A

N
S
I

S
3
.
2
1
-
1
5
7
6

(
A
S
A

1
5
-
1
5
7
1
)

AMERICAN
NATIONAL
STANDARD
Methods for
Manual Pure-Tone
 Threshold
Audiometry

Standards Secretariat
Acousti
cal
Society
of
Americ
a 335
East
45th
Street
New York, New York 10017

Published by the American Institute of Physics for the Acoustical Society of America
AMERICAN NATIONAL STANDARDS ON ACOUSTICS
Thr .14.0m.50ca.: Society of America is the Secretariat
for American National Standards Corn- mores
St ,Dri Pi-n,sical Acoustics, S2 on Mechanical
Shock and Vibration, and S3 on Bio- acoustics
Standards developed by these committees, which
have wide representation from ihe tectinical
community (manufacturers, consumers, and
general-interest representatives Alm. are
published by the Acoustical Society of America
as American National Standards after approval by
its standards committee.
These standards are developed as a public service
to provide standards useful to the public, industry,
and consumers, and to Federal, State, and local
governments.

This standard was approved by the American

National Standards Institute as ANSI 53.21-1978
on 7 June 1978.

An American National Standard implies a consensus of those substantially concerned with its scope
and provisions. An American National Standard is
intended as a guide to aid the manufacturer, the
con-sumer, and the general public. The existence
of an American National Standard does not in any
respect preclude anyone, whether he has approved
the standard or not, from manufacturing, marketing-
purchas-ing, or using products, processes, or
procedures not conforming to the standard_
American Nation Standards are subject to periodic
review and users are cautioned to obtain the latest
editions.

Caution Notice: An American National Standard may be revised or withdrawn at any time. The proce-
dures of the American National Standards
Institute require that action be taken to reaffirm,
revise, or withdraw this standard no later than
five years from the date of publication.
Gov.-Apt ,'F7: r 9-8 Accasinca 5ocletv of Atnerica.No portion of this publication may be quoted
or reproduced 11, ors *arr. iodout p..-Tioission of the Acoustical Society of America.
FOREWORD
1-N. Foreword a not a part of American National Standard Methods for Manual Pure-Tone Threshold Audiometry,
S3.21-1978]
This Standard has been developed under the jurisdiction of American
sing
National Standards Committee 53 u the American National
mittee Procedure. The
Standards Institute (ANSI: Standards Com
Acoustical Society of
America holds the Secretariat for Committee S3.
n by ANSI and
This standard has been approved for publicatio by the
Acoustical Society of America Committee on Standards (ASACOS).
This American National Standard presents procedures for
accomplishing manual hearing-threshold measure-ment with pure
tones that are applicable in a wide variety of settings. No standard
sly
has previou existed. This standard is meant to provide a
procedure of pure-tone audiometry that will serve the needs of
rsons
pe conducting threshold measurements in industry, schools,
ork
medical settings, and other areas who wish to w from a
baseline model in the conduct of their tests. Although the standard
has been written to aid in the accomplishment of a measurement,
it is appropriate to point out that it differs from other measurement
tech-niques in that it deals with human behavior. Rigid adherence to
the procedure in every circumstance will not necessarily produce
effective results. Certain individuals such as infants, children with
severe physical and mental retardation, highly uncooperative
ly
persons, those with central nervous system disorders, many elder
persons, and numerous other members of SOCifly who fall into
special groups will not be good subjects for the standard procedure and
will necessitate a variety of modifications. In any instance where
response behavior is apt to veer from the usual, the procedure
should be modified; however, the modification shall be read ily
identified and specified by the user. Another kind of modification
is exemplified as follows: The user of the standard who functions
in a work setting which requires monitoring audiometry or diagnostic
audiometry will use instrumentation which pertains to that particular
setting and the frequencies at which threshold is measured will be
dictated by that situation. The choice of frequencies will depend on
the purpose for which the proce-dure is being used.
American National Standards Committee S3,,under whose
jurisdiction this standard was developed, has the following scope:
Standards, specifications, methods of measurement and test, and
fields of psychological and
terminology in the
acoustics, including aspects of
physiological
general acoustics, noise, shock, and vibration which pertain to
biological safety, tolerance, and comfort.

