Abstract:
A method for automatedly administering an audiometric test includes the steps of controlling an audiometer to selectively switch the audiometer output between test tones generated by the audiometer and sound signals generated from digital information; first switching the audiometer output to sound signals when the step of controlling indicates a beginning of a new test, a completion of a current test, or a test error; outputting sound representative of the sound signals after the step of first switching; second switching the audiometer output to test tones after the step of outputting; and outputting test tones until the next step of first switching.

Description:
This application is a continuation of application Ser. No. 08/639,694 filed on Apr. 29, 1996 and U.S. Pat. No. 5,811,681. 
    
    
     BACKGROUD OF THE INVENTION 
     The present invention relates to a multimedia interface of a diagnostic test instruction and, more particularly, to automated testing, including multimedia-derived instruction, test monitoring, and error response, by an audiometer or other medical or diagnostic test instrument. 
     A wide variety of medical and diagnostic test instrumentation is known. An example of such instrumentation is an audiometer. The audiometer is an electrically activated generator of test tones for evaluation of hearing. Other medical and diagnostic instrumentations include a spirometer for measuring lung capacity, vision testing equipment, blood alcohol testing equipment, and occupational health industry maintenance testing equipment, such as blood pressure, EKG, and other wellness testing equipment. Generally, these and other prior testing instrumentations require one or more individuals to administer the test by operating the equipment and giving instructions to the test subject. 
     The trend in testing, however, appears to be toward automation. Through automation, reduced numbers of test administrators may be required and increased accuracy of testing, with lack of deviation caused by human administrator error, may be possible. Although certain limited automation has previously been possible, that automation has been directed primarily to the automated compilation, organization, and reporting of data in desirable formats. Processing units, such as, for example, personal computers, have previously been employed to achieve the automation of the compilation, organization, and reporting functions. Little automation, if any, has previously been achieved, however, in connection with the actual administration of the test. Administration of such tests has typically been performed almost wholly by one or more human test administrators. 
     Hearing testing has for several decades been performed utilizing an instrument called an audiometer. Prior to the audiometer, tuning forks and other tone generating devices were employed. In the early testing, a test subject responded directly to a test administrator who recorded test results based on the administrator&#39;s subjective determinations. The advent of the audiometer, an electronic instrument that generates tones, provided a degree of standardization in hearing testing because uniform tones and proper calibrations are better achieved. 
     Even after the invention of the audiometer, however, hearing testing was far from standardized, as testing varied in both procedures and determinations. A standardized procedure, still followed today, was then developed for hearing testing. That procedure is referred to as the “Hughson-Westlake” procedure. Other procedures are followed in some instances, but the Hughson-Westlake procedure is probably the most common. 
     In the Hughson-Westlake procedure, tones at a level audible to the test subject, such as, for example, 30 dB, are first presented to the subject. The test subject responds that the tones are heard, and then the level of the tones are reduced by 10 dB. This is repeated with the test subject responding that the tones are heard followed by 10 dB reductions until the test subject&#39;s response (or lack of response) indicates that the tones are not heard. When the test subject so responds that the tones are not heard, the tone level is raised 5 dB. If the test subject does not then respond, the level is raised another 5 dB, and this is repeated until the subject signals that the tone is heard. This entire process is repeated until the test subject has three ascending positive responses at the same level. In order to make comparison of hearing quality over time, a first test is administered to establish a base line hearing level and later testing, undertaken at subsequent time intervals, provides results for comparison to base line. The comparison indicates any hearing loss or other changes over time. 
     As with diagnostic and industrial health testing instruments, generally, audiometers have progressed towards more automation. Also as with other instruments, however, automation of audiometers has typically focused on compilation, organization, and reporting of test results. The automation has not been directed to replacement of a human test administrator (or at least the traditional functions of such an administrator) by a machine automated process. 
     As previously mentioned, automation, particularly by a machine such as a computer, achieves certain advantages. In particular, the testing may be more uniform among subjects and test periods, whereas testing is subject to variation when a human test administrator administers and grades the test. Also, supplying human test administrators to conduct tests is rather costly. Reducing the required number of test administrators through further automation of testing procedures may reduce or eliminate those costs. Furthermore, test presentation and determined results may vary among human test administrators. More standardized and accurate testing may be possible if intervention of a human test administrator is reduced through further automation. In addition to those advantages, certain automation may provide added advantages, for example, multi-lingual test administration, multiple simultaneous different tests, multiple simultaneous test subjects, visual features, and other possibilities. 
