conduction and / or air conduction stimulation, can be assessed for purposes such as speech enhancement. Hearing aid functional gain testing for cochlear loss can be performed, for example, in a portable manner. The ability to vary the timing and level of stimulation across multiple channels and / or modes enhances the type and effectiveness of diagnoses that can be made. Sound perception from a wide range of locations around the subject's body can be assessed. Enhanced central hearing tests can be performed that evaluate temporal integration and masking by manipulating the interaction of time and intensity.

[0052] For example, audiometer 12 may be used in applications to assess perceived hearing when a user's air-conduction hearing is attenuated or masked, such as by hearing protection (e.g., earplugs or earmuffs) or in response to air-conduction noise cancellation (e.g., as provided through headphones). While the subject's 16 air-conduction hearing is attenuated, electrical and / or bone-conduction stimuli may be applied to the subject. The electrical and / or bone-conduction stimuli may have the properties of, for example, speech or background noise, and the frequency and / or intensity of the stimuli may be varied (e.g., independently). By applying these test routines and evaluating the auditory response information obtained from subject 16, a stimulus modality and characteristics that provide the subject with optimized perception of speech or other desired sounds can be determined. Similarly, electrical and / or bone-conduction stimulus test routines may be applied to subject 16 while the subject is in a noisy environment (e.g., generated by an air-conduction stimulus test routine representative of a noisy environment). Auditory response information obtained from the subject 16 in response to the testing routines can be used to determine stimulus modalities and characteristics that will provide the subject with optimized perception of speech or other desired sounds in air-conducted, noisy environments. This determination can be made in a wide range of application environments, including quiet, noisy, and noise-cancelled environments. These types of applications can be performed with attenuation applied to one or both ears of the subject for lateralization-specific diagnosis or evaluation, such as in connection with the assessment of central auditory processing.

[0053] As another example, the responses of the subject 16 to various testing routines can be used to determine stimulation modalities and characteristics that minimize or otherwise reduce tinnitus in the subject 16, for example, when stimulation parameters such as current level and frequency affect the perception of tinnitus.

[0054] As another example, electrical testing routines can include multi-channel stimulation providing for varying the timing of stimuli between channels to provide complex auditory stimuli, for example for evaluation of the effects of stimulation on central auditory system disorders and lateralization of binaural and unilateral hearing loss.

[0055] As another example, sound may be delivered through speakers in the room rather than through earphones or head-mounted electrodes. 4 is a schematic diagram of an exemplary computer system 238 that may be used to implement the functional components of audiometer 12. The illustrated embodiment of computer system 238 includes a processing component 252, a storage component 254, a network interface component 256, and a user interface component 258 coupled by a system network or bus 259. Processing component 252 may include, for example, a central processing unit (CPU) 260 and a graphics processing unit (GPU) 262, which may provide processing functionality for test routine control 200 and stimulus generators 202, 204, and 206. Storage component 254 may include RAM memory 264 and hard disk / SSD memory 266, which may provide storage functionality for test routine storage 208 and subject response storage 212. For example, operating system software used by processing component 252 to implement the methods described herein may be stored by storage component 254. In embodiments, network interface components may include, for example, one or more web servers 270 and one or more application programming interfaces (APIs) 272 to provide the functionality of subject response input 214. Examples of user interface components 258 include a display 274, a keypad 276, and a graphical user interface (GUI) 278, which may provide the functionality of user interface 210, for example. Embodiments of computer system 238 may include other conventional or otherwise known components to implement methods according to embodiments described herein.

[0056] It is to be understood that the above description is intended to be illustrative, and not limiting. Many other embodiments will become apparent to those skilled in the art upon reading and understanding the above description. It is contemplated that features described in connection with one embodiment may optionally be used in addition to, or as a substitute for, features described in or associated with another embodiment. The scope of the invention should, therefore, be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.

Claims

1. 1. An audiometric method comprising: applying a first test electrical stimulus to the subject, the first test electrical stimulus being configured to stimulate an auditory perception in the subject; applying a second test electrical stimulus to the subject, the second test electrical stimulus being configured to stimulate an auditory perception in the subject and different from the first test electrical stimulus; receiving from the subject an identification of one or more characteristics of the perceived hearing produced by the first test electrical stimulus and the second test electrical stimulus, the one or more characteristics including a location of origin of the perceived hearing; and recording the one or more characteristics of perceived hearing identified by the subject in association with the first test electrical stimulus and the second test electrical stimulus.

2. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises applying the first test electrical stimulus and the second test electrical stimulus simultaneously.

3. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises sequentially applying the first test electrical stimulus and the second test electrical stimulus.

4. 2. The audiometric method of claim 1, wherein applying at least one of the first test electrical stimulus and the second test electrical stimulus comprises applying an electrical stimulus corresponding to one or more of: (1) a tone; (2) a broad tone; (3) speech; or (4) background noise.

5. applying at least one of the first test electrical stimulus and the second test electrical stimulus includes applying electrical stimuli corresponding to a wide range of intensities; 10. The audiometric method of claim 1, wherein receiving from the subject an identification of a characteristic of perceived hearing includes an identification of a threshold intensity at which the subject perceives hearing.

6. applying the first test electrical stimulus includes applying a stimulus configured to at least primarily stimulate hearing at a first side of the subject; 2. The audiometric method of claim 1, wherein applying the second test electrical stimulus comprises applying a stimulus configured to at least primarily stimulate hearing at a second side of the subject that is different from the first side.

7. applying the first test electrical stimulus includes applying the first electrical stimulus to a first lateral mastoid region of the subject; 7. The audiometric method of claim 6, wherein applying the second test electrical stimulus comprises applying the second electrical stimulus to a second lateral mastoid region of the subject.

8. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises applying electrical stimuli corresponding to a source of hearing perceived at a first side of the subject.

9. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises applying electrical stimuli corresponding to a source of hearing perceived at a second side of the subject.

10. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises applying electrical stimuli corresponding to a source of hearing perceived in front of the subject.

11. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises applying electrical stimuli corresponding to a source of hearing perceived at the back of the subject.

12. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises applying electrical stimuli corresponding to a source of hearing perceived on the subject.

13. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises applying electrical stimuli corresponding to a source of hearing perceived by the subject.

14. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises applying electrical stimuli corresponding to stationary sources of perceived hearing.

15. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises applying electrical stimuli corresponding to a moving source of perceived hearing.

16. The method further comprises: applying at least a third test electrical stimulus to the subject, the third test electrical stimulus being different from the first test electrical stimulus and the second test electrical stimulus; receiving from the subject an identification of perceived auditory characteristics produced by the first test electrical stimulus, the second test electrical stimulus, and the third test electrical stimulus; and recording the characteristics of perceived hearing identified by the subject in relation to the first test electrical stimulus, the second test electrical stimulus, and the third test electrical stimulus.

17. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises applying the first stimulus and the second stimulus with a timing change between the first stimulus and the second stimulus.

18. 2. The audiometric method of claim 1, wherein applying the first test electrical stimulus and the second test electrical stimulus comprises applying at least one of the first test electrical stimulus and the second test electrical stimulus corresponding to increasing intensity with changing frequency.

19. applying one or more of a test bone conduction stimulus to the subject, the test bone conduction stimulus configured to stimulate an auditory perception in the subject, or a test air conduction stimulus to the subject, the test air conduction stimulus configured to stimulate an auditory perception in the subject; receiving from the subject an identification of perceived hearing characteristics produced by one or more of the first test electrical stimulus, the second test electrical stimulus, the test bone conduction stimulus, and the test air conduction stimulus; and recording the characteristics of perceived hearing identified by the subject in association with one or more of the first test electrical stimulus, the second test electrical stimulus, and the test bone conduction stimulus or the test air conduction stimulus.

20. applying the first test electrical stimulus and the second test electrical stimulus includes: applying a stimulus to at least primarily stimulate hearing at a first side of the subject; and applying a stimulus to mask hearing at a second side of the subject, the second side being different from the first side, produced by the stimulus at the first side of the subject.

21. 10. The audiometric method of claim 1, further comprising attenuating the subject's air-conduction hearing while performing the method.

22. 22. The audiometric method of claim 21, wherein attenuating air-conducted hearing comprises applying earplugs, earmuffs, or other physical sound-attenuating structures to one or both ears of the subject.

23. 22. The audiometric method of claim 21, wherein attenuating air-conducted hearing comprises applying attenuated air-conducted stimuli to one or both ears of the subject.

24. 10. The audiometric method of claim 1, wherein the method is performed while the subject's ears are protected from ambient sounds, for example by earmuffs, earplugs, or noise cancellation.

25. 10. The audiometric method of claim 1, used to diagnose tinnitus.

26. 10. The audiometric method according to claim 1, which is used to diagnose a lesion in the subject's ear organ, for example the outer ear, middle ear, or inner ear.

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