U.S. patent application number 11/469461 was filed with the patent office on 2007-06-14 for interpretive report in automated diagnostic hearing test.
This patent application is currently assigned to TYMPANY, INC.. Invention is credited to Daniel Cromwell, Linda Galow, Kenneth R. Stott.
Application Number | 20070135730 11/469461 |
Document ID | / |
Family ID | 37809579 |
Filed Date | 2007-06-14 |
United States Patent
Application |
20070135730 |
Kind Code |
A1 |
Cromwell; Daniel ; et
al. |
June 14, 2007 |
Interpretive Report in Automated Diagnostic Hearing Test
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.
Inventors: |
Cromwell; Daniel; (Salt Lake
City, UT) ; Galow; Linda; (Salt Lake City, UT)
; Stott; Kenneth R.; (Salt Lake City, UT) |
Correspondence
Address: |
LOCKE LIDDELL & SAPP LLP;ATTN: DOCKETING
600 TRAVIS
SUITE 3400
HOUSTON
TX
77002-3095
US
|
Assignee: |
TYMPANY, INC.
2795 Cottonwood Parkway, Suite 660
Salt Lake City
UT
|
Family ID: |
37809579 |
Appl. No.: |
11/469461 |
Filed: |
August 31, 2006 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60713538 |
Aug 31, 2005 |
|
|
|
Current U.S.
Class: |
600/559 |
Current CPC
Class: |
G16H 50/20 20180101;
G16H 15/00 20180101; A61B 5/121 20130101 |
Class at
Publication: |
600/559 |
International
Class: |
A61B 5/00 20060101
A61B005/00 |
Claims
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 to claim 1, wherein one or more of the
patient's hearing test results are presented in graphical form.
3. The method according to claim 1, further comprising presenting
one or more quality and/or reliability indicators with the
patient's hearing test results.
4. The method according to claim 1, further comprising presenting
one or more masking indicators with the patient's hearing test
results.
5. The method according to claim 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 to claim 1, wherein the interpretive
comments include at least a degree of hearing loss and a type of
hearing loss.
7. The method according to claim 6, wherein the type of hearing
loss is derived based on a plurality of air-bone gap rules.
8. The method according to claim 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 to claim 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 to claim 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 to claim 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 to claim 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 to claim 9, wherein the interpretive
comments include at least a degree of hearing loss and a type of
hearing loss.
15. The system according to claim 14, wherein the type of hearing
loss is derived based on a plurality of air-bone gap rules.
16. The system according to claim 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 to claim 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 to claim 17, wherein the
type of hearing loss is derived based on a plurality of air-bone
gap rules.
20. The computer-readable medium according to claim 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.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] 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
[0002] 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
[0003] 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.
[0004] 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.
[0005] 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.
[0006] 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.
[0007] 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.
[0008] 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.
[0009] 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
[0010] 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
[0011] 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:
[0012] FIG. 1 illustrates an exemplary system for providing an
automated hearing test according to embodiments of the
invention;
[0013] FIG. 2 illustrates a block diagram of a system having a user
interface for an automated hearing test according to embodiments of
the invention;
[0014] FIG. 3 illustrates an exemplary user interface for an
automated hearing test according to embodiments of the
invention;
[0015] FIG. 4 illustrates an exemplary implementation of a patient
input component of the user interface according to embodiments of
the invention;
[0016] FIGS. 5A-5M illustrate an exemplary implementation of a
system configuration component of the user interface according to
embodiments of the invention;
[0017] 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;
[0018] 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;
[0019] FIGS. 8A-8I illustrate an exemplary implementation of a
patient testing component of the user interface according to
embodiments of the invention;
[0020] FIG. 9 illustrates an exemplary implementation of a patient
management component of the user interface according to embodiments
of the invention;
[0021] FIGS. 10A-10F illustrate an exemplary implementation of a
reporting component of the user interface according to embodiments
of the invention; and
[0022] FIGS. 11A-11C illustrate an exemplary hearing test report
according to embodiments of the invention.
DETAILED DESCRIPTION OF THE INVENTION
[0023] 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.
[0024] 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.
[0025] 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.