At the time this standard was submitted to Standards

Committee S3 for approval, the membership was as follows:
W. Melnick, Chairman W.A. Yost, Vice-Chairman A. Brenig, Secretary

Acoustical Society of America W. Melnick, W.A. Yost Environmental Protection Agency (Raison)
R Marrazzo
American Academy of Ophthalmology and Air Conditioning and Refrigeration Institute A.C.
Otolaryngology Potter, R.J.
R.F. Naunton, L.A. Michael (Alt) Evans (Alt)
American Conference of Governmental Food and Drug Administration
Industrial tiiiiienists (Mallon) M Gluck Hearing Aid
industry Conference, Inc. W.G.
Home Ventilating Institute J W
Harper. V.
Ikaimpois cAtit
Medical Association J. SamiosT. H
industrial Schulz It&
Safety Equipment Association. klir- F LAXINCL t
Industrial
D. C. Gasaway Campbell (Alt), F.E. Witcher (At,
Association of Home Appliance Institute of Electrical and Electronics Engineers -4 Sohoger
Manufacturers (representa- J.D. Griffiths (Alt), W.D. O'Brien. Jr. JAE)
tion vacant)
American Industrial Hygiene Motor Vehicle Manufacturers Association P E
Kooiman (Alt)
Association P.L. Michael, T.B. National Bureau of Standards E.L.R. Corks, F R &vote,-
Bonney (Alt) ridge (Alt)
American Insurance Association National Electrical Manufacturers Association R.J.tseia B
M.W. Blachman American Iron and Steel Moreland (Alt)
Institute E.H. Toothman, J.B. Masaitis National Hearing Aid Society W.F.S. Hopmeier, C.A. Murdock
(Alt)
American Mutual Insurance A.L.
Cudworth
American Otological Society, Inc. 1.
Tonndorf
American Petroleum Institute W.R. Thornton, W. Ward (A/t) (Alt)
American Society of Heating, Refrigerating, Society of Automotive Engineers, Inc. R.N. Janeway,R.K. Hilt-
and Air Condition- quist, W.). Toth (Alt)
ing Engineers P.K. Baade, N.A. LaCourte Telephone Group L.A. Strommen, L.A. Berry (Alt)
Ultrasonics Industry Association E.). Murray
(AM
American Society for Testing and U.S. Army Medical Corps Major R.K. Sedge
Materials R.M. Guernsey, R. U.S. Army Human Engineering Laboratory G.R. Price, D.C.
Huntley (Alt), J.A. Thomas (.411)
American Society of Mechanical
Engineers D.K. Van Zile, S.I.
Roth (A /1)
American Speech and Hearing Association L.E. Feth Hodge (Alt)
Audio Engineering Society R. U.S. Army Electronics Command H.S. Bennett
Campbell, M.R. Chial (Alt) Canadian Standards U.S. Department of the Air Force H.E. von Gierke, C. Nixon
Association (liaison) T.D. Northwood, B. (Alt)

Electric Light and Power Group W Department of Housing and Urban Development G.E.
U.S.
Brownlee (A/t)

C.E. Hickman, J.P. Markey (Alt) Electronic

Industries Association F.X. Worden, W.W. i
Lang (Alt) n
t
e
r,
R
.
H
.
B
r
o
u
n
(
A
lt
)
ii
i
US. Department of the Interior, Bureau of Mines A. Goodwin U.S. Department of the Navy, Naval Sea
Systems Command
US Deiparbment of Transportation J.E. Wester J.R. Ruff
U.S. Department of the Navy, Bureau of Medicine and Sumery U.S. Public Health Service R.D. Willson,
D. Wasserman tAki
113 Karns U.S. Department of LaborOSHA D. Lee

Individual Members of the S3 Committee were

L Batchelder R.S. Gales W. Koidan S.F.

Lybarger
W Benson W.J.Galloway Kryter G.
Studebaker
H. Davis E.E. Gross, Jr. W.W. Lang H.E. von
Gierke
K.M. Eldred I.1. Hirsh H. Levitt R.W. Young

The 53-W-35 Task Force on Pure-Tone Audiometry, which developed this standard, had
the following
personnel:

Norma T. Hopkinson, Chairwoman

Rufus L. Grason Juergen Tonndocf
Paul L. Michael Laura A. Wilber
Ralph F. Naunton Wesley R. Wilson

Suggestions for improvement gained in the use of this standard will

the
be welcomed. They should be sent to Standards Secretariat,
Acoustical Society of America, 335 East 45th Street, New York, NY
10017.
iv
 CONTENTS

1 SCOPE

1
1.1 Purpose of standard

1
1.2 Limit of standard

1
1.3 Modifications of standard procedures

1
1A Source

2 DEFINITIONS
2.1 Air conduction
2.2 Bone conduction
1
2.3 Threshold of hearing
1
2.4 Reference equivalent threshold sound pressure level
1
2.5 Otologically normal subject
1
2.6 Hearing level for pure tones
1
2.7 Masking
1
2.8 Effective masking
2
2.9 Manual pure-tone threshold audiometry
2.10 Screening audiometry
2.11 Pulsed tone

