US20070135730A1 - Interpretive Report in Automated Diagnostic Hearing Test - Google Patents

Abstract

A multimedia user interface for an automated diagnostic hearing test allows a patient to interact with the automated hearing test in order to conduct various hearing related tests. The patient is given instructions and guidance for every test, and can call the operator at any time for help. Warning messages and progress indicators are provided to help the patient gauge his progress. This allows the patient to test his own hearing with minimal or no assistance from an audiologist or other hearing health professional. The user interface also allows the operator to configure and customize the automated hearing test as needed. The results of the hearing related tests are summarized in a single report that is concise, convenient, and thorough. The report may include interpretive comments that point out possible inconsistencies, asymmetries, or areas of concern in the test results and, where appropriate, also recommend certain types of medical treatment.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application claims priority to, and hereby incorporates by reference, U.S. Provisional Patent Application No. 60/713,538, entitled “Interpretive Report in Automated Diagnostic Hearing Test,” filed Aug. 31, 2005.
FIELD OF THE INVENTION
• This invention is directed in general to the field of audiology and in particular to a user interface for an automated method and system of assessing and analyzing hearing loss.
Description of the Related Art
• According to recent studies, over 20 million people in the United States alone have some degree of hearing loss. The number of people worldwide who have some degree of hearing loss is estimated to be much greater. Not surprisingly, many of these people are unaware that they have suffered a decrease in hearing capacity. The decreased hearing capacity may be due to several factors, including age, health, occupation, injury, and disease. This loss of hearing can lead to significant reductions in quality of life, impaired relationships, reduced access to employment and diminished productivity. Failure to treat the hearing loss may worsen the impact. According to the Better Hearing Institute, the annual cost in the United States in terms of lost productivity, special education, and medical care because of untreated hearing loss is approximately $56 billion. Much of this staggering cost can be reduced or prevented by early detection and treatment. Unfortunately, few people obtain regular and frequent hearing tests as a part of their routine healthcare due, in part, to the lack of a simple, convenient, and relatively inexpensive hearing test.
• Traditionally, a hearing test is conducted in a clinical setting by a hearing health professional, such as an audiologist, who administers the hearing test manually. The hearing health professional controls an audiometer to produce a series of tones that each have a very specific frequency and intensity. The term “intensity” as used herein refers to the amplitude of the tone and is usually stated in decibels (dB). The tones are then conducted through a transducer, such as earphones or ear inserts, to the patient in a quiet room or sound isolation booth. For each audible tone, the patient gestures or otherwise indicates that he has heard the tone. If the tone is not audible, the patient does not respond. The hearing health professional thereafter adjusts the intensity level of the tone in preset increments until it becomes audible to the patient. By repeating this process for several different tones and compiling the results, the hearing health professional is able to determine the extent of the hearing loss, if any.
• An advantage of having a hearing health professional manually administer the hearing test is the hearing health professional can apply his considerable training and experience during the test. For example, by simply talking to the patient and varying the loudness of his voice, the hearing health professional can determine an initial intensity level at which to start the tones. Furthermore, the hearing health professional can adapt the pace of the test as needed to accommodate a tired or uncooperative patient. More importantly, the hearing health professional can discern between false responses or guesses and responses that are legitimate. Finally, the hearing health professional can adjust the results of the hearing test as needed to reflect extenuating circumstances or problems, such as excessive ambient noise, equipment limitations, and other similar factors.
• Like most highly trained and specialized medical professionals, however, a hearing health professional's time and services are usually expensive. Accessibility and convenience may also be issues, as there are fewer hearing health professionals relative to other types of medical professionals. And while hearing health professionals are highly trained, they are limited in their ability to make rapid and accurate calculations of the test data and must rely on approximations and rules of thumb for guidance in many instances. In addition, few hearing health professionals in the United States can speak a foreign language. As a result, traditional hearing tests are almost always administered in English, which can present a problem for non-English speaking patients.
• Other drawbacks of the traditional, manually administered hearing tests include the need for a quiet room or sound isolation booth in order to properly conduct the tests. The quiet room or sound isolation booth has to comply with ANSI (American National Standards Institute) requirements in terms of how much noise may penetrate the room or booth during a test. Typically, a specially trained technician must evaluate and certify the quiet room or sound isolation booth as meeting ANSI standards before the room or booth can be used. At present, there are relatively few technicians who are trained to perform such evaluations and certifications. All the above factors combine to increase the complexity of the traditional hearing tests and thereby discourage or at least contribute to a general lack of interest by most people in obtaining regular and frequent hearing tests.
• One attempt to simplify the traditional hearing test involves the use of a computer network, such as the Internet, to administer the test. The computer network facilitates interaction between a centralized test administration site and remotely located patient sites. Such an arrangement makes it possible (or at least more convenient) for people in remote or rural areas to obtain a hearing test. And the hearing test can be performed so that it meets standardized guidelines such as ANSI requirements or certification standards. Despite the increased convenience, a hearing health professional must still manually administer the test, albeit remotely. In this regard, the test is very similar to the traditional hearing test and has many of the same shortcomings.
• Accordingly, what is needed is a hearing test that overcomes the shortcomings of the traditional hearing test. Specifically, what is needed is a hearing test, and a user interface therefor, that is simpler, more convenient, less expensive, can be administered by the patient instead of the hearing health professional, yet does not compromise the accuracy or thoroughness of the traditional, manually administered hearing test.
SUMMARY OF THE INVENTION
• The present invention is directed to a multimedia user interface for an automated diagnostic hearing test. The user interface allows a patient to interact with the automated hearing test in order to conduct various hearing related tests. The patient is given instructions and guidance for every test, and can call the operator at any time for help. Warning messages and progress indicators are provided to help the patient gauge his progress. This allows the patient to test his own hearing with minimal or no assistance from an audiologist or other hearing health professional. The user interface also allows the operator to configure and customize the automated hearing test as needed. The results of the hearing related tests are summarized in a single report that is concise, convenient, and thorough. The report may include interpretive comments that point out possible inconsistencies, asymmetries, or areas of concern in the test results and, where appropriate, also recommend certain types of medical treatment.
BRIEF DESCRIPTION OF THE DRAWINGS
• A better understanding of the invention may be had by reference to the following detailed description when taken in conjunction with the accompanying drawings, wherein:
• FIG. 1 illustrates an exemplary system for providing an automated hearing test according to embodiments of the invention;
• FIG. 2 illustrates a block diagram of a system having a user interface for an automated hearing test according to embodiments of the invention;
• FIG. 3 illustrates an exemplary user interface for an automated hearing test according to embodiments of the invention;
• FIG. 4 illustrates an exemplary implementation of a patient input component of the user interface according to embodiments of the invention;
• FIGS. 5A-5M illustrate an exemplary implementation of a system configuration component of the user interface according to embodiments of the invention;
• FIGS. 6A-6B illustrate an exemplary implementation of a tympanometry, acoustic reflex, and otoacoustic emission component of the user interface according to embodiments of the invention;
• FIGS. 7A-7B illustrate an exemplary implementation of a portion of a patient training component of the user interface according to embodiments of the invention;
• FIGS. 8A-8I illustrate an exemplary implementation of a patient testing component of the user interface according to embodiments of the invention;
• FIG. 9 illustrates an exemplary implementation of a patient management component of the user interface according to embodiments of the invention;
• FIGS. 10A-10F illustrate an exemplary implementation of a reporting component of the user interface according to embodiments of the invention; and
• FIGS. 11A-11C illustrate an exemplary hearing test report according to embodiments of the invention.
DETAILED DESCRIPTION OF THE INVENTION
• Following is a detailed description of the invention with reference to the drawings wherein reference numerals for the same or similar elements are carried forward. It should be noted that unless otherwise indicated, the design and layout of the various features shown in the drawings, including the size, shape, color (or lack thereof), location, and arrangement of the various fields, checkboxes, text boxes, graphics, and other information, are provided for illustrative purposes only, and the invention is not to be limited to any particular design or layout.
• As mentioned above, the present invention is directed to automated testing of a patient's hearing and, more specifically, to a user interface for such an automated hearing test. The term “automated testing” as used herein refers to testing that is performed primarily by a computer, as opposed to testing that is performed primarily by a hearing health professional. The user interface allows the patient to test his own hearing with minimal or no assistance from a hearing health professional. Typically, an operator, such as the hearing health professional or a trained administrator, helps the patient with the initial set up (e.g., seating, putting on the transducers, demonstrating button usage, etc.) and explains in general how the test works. Thereafter, the user interface instructs and prompts the patient through the remainder of the test.
• Patients will realize a number of benefits from the user interface of the present invention. In general, the user interface is an intuitive, user-friendly interface that makes the automated hearing test simple to use and provides for a more pleasant and enjoyable patient experience. In addition, the user interface has a “high-tech” look and feel that inspires confidence in the patient that he is using state-of-the-art technology that will produce more accurate results. Moreover, the user interface provides a clear and consistent voice that may be easier to understand than some hearing health professionals who may speak with an accent or whose speech may otherwise be difficult to understand. Finally, the user interface allows the patient to proceed with the hearing test at his own pace, since little or no assistance is needed from the hearing health professional.
• Referring now toFIG. 1, asystem100 is shown for providing automated hearing tests in which the user interface according to embodiments of the invention is used. Thesystem100 has three main components, namely, acomputer102, adisplay screen104, and at least onetransducer106. Other components of thesystem100 that may be present include a tympanometer, keyboard, mouse, printer, paging system, and the like (indicated generally at108). The paging system may be any suitable paging technology that uses one ormore pagers108 for alerting the operator. The one ormore pagers108 preferably can display text messages for informing the operator of the nature of the alert. Other types of paging system may also be used without departing from the scope of the invention (e.g., Internet based paging systems).
• Thecomputer102 may be any suitable computer, from a desktop PC to a high-end workstation, as the particular type/model/brand of computer is not overly important to the practice of the invention. Thedisplay screen104 may likewise be any suitable display screen, from a CRT to an LCD, as the particular type/model/brand of display screen is not overly significant for purposes of the present invention. In some embodiments, however, a touchscreen monitor may be easier to use than conventional CRT or LCD display screens in terms of the physical interaction between the patient and the automated hearing test.
• As for thetransducer106, this component may be an ear insert, earphones, and the like for air conduction testing. For bone conduction, thetransducer106 may be a vibrator or other similar devices. In some cases, thetransducer106 may be mounted on a headset worn by the patient. Usually, a separate transducer is used for air conduction versus bone conduction and the transducers are swapped as need during the hearing test. Preferably, the bone conduction transducer is arranged in such a way as to allow testing of either ear without moving the transducer and without interfering with the air conduction transducer. An example of a transducer that may be used with the present invention is described in U.S. patent application Ser. No. 10/438,751, entitled “Apparatus for Bone Conduction Threshold Hearing Test,” which is hereby incorporated by reference.
