CROSS-REFERENCE TO RELATED APPLICATIONS

[0011 This application claims the benefit under 35 U.S.C. 1 1 of the earlier filing date of U.S. Provisional Application No. 61/847,026 entitled "HEARING PROFILE TEST SYSTEM AND METHOD," filed July 16, 2013 and this application also claims the benefit of and is a continuation of U.S. Non-Provisional Application 14/01 1 ,620 entitled "HEARING PROFILE TEST SYSTEM AND METHOD; ⁵ filed August 27, 2013. The aforementioned applications are hereby incorporated by reference in their entirety, for any purpose,

TECHNICAL FIELD

|002] Examples described herein relate to methods and systems of hearing testing, particularly for rapidly profiling the hearing ability of a person, and for determining hearing aid candidacy. This application is related to U.S. Patent No. 8,467,556, titled, "CANAL HEARING DEVICE WITH DISPOSABLE BATTERY MODULE," pending U.S. Patent Application No. 13/424,242, titled, "BATTERY MODULE FOR PERPENDICULA DOCKING INTO A CANAL HEARING DEVICE," filed on March 19, 2012, all of which are incorporated herein by reference in their entirety for any purpose. This application is also related to the following concurrently filed U.S. Patent Applications; Company Docket No. IH 13, titled, "HEARING AID FITTING SYSTEMS AND METHODS USING SOUND SEGMENTS REPRESENTING RELEVANT SOUNDSCAPE," listing Adnan Shennib as the sole mventor; Company Docket No. M 16, titled, "INTERACTIVE HEARING AID FITTING SYSTEM AND METHODS," listing Adnan Shennib as the sole inventor; and Company Docket No. IH17, titled, "ONLINE HEARING AID FITTING SYSTEM AND METHODS FOR NON- EXPERT USER," listin Adnan Shennib as the sole inventor; all of which are also incorporated herein by reference, i thei entirety, tor any purpose. BACKGROUND

] Pure tone audiometry is the gold standard for hearing assessment. It relies on identifvini* the threshold of hearing for an individual, general! v using tonal sounds generated by instrumentation designed for clinical use by a hearing professional. The instrumentation and accessories for standard hearing tests are generall specialized electro-medical devices for use in a clinical setting. For example, to obtain a valid threshold test and an audiogram report, tests are generally performed in specialized sound-isolated rooms, often referred to as a "sound room," to reduce noise levels present in the environment generally to that below the threshold of normal hearing. The combined cost of a sound room and clinical instrumentation for standard audiogram testing can easily exceed $20,000.

) Performing a hearing assessment is generally not practical for lay consumers to self-administer, particularly in their home or office setting. Even in quiet room environments, noise levels typically exceed the maximum level required for accurately determining the threshold of hearing. Another limitation for self-administration of a hearing test at home is the complexit associated with the test procedure, which can be perplexing and time consuming for a lay person.

) Current hearing evaluation methods and associated reports are generally designed for administration and interpretation by hearing professionals, such as an audiologist, an otolaryngologist, a hearing aid dispenser, etc. Standard audiogram results are generally of little value to a lay consumer and generally present irrelevant information pertaining to hearing aid candidacy. The audiogram test report, generally considered the standard form for hearing assessment and hearing aid prescription, is technical and not suitable for interpretation by a potential hearing aid consumer. For example, a standard audiogram report generally presents a person's hearing sensitivity for tonal sounds from -10 to 10 dB, inversely displayed, versus test frequencies from 125 to 8000 Hz. The hearing sensitivity for each frequency may also be tabulated in other audiogram forms. However, since these reports were designed mainly for clinical diagnostics and interpretation by a professional, they are generally not useful for a lay consumer, particularly for indicating hearing aid candidacy. Furthermore, determining the hearing ability in certain ranges, such as -10 to +15 dB L, is generally not relevant to a person's ability to carry on .normal conversations. Another limitation is the irrelevance of audioraetrk tonal sounds, which generally do not represent real life sounds. Another barrier for self-performed hearing assessment is related to the aforementioned cost, complexity and inaccessibility of standard hearing test instruments.

| ^' 086] To circumvent some of the limitations of standard hearing evaluation methods, automated, computer-based hearing evaluation methods have been proposed, including self-administered online tests using personal computers. These tests are often inadequate, however, due to their inaccuracy, often caused by audio characteristics of consumer electronics not meeting the standards of audiometric testing. For example, consumer electronics, such as a sound card, may introduce unacceptable total harmonic distortion (THD), unpredictable frequency response, excessive signal noise, and/or excessive cross-over distortion. The sources of adverse audio characteristics can be attributed to the sound card, the speaker, consumer headphones, cabling, connectors, etc. hi addition to the aforementioned obstacles related to audio characteristics, the calibration of acoustic signals emanating from a consumer transducer (a consumer earphone, for example) represents a daunting challenge, preventin accurate hearing evaluation by the lay consumer using a personal computer, or a personal electronic device.