2
2.12 Warble tone

2
2.13 Audiogram

2
2.14 Pure-tone audiometer

2
3 GENERAL REQUIREMENTS

2
 3.1 Ear canal

2
3.2 Earphone placement

2
3.3 Instructions

2
3.4 Response task

2
3.5 Interpretation of response

2
4 DETERMINATION OF THRESHOLD

3
4.1 Familiarization procedure

_.3
4.2 Determination of threshold

3
5 STANDARD PROCEDURES FOR AIR-CONDUCTION MEASURES

3
5.1 Test environment

3
5.2 Instrumentation and calibration

3
5.3 Frequency

3
5.4 Order

3
5.5 Masking in air-conduction audiometry

3
5.6 Recording of results

4
6 STANDARD PROCEDURES FOR BONE-CONDUCTION MEASURES IN
DIAGNOSTIC
AUDIOMETRY

4
6.1 Instrumentation

4
6.2 Calibration
4
6.3 Vibrator placement

4
6.4 Covering of ears

4
6.5 Frequencies
4
6.6 Order

4
6.7 Masking

4
6.8 Recording of results

4
7 REN 5 Cos OF AMERICAN NATIONAL STANDARD SPECIFICATIONS REFERRED TO IN
THIS
DOCL MENT

4
-.7 General

4
APPENDIX A

4
APPENDIX B

6
REFERENCES

6
vi
American National Standard
Met
hod
s
for
Ma
nual
Pur
e-
Ton
e
Thr
esh
old
Aud
iom
etry
1. SCOPE threshold au-diometry. Hearing screening
1.1 Purpose of standard techniques are outside its purview.

Pure-tone threshold audiometry 1.3 Modifications of standard

is the procedure used in the
assessment of an individual's
of
threshold hearing for pure tones.
Pure-tone threshold audio-metry
includes manual air-conduction
measurements at octave intervals
from 250 through 8000 Hz and at
intermediate frequencies as needed.
When abrupt dif-ferences of 20 dB
or more occur between adjacent oc-
tave frequencies, additional
frequencies may be includ-ed at the
discretion of the tester. Bone-
conduction measurements may be
carried out if indicated by the test
requirements at octave intervals
from 250 through 4000 Hz. Also,
when required, masking is to be
used. The purpose of this standard
is to present procedures For
conducting manual pure-tone
threshold audio-metry whose uses
will minimize intertest differences
based on test method.
1.2 Limit of standard
This standard is limited to a
description of the mea-surement
method of manual pure-tone
procedures
The procedures described in this standard
are us-able in a wide variety of circumstances.
However, cer-tain individuals, such as young
children, mentally re-tarded
persons, uncooperative
persons, or neurologically
handicapped persons may require
modifications of the procedures. If so, the
modifica-tions shall be noted in the
reporting of results.
1.4 Source
The procedures detailed in this standard
are adapt-ed from those described in the
Draft Guidelines for Manual Pure-Tone
Audiometry (Wilson et al. 19740 and the
Guidelines for a Training Program for Audio-
metric Technicians (NASNRC, 1973).
2. DEFINITIONS
NOTE: Standard definitions have been used where
they exist (ANSI Standard S3.20-1973).
2.1 Air conduction
Air conduction is the process by which
so.)1d is conducted to the internal ear
through the air in the external acoustic
meatus (ear canal) as part of the pathway.
2.2 Bone conduction
 Bone conduction is the process
by which sound is conducted to
the internal ear through the
cranial bones.
1
2.3 Threshold of hearing
The threshold of hearing for
a specified signal is the
minimum effective sound
pressure level of the signal that
is capable of evoking an
sation in a
auditory sen specified
fraction of the trials. The
characteristics of the signal, the
manner in which it is presented
to the subject, and the point at
re lev-
which the sound pressu el
is measured must be specified.
NOTE 1: Unless otherwise
indicated, the ambient noise reach
the cars is assumed to be negligible.
NOTE 2: The threshold of
audibility is usually gives as a soma
pressure level in decibels, relative to 20
IAN/tu'_
NOTE 3: Instead of the
method of constant stank. Irkaek n
implied by the phrase "a specified
fraction of the trials.' w eber
psychophysical method (which
should be specified) may be
employed_
2.4 Reference equivalent
threshold sound pres-sure
level
The reference equivalent
threshold sound pressure level
is the modal value, at a specified
frequency, of the equivalent
threshold sound pressure levels
of an ade-quately large number
of ears of otologically normal
subjects within the age limits of
18-30 years inclusive_
NOTE 1: The equivalent threshold
sound pressure level for mon-otic
earphone listening is the sound
pressure level set up by the specified
earphone at a specified frequency in a
specified artificial car or coupler
when the earphone is actuated by a
voltage that would correspond to the
threshold of audibility, if the
earphone were applied to the ear
concerned.
NOTE 2: The values for are
conduction of refereoce equivalent
threshold sound pressure levels are
specified in ANSI Standard
53.6-1969.
NOTE 3: The values for bone
conduction of reference equivalent
threshold vibration levels are
specified in ANSI Hearing level (HL) of a
Standard S3 II, 1972.
given ear (for a pure tone) at a
2.5 Otologically normal subject specified frequency is the
equivalent threshold sound
An otologically pressure level for that ear
normal subject is a minus the reference equivalent
person in a nor-mal threshold sound pressure level.
state of health who is
free from all signs or 2.7 Masking
symp-toms of ear Masking is the process by
disease and from which the threshold of
occlusive was in the audibility for a signal is raised
ear canals and has no by the presence of a second
history of undue sound. Masking is used in
exposure to noise. manual pure-tone threshold
2.6 Hearing level for pure tones audiometry, when necessary, to
exclude the nontest ear.
2 AMERICAN NATIONAL STANDARD

