Cox R M, Alexander G C, Taylor I M, Gray G A
University of Memphis, Tennessee, USA.
Ear Hear. 1997 Oct;18(5):388-400. doi: 10.1097/00003446-199710000-00004.
This article presents the underlying rationale, normative data, and reliability data for a test of loudness perception (the Contour Test) that was devised for use in clinical hearing aid fitting. The Contour Test yields data describing the sound level required for each of seven categories of loudness ranging from very soft to uncomfortably loud.
Two experiments are described. Experiment 1 yielded norms for the test. The subjects were 23 male and 22 female normal-hearing listeners. Test stimuli included warble tones at six frequencies and broad band speech. Experiment 2 assessed the reliability of the test results. Ten hearing-impaired listeners responded to the test at two frequencies on two occasions separated by several days. Both experiments also evaluated the effect of using different stimulus increment sizes on the measured levels of loudness categories.
Based on the data from experiment 1, norms for each category of each stimulus are reported in terms of mean level and typical between-subject variation in responses. Data are provided in HA-12 cm3 coupler levels as well as in hearing levels (dB HL). The shape of the loudness growth function for warble tones was somewhat different from that for speech. When data were expressed in HL, there were no differences in mean loudness category levels across warble tone test frequencies. Thus, test frequencies were combined and equations were generated to describe the upper and lower limits of typical normal performance for warble tone stimuli. These equations can be used to construct a template for clinical comparison of normative values to patient loudness growth curves. Experiment 2 provided information about the test-retest variability of data yielded by the Contour Test. Reliability appears to be similar to that of the few other category scaling tests described in the literature. Most test-retest differences were 6 dB or less. Although a moderate variation in test increment size did not significantly affect the loudness category levels for young normal-hearing listeners, levels corresponding to loudness categories were significantly higher when larger increments were used with elderly hearing-impaired listeners.
Evidence from this and other research indicates that standardized measurement of loudness perception is an achievable goal for clinical practice. The Contour Test appears to offer a viable approach to clinical measurement of loudness perception: It has good patient acceptance and combines fairly rapid administration with acceptable reliability. Details of test procedures and scoring sheets for manual administration can be downloaded from the Internet at www.ausp.memphis.edu/harl. However, it is important to keep in mind that the application of loudness perception data for narrowband stimuli (such as warble tones) to hearing aid prescription is complicated by the need to account for the effects of loudness summation across bandwidth. There is a need for additional research to establish an empirical link between clinically measured loudness perception and optimal amplification characteristics.
本文介绍了一种为临床助听器验配设计的响度感知测试（等高线测试）的基本原理、标准数据和可靠性数据。等高线测试产生的数据描述了从非常轻柔到令人不适的响亮这七个响度类别中每个类别所需的声级。
描述了两项实验。实验1得出了该测试的标准。受试者为23名男性和22名女性听力正常的听众。测试刺激包括六个频率的啭音和宽带语音。实验2评估了测试结果的可靠性。十名听力受损的听众在相隔数天的两个时间点对两个频率的测试做出反应。两项实验还评估了使用不同刺激增量大小对响度类别测量水平的影响。
基于实验1的数据，报告了每种刺激的每个类别的标准，以平均水平和受试者间反应的典型差异表示。数据以HA-12 cm³耦合器水平以及听力水平（dB HL）提供。啭音的响度增长函数形状与语音的有所不同。当数据以HL表示时，不同啭音测试频率的平均响度类别水平没有差异。因此，将测试频率合并并生成方程来描述啭音刺激典型正常表现的上限和下限。这些方程可用于构建一个模板，以便将标准值与患者响度增长曲线进行临床比较。实验2提供了关于等高线测试产生的数据的重测变异性的信息。可靠性似乎与文献中描述的其他少数类别标度测试相似。大多数重测差异为6 dB或更小。虽然测试增量大小的适度变化对年轻听力正常的听众的响度类别水平没有显著影响，但对于老年听力受损的听众，使用较大增量时，与响度类别对应的水平明显更高。
来自本研究和其他研究的证据表明，响度感知的标准化测量是临床实践中可以实现的目标。等高线测试似乎为响度感知的临床测量提供了一种可行的方法：它具有良好的患者接受度，并且将相当快速的测试过程与可接受的可靠性相结合。手动测试的测试程序和评分表的详细信息可从互联网上www.ausp.memphis.edu/harl下载。然而，重要的是要记住，由于需要考虑带宽上响度总和的影响，将窄带刺激（如啭音）的响度感知数据应用于助听器处方会变得复杂。需要进行更多研究以建立临床测量的响度感知与最佳放大特性之间的实证联系。