J007] Hearing screening tests offer basic hearing assessment for individuals on the basis of a pass or fail criteria. Generally speaking, these tests are administered b a hearing professional or a nurse, using a portable instalment, which produces a limited set of test stimuli often at a predetermined level between 20 and 40 dB HL depending on the age of the group being tested. These tests generally vary according to the guidelines of the agency, state, and country. Similar to standard audiometric evaluations, tonal and narrow-band noises are generally presented to administer the hearing screenin test. One major drawback of current hearing screening methods is the lack of sensitivity and specificit for determining the hearing ability and indicating hearing aid candidacy. As a result, "failed ^" " subjects are generally referred to a hearing professional for further hearing assessment prior to hearing aid candidacy assessment and hearin aid fitting. SUMMARY

|008] The present disclosure describes example systems and methods for calibrated evaluation of a consumer's hearing ability and hearing aid candidac , without requiring clinical instrumentation and professional settings- In some embodiments, the hearing evaluation uses standard personal computers in conjunction with an audio signal generator device configured to generate calibrated audio signals to administer a rapid hearing profile test in the consumer's environment, such as the consumer's home or office. In some embodiments, the audio signal generator device may be handheld and worn on the body or placed on a table during the hearing test. The hearing profile test presents a sequence of supra-thresholtt test stimuli, generally above 20 dB HL with increments in the range of 10-20 decibels, up to test levels of approximately 70-80 dB HL. The test signals may be presented in frequency bands in the range of 400-8000 Hz. The consumer's minimum audibility response within the suprathreshold sound level range presented at each test frequency band may be registered using a personal computer, which may comprise a smart hone or a tablet computer. The personal computer executes a hearing profile software application to implement the hearing profiling method described herein, and to present a computed hearing profile score, indicting the general hearing ability and hearing aid indication. The hearing profile score may be whole or fractional, for example indicating approximately one of five discrete levels or categories of hearing ability. The entire evaluation process, including profiling, scoring and hearing aid indication, may take approximately less than 10 minutes, in one embodiment. The cost to a consumer may be less tha $50, including minimal incremental hardware and software to administer the calibrated test using a personal computer virtuall anywhere, including at home.

1009] in an example embodiment, the acoustic stimuli presented are in the supratlireshold range of 30-80 dB HL, with a test increment of approximately 1 decibels, presented at frequency bands of 500, 1000, 2000, 4000 and 6000Hz. The score may be computed based on minimal audibility level (MAI.) within the suprathreshold range presented, and weighted by appropriate factors such as the speech intelligibility index (SII) as per American National Standards ANSI/ ASA S3.5.

010J In one example embodiment, the delivery of the acoustic test signal from the hearing profile evaluation system may be provided by a standard consumer-type earphone with calibrated el ctroacoastic performance. The earphone may be provided with insert eartips, to occlude the ear canal and reduce the audibilit of ambient background sounds present in typical room environments. By limiting the test presentations to suprathreshoid levels, generally exceeding 20 dB HL. and using ear occluding eartips, hearing profiling may be performed in any reasonably quiet room environments, eliminating the cost and inconvenience of specialized earphones and clinical settings. In one embodiment, a microphone may be incorporated to sense the level of ambient background noise and adjust the hearing evaluation process according!}'. By reducing the range of presentation levels and test frequencies, increasing the test increment level to 10 dB or more, and providing a simplified scoring system, the lay consumer may be presented with an alternative hearing evaluation method that is easy to understand and correlate to hearing device candidacy.

