Masking Level Difference (MLD)

10 February 2022

10 mins

Reading

What is the Masking Level Difference (MLD)?

The Masking Level Difference (MLD) is the improvement in detecting a tone or speech in noise when the phase of the tone or the noise is reversed by 180 degrees. It aims to assess central auditory function and is specifically sensitive to brainstem lesions, but peripheral changes (like a hearing loss) may also affect the MLD.

The MLD is a low frequency phenomenon, related to the ability of the auditory system to perceive differences in timing of a sound reaching the two ears. This helps to localise low frequency sounds that reach the ears at different times due to the longer wave length.

The MLD is usually referred to as the difference of improvement in dB between a “homophasic” (in-phase) condition and an “antiphasic” (out of phase) condition. Homophasic means that both the signal and the noise are in phase with each other when reaching the two ears. Antiphasic means that either the signal or the noise (not both) is out of phase with each other when reaching the two ears.

The three test conditions for the MLD are:

S0N0: Signal and Noise are IN PHASE when reaching the two ears (Homophasic condition).

SπN0: Signal is OUT OF PHASE, noise is IN PHASE when reaching the two ears (Antiphasic condition).

S0Nπ: Signal is IN PHASE, noise is OUT OF PHASE when reaching the two ears (Antiphasic condition).

The MLD is measured by presenting a low frequency pulsed tone with simultaneous presentation of the corresponding narrow band noise, starting at an intensity of 60 or 65dB to both ears. The first condition should be to find the threshold for the homophasic condition (referred to as S0N0). The next step is to measure the antiphasic condition, either presenting the tone out of phase or the noise out of phase and the masked threshold is determined again. If the brainstem is functioning normally, there will be an improvement in the masked threshold from the homophasic condition to the antiphasic condition. The condition that will yield the greatest MLD is the SπN0 condition, that is, the condition where the signal is out of phase when reaching the two ears but the noise is still in phase.

Required equipment

AC40 audiometer
Headphones or insert phones
A response button

Test procedure

Press and hold the Tests button on the audiometer and use the scroll wheel on the audiometer to select MLD: Masking Level Difference.
Before mounting the headphones on the patients, explain to them that they will now hear tones (identical to the ones from the air conduction audiometry) and noise through the headphones. Emphasize that they should only focus on the tones and press the response button whenever it is audible.
Select the frequency that you would like to test; 250Hz or 500Hz is a good starting point.
Select S0N0 and set the intensity level for both channels at 60dB.
Ensure that the decibel steps are set to 2dB.
S0N0: The signal will be presented to both ears in phase (S0N0). Narrow band noise is also presented at a fixed level.

Make a masked threshold search. The threshold will typically be equal to the noise in the S0N0 condition.

When you have established a threshold, click in the Store
SπN0: Select the SπNo button, leaving the narrow band noise intensity level at 60dB. The pulsed tone detection should lower significantly.
The difference between the S0N0 threshold and the SπN0 threshold will be the MLD.
S0Nπ: If desired, you can also establish the threshold for the S0Nπ condition.
Press to end the test.

MLD results (example)

The masked threshold for the S0N0 condition is 60dB and we reverse the phase of the signal by 180 degrees the threshold for this phase reversed condition (SπN0) improves to 44dB. Then the masking level difference (MLD) from SoNo to SπN0 is 16dB.

Most research having been done on the MLD indicates that in general, if the MLD is less than 7dB, this will indicate a problem with the brainstem and binaural interaction. There will also be a decrease in the hearing MLD if there is a peripheral hearing loss or if the hearing aid is asymmetrical. A normal result for MLD is usually around 12dB (Brown & Musiek, 2013).