Efficient estimation of the binaural masking level difference using a technique based on manual audiometry

Purpose: The Masking Level Difference (MLD) has been used for decades to evaluate the binaural listening advantage. Although originally measured using Bekesy audiometry, the most common clinical use of the MLD is the CD-based Wilson 500-Hz technique with interleaved N0S0 and N0Sπ components. Here, we propose an alternative technique based on manual audiometry as a faster way of measuring the MLD. The article describes the advantages to this admin-istration technique and evaluates if it is a viable alternative for the Wilson technique. Method: Data were retrospectively analyzed on 264 service members (SMs). All SMs completed both the Wilson and Manual MLDs. Descriptive and correla-tional statistics were applied to evaluate the comparisons between the two techniques and highlight the differences. Equivalence measures were also com-pleted to compare the tests using a standardized cutoff score. Analyses were also made to compare both techniques to subjective and objective measures of hearing performance. Results: Moderate to high positive correlations were determined between Wilson and Manual measures of each threshold (N0Sπ and N0S0). Although the Manual and Wilson MLD techniques produced significantly different thresholds, simple linear transformations can be used to obtain approximately equivalent scores on the two tests, and agreement was high for using these transformed scores to identify individuals with substantial MLD deficits. Both techniques had moderate test–retest reliability. The Manual MLD and components had stronger correlations to the subjective and objective hearing measures than the Wilson. Conclusions: The Manual technique is a faster method for obtaining MLD scores that is just as reliable as the CD-based Wilson test. With the significant reduction in assessment time and comparable results, the Manual MLD is a via-ble alternative for direct use in the clinic.