• FIG. 2 illustrates thesystem100 in block diagram form. As can be seen, thecomputer102 has a number of functional components, including avideo unit200, acentral processing unit202, ahearing test device204, and astorage unit206. These components are well known in the computer art and will therefore be described only briefly here. In general, thevideo unit200 provides the video signals that are displayed as images on thedisplay screen104. In some embodiments, thevideo unit200 may be any one of several commercially available video cards. Thecentral processing unit202 is responsible for the overall operation of thecomputer102, including execution of the operating system and any software applications residing on thecomputer102. In some embodiments, thecentral processing unit202 may be any one of several commercially available microprocessors. Thehearing test device204 may comprise any or all of an audiometer, an otoacoustic emission test device, a tympanometer, a masking noise generator, or other hearing test devices. In some embodiments, thehearing test device204 may be one or more electronic circuit boards within thecomputer102 for performing the functionality of such test devices. Alternatively, thehearing test device204 may be a separate unit that is external to thecomputer102. Thestorage unit206 stores the automated hearing test and provides long-term and temporary (i.e., caching) storage for the software and data that are used by thecomputer102 and may include one or more of, for example, a hard drive, main memory, removable storage (e.g., CD-ROM, floppy disk), and the like.
• In some embodiments, thestorage unit206 also stores amultimedia user interface208 for the automated hearing test. More specifically, thestorage unit206 stores a computer-readable version of theuser interface208 that can be executed by thecomputer102. During execution, a portion of theuser interface208 may be temporarily loaded from, for example, the hard disk and into the main memory components of thestorage unit206. In addition to the stand-alone arrangement, it is also possible to execute theuser interface208 from a network. For example, theuser interface208 may be stored on a server computer (not expressly shown) that is accessible to several client computers. This arrangement has an advantage in that updates to theuser interface208 may be quickly and easily implemented for all client computers via the server computer. Other environments for executing theuser interface208 may also be used without departing from the scope of the invention.
• FIG. 3 shows an exemplary implementation of theuser interface208. As can be seen, theuser interface208 has a number of functional components, including apatient input component300, asystem configuration component302, a tympanogram, acoustic reflex (AR), and otoacousticemission testing component304, apatient training component306, apatient testing component308, apatient management component310, areporting component312, and aninterpretive comments component314. The various functional components are typically executed in sequence as the automated hearing test progresses, but any functional component can be executed before, during, or after execution of any other functional component as needed. In addition, each functional component300-314 may be a modular, stand-alone component that is capable of accepting data from and/or passing data to other functional components. This modularized approach allows individual functional components300-314 to function independently of other functional components such that one or more functional components may be removed from theuser interface208 and/or inserted into another user interface (not expressly shown) with little or no modification. Operator and/or patient interaction with theuser interface208 may be accomplished using any suitable input device, for example, a mouse, keyboard, separate dedicated response button, or using a touchscreen display unit. Where a touchscreen display unit is used, theuser interface208 may display a graphical keyboard (in addition to or instead of a conventional keyboard) from which the operator and/or patient may select alphanumeric characters as needed.
• Briefly, thepatient information component300 allows the operator and/or the patient to enter basic information about the patient and to select which hearing related tests to perform for the patient. Thesystem configuration component302 allows the operator to custom configure various aspects of the automated hearing test according to his preferences. The tympanogram, acoustic reflex, and otoacousticemission testing component304 facilitates obtaining a tympanogram and/or AR test for the patient. Thepatient training component306 provides instructions for and guides the patient in the use of the automated hearing test prior to as well as during the actual testing. Thepatient testing component308 allows the patient to interact with the automated hearing test based on the particular hearing related tests being performed (e.g., pure tone threshold, speech reception threshold, and speech discrimination). Thepatient management component310 notifies the operator and/or the patient of any problems or contingencies that may arise during testing and generally helps the patient stay on course. Thereporting component312 allows the operator to view and print the results of the testing, as well as to store the results of the testing in various formats. Finally, theinterpretive comments component314 point out possible inconsistencies, asymmetries, or areas of concern in the test results and, where appropriate, recommends certain types of medical treatment. Each of the above functional components will now be described in more detail.
• Referring now toFIG. 4, an exemplary implementation of thepatient information component300 is shown. In some embodiments, thepatient information component300 may include anew session screen400. This is the first screen to be displayed after powering on thesystem100 and functions to allow the operator and/or the patient to enter certain items of basic information for the patient. For example, thenew session screen400 may include achart number field402 for entering the patient's chart number and apatient name field404 for entering the patient's name. This information, along with the date and possibly other information, may be used to store and subsequently retrieve the results of any test session. In addition, because the automated hearing test is capable of testing in multiple languages (e.g., English, Spanish, French, etc.), in some embodiments, thenew session screen400 may also include afield406 for selecting which language to be used to test the patient. Thenew session screen400 may also include a plurality ofcheckboxes408 for selecting which hearing related tests will be performed for the patient. For example, thenew session screen400 may include a checkbox for selecting a tympanogram test, an acoustic reflex test, and a distortion product (DP) otoacoustic emission test. Also available for selection are an air and bone conduction test, a speech reception test, and a speech discrimination test. Selecting a patient survey allows the automatic hearing test to gather certain hearing related information about the patient that can be used by the hearing health professional to diagnose and recommend treatment.
• From thenew session screen400, the operator may access various functions related to the automatic hearing test by pressing the appropriate buttons. For example, pressing a view reportsbutton410 allows the operator to view patient reports previously stored on thesystem100. This aspect of the invention will be described later herein with respect to thereporting component312. The operator may also press anadvanced options button412 to view and select various advanced options related to a manual testing feature of the automated hearing test. Such annual testing allows the hearing health professional to manually administer the hearing test using various functions of the automated hearing test (i.e., computer-assisted audiometry). AnOff button414 allows the operator to turn the automated hearing test off. Finally, areconfiguration button416 allows the operator to initiate thesystem configuration component302 of theuser interface208, described below.
• FIGS. 5A-5M illustrate an exemplary implementation of thesystem configuration component302 of theuser interface208. In some embodiments, thesystem configuration component302 includes a plurality of screens, each screen presenting a different set of system configuration options from which the operator may select. It should be noted that not all screens need to be present in every embodiment, and that additional screens not expressly shown may be present in some embodiments.
• In one embodiment, thesystem configuration component302 may include aninput screen500. Theinput screen500 may have aninformation selection area502 that allows the operator to select various items of information to be entered for the patient. Theinformation selection area502 may include fields for the doctor's name, the clinic's name, the patient's date of birth, the patient's gender, and the name of the operator. Theinformation selection area502 also allows the operator to choose whether to make certain information items optional only, or required information. Thereafter, at the start of each new test session, thenew session screen400 displays all the fields in theinformation selection area502 selected by the operator and then waits for the patient and/or the operator to fill in the fields, either on an optional or a required basis.
• In some embodiments, theinput screen500 may also include fields for entering default settings for some of the information items. For example, theinput screen500 may include a default doctor'sname field504, a default administrator'sname field506, a default clinic'sname field508, and a defaultchart number field510. In some embodiments, theinput screen500 may further include an area for entering several default doctor names into alist512 and several default administrator names into alist514. The names that are entered into the lists may then be used as default options in a drop-down list from which the operator and/or the patient may select to fill out the information fields. To add or remove a name from the list, one simply clicks on the appropriate “Add” or “Remove” buttons as needed. To scroll through the list, one simply clicks the “Up” or “Down” navigation buttons as needed.
• In some embodiments, thesystem configuration component302 further includes a pagingencoder interface screen520. By way of background, the automated hearing test typically includes a patient response system that allows the operator to monitor the patient's progress during the hearing test and also allows patient to contact the operator, usually via a pager, at any time during the test. The function of the pagingencoder interface screen520 is to let the operator customize the paging protocol used by the automated hearing test. To enable paging, for example, acheck box522 may be selected to indicate that a paging device is attached to the automated hearing test. The pagingencoder interface screen520 also makes available a plurality ofoptions524 for specifying various parameters of the paging encoder interface, such as the communications port, an encoder ID, an encoder timeout period, a pager CapCode, and a pager data rate.
• In some embodiments, thesystem configuration component302 further includes apaging options screen530. The paging options screen530 allows the operator to select when a page will be issued. For example, the paging options screen530 may include acheck box532 for paging the operator at the end of the test session, acheck box534 for paging the operator at the end of each test in the test session, acheck box536 for paging the operator after a certain amount of inactivity by the patient, and acheck box538 for paging the operator if the automated hearing test cannot determine a pure tone threshold for the patient within a predetermined amount of time.
• The paging options screen530 also includes a plurality ofpaging options539 that allows the operator to customize certain aspects of the page. For example, the operator may specify a short text message to be sent with pages that occur at the end of a testing session, and a brief text message to be sent with pages that occur at the end of each test. The operator may also specify a short text message to be sent with pages that occur due to inactivity, and to specify the inactivity threshold. Furthermore, the operator may specify a brief text message to be sent with pages that occur due to the inability to reach a pure tone threshold, and to specify the amount of time to wait for a threshold.
• Thepaging device option540 allows the operator to specify the type of paging mechanism. For example, the operator may specify a wireless or radio based paging mechanism, a web based paging mechanism wherein an alarm (visual and/or audio) is issued on a web page monitored by the operator, or an FTP based paging mechanism where a file is sent to the operator to notify him of a paging event.
• In some embodiments, thesystem configuration component302 further includes a machine options screen544. The function of this screen is to allow the operator to assign a specific identifier to the automated hearing test. This function is especially useful in clinics where multiple systems are used. For example, the machine options screen544 may include amachine identifier field546 into which the operator may enter an alphanumeric identifier for the particular automated hearing test.
• In some embodiments, thesystem configuration component302 further includes areporting options screen548. The function of this screen is to allow the operator to pre-configure the number of test reports to be printed automatically after each testing session. For example, the reporting options screen548 may include afield550 for entering the number of reports to be printed automatically at the end of a testing session (e.g., 2). In some cases, the reporting options screen548 also includes afield552 for entering the minimum testing intensity level that the operator wishes to be reported (e.g., 0 dB).
• In some embodiments, thesystem configuration component302 further includes a network options screen554. The function of this screen is to allow the operator to specify where patient reports are stored on aparticular computer102 of the automated hearing test. In the example shown, afield556 indicates that the patient reports are stored in a directory called “c:\inetpub\wwwroot\” ofcomputer102. When thecomputer102 is accessed from a network, the information that will be available to the network is the patient reports that are stored in the specified directory. Thus, any personnel with authorized access to the network to which thecomputer102 is connected may view the patient reports that are stored on thecomputer102. In some embodiments, thecomputer102 of each automated hearing test functions as a web server, and thefield556 indicates the web server root directory. In that case, the patient reports stored on thecomputer102 may be viewed from the network as a web page using any suitable web browser.
• In some embodiments, thesystem configuration component302 includes atest options screen560. The function of this screen is to allow the operator to configure various aspects of the hearing related tests that will be performed. For example, the test options screen560 includes a plurality ofcheckboxes562 that allow the operator to specify which hearing related tests will be selected by default from the new sessions screen400.