     Embodiments of the present invention provide advantages of multimedia automation in diagnostic testing employing electronic or other instrumentation. The embodiments are particularly suited in the case of an audiometer, however, numerous other applications of the embodiments are possible. The above-described advantages, as well as other advantages, are achieved through the embodiments. The present invention is, thus, a significant improvement in the art and technology. 
     SUMMARY OF THE INVENTION 
     An embodiment of the invention is a method for automatedly administering an audiometric test. The method comprises the steps of controlling an audiometer to selectively switch the audiometer output between test tones generated by the audiometer and sound signals generated from digital information, first switching the audiometer output to sound signals when the step of controlling indicates a beginning of a new test, a completion of a current test, or a test error, outputting sound representative of the sound signals after the step of first switching, second switching the audiometer output to test tones after the step of outputting, and outputting test tones until the next step of first switching. 
     Another embodiment of the invention is a multimedia audiometer. The multimedia audiometer comprises means for outputting sound signals generated from digital information, means for outputting test tones, means for switching between the means for outputting sound signals and the means for outputting test tones, and means for controlling the means for switching, the means for controlling being communicatingly connected with the means for switching. The means for switching is communicatingly connected with the means for outputting sound signals and the means for outputting test tones. 
     Yet another embodiment of the invention is a multimedia audiometer. The multimedia audiometer comprises a computer, a tone generator, and a switch connected with the computer and the tone generator. The switch selectively causes either the tone generator or the computer to output sound waves, and the computer controls the switch. 
     Another embodiment of the invention is an audiometer. The audiometer comprises a processor, a memory, communicatingly connected with the processor, for storing digital data, a sound wave generator, for generating analog sound signals in respect of digital data, electrically connected with the processor, a test tone generator electrically connected with the processor, and a switch connected with the sound wave generator, the test tone generator, and the processor. The switch is controlled by the processor to selectively cause either the sound wave generator or the test tone generator to output sound waves. 
     A further embodiment of the invention is an instrument that conducts a test protocol on a test subject. The test protocol comprises an output by the instrument followed by an input to the instrument. The test subject determines the input, which input may be positive, negative, or null. The instrument comprises an output generator, an input detector for detecting the input, a digital data storage for storing a digital data, a multimedia converter, the multimedia converter converts the digital data to an analog signal, and logic circuitry connected to the input detector, the digital data storage, the multimedia converter, and the output generator, for logically operating on the input, reading the digital data, delivering the digital data to the multimedia converter, and controlling the output generator. 
     Yet another embodiment of the invention is a multimedia audiometer. The multimedia audiometer comprises a basic audiometer, a computer, a multimedia input interface communicatingly connecting the computer and the basic audiometer, and a communications interface communicatingly connecting the computer and the basic audiometer. 
     Another embodiment of the invention is a diagnostic instrument. The diagnostic instrument comprises means for outputting an audible sound, means for generating a test tone, means for storing a digital data, means for generating an analog signal derived from the digital data, means for switching an output of the means for outputting between the test tone and the analog signal, the means for switching being electrically connected to the means for generating a test tone and the means for generating an analog signal, means for processing, means for inputting, the means for inputting connects the means for processing to the means for outputting, and means for communicating, the means for communicating connects the means for processing to the means for outputting, the means for generating the test tone, the means for storing the digital data, the means for generating the analog signal, the means for switching, and the means for inputting. 
     Yet another embodiment of the invention is a method of performing a diagnostic test protocol. The method comprises the steps of outputting an audible sound, generating a test tone, storing a digital data, generating an analog sound derived from the digital data, switching the audible sound from the step of outputting between the test tone and the analog signal, processing the digital data, and controlling the steps of outputting, generating the test tone, storing, generating the analog sound, and switching. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a functional block diagram of a conventional audiometer; 
     FIG. 2 is a detailed schematic of a typical audiometer, corresponding to the functional block diagram of FIG. 1; 
     FIG. 3 is a schematic of a talkover card for use with the audiometer of FIG. 2; 
     FIG. 4 is a block diagram of an audiometer interfaced with a personal computer for multimedia automation of audiometer testing; 
