title: The acceptable noise level: the effect of repeated measurements.
abstract: OBJECTIVE
  This study explores if increasing number of repetitions might improve the precision of the acceptable noise level (ANL) test.
  
  
  METHODS
  We measured twelve ANL repetitions, i.e. four complete ANL tests (4 × 3 repetitions), at one session using diotic presentation and a non-semantic ANL version.
  
  
  METHODS
  Thirty-two normal-hearing adults.
  
  
  RESULTS
  Small order and fatigue effects were seen. We used the coefficient of repeatability (CR) to assess the repeatability; CRs ranged between 3.9 and 7.6 dB for the four ANL tests. Using the twelve ANL repetitions we removed the variability of the ANL across subjects by normalizing the data to the individual mean ANL for the twelve repetitions. The mean normalized ANL across the subjects rapidly approached the ANL normalized to the individual mean for the 12 repetitions (0 dB), and after three repetitions the SD seemed to be stable at about 3 dB.
  
  
  CONCLUSIONS
  The findings suggest that both order and fatigue affect the ANL. The findings also suggest that it may be more accurate to speak of an acceptable noise range than ANL. These findings have large implications for how we understand acceptable noise and it would explain a large part of the variability seen among normal-hearing and perhaps hearing-impaired subjects.
authors.affiliation: * Department of Logopedics, Phoniatrics and Audiology, Clinical Sciences in Lund, Lund University , Sweden.
authors.forename: K Jonas
authors.initials: KJ
authors.lastname: Brännström
authors.forename: Lucas
authors.initials: L
authors.lastname: Holm
authors.forename: Tobias
authors.initials: T
authors.lastname: Kastberg
authors.forename: Steen Østergaard
authors.initials: SØ
authors.lastname: Olsen
mesh_terms: D000161:Acoustic Stimulation; D000293:Adolescent; D000328:Adult; D001288:Attention; D001301:Audiometry, Pure-Tone; D001302:Audiometry, Speech / Q000379:methods*; D001305:Auditory Fatigue; D001309:Auditory Threshold; D005260:Female; D006801:Humans; D008297:Male; D009622:Noise / Q000009:adverse effects*; D010470:Perceptual Masking; D011237:Predictive Value of Tests; D012016:Reference Values; D015203:Reproducibility of Results; D013067:Speech Perception; D055815:Young Adult