[Oil ^' I In one embodiment, one or more natural sounds are presented as calibrated test signals, For example, a drum sound may be presented for testing the low frequency range of hearing, and a bird chirp sound may be presented for testing the high frequency range of hearing. The hearing profile test may be administered online with a hearing profile software application at least partially hosted by a remote server and executed by the consumer's ow personal computer that is connected online to the remote server and to the handheld audio generator device at the consumer side. The online computerized hearing test system may be advantageous by offering online support during the hearing evaluation process. In one embodiment, a customer support personnel may send speech communications online from a customer support computer system into the test earphone. The customer support personnel may also use the customer support computer system to receive speech communications online from the consumer by the aforementioned microphone using Voice-Over internet Protocol (VoIP } communications.

BRIEF DESCRIPTION OF THE DRAWINGS

[012) The above objectives, features, aspects and attendant advantages of the present invention will become apparent from the following detailed description of various embodiments, including the best mode presently contemplated of practicing the invention, when taken in conjunction with the accompanying drawings, in which:

3 | ^' 013| FIG. 1 is a view of a computerized, hearing test system, including a handheld device comprising an audio signal generator for generating calibrated audio signal, a personal computer and an insert earphone for producing calibrated test sounds, according to one embodiment.

[014] FIG. 2 is a representation of a hearing profile test system using a smart phone and a handheld device ciipped on the shirt of a user, according to one embodiment.

[015] FIG. 3 is a representation of a hearing profile scoring system, including hearing profile categories, hearing profile score scale, and indication of hearing aid candidacy indication, according to one embodiment.

(016) FIG . 4 is a view of a calibration system for standard consumer type earphones, with assorted eartips, a 2-CC acoustic coupler, earphone-coupler interface, and a sound level meter, according to one embodiment.

[017] FIG. 5 is a time domain graph of a test signal from a drum snare sound receding for evaluating the hearing ability in the low frequency at a 500 Hz band.

(0 8] FIG . 6 is a frequency spectrum graph of t he drum snare test signal of FIG. 5. | I9j FIG. 7 is a time domain graph of a test signal from a bird chirp sound recording for evaluating the hearing ability in the high frequency at a 6000 Hz band.

(020) FIG. 8 is a frequency spectrum graph of the bird chirp test signal of FIG, 7. (021.) FIG. 9 is a flow chart depicting a simplified example process for automatically presenting test signals and determining minimum audibility levels, according to one embodiment.

[0221 FIG. 10 is a diagram depicting an example online hearing profile test system, including a remote server for hosting a hearing profile test application and a remote customer support computer system and personnel, according to one embodiment.

[023] FIG. i l is a view of a hearing profile test user interface from a web browser, with test in progress, according to one embodiment.

(024| FIG. 12 is a front view of a hearing profile test scale and score presented on a browser user interface, indicating hearing aid candidacy and a hearing aid recommendation, according to one embodiment.

[025 j FIG. 13 is a representation of ^" a fractional hearing profile test score presented in conjunction with a scale descriptive of hearing ability and hearing device candidacy, according to one embodiment. DETAILED DESCRIPTION

[026] Certain details are set forth below to provid a sufficient understanding of embodiments of the invention. Some embodiments, however, may not include all details described herein. In some instances, some well-known structures may not be shown, in order to avoid imnecessariiy obscuring the described embodiments of the invention.

[0271 The present disclosure describes example systems and methods, as shown in FIGS, 1 -1.3, for profiling the hearing ability of a consumer and indicating hearing aid candidacy rapidly and inexpensively without requiring expensive equipment and clinical settings. Referring to FIG. 1 , in one embodiment, the evaluation process uses a general purpose computing device, for example a standard personal computer 1.0, in conjunction with a handheld device 30 configured to generate a calibrated audio signal 31 (also referred to herein as "test audio signal" and ''audio signal") to earphones 40 to administer a bearing test in the consumer's normal ei ironraent. such as the consumer's home or office. The persona! computer 10, the handheld device 30, hearing profile software application 50, and the earphones 40 may collectivel form a computerized test system 20 (also referred to herein as ''computerized bearing test, system"). The computerized test system 20 presents a sequence of supra-threshold test stimuli 4.1 , generally above 20 dB HL, into the ear 2 of the consumer 1. For reference purposes, 0 HL represents the threshold of hearing for norma! bearing individuals, and suprathreshold refers to sound levels above the threshold of normal hearing. Also, 20 dB represents a significant, increase over threshold levels, from the sound level perspective, as well as electrical signal requirements for the electrical audio signal 31 producing the acoustic test stimuli 41. i various embodiments., the test stimuli 41 may be provided in step levels in the range of 10-20 dB. in contrast to standard audiometric test methods which, specif 5 dB increments, for example as per ANSI/ASA 3.6 standard.