[0026] Referring now to FIG. 1, a system 100 is shown for providing
automated hearing tests in which the user interface according to
embodiments of the invention is used. The system 100 has three main
components, namely, a computer 102, a display screen 104, and at
least one transducer 106. Other components of the system 100 that
may be present include a tympanometer, keyboard, mouse, printer,
paging system, and the like (indicated generally at 108). The
paging system may be any suitable paging technology that uses one
or more pagers 108 for alerting the operator. The one or more
pagers 108 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).
[0027] The computer 102 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. The display screen 104 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.
[0028] As for the transducer 106, this component may be an ear
insert, earphones, and the like for air conduction testing. For
bone conduction, the transducer 106 may be a vibrator or other
similar devices. In some cases, the transducer 106 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.
[0029] FIG. 2 illustrates the system 100 in block diagram form. As
can be seen, the computer 102 has a number of functional
components, including a video unit 200, a central processing unit
202, a hearing test device 204, and a storage unit 206. These
components are well known in the computer art and will therefore be
described only briefly here. In general, the video unit 200
provides the video signals that are displayed as images on the
display screen 104. In some embodiments, the video unit 200 may be
any one of several commercially available video cards. The central
processing unit 202 is responsible for the overall operation of the
computer 102, including execution of the operating system and any
software applications residing on the computer 102. In some
embodiments, the central processing unit 202 may be any one of
several commercially available microprocessors. The hearing test
device 204 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, the hearing test
device 204 may be one or more electronic circuit boards within the
computer 102 for performing the functionality of such test devices.
Alternatively, the hearing test device 204 may be a separate unit
that is external to the computer 102. The storage unit 206 stores
the automated hearing test and provides long-term and temporary
(i.e., caching) storage for the software and data that are used by
the computer 102 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.
[0030] In some embodiments, the storage unit 206 also stores a
multimedia user interface 208 for the automated hearing test. More
specifically, the storage unit 206 stores a computer-readable
version of the user interface 208 that can be executed by the
computer 102. During execution, a portion of the user interface 208
may be temporarily loaded from, for example, the hard disk and into
the main memory components of the storage unit 206. In addition to
the stand-alone arrangement, it is also possible to execute the
user interface 208 from a network. For example, the user interface
208 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 the user interface 208 may be quickly
and easily implemented for all client computers via the server
computer. Other environments for executing the user interface 208
may also be used without departing from the scope of the
invention.
[0031] FIG. 3 shows an exemplary implementation of the user
interface 208. As can be seen, the user interface 208 has a number
of functional components, including a patient input component 300,
a system configuration component 302, a tympanogram, acoustic
reflex (AR), and otoacoustic emission testing component 304, a
patient training component 306, a patient testing component 308, a
patient management component 310, a reporting component 312, and an
interpretive comments component 314. 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 component 300-314
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
components 300-314 to function independently of other functional
components such that one or more functional components may be
removed from the user interface 208 and/or inserted into another
user interface (not expressly shown) with little or no
modification. Operator and/or patient interaction with the user
interface 208 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, the user interface 208 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.
[0032] Briefly, the patient information component 300 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. The system configuration component 302 allows the
operator to custom configure various aspects of the automated
hearing test according to his preferences. The tympanogram,
acoustic reflex, and otoacoustic emission testing component 304
facilitates obtaining a tympanogram and/or AR test for the patient.
The patient training component 306 provides instructions for and
guides the patient in the use of the automated hearing test prior
to as well as during the actual testing. The patient testing
component 308 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). The patient management component 310
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. The reporting component 312 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,
the interpretive comments component 314 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.
[0033] Referring now to FIG. 4, an exemplary implementation of the
patient information component 300 is shown. In some embodiments,
the patient information component 300 may include a new session
screen 400. This is the first screen to be displayed after powering
on the system 100 and functions to allow the operator and/or the
patient to enter certain items of basic information for the
patient. For example, the new session screen 400 may include a
chart number field 402 for entering the patient's chart number and
a patient name field 404 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, the new session screen 400 may
also include a field 406 for selecting which language to be used to
test the patient. The new session screen 400 may also include a
plurality of checkboxes 408 for selecting which hearing related
tests will be performed for the patient. For example, the new
session screen 400 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.
[0034] From the new session screen 400, the operator may access
various functions related to the automatic hearing test by pressing
the appropriate buttons. For example, pressing a view reports
button 410 allows the operator to view patient reports previously
stored on the system 100. This aspect of the invention will be
described later herein with respect to the reporting component 312.