2.8 Effective (2) The earphone

masking
Effective masking occurs
when the masker is just strong
enough to prevent the test subject
from hearing the test stimulus
when stimulus and masking
signals are presented
simultaneously to the same earl,
2.9 Manual pure-tone
threshold audiometry
should be centered over
the ear and its position
should be adjusted by test
ct
subje
2.14 Pure-tone audiometer
An electroacoustical generator
which provides pure tones of selected
frequencies and of calibrated output
(ANSI Standard S3.6-1969).
3. GENERAL REQUIREMENTS
3.1 Ear canal

Manual pure-tone threshold The ear canal opening shall be

audiometry is the mea-surement of inspected for block-age by cotton or
other foreign objects and to recognize
an individual's threshold of
soft-walled canals that may "collapse"
hearing for pure tones in which
with or without earphones.
the signal presentations, frequen-
cies, and levels are controlled NOTE: Collapse of canal if suspected may
manually by the person be obvited by plac-ing a small rigid sound
administering the test. conducting nipple into the Opening of the
canal before the test and removing it
2.10 Screening audiometry afterwards; the maneuver should be noted on
the audiogram form.
Screening audiometry is a
method of testing in which a
selected hearing level is held 3.2 Earphone placement
constant while frequency is
(1) Earphones should be held
varied. Screening audiometry in place by a
separates test subjects into only headband.
two groups, those who respond at
or below a certain hearing level,
and those who do not.

2.11 Pulsed tone

A pulsed tone is a tone which is

pulsed automatical-ly by the
audiometer during stimulus
presentation.

2.12 Warble tone

A warble tone results from

frequency modulation, usually in
a sinusoidal pattern, above and
below the test-tone frequency.

2.13 Audiogram

The audiogram is the graphic

representation of the results of a
pure-tone threshold audiometric
test.
for most comfortable Overt responses are required
listening (or loudest signal) from the test subject to indicate
at 250 Hz. when he hears the tone go on
and off; any response task
(3) The space under meeting this criterion is
uld be
the earphone sho acceptable. Ex-amples of
clear of long hair, glasses, commonly used responses are
hearing aids, and other (1) raising and lowering the
obstacles. finger, hand, or arm, and (2)
3.3 Instructions press-ing and releasing an
indicator-light switch.
The instructions shall be
phrased in language ap- 3.5 Interpretation of response
propriate to the test subject. The primary parameters
The subject shall be told used in determining threshold
that smoking and gum are presence of on and off
chewing interfere with the responses, latency of responses,
test and are not allowed. and number of false responses.
(1) Indicate the 3.5.1 On response and off response
purpose of the test
Each suprathreshold
to find the faintest presentation should elicit two
tone that can be responsesone at the start and
heard. one at the end of the test tone.
(2) Indicate the need 3.5.2 Latency of response
to respond whenever The latency of the on
the tone is heard, no response varies usually with the
matter how faint it may
level of presentation. The first
be.
response to a test tone in an
(3) Indicate the need ascending series may be
to respond overtly as hesitant, but the response to a
soon as the tone test tone presented 5 dB higher
comes on and also to should be without hesitation.
respond
overtly immediately when the tone goes 3.5.3 False responses
off.
False responses may be of
(4) Indicate that two types: (1) a response when no
each ear is to be tone is presented (false positive)
tested separately. or (2) fail-ure to respond on
presentation of a tone which
3.4 Responset ask the tester believes to be audible
to the test subject (false
I ANSI
3
negative). Either type complicates the measurement
procedure. Reinstruction may reduce the occurrence
rate of either type.