     FIG. 5 is a functional block diagram of an audiometer interfaced with a multimedia personal computer; 
     FIG. 6 is a schematic of the personal computer connection with the talkover card of FIG. 3, to provide multimedia automation of audiometer testing; and 
     FIG. 7 is a flow diagram of a protocol for audiometric testing utilizing the multimedia features of the embodiments of the present invention to automate the test process. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Referring to FIG. 1, a functional block diagram of a conventional audiometer  2  may be described. Although the following discussion primarily addresses embodiments of the present invention employed for an audiometer, the embodiments have varied application in a wide variety of medical and diagnostic instrumentation. All those applications are intended as included within the scope of the invention. Also, the following describes various embodiments of the present invention as particularly employed with the conventional audiometer  2 . It is to be understood that the conventional audiometer  2  is detailed only for example purposes, and all other alternative audiometer configurations, as well as other instrumentation and configurations thereof, are also applications for the invention in accordance with the principles herein. 
     Conventional Audiometer 
     The conventional audiometer  2  is generally comprised of three parts: microprocessor circuitry  4 , audio circuitry  6 , and certain optional elements  8 . In addition to those three parts, the conventional audiometer  2  includes a power supply and related elements not shown in the functional block diagram. One example of the conventional audiometer  2  is the RA250 Microprocessor Audiometer available from TREMETRICS, Inc., Austin, Tex. Of course, as previously mentioned, the conventional audiometer  2  illustrated is shown only for purposes of illustration and example. Other audiometers and other types of medical and diagnostic instrumentation are also within the scope of the invention. 
     Microprocessor Circuitry 
     The microprocessor circuitry  4  of the conventional audiometer  2  may include a processing unit (CPU)  12 , such as, for example, an Intel™ 8085 microprocessor or another microprocessor. The CPU  12  serves to coordinate and control operations and functions of the conventional audiometer  2 . The CPU  12  conductively connects with various memory, such as, for example, erasable programmable read only memory (EPROM)  14  and random access memory (RAM)  16 . The memory  14 ,  16  may serve to store a software protocol which controls the CPU  12  to cause the conventional audiometer  2  to provide audiometric functions. The memory  14 ,  16  may also serve to maintain certain variables to achieve desired operations and calibration of the conventional audiometer  2 , or simply to provide storage for values made available to and from the CPU  12 . 
     In addition to the memory  14 ,  16 , the CPU  12  conductively connects with various input and output ports and peripherals. Input and output ports may include a serial I/O port  22  and a parallel interface  24 . The serial I/O port  22  may provide connections for certain optional elements  8 , as hereinafter discussed. The parallel interface  24  may connect with an input device, for example, a keyboard  20 . The parallel interface  24  may also connect with the audio circuitry  6 , as later explained. Another input device, such as a display  18 , for example, may connect with the memory  14 ,  16 , CPU  12 , and other features of the microprocessor circuitry  4 . Such other features of the microprocessor circuitry  4  may include, for example, certain programmable registers  26  and other elements. 
     Audio Circuitry 
     Now discussing the audio circuitry  6  of the conventional audiometer  2 , the audio circuitry  6  interfaces with the microprocessor circuitry  4  in several ways. The programmable registers  26  may serve as ports that connect with an oscillator (also “frequency generator”)  30 . The oscillator  30  may provide timing for a sine wave generator  32  that produces a digitally synthesized sine wave from which audible test tones are derived. Because the sine wave generator  32  produces a digitally synthesized wave, the wave may be smoothed by a low pass filter  34 . 
     The low pass filter  34  may connectively interface with the parallel interface  24  of the microprocessor circuitry  4 . Other elements of the audio circuitry  6 , such as a frequency selector  36 , an electronic attenuator  38 , a pulse control  40 , a relay control attenuator  42 , and a handswitch jack  44 , may conductively connect with the parallel interface  24  to complete the interface of the audio circuitry  6  with the microprocessor circuitry  4  of the conventional audiometer. Pursuant to this interface arrangement, the audio circuitry  6  and the microprocessor circuitry  4  may communicate signals for control and other purposes. 
     In addition to the connection of the low pass filter  34  with the parallel interface  24 , the low pass filter  34  may conductively connect with frequency compensation circuitry, such as, for example, a frequency selector  36  that, together with the control provided through the parallel interface  24 , helps compensate for attenuation. Other elements, such as the electronic attenuator  38  which connects with the frequency selector  36 , also provide compensation for attenuation. The sine wave generator  32  feeds the pulse control  40  which, together with input to the pulse control  40  from the electronic attenuator  38 , delivers signals representative of desired test tones to a power amplifier  46 . The power amplifier  46  feeds the relay control attenuator  42  for left and right earphone signals. The relay control attenuator  42  is conductively connected with an earphone jack  48 . 