The operator may also press an advanced options button 412 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). An Off button 414 allows the
operator to turn the automated hearing test off. Finally, a
reconfiguration button 416 allows the operator to initiate the
system configuration component 302 of the user interface 208,
described below.
[0035] FIGS. 5A-5M illustrate an exemplary implementation of the
system configuration component 302 of the user interface 208. In
some embodiments, the system configuration component 302 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.
[0036] In one embodiment, the system configuration component 302
may include an input screen 500. The input screen 500 may have an
information selection area 502 that allows the operator to select
various items of information to be entered for the patient. The
information selection area 502 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. The information selection
area 502 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, the new session
screen 400 displays all the fields in the information selection
area 502 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.
[0037] In some embodiments, the input screen 500 may also include
fields for entering default settings for some of the information
items. For example, the input screen 500 may include a default
doctor's name field 504, a default administrator's name field 506,
a default clinic's name field 508, and a default chart number field
510. In some embodiments, the input screen 500 may further include
an area for entering several default doctor names into a list 512
and several default administrator names into a list 514. 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.
[0038] In some embodiments, the system configuration component 302
further includes a paging encoder interface screen 520. 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 paging encoder interface screen 520 is to let the
operator customize the paging protocol used by the automated
hearing test. To enable paging, for example, a check box 522 may be
selected to indicate that a paging device is attached to the
automated hearing test. The paging encoder interface screen 520
also makes available a plurality of options 524 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.
[0039] In some embodiments, the system configuration component 302
further includes a paging options screen 530. The paging options
screen 530 allows the operator to select when a page will be
issued. For example, the paging options screen 530 may include a
check box 532 for paging the operator at the end of the test
session, a check box 534 for paging the operator at the end of each
test in the test session, a check box 536 for paging the operator
after a certain amount of inactivity by the patient, and a check
box 538 for paging the operator if the automated hearing test
cannot determine a pure tone threshold for the patient within a
predetermined amount of time.
[0040] The paging options screen 530 also includes a plurality of
paging options 539 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.
[0041] The paging device option 540 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.
[0042] In some embodiments, the system configuration component 302
further includes a machine options screen 544. 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 screen 544 may include a machine identifier field 546 into
which the operator may enter an alphanumeric identifier for the
particular automated hearing test.
[0043] In some embodiments, the system configuration component 302
further includes a reporting options screen 548. 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 screen 548 may include
a field 550 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 screen 548 also includes a field 552
for entering the minimum testing intensity level that the operator
wishes to be reported (e.g., 0 dB).
[0044] In some embodiments, the system configuration component 302
further includes a network options screen 554. The function of this
screen is to allow the operator to specify where patient reports
are stored on a particular computer 102 of the automated hearing
test. In the example shown, a field 556 indicates that the patient
reports are stored in a directory called "c:\inetpub\wwwroot\" of
computer 102. When the computer 102 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 the
computer 102 is connected may view the patient reports that are
stored on the computer 102. In some embodiments, the computer 102
of each automated hearing test functions as a web server, and the
field 556 indicates the web server root directory. In that case,
the patient reports stored on the computer 102 may be viewed from
the network as a web page using any suitable web browser.
[0045] In some embodiments, the system configuration component 302
includes a test options screen 560. 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
screen 560 includes a plurality of checkboxes 562 that allow the
operator to specify which hearing related tests will be selected by
default from the new sessions screen 400.
[0046] The test options screen 560 also includes a plurality of
hearing related test option screens, for example, a pure tone
options screen 566. Because naming conventions for the various
hearing related tests differ from country to country, the pure tone
test options screen 566 includes a naming field 568 to allow the
operator to customize the test name used for this test in his
clinic. The pure tone test options screen 566 further includes
frequency options 570 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 at 572. A check box 574 allows the
operator to always use bone masking if he so desires.
[0047] In some embodiments, another hearing related test options
screen that is included is the tympanometry options screen 576.
This tympanometry options screen 576 allows the operator to specify
various parameters for the tympanometry test. For example, the
tympanometry options screen 576 includes field 578 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 screen 576 also includes field 580 for
allowing the operator to specify the starting pressure and the
ending pressure for the test. A plurality of calibration parameters
582 allows the operator to enter calibration values for the left
and right ears and to calibrate the tympanometer for those ears
accordingly.