4. DETERMINATION OF
THRESHOLD
4.1 Familiarization
procedure
4.2.5 Threshold of hearing

The method described is considered

the standard procedure for manual pure-
tone threshold audiometry.

4.2.1 Tone duration

Threshold exploration is carried out

The test subject shall be by presenting tones of 1-2-s duration.
familiarized with the listen-ing task 4.2.2 Interval between tones
by a signal presented at 1000 Hz at
estimated hearing level such as to The interval between successive
evoke a prompt and clear re- presentations shall be varied, but shall
sponse. One of the following not be shorter than the test tone.
methods should be used: 4.2.3 Level of first presentation
(1)Beginning with the The level of the first presentation of
tone continuously on but tone for thresh-old measurement is 10 dB
completely attenuated, below the level at which the test subject
gradually in- responded during the familiarization
ert-115r the sound procedure.
pressure level of the tone
4.2.4 Levels of succeeding
until a response occurs.
presentations
Switch the tone off for
at least 2 s and present The level of succeeding presentation is
it again at the same 'etctermined by the preceding response.
level. If there is a second After each failure to re-spond to a
response pro-ceed to signal, the level is increased in 5-dB
threshold steps until the first response occurs. After
measuurreermneenntt.. If the response, the intensity is decreased
there is no second 10 dB and another ascending se-ries is
response, repeat the begun.
familiariza-tion
procedure_

(2 )Present the tone at a

hearing level or 30 dB. If
a clear response occurs,
commence
threshold med,i s_ _ .
1.aait. If no response oc-
curs,- preselii-i ne
at 50 dB HL and at
successive additional
increments of 10 dB
until a response is
obtained.

Familiarization is
preliminary
to cileshold
determination.

4.2 Determination of
threshold_,w,
 Threshold is defined as purposes for which the
the lowest hearing level procedure is being used.
at
which responses occur
in at least one-half of a 5.4 Order
series of ascending trials,
with a minimum of two When appropriate
responses oat of three information is available, the bet-
required at a single level_ ter ear shall be tested first. The
If variation oc t limits frequency of the first test
must be set as noted in stimulus shall be 1000 Hz.
Appendix if Higher frequencies shall then
be assessed in ascending order
followed by a retest of 1000 Hz,
5. STANDARD and finally the lower test
PROCEDURES FOR frequen-cies, 500 and 250 Hz,
MR-CONDUCTION shall be tested. If the retest re-
MEASURES sults of 1000 Hz differ from
the first test by more than 5
5.1 Test errvtronment dB, the lower of the two
thresholds may be accepted
The test environment
and at least one other test
shall meet the matt
frequency should be retested.
detailed in ANSI
Standard S3_1-1977
NOTE: Presentation order of
frequencies does not significantly
5.2 Instrumentation and calibration influence test results; the above order is
based on an arbitrary choice which will
Air-conduction
ensure consistency of approach to each
audiometry shall be test subject and minimize the risk of
a=mphshed with an omissions.
audiometer and
earphones that meet the
5.5 Masking in air-conduction audiometry
speci-ifcations of
American National When the air-conduction
Standard Specifica-tions hearing level obtained in one
for Audiometers S3.6- ear exceeds the apparent or
1969. obtained bone-conduc-tion
hearing level in the contralateral
5.3 Frequency (nontest) ear by
40 dB or more, masking shall be
Threshold
applied to the nontest ear. The
measurements shall be
type and magnitude of the
made at octave intervals
masking sound should be
from 250-8000 Hz and at
noted on the form on which the
intermediate fre-quencies
test results are recorded.
as required to satisfy the
NOTE: A standard for procedures in masking does not exist.
4 AMERICAN NATIONAL STANDARD