• The test options screen560 also includes a plurality of hearing related test option screens, for example, a pure tone options screen566. Because naming conventions for the various hearing related tests differ from country to country, the pure tone test options screen566 includes a namingfield568 to allow the operator to customize the test name used for this test in his clinic. The pure tone test options screen566 further includesfrequency options570 that allow an operator to specify when the various pure tone frequencies are tested. For example, the operator may specify that a certain frequency is always tested, never tested, or tested as needed. The operator may define the pure tone average (PTA) for the pure tone test by selecting one of several predetermined definitions at572. Acheck box574 allows the operator to always use bone masking if he so desires.
• In some embodiments, another hearing related test options screen that is included is the tympanometry options screen576. This tympanometry options screen576 allows the operator to specify various parameters for the tympanometry test. For example, the tympanometry options screen576 includesfield578 where the operator may specify a name for the test, the communications port, and may select one of several available to manometer. The tympanometry options screen576 also includesfield580 for allowing the operator to specify the starting pressure and the ending pressure for the test. A plurality ofcalibration parameters582 allows the operator to enter calibration values for the left and right ears and to calibrate the tympanometer for those ears accordingly.
• In some embodiments, the test options screen560 further includes an acoustic reflex options screen583 that can be used to specify various parameters for the acoustic reflex test. For example, the acoustic reflex options screen583 may include afield584 that allows the operator to specify the name to be used with the test.Checkboxes585 allow the operator to specify which one of several available frequencies to be used with the ipsilateral and contralateral ear. The initial intensity level, incremental intensity, and the reflex threshold level may also be specified in the fields shown at586.
• In some embodiments, yet another hearing related test options screen that is included is the speechdiscrimination options screen587. This screen allows the operator to specify various parameters for the speech discrimination test, including the name of the test at588. A plurality offields589 allow the operator to specify, for example, the base presentation level, the presentation type (e.g. closed, open), the number of presentations, the minimum presentation level, the maximum presentation level, and the particular word list to be used.
• In some environments, the test options screen560 additionally includes a speech reception threshold options screen590 that can be used to specify various parameters for the speech reception threshold test. For example, the speech reception threshold options screen590 may include afield591 for specifying the name to be used for the test.
• In embodiments where a patient survey is taken, the test options screen560 may include a survey options screen592. This screen can be used to specify various aspects of the survey at593, including the name to be used for the survey, and the particular survey of several available surveys to be used. In some embodiments, the questions that are asked in the survey may comply with the Hearing and Hearing Handicap Inventory for the Elderly (HHIE).
• Finally, in some embodiments, the test options screen may include an otoacoustic emission options screen594. The otoacoustic options screen594 may include a namingfield595 for specifying the name to be used with this test. A set ofoptions596 allows the operator to select which one of several frequencies to test, set the response floor and noise ceiling, and specify the intensity levels L1 and L2.
• FIGS. 6A-6B illustrate an exemplary implementation of the tympanometry, acoustic reflex, andotoacoustic emission component304 of theuser interface208. In some embodiments, the tympanogram, acoustic reflex, andotoacoustic emission component304 includes acombination test screen600. The function of this screen is to allow the operator and/or the patient to obtain a tympanogram, acoustic reflex, and otoacoustic emission measurement for the patient. Note that although all three tests may be performed from the same screen, only the tests that have been selected will be performed. The tympanogram, acoustic reflex, andotoacoustic emission screen600 may include a series of instructions for the operator and/or patient that walks him step-by-step through the procedure. The instructions may be presented in text, or they may be presented verbally, or both. Where verbal instructions are presented, a confirmation button (not expressly shown) may be pressed to confirm completion of each instruction and move on to the next instruction. While the test is being performed, thescreen600 may include achart602 that captures the data being obtained for the tympanogram. The raw data is shown generally at604. The amount of pressure that is being used is shown at606. Pressing acommand button608 brings up a list of commands that may be selected (e.g., exit, pause, microphone on, etc.). Pressing askip button610 allows the operator and/or the patient to skip the current ear and move to the next ear.
• When the tympanogram, acoustic reflex, and otoacoustic emission portion is completed, ascreen612 presents the final results. From this screen, the operator and/or patient may press an acceptresults button614 to accept the results, a redoright ear button616 to redo the right ear, and a redoleft ear button618 to redo the left ear.
• Once the tympanogram, acoustic reflex, and otoacoustic emission portion is completed and the results therefor accepted, the patient may proceed with the remaining hearing related tests. First, however, the patient should be given some instructions and guidance on how to proceed and what to expect. Thepatient training component306 performs this training task. Patient training is given in two phases, a general training phase where general instructions are given, and a test specific phase where instructions that are specific to a particular test are given before the test begins.
• FIGS. 7A-7B illustrate an exemplary implementation of the general phase of thepatient training component306. In some embodiments, the general training phase includes awelcome screen700. The function of this screen is to give the patient a general idea of how the automated hearing test works in general. For example, thewelcome screen700 may display some of the basic instructions (shown generally at702) for the automated hearing test. At the same time, thepatient training component306 may cause a verbal welcome message to be played in the transducers worn by the patient. The welcome message may provide the patient with detailed information about the upcoming tests. For example, the welcome message may explain that the tests are automated and therefore the operator may not be in the room during the test, but that the patient may press the help button at any time to call the operator.Volume control buttons704 allow the patient to increase or decrease the volume of the welcome message as needed. If the patient wishes to skip the message altogether, he may press theskip button706.
• Before discussing thepatient training component306 further, it may be useful to discuss one aspect of thepatient management component310 of theuser interface208. In some embodiments, thepatient management component310 may include aprogress indicator708 that allows the patient and/or operator to track the patient's progress for a given test session. Theprogress indicator708 may include a plurality of bubbles, one of which is shown at710, to indicate the patient's current hearing related test. For example, there may be a bubble for the tympanometry test, the acoustic reflex test, the otoacoustic emission test, the pure tone threshold test, the speech reception test, and the speech discrimination test. The bubbles are empty at first, but as the patient begins a particular hearing related test, the bubble for that test is filled in. The color used to fill in the bubbles may be the same for every bubble, or some type of progressive color scheme may be used (e.g., darker colors at the beginning stages and lighter colors at the end).
• In some embodiments, theprogress indicator708 of thepatient management component310 may also includeprogress bars712 and714. The progress bars712 and714 provide an indication of the completion percentage of the total test session and of each individual hearing related test, respectively.
• Continuing now with the general training phase of thepatient training component306, if aprogress indicator708 is present, thepatient training component306 also provides training on how the patient can track the progress of his testing using theprogress indicator708. For example, after the welcome message is completed (or skipped), thepatient training component306 may present aprogress training screen720. Theprogress training screen720 may display atext explanation722 of the basic feature of theprogress indicator708. In addition, or alternatively, a detailed verbal explanation of theprogress indicator708 may also be presented. Both the text and verbal based training explain to the patient how to interpret the plurality ofbubbles710 and the progress bars712 and714.
• After the general training stage is completed, thepatient training component306 then provides the test-specific training. The test-specific training may be provided for the specific tests that are about to be performed only, or it may be provided for all the available hearing related tests. In addition, the test specific training may be provided all at once and upfront before beginning any specific test, or the training for a specific test may be provided one test at a time before beginning that hearing related test. This latter embodiment will now be explained in conjunction with an explanation of thepatient testing component308.
• In general, at the beginning of each test, thepatient training component306 presents the patient with an instruction screen and/or a verbal explanation of the test. The instruction screen may show some of the basic instructions for the test and how to proceed, and the verbal explanation may provide a more detailed explanation. Thepatient testing component308 then allows the patient to proceed with the actual testing.FIGS. 8A-8I illustrate an exemplary implementation of thepatient testing component308 and the test specific training portion of thepatient training component306.
• For example, where the patient is getting ready to take the pure tone threshold portion of the automated hearing test, thepatient training component306 presents the patient with a pure tonethreshold training screen800 and, in some cases, a verbal explanation thereof. The pure tonethreshold training screen800 includestext802 that lists some of the basic instructions for the pure tone threshold test. For example, the text may explain that the tones start loud, then get soft, then pulse on and off. Thetraining screen800 may also present an example804 of the response button with an explanation that the patient is to push the button only when he hears a tone. The verbal explanation, when used, may provide essentially the same information plus a few more details, such as the fact that one ear will be tested at a time, and may also provide a sample tone.Volume control buttons806 allow the patient to control the volume of the verbal message, and askip button807 allows the patient to skip the verbal message. Acommand button808 brings up a list of commands that may be used at this point.
• After the pure tone threshold training is completed, thepatient testing component308 presents the patient with aresponse screen810 for responding to the pure tone threshold test. The purpose of the pure tone threshold test is to determine the patient's hearing threshold (i.e., the softest level he can hear) at various frequencies or tones. To this end, theresponse screen810 may include abutton812 that the patient can press each time he hears a tone. Where color is used, thebutton812 and thescreen810 may have a comfortable yet distinctive color scheme that helps the patient to concentrate on the test. For example, the button may be vivid color such as red, while the surrounding area may have a lighter, softer color. Other suitable color schemes may also be used here as well as throughout the various drawings. In addition, or alternatively, thepatient testing component308 may activate or engage a separate response button (not expressly shown) that the patient may press each time he hears a tone. The automated hearing test then presents a series of tones to the patient, and thepatient testing component308 waits for the patient to respond by pressing thebutton812. Ahelp button814 allows the patient to call the operator at any time.
• Where the patient is to undergo a speech reception threshold portion of the automated hearing test, thepatient training component306 presents the patient with a speechreception training screen820 and, in some cases, a verbal explanation thereof. The speechreception training screen820 includes some of thebasic instructions822 for the test, for example, that there will be X pictures, and that the patient should always make a guess at the correct answer, even if he is not sure. In addition, the speechreception training screen820 may also include an example824 of the test screen displayed during the test. The verbal explanation, when used, may provide essentially the same information plus a few more details, such as how many pictures will be shown to the patient.
• After the speech reception training is completed, thepatient testing component308 presents the patient with aresponse screen830 for responding to the speech reception threshold portion of the automated hearing test. The speech reception threshold test is used to determine the softest level at which the patient can hear and recognize a word. To this end, theresponse screen830 presents aset832 of randomly chosen pictures (one shown at834) to the patient along with the corresponding words (one shown at836) for the pictures. In some embodiments, there are nine randomly chosen pictures and words in aset832, and thesame set832 is used for the entire speech reception threshold portion (although it is possible to use more than one set). Preferably, the words that are used are compound words with two distinct syllables. For languages where no such words are available, appropriate substitutions may be made. The automated hearing test then verbally presents the words to the patient one at a time, randomly, and at a decreasing intensity level, with no emphasis on any syllable. Thepatient testing component308 then waits for the patient to select the picture or word from theresponse screen830 that matches the verbally presented word. This procedure is performed for each ear until the lowest or softest verbal presentation level at which the patient can correctly identify 50% of words is determined.