[0048] In some embodiments, the test options screen 560 further
includes an acoustic reflex options screen 583 that can be used to
specify various parameters for the acoustic reflex test. For
example, the acoustic reflex options screen 583 may include a field
584 that allows the operator to specify the name to be used with
the test. Checkboxes 585 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 at 586.
[0049] In some embodiments, yet another hearing related test
options screen that is included is the speech discrimination
options screen 587. This screen allows the operator to specify
various parameters for the speech discrimination test, including
the name of the test at 588. A plurality of fields 589 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.
[0050] In some environments, the test options screen 560
additionally includes a speech reception threshold options screen
590 that can be used to specify various parameters for the speech
reception threshold test. For example, the speech reception
threshold options screen 590 may include a field 591 for specifying
the name to be used for the test.
[0051] In embodiments where a patient survey is taken, the test
options screen 560 may include a survey options screen 592. This
screen can be used to specify various aspects of the survey at 593,
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).
[0052] Finally, in some embodiments, the test options screen may
include an otoacoustic emission options screen 594. The otoacoustic
options screen 594 may include a naming field 595 for specifying
the name to be used with this test. A set of options 596 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.
[0053] FIGS. 6A-6B illustrate an exemplary implementation of the
tympanometry, acoustic reflex, and otoacoustic emission component
304 of the user interface 208. In some embodiments, the
tympanogram, acoustic reflex, and otoacoustic emission component
304 includes a combination test screen 600. 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, and
otoacoustic emission screen 600 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, the screen 600 may include a chart 602 that
captures the data being obtained for the tympanogram. The raw data
is shown generally at 604. The amount of pressure that is being
used is shown at 606. Pressing a command button 608 brings up a
list of commands that may be selected (e.g., exit, pause,
microphone on, etc.). Pressing a skip button 610 allows the
operator and/or the patient to skip the current ear and move to the
next ear.
[0054] When the tympanogram, acoustic reflex, and otoacoustic
emission portion is completed, a screen 612 presents the final
results. From this screen, the operator and/or patient may press an
accept results button 614 to accept the results, a redo right ear
button 616 to redo the right ear, and a redo left ear button 618 to
redo the left ear.
[0055] 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. The patient training
component 306 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.
[0056] FIGS. 7A-7B illustrate an exemplary implementation of the
general phase of the patient training component 306. In some
embodiments, the general training phase includes a welcome screen
700. The function of this screen is to give the patient a general
idea of how the automated hearing test works in general. For
example, the welcome screen 700 may display some of the basic
instructions (shown generally at 702) for the automated hearing
test. At the same time, the patient training component 306 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 buttons 704 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 the
skip button 706.
[0057] Before discussing the patient training component 306
further, it may be useful to discuss one aspect of the patient
management component 310 of the user interface 208. In some
embodiments, the patient management component 310 may include a
progress indicator 708 that allows the patient and/or operator to
track the patient's progress for a given test session. The progress
indicator 708 may include a plurality of bubbles, one of which is
shown at 710, 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).
[0058] In some embodiments, the progress indicator 708 of the
patient management component 310 may also include progress bars 712
and 714. The progress bars 712 and 714 provide an indication of the
completion percentage of the total test session and of each
individual hearing related test, respectively.
[0059] Continuing now with the general training phase of the
patient training component 306, if a progress indicator 708 is
present, the patient training component 306 also provides training
on how the patient can track the progress of his testing using the
progress indicator 708. For example, after the welcome message is
completed (or skipped), the patient training component 306 may
present a progress training screen 720. The progress training
screen 720 may display a text explanation 722 of the basic feature
of the progress indicator 708. In addition, or alternatively, a
detailed verbal explanation of the progress indicator 708 may also
be presented. Both the text and verbal based training explain to
the patient how to interpret the plurality of bubbles 710 and the
progress bars 712 and 714.
[0060] After the general training stage is completed, the patient
training component 306 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 the patient testing component 308.
[0061] In general, at the beginning of each test, the patient
training component 306 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. The patient testing component 308 then allows the
patient to proceed with the actual testing. FIGS. 8A-8I illustrate
an exemplary implementation of the patient testing component 308
and the test specific training portion of the patient training
component 306.
