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Acceptable Noise Level (ANL) Test

Acceptable Noise Level (ANL) Test

Learn how to perform the acceptable noise level (ANL) test with the Affinity Compact.
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The acceptable noise level (ANL) test is a method of determining how much noise the patient is able to tolerate whilst listening to a target signal/speaker (Nabalek et al., 1991). It is used as a predictor for how well a patient will cope with amplification when receiving a hearing aid (Nabalek et al., 2006).

The ANL test is designed to be performed via loudspeaker as it is a free field test. However, it can be configured to perform monaurally via selection of headphones and routing the signal to the relevant ear-side. The Affinity Compact can perform the test binaurally via the R+L feature.
The ANL test is typically performed before the patient is given any form of amplification as a rehabilitative action for their hearing loss.
Launch the Affinity Suite from Noah or OtoAccess®.
Click on the AUD tab on the upper right hand side of the screen. Ensure that your Audiometry has been performed ahead of advancing into the SIN test as this determines the start level for the test.
Click on Menu, Tests and then select ANL
Once in the ANL test screen, you will see that there are 4 different conditions which you can choose to measure.MCL High – This is the loudest comfortable level the patient can listen to without any competing noiseMCL Low – This is the lowest comfortable level the patient can listen to without any competing noiseMCL Real – This is the patient most comfortable level without any competing noiseBNL – This is the actual ANL test where the MCL Real is presented and the competing noise is manipulated to find an ANL valueIt is not essential to perform MCL High and MCL Low for the ANL test, but these are also good indicators of the patients’ comfortable hearing range. Instructions for the patient will always be displayed at the bottom of the screen.
MCL HighClick on the MCL High Icon and click play. This will loop your speech material. Increase and decrease the stimulus intensity to match the patients loudest MCL.There will be no other change in the display to represent this, only the level in the MCL High icon box.

Most comfortable level high test screen. The written instructions to the patient state the following: I will play a story for you. I want you to signal me to increase or decrease the story to determine your most comfortable listening level. I will instruct you along the way. First, signal me to increase the loudness of the speech until it is too loud.

Most comfortable level low test screen. The written instructions to the patient state the following: Now you will hear the story at a softer level. Signal me to decrease the volume until the story is too soft.

Most comfortable level real test screen. The written instructions to the patient state the following: Now you will hear the story at a normal level. Signal me to increase or decrease the story to a comfortable listening level for you. Imagine I am the volume control of your television set and you want the volume to be adjusted so you can hear the television at a comfortable level all evening.

BNL test screen. The written instructions to the patient state the following: You will listen to the same story with background noise of several people talking at the same time. First signal me to turn up the noise level until the noise is too loud. Then you will signal me to turn down the noise level until the story becomes very clear. Finally signal me to turn up the noise until we reach the MAXIMUM level that you would be willing to 'put up with' for a long time while following the story.

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