• Where the patient is to undergo the speech discrimination portion of the automated hearing test, thepatient training component306 presents the patient with a speechdiscrimination training screen840 and, in some cases, a verbal explanation thereof. The speechdiscrimination training screen840 includes some of thebasic instructions842 for the test, for example, that there will be X pictures, and that the patient should always make a guess at the correct answer, even if he is not sure. In addition, the speechdiscrimination training screen840 may also include an example844 of the test screen displayed during the test. The verbal explanation, when used, may provide essentially the same information plus a few more details, such as how many pictures will be shown to the patient.
• After the speech discrimination training is completed, thepatient testing component308 presents the patient with aresponse screen850 for responding to the speech discrimination portion of the automated test. The speech discrimination test, unlike the pure tone threshold and speech reception threshold tests, does not test for the softest level the patient can hear. Rather, the speech discrimination test checks to see how well the patient is able to discern between similar sounding words. To this end, theresponse screen850 presents randomly chosen sets852 of pictures (one shown at854) along with their corresponding words (one shown at856). Thewords856 are preferably single syllable words that sound alike. In some embodiments, there are foursuch words856 along with theircorresponding pictures854 in eachset852. For languages where such words are not available, appropriate adjustments may be made.
• As each set852 of pictures is presented on theresponse screen850, the automated hearing test verbally presents one of thewords856 to the patient, preferably at a constant level. The level at which the word is verbally presented is chosen so that the patient is mostly like to correctly hear the word presented. Usually the same word from eachset852 is verbally presented. It is possible for somesets852 to have overlapping pictures, but the sameexact set852 of pictures should not be repeated. The automated hearing test randomly chooses thesets852 of pictures from a large pool of such sets, then presents one word from each set at a constant level. Thepatient testing component308 thereafter waits for the patient to select the picture or word from theresponse screen850 that matches the verbally presented word. The automated hearing test continues this procedure until either a sufficient percentage of correct responses has been received (e.g., 85 percent), or a large enough sample has been obtained to give an accurate assessment.
• In some embodiments, thepatient management component310 includes acongratulatory screen860 that is used to notify the patient and congratulate him for successfully completing the hearing related tests. In some cases, thecongratulatory screen860 may also be accompanied by a verbal congratulatory message informing the patient that he has completed the tests and, if appropriate, the patient will now be given instructions for a survey.
• An example of a survey instructions screen is shown at870. The purpose of the survey instructions screen870 is to instruct the patient regarding how to take the survey. Thus, thesurvey instruction screen870 may include a set ofinstructions872 that tell the patient, for example, that he should read the questions and then select the best answer. An example of the survey is given at874. In some embodiments, a verbal message may also be presented that explains the survey in more detail. For example, the verbal message may explain that the purpose of the survey is to gather information about the patient to help the hearing health professional provide a diagnosis and recommend treatment, if necessary.
• Once the instructions are completed, the patient is presented with asurvey screen880. The survey screen includes asurvey question882 followed by a set ofanswers884. After the patient reads the question, he may then select the best answer from the set ofanswers884. This process is continued until all the survey questions have been answered.
• FIG. 9 illustrates an exemplary implementation of thepatient management component310. As mentioned above, the function of thepatient management component310 is to notify the operator and/or patient of any problems or contingencies that may have arisen, and to generally help the patient stay on course through the testing. For example, if the patient is not responding during a test, or is responding too quickly, thepatient management component310 may issue an on-screen warning to the patient. The warning may include a short text message describing the problem to the patient, and may include an on-screen acknowledgment such as an “Okay” button or a “Continue” button. The patient must then acknowledge the warning by pressing the acknowledgement button in order to continue testing. A verbal warning may also accompany the on-screen warning.
• If the patient's responses indicate that there is an equipment problem or some other problem that requires the operator's attention, the automated hearing test may alert the operator. Alerting the operator may be accomplished by wireless paging or by any other suitable techniques (e.g., e-mail, console lights, buzzer, etc.). In the event that the operator needs to be paged, thepatient management component310 may include apaging screen900 that can be used to inform the patient that the operator is being paged. For example, thepaging screen900 may include a short text message saying that the operator is being paged and that the patient should simply wait for the operator to come in.
• FIGS. 10A-10F illustrate an exemplary implementation of thereporting component312 of theuser interface208. Thereporting component312 allows the operator to view the results of the hearing test, and to save them in various formats (e.g., xml, html, etc.). In some embodiments, thereporting component312 includes areporting screen1000 from which the operator may select a number of options. For example, the operator may press the redo sometests button1002 to redo one or more hearing related tests. Selecting this button returns the operator to thenew session screen400, but the patient's basic information is retained so that one or more tests may be performed again without re-entering the basic information. Pressing thenew session button1004 returns the operator to thenew session screen400, but clears the basic information fields so that new information may be entered.
• Pressing the view reportsbutton1006 allows the operator to search and view the results of previous hearing tests saved on thesystem100. Pressing theprint billing button1008 prints the billing information associated with the patient, including insurance codes for services rendered. Pressing theprint report button1010 prints a full report that contains all the relevant results of the patient's hearing test that a physician usually would like to see.
• An exemplary report that may be generated when theview report1006 button is pressed can be seen from thereport screen1020. Thereport screen1020 may present the results of the hearing test in a two-panel format, with the results of the right ear in onechart1022, and the results of the left ear in anotherchart1024. Note that only a portion of the results can be seen here, and that the entire report may be viewed by scrolling down the screen as needed. Thecharts1022 and1024 are computer-generated audiograms that reflect the patient's performance for a particular test (e.g., the air and bone conduction test). Other charts are available for other tests within a specific test session, as well as charts from multiple test sessions for a particular patient. The relevant data for each chart is also displayed (generally at1026), as well as some basic information (generally at1028), including the patient's name, date and time of the test, chart number, the physician, the tester, the clinic, and the elapsed time for the test.
• Asave report button1030 allows the operator to save the results of the current hearing test. Pressing this button brings up a save report dialog box (not expressly shown) that allows the operator to specify a name for the report and to save the report under that name.
• A changereport style button1032 allows the operator to change the style of the report from the two-panel format to, for example, a one-panel format1040, where data for both ears are presented in one chart. As can be seen, the one-panel format1040 includes asingle chart1042 along with the data therefor (generally at1044).Basic information1046 about the patient is also provided.Navigation buttons1048 allows the operator to navigate around the report.
• A view savedreport button1034 allows the operator to view reports that have been previously saved. Note that this task can also be performed by pressing the view reportsbutton410 from the new sessions screen400 inFIG. 4. Pressing either button brings up asearch screen1050, from which the operator may search for previously saved reports to open and view. Thesearch screen1050 includes a plurality ofsearch criteria1052 that the operator can use to find previously saved reports. Pressing the search button initiates the search. Pressing the display allbutton1054 displays all of the previously saved reports.
• Thereporting component312 also includes asearch result screen1060 that presents the results of the search. This screen lists all theavailable reports1062 that match the one or more search parameters from the reportsearch dialog box1050. The reports are listed in this example according to the date they were taken, but they may certainly be listed in some other order if desired. In addition to the date information, other information about the reports may also be shown, such as the patient name, the chart number, the test time, the clinic, the physician overseeing the test, and the operator administering the test. In some embodiments, each patient's name and chart number is ahyperlink1064 that takes the operator to the report associated with that patient's name or chart number. As mentioned previously, in some embodiments, each report can be viewed as a web page using any suitable web browser.
• The result screen also includes alog hyperlink1066 that allows the operator to view a log for any report. The log includes a listing of every action taken by the patient and/or operator (e.g., picked the wrong picture for a word) during the test as well as every action taken by the automated hearing test (e.g., increased intensity at 5 kHz by one increment). Adata hyperlink1068 to the data allows the operator to view the raw data for any test session. Atympanogram hyperlink1070 allows the operator to view the tympanogram, acoustic reflex, and otoacoustic reflex results. And anaudiogram hyperlink1072 to the audiogram allows the operator to view the audiogram (e.g., chart1022) by itself without the rest of the report.
• Other aspects of thesearch result screen1060 may include a plurality of checkboxes (shown generally at1074), each checkbox corresponding to one of the reports listed, that allows the operator to select several reports. A comparebutton1076 allows the operator to view a comparison of the reports that have been selected. Pressing this button brings up a comparescreen1080 that includes a comparison of the data charts from the selected reports, shown at1082 and1084, for the right and left ears of the patient. Thecharts1082 and1084 are computer-generated charts that show a comparison of the patient's performance for a particular test (e.g., the air and bone conduction test). Similar comparisons may also be performed for other hearing related tests as well. In some embodiments, for the reports being compared, the older results will be displayed less prominently, and the newer results will be displayed more prominently. A comparison of the relevant data for the charts is also displayed (generally at1086 and1088), as well as some basic information (generally at1090), including the patient's name, dates and times of the test, chart numbers, the physician, the tester, the clinic, and the elapsed time for the more recent test. Anavigation button1096 allows the operator to return to the previous screen.
• As mentioned above, pressing theprint report button1010 prints a full report that contains all the relevant results of the patient's hearing test.FIGS. 11A-11C illustrate an exemplaryhearing test report1100 according to embodiments of the invention. As can be seen inFIG. 11A, thereport1100 may have several sections, including atest results section1102, atest summary section1104, amedical recommendations section1106, apatient history section1108, and possibly one or more other sections1110 (e.g., medical release, billing, etc.). These various sections1102-1110 together provide a single report that is concise, convenient, and thorough. Note that some of these sections, for example, thetest results section1102, were discussed briefly above with respect to thereporting component312.
• In accordance with embodiments of the invention, one or more of the sections1102-1110 may include interpretive comments regarding the results of the hearing related tests in thereport1100. The interpretive comments are generated by the interpretive comments component314 (FIG. 3) of theuser interface208. As alluded to above, theinterpretive comments component314 may be a modular, stand-alone component that is capable of accepting data from and passing data to other functional components. Theinterpretive comments component314 generates the interpretive comments based on the same data received by theresults reporting component312. This modularized approach allows theinterpretive comments component314 to function independently of other functional components such that it may be removed from theuser interface208 and/or inserted into another user interface (not expressly shown) with little or no modification. The interpretive comments provide a sort of guide through the test results for the audiologist or other hearing health professional, noting potential inconsistencies, asymmetries, and areas of concern in the test results and, where appropriate, may recommend certain types of medical treatment in some instances. In no instances, however, are the interpretive comments intended to replace the judgment or medical evaluation of the audiologist or hearing health professional.
• For the pure tone frequency threshold tests, the interpretive comments provide information about the degree and the type of hearing loss. The degree of hearing loss refers to the severity of the loss and may be characterized as “normal,” “mild,” “moderate,” “severe,” or “profound.” These characterizations are based on accepted audiology standards and are dictated by the range where the patient's results fall, but it is also possible to customize the characterizations if desired. The types of hearing loss may range from “normal,” “mixed,” and “unspecified” to other types of hearing loss. An exemplary list of hearing loss types is provided below in Table 1 along with a brief description of each. In Table 1, the term “SNHL” refers to sensorineural hearing loss.