[028] FIG. 2 shows a smartplione embodiment of a computerized hearing test system with a handheld device 30 connected to smartpbone 15, executing a hearing evaluation application for self-administration. The user 1 follows instructions and registers audibility responses using the touch screen 12 of the soiariphone 15. Similarly, a hearing profile score 72, hearing profile 76 (also referred to herein as "hearing ability"}; and hearing aid candidacy 79 are presented to the user following the hearing profile test. The computerized hearing test system 20 may be implemented to enable rapid and sufficiently accurate assessment of a consumer's hearing ability in environments outside clinical setting, and to provide easy to understand scoring system with hearing ability scale 75 and hearing aid candidacy scale 78.

[0291 .¾ one embodiment, the acoustic test stimuli 41 may be presented at three or more frequency bands within the audiometric frequency range of about 400 to 8000Hz. The consumer's minimum audibility level (MAI.) within the suprathreshold (with respect to normal hearing) range of sound levels presented at each test frequenc band ma be registered using the personal computer's standard interface, such as a keyboard 11. mouse, or touch screen 12. The personal computer 10 may also be in the form of a smartphone 55 as shown in FIG. 2, or a tablet computer (not shown). A personal computer herein generally refers to any consumer computing device capable of executing a hearing profile software application 50 according to the teachings herein. Alter executing the hearing profile test (also referred to herein as "hearing test" and "hearing profile evaluation '), the consumer 1 may be presented with a hearing profile score 72 (FIG. 3) .from a hearing profile score scale 71 , with each hearing profile score (HPS) corresponding to a hearing profile within hearing profile scale 75, and hearing aid candidacy indicatio within hearing aid indication scale 78. The levels within the hearing profiling system may be in the range of about 4-6 discrete levels or categories. Throughout this application, the term "consumer" refers to any person taking the hearing test and is interchangeable with other, similar terms, including but not limited to "user," "person," "client," "hearing impaired," "tester," "test subject ⁵ etc. The term "hearing aid." is used herein to refer to all types of hearing enhancement devices, including medical devices generally prescribed for the hearing impaired, and personal sound amplification products (PSAP) generally not requiring a prescription or a medical waiver,

[030] In some example embodiments, the suprathreshold level of acoustic test stimuli

41 may be limited to a range of about 30-80 dB HI ., with level increments in a range of about 10-20 dB between consecutive stimuli, at multiple frequency bands within a range of about 5G0-600OHz. The hearing profile score, 72 for example, is generally based on a computation incorporating the minimal audibility levels at the test .frequencies. The scoring computatio may optionally incorporate, at least partially, frequency weighting factors, such as the speech intelligibility index (SB) as per ANSI S3.5 standard, as will be described in more details in an example below. In one aspect, the consumer 1 is offered a simplified scoring system for indicating hearing ability and hearing aid requirements.

[031] in some embodiments, the acoustic test signal 41 from the computerized hearing test system 20 may be delivered via an earphone 40 with an eartip 47(FIG. 4), also referred to here as ear canal "insert," which occludes the ear canal and minimizes the adverse effects of ambient background noise 5 (FIG. 1 ) present in room environments during the hearing profiling process evaluation. The insert 47 is connected to the earphone earpiece 46 incorporating a transducer (not shown) within. In the preferred embodiments, the eartip 47 provides at least 5 dB of noise attenuation, within the audiometric range of 500 Hz to 6,000 Hz. Noise herein generally refers to sounds which may compete with the test stimuli 41 presented to the ear 2 by the earphone 40, which may be insert type (as shown) or circumaural headphone (not shown). The insert 47 may be removable and offered in assorted sizes, for example with a relatively large eartip 48 as an alternative for individuals with relatively larger ear canals, m some embodiments, an assortment of 3-4 eartips may be provided, to ensure proper fit in variety of ear canal sizes. By presenting calibrated acoustic test signals 41 at suprathreshold levels generally exceeding 20 dB HL, and in combination with an occluding earphone 40, a hearing profile evaluation may be administered in a typical room environment, as is further described below.

j032j To further mitigate the effects of potentially excessive noise in certain room environments, a microphone 35 (FIG. 1 ) ma be incorporated within the handheld device 30 to sense room sound 5 in the vicinity of the user 1. The hearing profile test process may then be adjusted according to the noise condition, for example by delaying the presentation of test stimuli 41 during a noise burst, or by halting the test process in the presence of persistent or excessive noise.

