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Masking made easy: a picture does speak a thousand words
3 October 2011
Sir,
Candidates undertaking ENT professional examinations
often find it difficult to understand audiological masking
(personal experience: http://www.enttzar.co.uk). We have
therefore developed a simple tool (Fig. 1) to address this
problem and feel that your readers may also find it help-
ful when determining whether masking is required.
Important notes
1 Masking is necessary to overcome the problem of
cross-hearing and involves temporarily elevating the hear-
ing threshold of the non-test ear by a known amount of
noise, so that an accurate assessment of the test ear
threshold can be made.
2 Masking always involves a noise given through air con-
duction (never through bone conduction).
3 Each rule of masking applies independently at each
frequency on an audiogram.
4 When rule 2 is invoked, the bone conduction
threshold needs to be masked as opposed to rules 1 and
3 when the air conduction threshold in the better ear is
masked.
5 Figure 1 is based on the air-conducted signal being
delivered through a standard supra- or circum-aural
earphone rather than inserting earphone (inter-aural
attenuation for the latter is 55 dB).
Conflict of interest
None to declare.
Persaud, R.A.P.* & Upile, T.�*ENT Departments, St Mary’s Hospital, London, UK, and
�Chase Farm Hospital, London, UK.
E-mail: [email protected]
CO
RR
ES
PO
ND
EN
CE
:L
ET
TE
RS
∆
O X
RIGHT LEFT
2
≥10 dB difference ≥40 dB difference
≥40 dB difference
3
1
Fig. 1. A simple and effective tool that illustrates the three rules
(1, 2 & 3) when masking is needed (each arrow points to the
test ear, O unmasked air conduction right ear, X unmasked air
conduction left ear, D unmasked bone conduction – relevant to
both ears because of the 0 dB inter-aural attenuation).
Correspondence 591
� 2011 Blackwell Publishing Ltd • Clinical Otolaryngology 36, 588–598