  TABLE 1
  Type	Description
  Normal	No hearing loss detected.
  Essentially normal	All values except one fall within the
  	normal range or all pure tones are within
  	normal limits with a mild air-bone
  	gap noted.
  SNHL	Hearing loss detected with no air-bone
  	gaps greater than 10 dB noted.
  Predominately SNHL	Hearing loss detected with minimal
  	air-bone gaps and normal tympanogram
  	(if data available).
  Conductive	Hearing loss detected with significant
  	air-bone gaps noted and bone
  	thresholds less than 25 dB.
  Mixed	Hearing loss detected with air-bone gaps
  	noted and at least one bone
  	threshold greater than 20 dB.
  Unspecified	Hearing loss cannot be classified because
  	bone conduction scores do not clearly
  	define the type of hearing loss (e.g.,
  	SNHL, conductive, mixed, etc.).
  Inconsistent/Incomplete data	Test results do not fall within software
  	guidelines and are unable to be
  	interpreted.

• To arrive at the appropriate type of hearing loss for the pure tone frequency threshold test, the interpretive comments component applies the test results to a set of rules that are based on the gap between the air conduction threshold and the bone conduction threshold. Table 2 below provides an exemplary list of the air-bone gap rules that may be used to derive the type of hearing loss for the pure tone frequency test. These rules are intended to be examples only and a different set of rules may certainly be used depending on the particular application. In Table 2, the term “limit” refers to the audiology equipment limit (i.e., the audiology equipment has reached its maximum capability) and the tympanometry type refers to industry accepted tympanometry classifications.