[033] in some embodiments, the handheld device 30 is placed generally on the user's body in proximity to the ear 2, for example on the torso 3 area as shown in FIGS. 1 and 2. In. some embodiments, the handheld device 30 may be affixed to the users shirt or jacket with a clip (not shown) or held by a necklace (not shown). The computerized hearing test system 20 and methods {hereof allow rapid and accurate hearing profiling for a lay person with minimal hardware by leveraging their own persona! computing device while presenting calibrated test audio signals 31 by the handheld device 30. In some embodiments, the computerized hearing test system 20 is designed primarily for self-administration. However, it should be understood that assistance may be provided for certain individuals, for example those with limitations related to aging, heath condition, or mental capacity. The handheld device 30, in some embodiments, includes a USB interface 38 for interfacing with, and control by, a personal computer 10, and in some cases for streaming of digital audio representing test signals or audio instructions from the personal computer 10. Digital audio files representin test stimuli, as well as calibration constants associated with calibrated test stimuli, may be stored within the handheld device 30, within the client, personal computer 10, on a remote server 60 (FIG. 10), o generally anywhere on the internet "cloud" 65 (FIG. 10). The handheld device 30 houses audio signal generator 36 (also referred to herein as "digital audio system"), and includes programmable audio amplifiers to prov ide calibrated test audio signals 31. The digital audio system is generally independent of the personal computer 10 audio capabilities, and may be configured to provide calibrated audio signals 31 regardless of the computer platform used by the consumer 1. This allows for predictable audio characteristics conforming to accepted standards, for example as per ANSI/ASA 3 ,6, In preferred embodiments, a single-chip digital audio system is employed within the handheld device 20 to convert, digital audio data from the personal computer 10 to a predetermined level of audio signal 31 for delivery to the earphone 40, generating a calibrated test stimuli 41 signal to the ear 2. The term "calibrated" herein generally refers to the terms "known," "determined." "predetermined," and similar terras to describe an electrical or an acoustic signal having predicted characteristics, whether by a design or by a calibration process, to conform to a standard or a design specification.

FIG. 4 shows one embodiment of a system for calibrating a standard earphone

40 using a standard 2-cc coupler S3 and a sound level meter 80. The eartip 47 or 48 may be removed from the earphone earpiece 46 and coupled to the 2-cc coupler, using an. earphone-coupler interface 85. A microphone section 84 of the sound level meter 80 is typically inserted into the 2~ec coupler cavity for calibrating the sensitivity of the earphone earpiece 46, using the sound level measured and presented at the display 81 of the sound level meter 80. The calibration of the earphone 40 is preferably performed by the manufacturer or calibration service provider for the handheld device 30, and generall not of concern for the consumer 1. The consumer 1 ma plug the audio connector 42 of the earphone 40 into the handheld device 30 and plug USB connector 38 of the handheld device 30 into the personal computer 10. The consumer 1 may then begin the testing, using the hearing profile software application 50 (FIG. 1 1 ) provided to the consumer 1 for execution by the personal computer 10, and by the handheld device 30, which may be configured to deliver calibrated test signals 31.

] in one embodiment, one or more natural sounds may be employed as test stimuli 41 to engage the consumer with sounds relevant to the human hearing experience. In contrast to traditional methods, which employ tonal sounds, natural sounds represent sounds audible in normal listening experiences, such as human speech, music, animal sounds, bird chirp, wheel squeak, etc.

] I» an example embodiment, a drum snare sound recording may be used to test the hearing ability of the consumer Ϊ at relatively low frequency range of audible sound, as shown in FIGS, 5 (waveform) and 6 (frequency spectrum). A drum snare sound generally has significant content in the low frequency portion of the human auditor range, for example around 500 Hz. With further processing by an audio processing software, for example AUDACITY® for Windows, the original drum snare recording waveform may be modified to result in a frequency response peaking at approximately 500 Ez and with reduced frequency content outside the 500 Hz frequency band as shown in FIG. 6, Alternatively, hammer sound may demonstrate similar spectral characteristics and ma be employed for hearing testing in a low frequency range.

