Analysis of the coil generated impulse noise in extracranial magnetic stimulation.

An intense impulse noise artifact is generated by the coil used in extracranial magnetic stimulation (EMS) of the brain and cranial nerves. In this study we measured and analyzed the sound pressure level (SPL), spectral content, wave form, and time course of the magnetic coil acoustic artifact (MCAA) impulse noise in the sound field and in the ear canal of life-size models of the human cranium. Two different clinical magnetic stimulators and coils were used. Sound field measurements from both coils showed the MCAA to be a transient impulse noise with a rapid rise-time, brief duration, broad acoustic spectrum, and high intensity. Measurements made on models of the human head with the magnetic coils positioned at selected standard clinical positions for EMS, particularly the peripheral facial nerve, auricle and mastoid areas, indicated that the MCAA may reach sound pressure levels that exceed noise damage-risk criteria limits for sensorineural hearing loss. The maximum peak energy in the acoustic spectrum of the MCAA measured in the ear canal of the model heads was from 2 to 5 kHz, the range of highest sensitivity in human ears. Ear protectors were found to attenuate the SPL of the MCAA, reaching the ear canal of the model heads by 15-22 dB SPL, and were recommended for use by patients and subjects exposed to EMS.