5.6 Recording of should be covered with an

results earphone for contralateral
masking.
Results shall be recorded in graphic or tabular form
or both, and separate forms to The bone-conduction vibrator is to be
represent each ear may be used. calibrated in the interim-threshold
5.6.1 Audiogram form calibration values (Appendix A, Table IV)
of the American National Standard
When the graphic form is used, Specifi-
the abscissa should be frequency ations for Artificial Head-Bone for the
on a logarithmic scale and the Calibration of Udiometer Bone Vibrators
ordinate should be hearing level in S3.13-1972 and should ncorporate the
decibels on a linear scale. It is appropriate calibration for ei-her mas-toid
recommended that 1 octave on the or frontal placement.
frequency scale be linearly
NOTE: In addition to this standard, one may
equivalent to 20 dB on the hearing use comparison values for other artificial mastoids.
scale. The vertical scale is to be (Wilber, 1972; Dirks and Kamm, 1975).
labeled: "Hearing Level in
6.3 Vibrator placement
Decibels (dB)"; the horizontal
scale is to be labeled: "Frequency Vibrator and support construction shall
in Hertz (Hz)." Conventionally, 21':I.ow mas-toid or forehead
normal hearing is at the top of the placement with appropriate
graph and hearing loss is plotted calibration.
downward. (See Appendix A.)
6.4 Covering of ears
5.6.2 Audiogram symbols
The test ear should not be covered
When the graphic form is used, for standard bone-conduction
the symbols pre-sented in measurements. The nontest ear
Appendix A are recommended for
use.

5.6.3 Other information

Other pertinent information

describing the test situ-ation
should be reported on the
audiogram form.

6. STANDARD
PROCEDURES FOR BONE-
CONDUCTION MEASURES IN
DIAGNK)STIC AUDIOMETRY

6.1 Instrumentation

The testing shall be

accomplished with a wide-range
audiometer as defined by the
American National Standard
Specifications for Audiometers
S3.6-1969.

6.2 Calibration
 6.5 Frequencies STANDARDS
Threshold should be SPECIFICATIONS
obtained at octave REFERRED TO IN THIS
intervals from 250-4000 DOCUMENT
Hz.
7.1 General
6.6 Order
When the following
The initial frequency tested shall be 1000 Hz American National Standards
which Specifications referred to in this
0
document are super-seded by a
2
0 revision approved by the
0 American Nation-al Standards
0 Institute, Inc., the revision shall
shall be followed by the
higher test frequencies apply:
and 4000 Hz) in
ascending order and (1) American National
finally. by the lower test Standard Specifica-
frequencies as for air tions for
conduction.
Audiometers, S3.6-
6.7 Masking 1969;

Since the threshold (2 )American National

values on which the Standard Specifica-
cabliratica of bone tions for Artificial
vibrators is based were Head-Bone for the
measured monaurally. Calibration of
i.e., with masking noise Audiometer Bone
in the contralateral ear. Vibra-tors, S3.13-
mask-ing should be used I972;
in the testing procedure
(3 )American
also.
National Standard
6.8 Recording of results Psychoa- coustical
Terminology, S3.20-
Results may be 1973; and
recorded in tabular or
graphic form, and (4)American National
separate graphic forms Standard Criteria for
may be used to represen t Permissible Ambient
each ear. The set of Noise during
symbols illustrated in Audiometric Testing, S3.1-1977.
Appendix A is
recommended for use
m APPENDIX A: AUDIOGRAM SYMBOLS'
with the graphic for
(audiogram)) .
Air-conduction symbols

7. REVISION OF The air-conduction symbols

AMERICAN should be drawn on the
NATIONAL audiogram so that the midpoint
of the symbol centers


ANSI S3.21-1978

on the intersection of the vertical air-conduction threshold is the

ruling and horizontal axis at the
appropriate hearing level.
Bone-conduction symbols
The bone-conduction symbols,
with one exception, should be
placed adjacent to, but not
touching, the frequency coordinate
ruling and centered vertik.ally at
the appropriate hearing level. The
symbol for the left ear should be
placed to the right of the vertical
ruling and that for the right ear to
the left of the vertical ruling. The
symbol for unmasked forehead
bone con-duction should be
centered on the vertical ruling at
the appropriate hearing level.
same as the right-ear air-
conduction threshold, the left
air-conduction sym-bol should
be placed inside the right air-
conduction symbol. When bone-
conduction thresholds (except
un-masked forehead bone
conduction) occur at the same
hearing level as air-conduction
thresholds, the bone-conduction
symbols should be placed
beside but not touching the
air-conduction symbols_ The
midliale bone-conduction
symbol in this circumstance
should be placed with the point
of the carat barely easy
the region of the air-conduction symbols.