     In order to allow a test subject to interface with the audio circuitry  6 , earphone speakers  50  and a handswitch  52  may be provided. The earphone speakers  50  may plug into the earphone jack  48 . The test subject wearing the earphone speakers  50  will then receive test tones generated by the conventional audiometer  2 . The handswitch  52  may plug into the handswitch jack  44 . The handswitch  52  provides means for the test subject to interface with the conventional audiometer  2  in order to signal to the conventional audiometer  2  that the test subject either does or does not correctly receive test tones through the earphone speakers  50 . 
     Options 
     In addition to the basic elements just described, the conventional audiometer  2  may include certain optional elements  8 . Various optional elements  8  are possible, depending upon desired operations and functions. Two common optional elements  8  of the conventional audiometer  2  have been an RS232 port  8   a  and a talkover card  8   b . The RS232 port  8   a  may conductively connect to the serial I/O port  22  to allow communications of the microprocessor circuitry  4  with external peripherals (not shown) connected with the RS232 port  8   a . Examples of external peripherals which may connect to the RS232 port  8   a  may include printers, terminals, and modems. The RS232 standard and suitable connections to ports conforming thereto are generally known. 
     The other of the common optional elements  8 , the talkover card  8   b , is of particular significance in embodiments of the present invention. The talkover card  8   b  is conductively connected with the audio circuitry  6  of the conventional audiometer  2  between the relay control attenuator  42  and the earphone jack  48 . In effect, the talkover card  8   b  serves as a switch to divert input to the earphone jack  48  when desired by a human test administrator (not shown). The human test administrator may selectively “throw” the switch and cause the input to the earphone jack  48  to switch from signals from the relay control attenuator  42  representative of test tones to signals representative of the human test administrator&#39;s instructions then being voiced. Details of the talkover card  8   b  are hereinafter more fully discussed with respect to FIG.  3 . 
     Referring now to FIG. 2, a detailed schematic of the conventional audiometer  2  of FIG. 1 is shown. Those skilled in the art will understand and appreciate the electrical elements and connectivities of the detailed schematic. 
     Referring now to FIG. 3, a detailed schematic is provided of the talkover card  8   b  of the conventional audiometer  2 . The talkover card  8   b  comprises a fixed gain operational amplifier  60 . A voice microphone  62  is an input to the amplifier  60 . Other common electronic elements, such as, for example, resistors, capacitors, and others, may be included in the circuitry of the talkover card  8   b . The amplifier  60  is connected to the input to the earphone jack  48  of the audio circuitry  6  of the conventional audiometer  2  (shown in FIG. 1) by a relay  64   a . When a human test administrator wishes to deliver voice sounds, rather than test tones, to a test subject wearing the earphone speakers  50  plugged into the earphone jack  48  (shown in FIG.  1 ), the test administrator causes the relay  64   a  to be thrown. The test administrator, by such action, simultaneously causes the conventional audiometer  2  to interrupt the test then in progress, discontinuing test tone generation. 
     Referring to FIGS. 1-3, in conjunction, the relay  64   a  when so thrown connects the amplifier  60 , across switches  66   a , to the input to the earphone jack  48 . In particular, electrical connector  68  passes the voice signals from the amplifier  60  to the earphone jack  48  for delivery through the right ear speaker of the earphone speakers  50  and electrical connector  70  similarly passes the voice signals to the left ear speaker. When relay  64   a  results in closure of its switches  66   a , relay  64   b  results in opening of its switches  66   b , and vice versa. In this manner, either voice signals through the talkover card  8   b  or test tone signals through the audio circuitry  6  at any instant, but not both simultaneously, is delivered through the earphone speakers  50 . As those skilled in the art will understand and appreciate, this design of the conventional audiometer  2  has allowed a human test administrator to interrupt test tone testing to give instructions, error messages, and other voice commands. The conventional audiometer  2  has required intervention of a human test administrator, however, by selectively throwing relays  64   a,b  and speaking into the microphone  62  of the talkover card  8   b , in order to conduct hearing test with intermittent instructions and messages. 
     Multimedia Embodiments 
     Referring now to FIG. 4, a multimedia audiometer  100 , according to embodiments of the present invention, may be described. The multimedia audiometer  100  includes a basic audiometer  200  having the basic elements of the conventional audiometer  2  (shown in FIG.  1 ). That is, the multimedia audiometer  100  is also comprised of the microprocessor circuitry  4  and the audio circuitry  6  (or other similar processing and audio electronics and circuits) of the conventional audiometer  2  (shown in FIG.  1 ). The earphone speakers  50  and the handswitch  52  are also interfaced with the basic audiometer  200 . 