  TABLE 2
  Rule	Condition
  1	All gaps are less than or equal to 10 dB AND the number of gaps
  	that are less than −10 dB is less than two AND all other gaps
  	are −10 dB.
  2	The gap at 500 Hz is less than 10 dB AND the gaps at 1 KHz,
  	2 KHz, and 4 KHz are less than or equal to 10 dB AND the
  	number of gaps less than −10 dB is less than two
  	AND all other gaps are greater than −10 dB.
  2.1	The gap at 500 Hz is equal to 15 dB AND the gaps at 1 KHz,
  	2 KHz, and 4 KHz are less than or equal to 10 dB and the
  	tympanometry is Type A and the number of gaps less than −10 dB
  	is less than two AND all other gaps are greater than −10 dB.
  3	The gaps at 500 Hz and 1 KHz are greater than 10 dB AND are not
  	at the limit AND the number of gaps greater than −10 dB is
  	greater than two AND all other gaps are less than −10 dB; OR
  	the gaps at 1 KHz and 2 KHz are less than 10 dB AND are not at
  	the limit AND the number of gaps greater than −10 dB is greater
  	than two AND all other gaps are less than −10 dB; OR
  	the gaps at 2 KHz and 4 KHz are less than 10 dB AND are not at
  	the limit AND the number of gaps greater than −10 dB is greater
  	than two AND all other gaps are less than −10 dB.
  3.1	The gaps at 2 KHz and 4 KHz are greater than 10 dB AND are
  	both at the limit AND the tympanometry is Type A (if no
  	tympanometry data is available, then the gap at 500 Hz and 1 KHz
  	must be less than 15 dB); OR
  	the gap at 4 KHz is greater than
  	10 dB AND at the limit AND the tympanometry is Type A
  	(if no tympanometry data is available, then the gaps at 500 Hz
  	and 1 KHz must be less than 15 dB).
  4	The gap at 1 KHz is greater than 10 dB AND the number of gaps
  	less than −10 dB is less than two AND all other gaps are
  	greater than −10 dB; OR
  	the gap at 2 KHz is greater than 10 dB AND the number of gaps
  	less than −10 dB is less than two AND all other gaps
  	are greater than −10 dB; OR
  	the gap at 4 KHz is greater than 10 dB AND the number of
  	gaps less than −10 dB is less than two AND all other gaps
  	are greater than −10 dB AND the gap at 500 Hz is
  	less than 15 dB.
  5	The gaps at 500 Hz, 1 KHz, 2 KHz, 4 KHz are greater than
  	10 dB AND are not at the limit AND the number of gaps less
  	than −10 dB is less than two AND all other gaps
  	are greater than −10 dB; OR
  	the gaps at 500 Hz, 1 KHz, 2 KHz are greater than 10 dB AND
  	are not at the limit AND the number of gaps less
  	than −10 dB is less than two AND all other gaps are
  	greater than −10 dB; OR
  	the gaps at 1 KHz, 2 KHz, and 4 KHz are greater than 10 dB
  	AND are not at the limit AND the number of gaps less
  	than −10 dB is less than two AND all other gaps are
  	greater than −10 dB.
  6	All bone scores are at the limit and the tympanometry is Type A.

• Using the above set of air-bone gap rules, the interpretive comments component is able to determine the hearing loss type for the pure tone frequency threshold test. The interpretive comments component can determine the hearing loss type if certain air-bone gap rules are true along with certain conditions. An exemplary combination of rules and conditions required for each hearing loss type is shown in Table 3. In Table 3, references to “Rule” refer to the rules listed in Table 2 above and “#1,” “#2,” and “#3” indicate different circumstances under which the hearing loss type may occur.

  TABLE 3
  Type	Condition
  Normal	All air thresholds less are than or equal
  	to 20 dB; AND All bone thresholds are less
  	than or equal to 20 dB; AND
  	Rule #1 is true.
  Essentiallynormal #1	No air thresholds are greater than 30 dB; AND
  	One air threshold is greater than 20 dB; AND
  	Rule #1 is true orRule #4 is true.
  Essentiallynormal #2	All bone thresholds are less than 25 dB; AND
  	Rule #2.1 is true orRule #4 is true; AND
  	All air thresholds are less than 25 dB.
  Essentiallynormal #3	Air threshold for 8 KHz is greater than 20 dB;
  	AND All other air thresholds are less than
  	25 dB; ANDRule #1 is true.
  Predominately SNHL	Two or more thresholds are greater than 20 dB;
  	ANDRule #4 or Rule #3.1 is true.
  Predominately SNHL	All air scores are greater than bone scores;
  (“severe” to “profound”	AND Rule #6 is true.
  degrees of hearing loss)
  SNHL	Two or more thresholds greater than 20 dB;
  	Rule #1 is true.
  Conductive	All bone thresholds less than or equal to
  	20 dB; ANDRule #2 orRule #3 or
  	Rule #5 is true.
  Conductive	All bone threshold less than or equal to 20 dB;
  (Predominately SNHL)	AND Rule #2.1 is true; AND
  	Two or more air thresholds greater than 20 dB.
  Mixed	Two air thresholds greater than 20 dB; AND
  	One or more bone threshold greater than 20 dB;
  	ANDRule #2 orRule #3 orRule #5 is true.
  Mixed	Two air thresholds greater than 20 dB; AND
  (Predominately SNHL)	One or more bone threshold greater than 20 dB;
  	AND Rule #2.1 is true.
  Unclassified #1	Two or more air thresholds greater than 20 dB;
  	AND No bone conduction scores.
  	(Label as “predominately SNHL as indicated
  	by air conduction and the
  	tympanometry/acoustic reflex results” if the
  	tympanometry is Type A and one or more
  	ipsi reflexes are present.
  Unclassified #2	Two or more air thresholds greater than 20 dB;
  	AND All gap rules are false.
  	(Label as “predominately SNHL as indicated
  	by air conduction and the
  	tympanometry/acoustic reflex results” if
  	the tympanometry is Type A and one or more
  	ipsi reflexes are present.
  All other circumstances	Label as “insufficient/inconsistent data.”