[0062] For example, where the patient is getting ready to take the
pure tone threshold portion of the automated hearing test, the
patient training component 306 presents the patient with a pure
tone threshold training screen 800 and, in some cases, a verbal
explanation thereof. The pure tone threshold training screen 800
includes text 802 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. The
training screen 800 may also present an example 804 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 buttons 806 allow the
patient to control the volume of the verbal message, and a skip
button 807 allows the patient to skip the verbal message. A command
button 808 brings up a list of commands that may be used at this
point.
[0063] After the pure tone threshold training is completed, the
patient testing component 308 presents the patient with a response
screen 810 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, the response screen
810 may include a button 812 that the patient can press each time
he hears a tone. Where color is used, the button 812 and the screen
810 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, the patient testing component 308 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 the
patient testing component 308 waits for the patient to respond by
pressing the button 812. A help button 814 allows the patient to
call the operator at any time.
[0064] Where the patient is to undergo a speech reception threshold
portion of the automated hearing test, the patient training
component 306 presents the patient with a speech reception training
screen 820 and, in some cases, a verbal explanation thereof. The
speech reception training screen 820 includes some of the basic
instructions 822 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 speech
reception training screen 820 may also include an example 824 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.
[0065] After the speech reception training is completed, the
patient testing component 308 presents the patient with a response
screen 830 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, the response screen 830
presents a set 832 of randomly chosen pictures (one shown at 834)
to the patient along with the corresponding words (one shown at
836) for the pictures. In some embodiments, there are nine randomly
chosen pictures and words in a set 832, and the same set 832 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. The
patient testing component 308 then waits for the patient to select
the picture or word from the response screen 830 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.
[0066] Where the patient is to undergo the speech discrimination
portion of the automated hearing test, the patient training
component 306 presents the patient with a speech discrimination
training screen 840 and, in some cases, a verbal explanation
thereof. The speech discrimination training screen 840 includes
some of the basic instructions 842 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 speech discrimination training screen 840 may also include an
example 844 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.
[0067] After the speech discrimination training is completed, the
patient testing component 308 presents the patient with a response
screen 850 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, the response
screen 850 presents randomly chosen sets 852 of pictures (one shown
at 854) along with their corresponding words (one shown at 856).
The words 856 are preferably single syllable words that sound
alike. In some embodiments, there are four such words 856 along
with their corresponding pictures 854 in each set 852. For
languages where such words are not available, appropriate
adjustments may be made.
[0068] As each set 852 of pictures is presented on the response
screen 850, the automated hearing test verbally presents one of the
words 856 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 each set 852 is verbally presented. It
is possible for some sets 852 to have overlapping pictures, but the
same exact set 852 of pictures should not be repeated. The
automated hearing test randomly chooses the sets 852 of pictures
from a large pool of such sets, then presents one word from each
set at a constant level. The patient testing component 308
thereafter waits for the patient to select the picture or word from
the response screen 850 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.
[0069] In some embodiments, the patient management component 310
includes a congratulatory screen 860 that is used to notify the
patient and congratulate him for successfully completing the
hearing related tests. In some cases, the congratulatory screen 860
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.
[0070] An example of a survey instructions screen is shown at 870.
The purpose of the survey instructions screen 870 is to instruct
the patient regarding how to take the survey. Thus, the survey
instruction screen 870 may include a set of instructions 872 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
at 874. 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.
[0071] Once the instructions are completed, the patient is
presented with a survey screen 880. The survey screen includes a
survey question 882 followed by a set of answers 884. After the
patient reads the question, he may then select the best answer from
the set of answers 884. This process is continued until all the
survey questions have been answered.
[0072] FIG. 9 illustrates an exemplary implementation of the
patient management component 310. As mentioned above, the function
of the patient management component 310 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, the patient management
component 310 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.
[0073] 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, the patient management component 310 may include a paging
screen 900 that can be used to inform the patient that the operator
is being paged. For example, the paging screen 900 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.
[0074] FIGS. 10A-10F illustrate an exemplary implementation of the
reporting component 312 of the user interface 208. The reporting
component 312 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, the reporting component 312 includes a
reporting screen 1000 from which the operator may select a number
of options. For example, the operator may press the redo some tests
button 1002 to redo one or more hearing related tests. Selecting
this button returns the operator to the new session screen 400, 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 the new session button 1004 returns the
operator to the new session screen 400, but clears the basic
information fields so that new information may be entered.