     Although the multimedia audiometer  100  and the conventional audiometer  2  share these similar basic elements, the basic audiometer  200  is merely a subset of the entire multimedia audiometer  100 , as is apparent in FIG.  4 . In addition to the elements of the basic audiometer  200 ,  2 , the multimedia audiometer  100  includes a computer  102 , such as a personal computer, another type of computer, or some other processing and storage device. The computer  102  may be equipped and connected with peripherals, such as a keyboard  106  and a display monitor  104 , as well other known input/output, communications, printing, and peripheral equipment. In any event, the computer  102  should have multimedia capabilities, that is, the computer  102  should be capable of producing sound waves and/or visual images from representative digital information stored, generated, and/or manipulated within or by the computer  102 . 
     The computer  102  may be conductively connected with the basic audiometer  200  through two interfaces: a communications interface  108  and a multimedia input interface  110 . The communications interface  108  may allow for serial, parallel, or other communications. If communications are serial, the communications interface  108  may connect the computer  102  with the RS232 port  8   a  (shown in FIG. 1) in standard manner, as though the basic audiometer  200  is a peripheral to the computer  102 . The multimedia input interface  110  requires, however, that the conventional audiometer  2  be modified in certain respects to provide the basic audiometer  200  for multimedia automation of testing, as hereafter described. 
     Referring now to FIG. 5, the communications interface  108  and the multimedia input interface  110  connect the computer  102  with the basic audiometer  200  to form the multimedia audiometer  100 , as shown in functional block form. A serial input/output port (not shown in detail) of the computer  102  may directly connect via the communications interface  108  with the RS232 port  8   a  of the basic audiometer  200 . A multimedia output port (not shown in detail) of the computer  102  may directly connect via the multimedia input interface  110  with a multimedia talkover card  118   b , similar to the talkover cord  8   b  (shown in FIG. 3) of the conventional audiometer  2 . The multimedia output port of the computer  102  may, for example, be a port of a sound card (not shown in detail) from which sound signals are output by the computer  102 . Alternatively or additionally, other multimedia outputs (not shown) of the computer  102 , for example, graphical image or video outputs, may connect with the multimedia input interface  110  in similar manner. The talkover card  8   b  (shown in FIG. 3) of the conventional audiometer  2  configuration has not previously provided a port for connection of the multimedia input interface  110 . The conventional audiometer  2  may, therefore, be adapted to provide such port. The adapted conventional audiometer  2  is the basic audiometer  200 . 
     Referring now to FIG. 6, a sound port  120  of a multimedia talkover card  118   b  for multimedia input to the basic audiometer  200  may be described. The sound port  120  connects with the multimedia input interface  110 , so that multimedia outputs of the computer  2  are input to the multimedia talkover card  118   b . The sound port  120  may include a connector  120   a  to which the multimedia input interface  110  may be plugged. The connector  120   a  may be attached with two input leads  120   b . The input leads  120   a,b  may be attached with an audio jack plug  121 . The audio jack plug  121  is insertable in an audio jack  122  connected to the amplifier  60  output. When the audio jack plug  121  is not inserted in the audio jack  122 , the output of the amplifier  60  is shorted prior to the switches  66   a . When the audio jack plug  121  is inserted in the audio jack  122 , however, the circuit is completed and the computer  102  connected to the sound port  120  may supply multimedia input to the switches  66   a . In effect, the microphone  62  is substituted with the multimedia input via the sound port  120 . All other features of the multimedia talkover card  118   b  are substantially the same as the features of the talkover card  8   b  of the prior technology. 
     Although the input leads  120   b  of the sound port  120  are shown as connected with an output of the amplifier  60  in the Figure, alternatively, the input leads  120   b  could in similar manner connect with inputs to the amplifier  60  or at some other location prior to or after the amplifier  60 . Furthermore, although the multimedia talkover card  118   b  is expressly described as a “card” to the basic audiometer  200 , it is to be understood that any other functional elements and circuitry that perform similarly, such as, for example, a relay circuit that switches between the tone generator of the basic audiometer  200  and the multimedia output from the computer  102 , as well as other possibilities, are all within the scope of the invention. 
     Now referring to FIG. 7, in conjunction with FIGS. 4-6, operations  300  of the multimedia audiometer  100  and the software driving those operations  300  are discussed. When power is supplied to the multimedia audiometer  100 , the basic audiometer  200 , as well as the computer  102 , may perform various set-up functions  302 . Those set-up functions  302  of the multimedia audiometer  100 , for example, boot-up and initialization of the computer  102  and start-up and initialization of the basic audiometer  200 , are conventional. The start-up and initialization of the basic audiometer  200  may be substantially the same as that of the conventional audiometer  2  (shown in FIG.  1 ). 
     Generally, this start-up and initialization of the basic audiometer  200  may proceed, for example, as follows: 
     At turn-on, the basic audiometer  200  presents a first tone and a message appears on the display  18 . The basic audiometer  200  is now ready for operation. If a processing error by the CPU  12  is discovered during the turn-on, an appropriate message is displayed. 
     The following example illustrates an initialization procedure for the basic audiometer  200 . Keys of the keyboard  20  are indicated by [ ] and messages in quotes. To begin, press: 
     