• Interpretive comments may also be generated for the speech reception threshold (SRT) test. For this test, the interpretive comments note the correlation of the SRT and predicted SRT for each ear to alert the audiologist or other hearing health professional to any potentially poor quality tests. Thus, possible interpretive comments for the SRT test include: “consistent” if the SRT scores are within 10 dB of each other; “marginally consistent” if the SRT scores are within 20 dB of each other, and “inconsistent” if the SRT scores have a greater than 20 dB difference. A comment of “marginally consistent” or “inconsistent” on the SRT score means that the audiologist or hearing health professional should reconsider the validity of the test results. This may occur if a patient is malingering or is unable to provide reliable responses for the SRT and/or the pure tone test.
• For the Distortion Product-Otoacoustic Emissions (DP-OAE) test, the interpretive comments indicate whether the individual scores pass or fail and whether the overall results pass or fail for each ear.
• Interpretive comments are also available for the speech discrimination test. The speech discrimination test score is calculated by subtracting the actual speech discrimination score from the predicted speech discrimination score. Based on these speech discrimination loss score, the interpretive comments may include, for example, “Normal” if the discrimination loss is between 0-19% and “Unexpected Loss” if the discrimination loss is 20% or greater. A loss of 20% or higher is considered to be a pathological indication.
• In some embodiments, interpretive comments may also indicate asymmetries. Comments denoting asymmetries are presented, for example, if a significant difference is found for the pure tone threshold test. Since this test compares the right and left ear pure tone air conduction scores at each frequency, it is susceptible to asymmetrical results. Thus, if there is more than a 15 dB difference between the two ears at a given frequency, an asymmetrical comment is noted and the frequency listed accordingly. An asymmetrical comment may also be noted to indicate that the SRT scores show a difference of 20 dB or more between the two ears. Finally, an asymmetrical comment may be noted to indicate that the speech discrimination scores show a greater than 20% difference between the two ears.
• As mentioned above, in some embodiments, thereport1100 may also suggest medical recommendations based on the test results. The medical recommendations are generated by the interpretive comments component and may include several types of recommendations: medical referral/treatment, amplification, hearing conservation, re-testing, and the like. These recommendations are typically accompanied by a comprehensive case history and medical examination in order to determine the most appropriate next steps. Of course, fewer or additional types of recommendations may also be presented depending on the application without departing from the scope of the invention.
• Exemplary recommendations for medical referral/treatment include, for example, “Likely” and “Unlikely.” “Likely” is used if the results show mixed or conductive hearing loss. The “Likely” recommendation may also be triggered by asymmetrical pure tones thresholds for two or more frequencies, discrimination loss of 20% or more in either ear, or conductive or mixed hearing loss with significant air-bone gaps in either ear that are corroborated by tympanometry results (if data is available). Since all of these results are suggestive of other medical problems that may require medical treatment or evaluation, the interpretive comments recommend that the patient is referred for treatment. “Unlikely” is used if no asymmetries, significant air-bone gaps or speech discrimination loss is reported. A recommendation of “Possible-unspecified loss, retest/referral may be needed” is presented if the hearing loss type is determined to be “unspecified” (which may be due to the absence of bone conduction results).
• Amplification recommendations are based on the average of the two worst pure tone frequencies from 500 Hz to 4 KHz. Examples of recommendations for amplification include: “None” if the average is less than 35 dB; “Recommended” if the average is 35 dB or greater, the hearing loss is sensorineural, and the medical referral/treatment recommendation is “Unlikely”; “Reassess after medical referral/treatment” if the average of the two worst pure tone thresholds between 500 Hz and 4 KHz is 35 dB or greater and the medical referral/treatment recommendation is “Likely.” The “Reassess after medical referral/treatment” comment indicates that one of the following was reported on the results: conductive or mixed hearing loss, speech discrimination loss, or significant asymmetry for the pure tone thresholds.
• Exemplary recommendations for conservation/hearing protection typically include “recommended” in order to urge the patient to always be protective of his hearing. Exemplary recommendations for retest typically include “1 year” or “as needed” in order to encourage the patient to obtain regular follow-ups.
• The foregoing interpretive comments may be displayed on thereport1100 in one or more of the sections1102-1110, as will now be described with respect toFIGS. 11B and 11C. Turning first toFIG. 11B, theresults section1102 may have several subsections, with the number of subsections depending on the number of hearing tests conducted on the patient. In the example shown here, theresults section1102 has four subsections. The subsections include an air andbone conduction subsection1112, aspeech intelligibility subsection1114, and a tympanogram/DP-OAE subsection1116.
• The first subsection, namely, the air andbone conduction subsection1112, is similar to the one discussed previously with respect to the report screen1020 (FIG. 10B). For example, information about the patient, generally indicated at1120, is provided at the top of page. The results of the air and bone conduction test for the patient's right ear and left here are then provided via charts in a two-panel format. (It is also possible, of course, to report the results of the air and bone conduction test in a one-panel format with the data for both ears plotted in the same chart.) The right ear results are shown in theright chart1122 and the left ear results are shown in theleft chart1124. Thecharts1122 and1124 are computer-generated audiograms that reflect the patient's performance for the air and bone conduction tests. The placement of theright chart1122 on the left side and theleft chart1124 on the right side allows the audiologist or other hearing health professional to line up the charts with the patient's ears when facing the patient.
• On thecharts1122 and1124, the horizontal axis represents the frequency and the vertical axis represents the thresholds. In accordance with embodiments of the invention, the vertical axis is partitioned into five regions, including “normal,” “mild,” “moderate,” “severe,” and “profound.” Each region indicates a distinct degree of hearing loss. Although five regions are shown here, it is possible to have fewer or more than five regions of hearing loss without departing from the scope of the invention. In some embodiments, each region of hearing loss may be shown in a different color, shading, or pattern in order to help the audiologist or other hearing health professional more clearly distinguish between the different regions. In some embodiments, the bone conduction data points may be surrounded by shading or otherwise highlighted to indicate a masking dilemma. A masking dilemma occurs when the minimum masking level required at the non-test ear also masks the test ear due to crossover, causing the thresholds in the test ear to be shifted.
• The numerical data for eachchart1122 and1124 is reported in table form at1126 and1128. Each row of the tables1126 and1128 displays a hearing threshold while each column represents a certain frequency. In the exemplary implementation shown here, there are five rows, including a row for the air conduction threshold, the bone conduction threshold, the air-bone gap, the air conduction threshold with masking, and the bone conduction threshold with masking. For each cell in the tables1126 and1128, the data may be displayed with certain indicators to indicate the quality and/or reliability level of the test results. For example, a superscripted “F” indicates that the patient's false response ratio, which is the number of false responses over the total number of responses, has exceeded a certain predefined limit (e.g., 40%). By way of background, a false response refers to a response that is received outside a predefined response window (i.e., the patient responded either too early or too late and is therefore considered to be guessing). A superscripted “T” indicates that the number of presentations required to obtain a threshold for the patient at a given frequency has exceeded a predefined limit (e.g., 18) considered to be a cutoff for good quality. A subscripted “NR” indicates that for some presentations, no response was received. And similarly to thecharts1122 and1124, some bone conduction test results may be highlighted to indicate that the bone conduction loss prevented masking from being effectively presented. Another subscripted indicator, “U,” indicates that masking was insufficient during the presentation. Blank cells indicate no data.
• In some embodiments, alegend1130 may also be present to explain the meaning of the various symbols and markers displayed in the air andbone conduction subsection1112. The symbols are standard symbols used by most audiologist and hearing health professionals, but may certainly be modified as needed for a particular application.
• Thespeech intelligibility subsection1114 displays, again in table form, the results of the speech related hearing tests, including the speech reception threshold test and the speech discrimination test. For the speech reception threshold test, thespeech intelligibility subsection1114 displays the results of the average best pure-tone hearing within a speech range, the predicted SRT, and the lowest intensity level at which speech can still be understood by the patient. For the speech discrimination test, thespeech intelligibility subsection1114 displays the speech discrimination presentation level, the speech discrimination test score that is predicted by audibility factors alone, and the actual speech discrimination test score. (The audibility factors are based on the results of the patient's pure tone frequency thresholds.) In some embodiments, thespeech intelligibility subsection1114 also displays any speech discrimination loss that is not explained by the pure tone loss. This unexplained loss may be derived by subtracting the predicted speech discrimination test score and the actual speech discrimination test score.
• In the exemplary implementation shown here, thespeech intelligibility subsection1114 includes a column for thedescription1132 of each speech related test result described in the previous paragraph, a column for themeasure1134 used with each test (e.g., pure tone air conduction (PTA), SRT, etc.) along with a column for the units therefor, and a column for the results for theright ear1136 and theleft ear1138. In some embodiments, the numbers incolumns1136 and1138 may be shown with masking indicators, for example, a subscripted “msk” to indicate masking was presented and a superscripted number (e.g., “5”) to indicate the intensity level of the masking. In some embodiments, the actual speech discrimination test score may be accompanied by the possible range of the testing error, as well understood by those having ordinary skill in the art.
• The tympanogram/DP-OAE subsection1116 presents the results of an acoustic admittance test (in the form of a tympanogram) and the DP-OAE test. In the exemplary implementation shown here, the tympanogram/DP-OAE subsection1116 includes atympanogram1140 for the patient's right and left ears, reflecting the results of the acoustic admittance test. The numerical data for each ear is also reported in table form at1142 and1144 for the right and left ears, respectively, with the left column in each table listing the test type and the right column indicating the results. Another table displays the DP-OAE results at1146 and1148 for the right and left ears, respectively. As discussed above, the interpretive comments for the DP-OAE results are intended to indicate pass or fail for the individual scores as well as the overall results. In the example shown here, “OK” indicates a passing score and “X” indicates a failing score.
• A comments subsection1150 may also be present in some embodiments for providing interpretive comments about the tympanogram, for example, whether the tympanometry for each ear is “normal” or otherwise. The comments subsection1150 may also provide an AMA (American Medical Association) hearing score in some embodiments that indicates the percentage of a disability that is caused by the patient's hearing loss. The AMA hearing score requires a pure tone threshold at 3 KHz in order to be able to calculate the score. If a threshold is not available at 3 KHz, then the automated hearing test uses data from available thresholds to extrapolate the 3 KHz threshold. The extrapolated threshold is then used to calculate an Estimated Person Impairment score that is similar, to and may be used in lieu of, the AMA hearing score. Where available, the comments subsection1150 may also provide information regarding whether the patient has passed Stenger screening (e.g., “Stenger at 500 Hz is Negative,” etc.). For information regarding Stenger screening in an automated hearing test, the reader is referred to U.S. Non-provisional Application entitled “Stenger Screening in Automated Diagnostic Hearing Test,” filed concurrently herewith, and incorporated herein by reference.
• FIG. 11C shows an exemplary implementation of thetest summary section1104 for providing interpretive comments regarding various hearing related tests according to embodiments of the invention. As can be seen, thetest summary section1104 may include a table showing a description of the various tests at1152 and the interpretive comments therefor for the right ear and the left ear, respectively, at1154 and1156. The test types may include, for example, the pure tone threshold test, SRT, speech discrimination test, tympanogram, DP-OAE. The interpretive comments for these tests may be the same as the ones discussed previously, or they may include other test types and interpretive comments as needed. Thesummary section1104 may also note any asymmetries in the pure tone threshold test, SRT, and speech discrimination test, along with the interpretive comments therefor. In some embodiments, the results of the acoustic reflex test and the patient survey (e.g., the HHIE survey) may also be presented in this section. A synopsis of the various results and interpretive comments therefor may be provided with the summary table at1158 in some embodiments.
• In addition to thesummary section1104,FIG. 11C also shows an exemplary implementation of themedical recommendations section1106. Again, the information is provided in the form of a table, with the types of recommendations listed in one column at1160 and the recommendations themselves listed in another column at1162. The various types of recommendations and the recommendations themselves may be the same as the ones discussed previously, or they may be a modified version, depending on the particular application.
• As for thepatient history section1108, in some embodiments, thepatient history section1108 provides a list of possible symptoms that the patient may have experienced, indicated at1164. The symptoms are typical symptoms, known to those of ordinary skill in the art, that a patient with hearing related problems may experience. An audiologist or other hearing health professional may then manually mark (e.g., “Yes” or “No”) whether the patient has the symptoms for the right and left ears, as applicable, at1166 and1168, respectively. Comments may also be entered for each symptom at1170 as needed.
• Finally, thereport1100 may include one ore moreother sections1110, such as a medical release section. The medical release section allows the audiologist or other hearing health professional to either refer the patient to a specialist for further treatment or to release the patient, for example, as having no contraindications that would affect fitting for a hearing aid. An example of a medical release is illustrated at1110 inFIG. 11C. In some embodiments, billing information may also be presented in thereport1100, including information relating to the charges for the various hearing tests and other billing related information.
• While the invention has been described with respect to a number of specific embodiments, those skilled in the art will recognize that the innovative concepts described herein can be modified and varied over a wide range of applications. Accordingly, the scope of the invention should not be limited to any of the specific exemplary teachings discussed, but is instead defined by the following claims.