} In another example, a bird chirp sound recording ma be employed for testing hearing of the consumer I at a relatively high frequency range, as shown in FIGS. 7 (waveform) and 8 (frequency spectrum). A bird chirp sound generally has significant content in the high frequency portion of the human auditory range, for example around 6000 Hz. The original bird chirp recording may also be filtered by an audio processing software to produce a test signal substantially in the high frequency range, for example around 6000 Hz frequency band, as shown in FIG. 8.

[038) FIG. 9 shows a simplified example flowchart for an automatic hearing evaluation process for determining the minimum audibilit ' level (MAL) of the consumer 1 within the range of the suprathreshold sound levels presented. As shown in the flowchart with operations J 10-130, starting with deterrmning MAL at 1000 Hz. (operation i 10), a signal level of 50 dB HL may be initially set (operation 1 6) and test stimuli 4.1 is presented at 50 dB HL (operation 1 1.7) to the consumer .1. The response from the consumer 1 is then determined by operation Ϊ 18 and if no response is registered by the computerized hearing test system 20 within a time window, typically 1 to 1.5 seconds from the end of the stimuli period, the "current level" of the test stimuli 41 is incremented by 20 dB HL, up to a maximum level of 80 dB HL for example (operation ! 19) and the test stimuli 4 ! is then presented to consumer 1 at the increased level (operation 117). When a response is detected in operation 1 18, an MAL value is recorded (operation 120) for subsequent verification by operations 120-126 whereby the test signal level is decremented by 10 dB (operation 121) and presented (operation 122) for response determinatio (operation 123). if a response is not registered at operation 123, the test stimuli level is incremented by 10 dB (operation 124) and the test stimuli is presented (operation .122) with the increased level, and the process is repeated if necessary, until a response is registered at operation 123, The M AL for a test frequency is considered "found" (operation 126) generally when the computerized hearing test system 20 detects two consumer responses at the same presentation level as determined by operation 125, which compares a currently registered response level with a previously recorded MAL. if the current response level does not match the previousl recorded MAL, a new MAL value is set and recorded (operation 120) and the signal level is decremented by 10 dB (operation 121) until an MAL is determined (operation 125). In the preferred embodiments, the step size for consecutive test presentations is within the range of 10-20 dB.

J039] The process for determining M ALs for all test frequencies (operations 1 10-11 ) may be sequenced as in shown in FIG. 9, or interleaved (not shown), either randomly or a a predetennined interleave sequence. Interleaving may minimize predictability of test, process sequence by the consumer 1 and may improve the reliability of the test. A final verification process (operation 1 15) at one frequency, typically at 1000 ilz, is preferably administered to assess the reliability of the user's responses. For example by re-presenting a 1000 Hz test stimuli 41 (operation 127) at the MAL previously determined in operation 1 10, and determining if the consumer 1 is responding consistently at this level (operation 12%), and to determine either a reliable 'valid test" (operation 130) or inconsistent "invalid test" (operation 129). It should be understood that variations of the aforementioned example hearing evaluation process and algorithm thereof are possible and may be advantageous.

0401 Known attempts to address the issues and limitations of current audiometry methods include providing embodiments of automatic hearing testing and hearing aid programming integrated in a unitary headset instrument. These embodiments offer conventional test stimuli to compute standard prescriptive formulae to program into a hearing aid. Known attempts also include online home testing using the consumer's own personal computers and the consumer's own headphones or the computer's speakers. To circumvent issues related to signal quality and calibration, online tests generally employ signal-in-noise conditions, mainly to detect the person's ability to hear in the presence of noise. Although the may be valuable in assessing the hearing ability for certain types of losses, these signal-in-noise tests fail to indicate the level of hearing loss, and are considered as screening tools requiring further assessment by a hearing professional using diagnostic hearing assessment tools.

[041 J In an online embodiment of the hearing evaluation method of the present invention shown in FIG. 10, a hearing test software application 61 is hosted by a remot server 60 and executed locally by the consumer's personal computer 1.0, as a client computer connected online to the server 60 via the Internet 65. The hearing test- software application 50 executed by the computer 10 is at least partially hosted by the server 60. in the example online embodiment. The results of the hearing evaluation, including the hearing profile store, may be stored in a remote database.