       
         
               
               
               
             
               
             
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 KEYBOARD 
                 DISPLAY 
               
               
                   
                   
               
               
                   
                 [SPECIAL] 
                 SPC00 
               
               
                   
                 [ENTER] 
                 MM DD YY 
               
               
                   
                   
               
             
          
           
               
                 Now enter today&#39;s date. For example: 
               
             
          
           
               
                   
                 KEYBOARD 
                 DISPLAY 
                 COMMENT 
               
               
                   
                   
               
               
                   
                 [04 30 96] 
                 OM DD YY 
               
               
                   
                   
               
             
          
         
       
     
     The message “mode pulsed” then appears on the display  18 . Press [NO] to switch to continuous mode. “Continuous Mode” will be displayed. Press [ENTER] when the desired code is displayed. The display should now read “1 KL AA AUTO ” and then displays “PRESS [NEW TEST]”. Other parameters which may be selected include the test other ear first and delete 8000 Hz. To do this, press: 
     
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 KEYBOARD 
                 DISPLAY 
                 COMMENT 
               
               
                   
                   
               
               
                   
                 [SPECIAL] 
                 SPC 04 
               
               
                   
                 [04] 
                 SPC 04 
               
               
                   
                 [ENTER] 
                 LEFT EAR FIRST 
               
               
                   
                 [NO] 
                 RIGHT EAR FIRST 
               
               
                   
                 [ENTER] 
                 1KR AA AUTO 
                 (Now testing right 
               
               
                   
                   
                   
                 ear first) 
               
               
                   
                 [SPECIAL] 
                 SPC 06 
               
               
                   
                 [06] 
                 SPC 06 
               
               
                   
                 [ENTER] 
                 8KR SEL AUTO 
               
               
                   
                 [NO] 
                 8KR DEL AUTO 
               
               
                   
                 [ENTER] 
                 1KR AA AUTO 
                 (8 Khz is deleted) 
               
               
                   
                   
               
             
          
         
       
     
     The basic audiometer  200  is now initialized. 
     Any or all of the above-mentioned parameters can be changed at any time by entering a desired special routine. Various “Special” codes that may be possible with the basic audiometer  200  of the multimedia audiometer  100  may, for example, include the following: 
     
       
         
               
               
             
           
               
                   
               
               
                 SPECIAL 
                 FUNCTION 
               
               
                   
               
             
             
               
                 00 
                 Initialization of audiometer 
               
               
                 01 
                 Enter date and time 
               
               
                 02 
                 Mode Pulsed/Continuous 
               
               
                 03 
                 Enter Examiner ID 
               
               
                 04 
                 Invent runtable to test better ear first 
               
               
                 05 
                 Select Printer Format 
               
               
                 06 
                 Select or Delete 8K 
               
               
                 07 
                 Select Baud rate 
               
               
                 08 
                 Turn on or off audio feedback for key 
               
               
                   
                 pushes 
               
               
                 09 
                 Accelerated listening check 
               
               
                 10 
                 Check calibration date 
               
               
                 11 
                 Call Ram Rom check 
               
               
                 12 
                 Calibration mode and program 
               
               
                   
                 calibration eeprom 
               
               
                 13 
                 Printer text 
               
               
                 14 
                 Not used 
               
               
                 15 
                 Display routine for time and date (no 
               
               
                   
                 entry) 
               
               
                 16 
                 Not used 
               
               
                 17 
                 Display selected audiogram 
               
               
                 18 
                 Print selected audiogram or audiograms 
               
               
                 19 
                 Display and/or enter serial number 
               
               
                 20 
                 Not used 
               
               
                   
               
             
          
         
       
     