[0075] Pressing the view reports button 1006 allows the operator to
search and view the results of previous hearing tests saved on the
system 100. Pressing the print billing button 1008 prints the
billing information associated with the patient, including
insurance codes for services rendered. Pressing the print report
button 1010 prints a full report that contains all the relevant
results of the patient's hearing test that a physician usually
would like to see.
[0076] An exemplary report that may be generated when the view
report 1006 button is pressed can be seen from the report screen
1020. The report screen 1020 may present the results of the hearing
test in a two-panel format, with the results of the right ear in
one chart 1022, and the results of the left ear in another chart
1024. 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. The charts 1022 and 1024 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 at 1026),
as well as some basic information (generally at 1028), 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.
[0077] A save report button 1030 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.
[0078] A change report style button 1032 allows the operator to
change the style of the report from the two-panel format to, for
example, a one-panel format 1040, where data for both ears are
presented in one chart. As can be seen, the one-panel format 1040
includes a single chart 1042 along with the data therefor
(generally at 1044). Basic information 1046 about the patient is
also provided. Navigation buttons 1048 allows the operator to
navigate around the report.
[0079] A view saved report button 1034 allows the operator to view
reports that have been previously saved. Note that this task can
also be performed by pressing the view reports button 410 from the
new sessions screen 400 in FIG. 4. Pressing either button brings up
a search screen 1050, from which the operator may search for
previously saved reports to open and view. The search screen 1050
includes a plurality of search criteria 1052 that the operator can
use to find previously saved reports. Pressing the search button
initiates the search. Pressing the display all button 1054 displays
all of the previously saved reports.
[0080] The reporting component 312 also includes a search result
screen 1060 that presents the results of the search. This screen
lists all the available reports 1062 that match the one or more
search parameters from the report search dialog box 1050. 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 a hyperlink
1064 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.
[0081] The result screen also includes a log hyperlink 1066 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). A data hyperlink
1068 to the data allows the operator to view the raw data for any
test session. A tympanogram hyperlink 1070 allows the operator to
view the tympanogram, acoustic reflex, and otoacoustic reflex
results. And an audiogram hyperlink 1072 to the audiogram allows
the operator to view the audiogram (e.g., chart 1022) by itself
without the rest of the report.
[0082] Other aspects of the search result screen 1060 may include a
plurality of checkboxes (shown generally at 1074), each checkbox
corresponding to one of the reports listed, that allows the
operator to select several reports. A compare button 1076 allows
the operator to view a comparison of the reports that have been
selected. Pressing this button brings up a compare screen 1080 that
includes a comparison of the data charts from the selected reports,
shown at 1082 and 1084, for the right and left ears of the patient.
The charts 1082 and 1084 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 at 1086 and 1088), as well
as some basic information (generally at 1090), 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. A navigation button 1096 allows the operator to
return to the previous screen.
[0083] As mentioned above, pressing the print report button 1010
prints a full report that contains all the relevant results of the
patient's hearing test. FIGS. 11A-11C illustrate an exemplary
hearing test report 1100 according to embodiments of the invention.
As can be seen in FIG. 11A, the report 1100 may have several
sections, including a test results section 1102, a test summary
section 1104, a medical recommendations section 1106, a patient
history section 1108, and possibly one or more other sections 1110
(e.g., medical release, billing, etc.). These various sections
1102-1110 together provide a single report that is concise,
convenient, and thorough. Note that some of these sections, for
example, the test results section 1102, were discussed briefly
above with respect to the reporting component 312.
[0084] In accordance with embodiments of the invention, one or more
of the sections 1102-1110 may include interpretive comments
regarding the results of the hearing related tests in the report
1100. The interpretive comments are generated by the interpretive
comments component 314 (FIG. 3) of the user interface 208. As
alluded to above, the interpretive comments component 314 may be a
modular, stand-alone component that is capable of accepting data
from and passing data to other functional components. The
interpretive comments component 314 generates the interpretive
comments based on the same data received by the results reporting
component 312. This modularized approach allows the interpretive
comments component 314 to function independently of other
functional components such that it may be removed from the user
interface 208 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.
[0085] 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-US-00001 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.
[0086] 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-US-00002 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.