042J The online computerized hearing test system may further offer online customer support by connecting to a customer support computer system 66 operated by customer support personnel 68. The customer support personnel 68 may communicate with the consumer 1 by a headset 67. including a microphone to stream instructions from customer support computer 66 to the consumer 1 . For example, voice over IP (VOIP) may be used to stream instructional audio io the client computer 10, to the digital audio system 36 of the handheld device 30 via the USB connectivity 38, and ultimately as audible stimuli 41 to the consumer's ear 2 via the earphone 40, Instructional audio may include the speech of customer support personnel 68. recorded or generated audio massages from a server 60 or customer support computer 66. Speech communication from die consumer 1 may also he transmitted io the customer support personnel 68 by the reverse process, using the microphone 35 of the handheld device 30. or another microphone incorporated in the computerized hearing test system 20.

1 FIG. 1 1 shows an example user interface (Ul 50 for an online embodiment of the hearing evaluation method, employing a web browser to execute a server hosted hearing profile software application. The UJ 50 shows UJ elements, including user instructions 51 , test pause control 52, test presentation status 56, test process status 53, online connection status 54, and handheld device 20 connection status 55, in this embodiment of the user interface 50, the user j is generally instructed to listen to the calibrated test sounds 41 presented and press the space bar of the keyboard 1 1 (or a key- on the touch screen 12) when the sound 41 is heard. In one embodiment, the browser- based application operates in conjunction with a client application; which provides access to, and control of, the handheld device 30.

) FIG. 1.2 shows an example representation of the hearing profile scoring Ui 70, showing hearing profile score 72, hearing profile score scale 71 , and hearing ability 76 and hearing aid indication 79. Contrasting the hearing profiling system disclosed herein with standard audiogram reports, which display the sensitivity of hearing from -1 to 1 10 dB and in a reverse order without indicating hearing ability or candidacy, the hearing profile score 72 and corresponding hearing abilit 76 and hearing aid candidacy 79, indicates the general ability to hear from "Normal" 73 to "Extensive" 77, suggesting professional assessment and/or intervention. Hearing aid candidacy 79 may be computed at least partially from the hearing profile score, and in some cases other factors may also contribute.

] FIG. 13 shows an alterna te embodiment of the hearing profile scoring scale 71 , whereby the scale is primarily descriptive, and a fractional hearing profile score 90 is presented in conjunction with the descriptive scale. In some examples, the fractional hearing profile score 90 may be presented as an overlay, that is on top of the scoring scale 71 , in order to provide the consumer 1 with a more precise score while also pointing to general descriptive context. According to various alternative embodiments, suitable variations of the scoring system and method and corresponding indications may be made, such as reversing the order of the scoring scale 71 , with level I representing ' ^" Normal Hearing" and the highest level representing worst hearing ability. Alternatively, alphanumeric character representation, such A, B, C ₅ etc., may be used to represent the hearing ability. In the preferred embodiments, the scoring levels may be limited to 4-6 categories. The web page UI 70 of FIG. 12 also shows a hearing aid recommendation section 74, describing product and pricing options to the consumer. ( ^' 046] In contrast to conventional audiometric test methods and reports, the systems and methods disclosed herein simplify and expedite the test process by eliminating various redundancies and limiting the hearing evaluation to test signals relevant to hearing aid candidacy and fitting, generally at levels above 20 dB HL and frequencies above 500 Hz and up to 6,000 Hz. This is particularly applicable whe considering the fitting systems and methods that use subjective assessment by the consumer for determining hearing aid fitting parameters during the fitting process. By eliminating testing below 500 Hz, the adverse effects of low frequency noise commonly present in room environments may be substantially mitigated.

Experiment

[047] The following experiment was conducted to assess and validate the hearing profile test in normal room environments according to the teachings disclosed herein. Sound measurements were taken in an office with two personal computers operating and the test instruments used to conduct the experiment. Fan noise from the computers and street noise were noticeably audible by non-occluded ears. The measurements were taken approximately 4 feet away from the nearest computer. The room noise level was measured using a 2-channel spectrum analyzer (Stanford Research model S 785), two probe tube measurement systems (ER-7 manufactured by Etymotie Research) and an integrating sound level meter (Model 2200 manufactured by Quest), This experiment is reported here by way of example and to facilitate understanding and appreciation of the system and methods described herein. Inclusion of this experiment here is in no way intended to represent that all experiments performed did or will achieve like results.