     Software protocols to accomplish the start-up and initialization of the basic audiometer  200  may be stored in the memory  14 ,  16  of the basic audiometer  200  or elsewhere. Processing and control for the start-up and initialization of the set-up functions  302  are performed by the CPU  12  of the basic audiometer  200 . Alternatively, the basic audiometer  200  could be controlled by the computer  102  to perform the start-up and initialization, or start-up and initialization could be controlled manually or in some other manner. 
     After the set-up functions  302 , including start-up and initialization of the basic audiometer  200 , are completed, the basic audiometer  200  may be ready to begin administering a new audiometric test of a test subject. A new test may be begun, for example, by pressing a key of the basic audiometer  200  or, alternatively, by a similar input to the computer  102 . Upon the start of the new test, the computer  102  may control the basic audiometer  200  by communication over the communications interface  108  (shown in FIGS.  4 - 5 ). 
     If initial instructions to the test subject are desired, the computer  102  may control the basic audiometer  200  over the communications interface  108  (shown in FIGS.  4 - 5 ). This control  304  may trigger the relay  64   a  and the relays  64   b  (shown in FIG. 2) to close the switches  66   a  and open the switches  66   b  (shown in FIG.  2 ), respectively. When the switches  66   a  are closed and the switches  66   b  opened in this manner, sound signals passed to the sound port  120  from the computer  102  over the multimedia input interface  110  are delivered through the amplifier  69  of the multimedia talkover card  118   b  and through the earphone jack  48  to the earphone speakers  50 . 
     The particular sound signals so passed to the earphone speakers  50  may be derived from digital information stored or generated in, or read by, the computer  102 . The computer  102  may select and output  306  signals representative of the particular digital information. If the testing is just beginning, the signals so selected and output  306  may be initial instructions to the test subject about the test and the testing procedure. Of course, the particular signals could be representative of virtually any type of information which is subject to derivation from digital data. Although sound is described here as being derived from digital data, those skilled in the art will know and appreciate that digital data may be manipulated and processed in a multitude of ways to derive other types of information, for example, visual graphics and images and others. 
     After the computer has selected and output  306  the desired sound signals to the basic audiometer  200  and signals have been delivered to the test subject as sound waves through the earphone speakers  50 , the computer  102  again may control  308  the basic audiometer  200 . The control  308  at this instant may trigger the relay  64   a  to close the switches  66   a  and the relays  66   b  (shown in FIG. 2) to open the switches  66   b , respectively. The control  308 , then, causes the basic audiometer  200  to generate  310  a series of test tones, such as, for example, tones in accordance with the Hughson-Westlake procedure or another testing protocol. 
     When the switches  66   a  are closed and the switches  66   b  are opened because of the control  308 , the test tones generated  310  by the audio circuitry  6  of the basic audiometer  200  are delivered through the earphone jack  48  to the earphone speakers  50 . According to the particular testing protocol, the test subject may respond to the test tones by input  312  via the handswitch  52  connected to the basic audiometer  200 . The basic audiometer  200 , in cooperation with the computer  102 , will detect and determine any error  314  of the input  312  response. 
     If there is not any error  316 , then the basic audiometer  200  may continue to generate successive test tones  320  according to the particular test protocol, until the test is completed  322 . The successive test tones  320  are generated in the same manner as previously described. That is, the basic audiometer  200  operates to generate test tones  310  delivered to the test subject; the test subject responds with input  312  via the handswitch  52 ; and the audiometer  200 , in conjunction with the computer  102 , detects and determines  314  any error. 
     If an error  318  is detected and determined  314 , the computer  102 , based on its particular programmed logic, determines  324  whether to proceed  326  with the testing, to re-test  328 , or to perform some other function (not shown). Certain errors that may be encountered during the administration of the test include, for example, the following: 
     No response at 1 kHz, Error Code E1, signifies that the test subject is not responding to the test tone. The test subject may receive a multimedia sound message, generated by the computer  102  and passed through the earphone speakers  50 , as to how to take the test, for example, as follows: 
     “There has been no response for any tone in the initial test—as soon as you hear a tone cut it off by pressing and releasing the hand switch.” 
      Then, the test may be restarted. 
     Failed to Establish Threshold, Error Code E2, signifies that the basic audiometer  200  is unable to establish a hearing threshold level (HTL) from the response of the test subject. The test subject may be instructed based on digital data of the computer  102 , for example, as follows: 
     “The audiometer has been unable to establish a threshold—listen for the tone and as soon as you hear the tone cut it off by pressing and releasing the hand switch.” 
      The test may then recommence. 
     Hand Switch Error, Error Code E4, signifies that the test subject is not releasing the response handswitch  52 . The test subject may, for example, receive the following instructions generated from the digital data stored by computer  102 : 
     “The audiometer is recognizing the hand switch as being on for a length of time—as soon as you hear a tone cut it off by pressing and releasing the hand switch.” 
      The test may then recommence. 
     Response no tone, Error Code E5, signifies that the test subject has responded at least three times when no tone or stimulus was present. A multimedia message, for example, as follows, may be delivered through the earphone speakers  50 : 
     “The audiometer is recognizing responses when no tone is present—as soon as you hear a tone cut it off by pressing and releasing the hand switch.” 
      The test is, thereafter, restarted. 
     The foregoing error codes, multimedia messages, and operations are merely example possibilities. An example of an entire error code list is as follows: 
     
       
         
               
               
               
               
             
           
               
                   
                   
               
               
                   
                 Error 
                   
                 Multimedia Audiometer 
               
               
                   
                 Code 
                 Indication 
                 Response 
               
               
                   
                   
               
             
             
               
                   
                 AA 
                 Not Tested 
                   
               
               
                   
                 DD 
                 Deleted 
               
               
                   
                   
                 Frequency 
               
               
                   