[0087] 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-US-00003 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. Essentially
normal #1 No air thresholds are greater than 30 dB; AND One air
threshold is greater than 20 dB; AND Rule #1 is true or Rule #4 is
true. Essentially normal #2 All bone thresholds are less than 25
dB; AND Rule #2.1 is true or Rule #4 is true; AND All air
thresholds are less than 25 dB. Essentially normal #3 Air threshold
for 8 KHz is greater than 20 dB; AND All other air thresholds are
less than 25 dB; AND Rule #1 is true. Predominately SNHL Two or
more thresholds are greater than 20 dB; AND Rule #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; AND Rule #2 or Rule #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; AND Rule #2 or Rule #3 or Rule
#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."
[0088] 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.
[0089] 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.
[0090] 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.
[0091] 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.
[0092] As mentioned above, in some embodiments, the report 1100 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.
[0093] 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).
[0094] 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.
[0095] 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.
[0096] The foregoing interpretive comments may be displayed on the
report 1100 in one or more of the sections 1102-1110, as will now
be described with respect to FIGS. 11B and 11C. Turning first to
FIG. 11B, the results section 1102 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, the
results section 1102 has four subsections. The subsections include
an air and bone conduction subsection 1112, a speech
intelligibility subsection 1114, and a tympanogram/DP-OAE
subsection 11 16.
[0097] The first subsection, namely, the air and bone conduction
subsection 1112, is similar to the one discussed previously with
respect to the report screen 1020 (FIG. 10B). For example,
information about the patient, generally indicated at 1120, 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 the right chart
1122 and the left ear results are shown in the left chart 1124. The
charts 1122 and 1124 are computer-generated audiograms that reflect
the patient's performance for the air and bone conduction tests.
The placement of the right chart 1122 on the left side and the left
chart 1124 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.
[0098] On the charts 1122 and 1124, 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.
[0099] The numerical data for each chart 1122 and 1124 is reported
in table form at 1126 and 1128. Each row of the tables 1126 and
1128 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 tables 1126 and 1128,
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 the charts 1122 and 1124, 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.
[0100] In some embodiments, a legend 1130 may also be present to
explain the meaning of the various symbols and markers displayed in
the air and bone conduction subsection 1112. The symbols are
standard symbols used by most audiologist and hearing health
professionals, but may certainly be modified as needed for a
particular application.
[0101] The speech intelligibility subsection 1114 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, the
speech intelligibility subsection 1114 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, the
speech intelligibility subsection 1114 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, the speech intelligibility subsection 1114 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.
[0102] In the exemplary implementation shown here, the speech
intelligibility subsection 1114 includes a column for the
description 1132 of each speech related test result described in
the previous paragraph, a column for the measure 1134 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 the right ear 1136 and the left ear 1138. In some embodiments,
the numbers in columns 1136 and 1138 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.
[0103] The tympanogram/DP-OAE subsection 1116 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 subsection 1116 includes a tympanogram 1140 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 at 1142 and 1144 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 at 1146 and 1148 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.
[0104] A comments subsection 1150 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 subsection 1150 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 subsection 1150 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.
[0105] FIG. 11C shows an exemplary implementation of the test
summary section 1104 for providing interpretive comments regarding
various hearing related tests according to embodiments of the
invention. As can be seen, the test summary section 1104 may
include a table showing a description of the various tests at 1152
and the interpretive comments therefor for the right ear and the
left ear, respectively, at 1154 and 1156. 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. The summary section 1104 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 at 1158 in some
embodiments.
[0106] In addition to the summary section 1104, FIG. 11C also shows
an exemplary implementation of the medical recommendations section
1106. Again, the information is provided in the form of a table,
with the types of recommendations listed in one column at 1160 and
the recommendations themselves listed in another column at 1162.
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.
[0107] As for the patient history section 1108, in some
embodiments, the patient history section 1108 provides a list of
possible symptoms that the patient may have experienced, indicated
at 1164. 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, at 1166 and 1168, respectively. Comments may also be
entered for each symptom at 1170 as needed.
[0108] Finally, the report 1100 may include one ore more other
sections 1110, 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 at 1110 in FIG. 11C.
In some embodiments, billing information may also be presented in
the report 1100, including information relating to the charges for
the various hearing tests and other billing related
information.
[0109] 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.
* * * * *