When bone conduction is

Symbols representation measured at the snasticul with
Unless otherwise specified, unmasked and masked
symbols are to indicate that the test thresholds occurring it the same
signals used were pure tones. The hearing level, the unmasked
same symbols may be used for symbol should be placed
warble tones and narrow-band closest to the vertical ruling.
noise, if so noted on the The masked symbol should
audiogram. surround, but not touch the
unmasked symbol.
Multiple notation
, 'Modified from "Guidelines
When the two ears are being for Audiometric sym-bols"
represented on the same graphic (American Speech and
form and when the left-ear Hearing Association,
unmasked 1974).

No response

To indicate "no response" at the maximum output

AUDIOGRA /A CET

Rich. Latt
0 30
0 30
60
xs 10 60
10 40
40
70
rn
20
z 70
50
20 50
 80
80 AC

111

AC
..
A
BC

<

BC
Yub a

q
IdAsatme N ,

BC
! e r rand

-11
bla s tad

B
o
a

BC
Fors h.A
d
Unnusko
s

Dowd
rleld
L
anvin of
N
o Reep3aa.

90 By mt.!.

90

100 "ICD

100

110 I ' ''

110
125 250 500 1000
8000
2000 4000

FREQUENCY IN
HERTZ

(Hz)

FIG. 1. Recommended form of audiogram and

audiogram symbols.
 AMERICAN NATIONAL STANDARD
of the audiometer, an arrow
should be attached to the
lower outside corner of the
appropriate symbolzand drawn
downward and at about 45
degrees outward from the vertical
rulingto the right for left-ear
sym-bols and to the left for right-
ear symbols. The arrow for sound-
field or unmasked forehead bone-
conduc-tion symbols should be
attached at the bottom and drawn
straight downward.
left-ear symbols and connecting lines,
with a third color used for the "both
ears" symbols.
APPENDIX B: VARIABILITY OF
THRESH-OLD MEASURES
Upon retest, if a test subject shows
variable thresh-old, a limitation should
be set on the acceptable vari-ation. If the
responses do not fall within;-the limita-
tions, then the test subject should be
referred to an outside source since
special methods and greater time may be
necessary to obtain accurate results.

The "no response" symbol Several investigators have reported

should be placed on the standard devi-ations for air-conducted
audiogram at the Hearing Level signals of from 5 to 10 dB. If the
representing the maximum output audiometer in use has a 5-dB-step
limit for the particular test frequen- attenuator, 10 dB is considered the
cy, test modality and audiometer. outside limit, attributable to causes
other than hearing.
Separate forms
In a study of reliability of pure-tone
A separate graphic form may measures Har-ris (1946) concluded that
be used to represent each ear.
audiograms will be consis-
Lines connecting symbols
Lines may be used to connect
symbols on an audio-gram. When
used, a solid line should connect
the air-conduction threshold
values. Bone-conduction sym-bols
may be connected by a dashed line
when an air-
-bone gap exists. Symbols
representing "no reponse" for air
conduction or bone conduction
should not be connected to each
other or to any of the response
symbols.

Color coding
Color coding is not necessary to
transmit informa-tion about
sidedness in this symbol system. In
practice, it may be desirable to
avoid color coding because of the
increasing use of multiple-copy
audiograms and photoduplication
of audiograms. However, if color is
employed, red should be used for
the right-ear symbols and
connecting lines and blue for the
tent to at least 5 dB.
Reasonably low noise
REFERENCES
levels, co-operative test
subjects, and intelligent American National Standards
Institute (1973). American Na- tional
trained operators are
Standard Psychoacoustical Terminology
mandatory. The time S3.20-1973.
between test and retests
American National Standards
can affect consistency of
Institute (1970). American Na-tional
the results. In a five-year Standard. Specifications for Audiometers
study of persons not S3.6-I969.
exposed to damaging American National Standards
noise, Pell (1973) found Institute (1973). American Na-tional
some variation related to Standard Specifications for Artificial
Head-Bone for the Cali-bration of
aging, but a great deal of
Audiometer Bone Vibrators Si 13-1972.
variation arose from test
error and ran-dom American National Standards Institute
(1977). Criteria for Per-missible
fluctuations. If the variation
Ambient Noise during Audiometric
is always in the same Testing S3,1-197'.
direction of lower or higher
American Speech and Hearing
thresholds. then one Association (1974) Am. Speech Hear.
away attribute more Assn,-, "Guidelines for Audiometric
significance to a small Symbols."