[048) Room noise was initially measured by the sound level meter, indicating average noise level of about 44 dB SPL, Using the spectrum analyzer and the probe tube system, the average noise level in i/3 octave bands was measured for frequencies between 500 and 6000 Hz frequencies as tabulated in Row-A of Table 1. The attenuation across the earphone 40 (model TMG-ACD) was also measured by the ER-7 probe tube measurement with the eartip snuggiy inserted in a SILICONE'S* rubber ear model, with one probe placed inside the ear mode! and the other outside to measure the deferential sound pressure level across the earphone in the ear model. The resultant attenuation of the earphone eartip was tabulated in Row~B.

[049) Row C shows the maximum allowable noise level in 1 /3 octave bands for audtometric testing of threshold levels according to ANSI 3.1 in the condition of ears not covered. Row-D estimates the permissible noise level for each frequency band according to the teachings of the present invention, with a presentation level 30 dB above normal threshold of hearing levels. The permissible level for present method was estimated by adding 30 dB to the permissible noise levels according to the ANSI standard for threshold testing, and the attenuation of the earphone earti occluding the ear.

[050] Accordingly, the permissible noise level (D) can be calculated from the equation: Earphone Attenuation (B) + Allowed noise level per ANSI (C) ^÷ 30 dB

Table 1

Analysis and Conclusion tor Experiment

1 ] Testing the hearing ability at or above 30 dB HL across the audiometric frequency range of 500 to 6000 Hz. is possible in reasonably quiet environments such as an office, even in the presence of computers and other instruments using the principles of the present invention. There was a substantial margin of noise at virtually all test frequencies, with the exception of 4,000 Hz having only an 8.8 dB margin. This is possible due to relatively poor sound attenuation of the eartip at this particular frequency. It should be understood that noise levels are expected to vary considerably across room environments due to room acoustics, noise sources, distance and the position of the consumer with respect to noise sources. However, these variations are expected to be substantially mitigated by testing at suprathreshold levels above 20 dB, and particularly at 30 dB 11 I... as in this example.

( ^' 052] Asymmetric hearing losses represent a challenge to hearing assessment, whereby masking sounds may be required for the non-test ear. Masking is a task not easily inKierstood or implemented by a lay person. However, the system and methods disclosed herein are well suited to automatically introduce masking sounds to the non- test ear in order to mitigate cross-over errors in asymmetrical hearing losses. For example, by automatically delivering a narrow band, or broad band noise to the non- test ear. In the example embodiments, test sounds are presented at frequencies of 500. 1000, 2000, 4000 & 6000 Hz, preferabl with at least one natural sound as disclosed above. Test signals may also be tonal such as warble tones, mixed tones, or band- limited noise. Pure tones may also be presented but are generally considered less desirable. Masking of a non-test ear using a stimulus of predetermined level may also mitigate the adverse effects of room noise, for example by presenting a masking noise to the test ear to compete and override ambient noise,

(053| The following method and computation formula represents an example for computing a hearing profile score (HPS), A scoring scale from 0 to 5 is assigned for each test levels from 30 to 80 dB HL (Table 2), incrementing by 10 dB, for 5 test frequencies of 500, 1000, 2000, 4000 and 6000 Hz, The hearing profile score is then computed according to the minimum audible level (MAL) values according to wemhttna factors from, the Speech ^' mtellisihilitv Index per ANSI S3,5- 1997; "Methods for Calculation of the Speech intelligibility index". The weighting factor for 250 Hz, was added to the value for 500 Hz weighting since hearing losses at these adjacent frequency bands is generally similar for the hearing loss population of interest, and since there is no testing at the frequency of 250 Hz in the example embodiment. The weighting factor for 8000 Hz was substituted for 6000 Hz, also since no testing occurs at 8000 Hz in this example. In other examples, testing at 8,000 Ez may be included.

Tabie 2 The hearing profile score is then computed by adding weighted scores for all frequency bands, and scaling if necessary to yield die maximum index level employed, being 5 in this case. The fractional hearing profile score 90 (FIG. 13) in the example tabulated below is 3 , 17 out of 5, which may be presented as die hearing profile score 71 of 3 when rounded to the nearest whole digit.

Although examples of the inventioa have bee described herein, variations and modifications of this exemplary embodiment and method may be made without departing from the true spirit and scope of the invention. Thus, the above-described embodiments of the invention should not be viewed as exhaustive or as limiting the invention to the precise configurations or techniques disclosed. Rather, it is intended that the invention shall be limited only by the appended claims and the rules and principles of applicable law.