Claims (20)

1. A method of presenting a patient's hearing test results in an automated diagnostic hearing test, comprising:

presenting the patient's hearing test results from the automated diagnostic hearing test on a report;

presenting one or more interpretive comments on the report based on the patient's hearing test results, the one or more interpretive comments pointing out possible inconsistencies, asymmetries, or areas of concern in the test results; and

presenting one or more medical recommendations on the report based on the patient's hearing test results and the one or more interpretive comments.

2. The method according toclaim 1, wherein one or more of the patient's hearing test results are presented in graphical form.

3. The method according toclaim 1, further comprising presenting one or more quality and/or reliability indicators with the patient's hearing test results.

4. The method according toclaim 1, further comprising presenting one or more masking indicators with the patient's hearing test results.

5. The method according toclaim 1, wherein the patient's hearing test results include results from at least one of the following tests: pure tone threshold, speech reception, speech discrimination, tympanogram, distortion product-otoacoustic emissions.

6. The method according toclaim 1, wherein the interpretive comments include at least a degree of hearing loss and a type of hearing loss.

7. The method according toclaim 6, wherein the type of hearing loss is derived based on a plurality of air-bone gap rules.

8. The method according toclaim 1, wherein the one or more medical recommendations include at least one of the following types of medical recommendations: medical referral/treatment, amplification, hearing conservation, and re-testing.

9. A system for reporting a patient's hearing test results in an automated diagnostic hearing test, comprising:

transducers, including an air conduction transducer and a bone conduction transducer;

a hearing test device connected to the transducers;

a computer connected to the hearing test device and storing a user interface for an automated hearing test thereon, the user interface configured to cause the computer to:

present the patient's hearing test results from the automated diagnostic hearing test on the report;

present one or more interpretive comments on the report based on the patient's hearing test results, the one or more interpretive comments pointing out possible inconsistencies, asymmetries, or areas of concern in the test results; and

present one or more medical recommendations on the report based on the patient's hearing test results and the one or more interpretive comments.

10. The system according toclaim 9, wherein the user interface is further configured to cause the computer to present one or more of the patient's hearing test in graphical form.

11. The system according toclaim 9, wherein the user interface is further configured to cause the computer to present one or more quality and/or reliability indicators with the patient's hearing test results.

12. The system according toclaim 9, wherein the user interface is further configured to cause the computer to present one or more masking indicators with the patient's hearing test results.

13. The system according toclaim 9, wherein the patient's hearing test results include results from at least one of the following tests: pure tone threshold, speech reception, speech discrimination, tympanogram, distortion product-otoacoustic emissions.

14. The system according toclaim 9, wherein the interpretive comments include at least a degree of hearing loss and a type of hearing loss.

15. The system according toclaim 14, wherein the type of hearing loss is derived based on a plurality of air-bone gap rules.

16. The system according toclaim 9, wherein the one or more medical recommendations include at least one of the following types of medical recommendations: medical referral/treatment, amplification, hearing conservation, and re-testing.

17. A computer-readable medium comprising computer-readable instructions for generating interpretive comments in an automated diagnostic hearing test, the computer-readable instructions comprising instructions for:

receiving a patient's hearing test results from the automated diagnostic hearing test;

generating one or more interpretive comments based on the patient's hearing test results, the one or more interpretive comments including at least a degree of hearing loss and a type of hearing; and

generating one or more medical recommendations based on the patient's hearing test results and the one or more interpretive comments.

18. The computer-readable medium according toclaim 17, wherein the computer-readable instructions further comprise instructions for generating one or more quality and/or reliability indicators for the patient's hearing test results.

19. The computer-readable medium according toclaim 17, wherein the type of hearing loss is derived based on a plurality of air-bone gap rules.

20. The computer-readable medium according toclaim 17, wherein the one or more medical recommendations include at least one of the following types of medical recommendations: medical referral/treatment, amplification, hearing conservation, and re-testing.

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