shift_ Dirks, D.D. (1964)."Factors related

to bone conduction reli- ability," Arch.
Steinberg and Munson
Otolaryngol. 79, 551-558.
(1936) found armholes
re-lated to the fit of the Dirks, D.D., and Kamm, C.
(1975)"Bone-vibrator measure-ments:
earphone with standard
Physical characteristics and
dem ations of 5-7 dB. behavioral thresholds," J. Speech
The place and the Hearing Res. 18, 242-260.
method d mea-surement Harris, J.D.(1946). "Free voice and
may contribute to pure tone audiometer for routine testing
va.riabakity, Koneser. of auditory acuity," Arch. Otolaryngol.
44, 452-467.
under carefully controlled
conditions. My%:rs and Myers, C.K., and Harris, J.D. (1949).
Har-ris (1949) found less "The inherent stability of the auditory
threshold," Nay. Med. Res. Lab. Rep.
than 1 dB of sartability.
No. 3.
siren 1-dB steps of
attenuation were used NASNRC Publ. (1973). "Guidelines
for a Training Program for Audiometer
Bone-conduction Technicians," Rep. Working Group 66,
measurements were Committee on Hearing, Bioacoustics, and

studied for stability and Biomechanies.

found to have good Pell. S. (1973). "An evaluation of a

inherent test-retest hearing conservation pro-grama five
year longitudinal study." Am. Ind.
reliability similar to that
Hyg. Assoc. J. 82-91 (February).
of air conduction. For a
com-plete and detailed Steinberg. J.C., and Munson. W.A.
(1936). "Deviations in the loudness
discussion see Dirks
judgments of 100 people,- J. Acoust
(1964). Soc. As 8. -71-80.
 ;. ANSI S3.21-1978

Wilber, L.A. (1972). "Comparability of Two Commercially Schocny, Z.G., Byers, V.W., and
Hopkinson. NIT Assam-
Available Artificial Mastoids, J. Acoust. Soc. Am. 52, 1265-1266. can Speech and Hearing Association,"
Draft Guidelines for Iletowal
Pure-Tone Threshold Audiocnary.-
Wilson, W.R., Graham, J.T., Chaiklin, J.B., Sonday,
A
C
O
US
TI
C
AL
SO
CI
ET
Y
OF
A
M
ER
IC
A
ST
AN
DA
RD
S
SE
CR
ET
AR
IA
T
The Standards Program of the Acoustical
Society of America is the responsibility of the
ASA's Committee on Standards (ASACOS) and is
executed by ASA's Standards Secretariat headed by
its Standards Manager.

The Acoustical Society of America is the

Secretariat for three standards committees of the
American National Standards Institute (ANSI): Si
on Physical Acoustics, S2 on Mechanical Shock
and Vibration, and S3 on Bioacoustics, and is also
responsible for the international activities of
150/TC 43 on Acoustics, for which 51 and 53
serve as the technical advisory
groups. ASA also administers the international
secretariat of

150/TC

108 on Mechanical Vibration and Shock (on behalf

of the American National Standards Institute) and
provides the U.S. input via the technical advisory
group for 150/TC 108, which is Standards
Committee S2.

Standards are produced in three broad areas:

physical acoustics, mechanical shock and
vibration, and bioacoustics, and are reaffirmed or
revised every five years. The latest informa-tion on
current ANSI standards as well as those under
preparation is available from the Standards
Secretariat.

This standard, ANSI S3.21-1978 (ASA Catalog

No. 19-1978), is available at a single-copy price of
$7.00 prepaid (a handling charge of $2.00 is
required if payment does not accompa-ny
order). Make checks payable to the ASA
Standards Secretariat. When ordering ANSI
S3.21-1978, please also use ASA Catalog No. 19-
1978 for easy reference. This standard and other
standards listed in the ASA Standards Catalog
may be ordered from the following address:
B
a
c
k

N
u
m
b
e
r
s

D
e
p
a
r
t
m
e
n
t
,

D
e
p
t
.

S
T
D

A
m
e
r
i
c
a
n

I
n
s
t
i
t
u
t
e

o
f

P
h
y
s
i
c
s
335 East 45th Street
N
e
w

Y
o
r
k
,

N
e
w

Y
o
r
k

1
0
0
1
7

T
e
l
e
p
h
o
n
e
:

(
5
1
 6
)

6
8
1
-
3
1
3
0
0

If you wish to have further information on the

Standards Publication Program of the Acous-tical
Society, address your inquiries to

Standards Manager
Standards Secretariat
A
c
o
u
s
t
i
c
a
l

S
o
c
i
e
t
y

o
f

A
m
e
r
i
c
a

3
3
5

E
a
s
t

4
5
t
h

S
t
r
e
t
:
N
e
w

Y
o
r
k
,

N
e
w

Y
o
r
k

1
0
0
1

T
e
l
e
p
h
o
n
e
:

(
2
1
2
)

6
6
1
-
9
4
0
4