                 EE 
                 No Response 
                 Test Continues 
               
               
                   
                 EF 
                 Test Incomplete 
               
               
                   
                 EB 
                 25 Presentations 
                 Test Continues 
               
               
                   
                   
                 No HTL 
               
               
                   
                 E1 
                 No Response 
                 Stops Test Repeat 
               
               
                   
                   
                 1 KHz 
                 Instructions 
               
               
                   
                 E2 
                 1 KHz 25 
                 Stops Test Repeat 
               
               
                   
                   
                 Presentations No 
                 Instructions 
               
               
                   
                   
                 HTL 
               
               
                   
                 E3 
                 1 KHz Retest 
                 Stops Test Repeat 
               
               
                   
                   
                 Error 
                 Instructions 
               
               
                   
                 E4 
                 Hand Switch 
                 Stops Test Holding 
               
               
                   
                   
                 Error 
                 Switch MSG 
               
               
                   
                 E5 
                 Response No Tone 
                 Stops Test Response 
               
               
                   
                   
                   
                 w/window 
               
               
                   
                   
                   
                 closed 
               
               
                   
                 E6 
                 Error For Second 
                 Stops Test Examiner 
               
               
                   
                   
                 Time 
                 Intervention 
               
               
                   
                 E7 
                 Max. Failed 
                 Stops Test Examiner 
               
               
                   
                   
                 Frequencies &gt;6 
                 Intervention 
               
               
                   
                 E8 
                 Hardware Error 
                 Only seen at Turnon and 
               
               
                   
                   
                   
                 After EPROM Diagnostic 
               
               
                   
                   
                   
                 Check 
               
               
                   
                   
               
             
          
         
       
     
     Error Codes That Do Not Stop Test 
     EE 
     Error Codes that Get Instructions and Resume Testing 
     EB- Same as E2 message 
     E1 
     E2 
     E4 
     E5 
     Error Codes That Stop Test and Pop Up Message on PC for Operator Test Does Not Restart 
     E3 
     E6 
     E7 
     In the case that a re-test  328  is warranted because of an error or otherwise, the operations  300  begin anew with the computer control  304  of the basic audiometer  200  over the communications interface  108  (shown in FIGS. 4-5) to trigger the relays  64   a,b . The testing thereafter proceeds through the steps of selection and output  306 , computer control  308 , test tone generation  310 , test subject response input  312 , and detection and error determination  314 . 
     Once the entire test protocol is completed in the foregoing manner, the test is completed  322 . The computer  102  may then control  330  the basic audiometer  200  to trigger the relays  64   a,b  to close the switches  66   a  and to open the switches  66   b . The control  330  is accomplished in the manners previously described by communications between the computer  102  and the basic audiometer  200  over the communications interface  108 . 
     After the control  330  so sets the switches  66   a,b , the computer  102  may further select and output  340  sound signals, which sound signals are derived from digital data stored, generated or read by the computer  102 . The sound signals may travel to the earphone jack  48  and the earphone speakers  50  to deliver final instructions and messages to the test subject. 
     Numerous alternatives and variations are possible for the multimedia audiometer  100 . For example, digital data stored, generated or read by the computer  102  may be representative of a wide variety of sounds, images, video, or other multimedia features. In certain embodiments, the particular digital data may allow the test subject to select any of a number of different languages through which testing is administered. Further, digital data may be manipulated by the computer  102  in such a manner that multiple simultaneous tests may be administered. There are, of course, numerous other possibilities. 
     There are also many possible variations and alternatives in the configuration of the computer  102  and the basic audiometer  200  by providing the audiometer with additional memory, processing, wave sound generation, and appropriate software. Alternatively, the computer  102  could include test tone generation means and appropriate software programming to perform the functions of the basic audiometer  200 . Even further, the multimedia audiometer  100  could be implemented by using a programmable digital tape player or compact disc (CD) player and allowing the basic audiometer  200  to select desired tracks to play. Other alternatives may be possible, it being understood that those skilled in the art will generally know and appreciate that the employment of computer or other control of instrumentation operations during test administration and the use of multimedia features for instruction, messages, and other herebefore required human administrative actions is possible with the incorporation of digital data, according to the embodiments of the present invention, from which are derived multimedia features. 
     It is to be understood that multiple variations, changes and modifications are possible in the aforementioned embodiments of the invention. Although illustrative embodiments of the invention have been shown and described, a wide range of modification, change, and substitution is contemplated in the foregoing disclosure and, in some instances, some features of the present invention may be employed without a corresponding use of the other features. Accordingly, it is appropriate that the foregoing description be construed broadly and understood as being given by way of illustration and example only, the spirit and scope of the invention being limited only by the appended claims.