Following the specific AHA! procedure instructions is very important in order to ensure a successful measurement and patient safety. 

Provide the following test form to the patient:

With the test form provide the patient with a short explanation of the test procedures. Here is an example of potential patient instructions: "During the following examination you will hear different sounds (or tones) that vary in loudness and pitch. Please indicate after each presentation how loud the signal is."

Playing an example of the presentation tone may be helpful for the patient. During the presentation of examples to the patient, encourage him/her to respond based on their natural instincts.  

Research has shown that the AHA! task is easier for hearing impaired individuals than normal hearing individuals. The training task is helpful because it helps the patient learn the procedure and to feel oriented with the task.  Instructions to the patient should be brief so that you do not influence the patient's decisions in any way.

Following the short training period, ask the patient:

“Please tell me how loud the test signal was”

Following the patient's response, present the signal a second time and ask the patient:

“Which number would you assign to the loudness?”

Following several practice rounds, begin with the actual test. If the patient seems unsure or if his/her selections do not make sense, stop the testing procedure. To minimize stopping during the test procedure, go through the complete loudness scaling test during the training period. This is the only way to ensure that the patient feels confident with the test procedures and his/her ability to make selections. Explain to the patient that he/she should only quantify the loudness of the presentation signals with the provided options; explain that it is not necessary for him/her to provide subjective thoughts about the presented signals. 

Important additional information:

During the testing it is necessary to provide the patient with the AHA! test form. The patient can use the form to select the loudness level of the signal based on the scaling options provided. Familiarize the patient with the loudness scaling options during the training period.

The goal of the scaling procedure is to determine the loudness perceived by the patient based on the signals presented. It is important to avoid instructions such as "We want to measure your sensation." It is bets to phrase the patient's instructions as: "How loud is (or was) the sound." These instructions will help to obtain loudness perception ratings, not emotional perception ratings.

The orientation/training period has some limitations:

• Presenting monotonous series of signals can cause comparisons to be made between the previous and currently played signals. To avoid this effect play signals that are dissimilar, meaning signals that elicit very different levels and frequencies within the same presentation series. 
• The complete loudness scaling procedure (i.e. all sensations from very smooth to very loud) should be completed within an appropriate time period.  As a rule of thumb, a number of 10 may be indicated inside of which every loudness category should be presented once.
• When the patient’s responses are skewed, cancel the test or do not save the values. When in doubt, select the two-stage presentation. In this procedure the patient can better orient and can correct the graduation (i.e. achieves his/her orientation again).

To obtain a copy of the AHA! Scaling test form, it can be downloaded from the following web-sites:

• In English: ftp://www.acousticon.de/ac/acousticon.de/AHAFORMGB.pdf
• In German: ftp://www.acousticon.de/ac/acousticon.de/AHAFORM.pdf