Patent Abstract:
a system for automatedly administering an audiometric test includes an audiometer for performing the test by outputting test tones , and a processor programmed for monitoring responses to the test tones , detecting an error condition , automatically delivering audible corrective instructions to address the error condition detected , and automatically resuming outputting test tones after the audible corrective instructions have been delivered without intervention by a human test administrator .

Detailed Description:
referring to fig1 , 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 . 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 . 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 optimal 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 . 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 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 wine 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 . 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 fig3 . referring now to fig2 , a detailed schematic of the conventional audiometer 2 of fig1 is shown . those skilled in the art will understand and appreciate the electrical elements and connectivities of the detailed schematic . referring now to fig3 , 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 fig1 ) 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 fig1 ), 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 fig1 - 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 microphone 62 of the talkover card 8 b , in order to conduct hearing test with intermittent instructions and messages . referring now to fig4 , 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 fig1 ). 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 fig1 ). 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 fig4 . 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 fig1 ) in standard manner , as though the basic audiometer 200 is 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 fig5 , 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 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 fig3 ) 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 fig3 ) 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 fig6 , 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 not is inserted in the audio jack 122 , the output of 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 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 fig7 , in conjunction with fig4 - 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 fig1 ). 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 : 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 “ 1kl 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 ) 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 rock 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 communications over the communications interface 108 ( shown in fig4 - 5 ). if initial instructions to the test subject are desired , the computer 102 may control 304 the basic audiometer 200 over the communications interface 108 ( shown in fig4 - 5 ). this control 304 may trigger the relay 64 a and the relays 64 b ( shown in fig2 ) to close the switches 66 a and open the switches 66 b ( shown in fig2 ), respectively . when the switches 66 a are closed and the switches 66 b are 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 fig2 ) 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 .” 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 foregoing error codes , multimedia messages , and operations are merely example possibilities . an example of an entire error code list is as follows : error code indication multimedia audiometer 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 instructions 1 khz e2 1 khz stops test repeat instructions 25 presentations no htl e3 1 khz retest error stops test repeat instructions e4 hand switch error stops test holding switch msg e5 response no tone stops test response w / window closed e6 error for stops test examiner intervention second time e7 max . failed stops test examiner intervention frequencies & gt ; 6 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 fig4 - 5 ) to trigger the relays 64 a , b . the testing thereafter proceeds through the steps of selections 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 a 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 . although the present invention has been described with reference to preferred embodiments , workers skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention 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