Speech audiometry

Question 1

Why is speech testing useful?

Answer 1

-Speech testing is more representative of the everyday listening experience than pure tones are
-It tests the patient’s functional hearing ability
-Predicts success with hearing aids

Question 2

What equipment is needed for speech testing?

Answer 2

-Two channel audiometer
-Microphone and talk-back facility so that we can hear what the patient is saying
-Headphones, inserts or soundfield (using loudspeaker)

Question 3

What are the speech materials that can be used for speech testing?

Answer 3

-Single words (can be monosyllabic or bisyllabic)
-Sentences
-Phonemes (vowel-consonant combinations)
-Nonsense words/ syllables

Question 4

What is the advantage and disadvantage of using nonsense words in speech testing?

Answer 4

-Use of nonsense words minimises context cues and word familiarity
-However it removes the sense of language from speech testing- how effective and useful is it for real life speech?

Question 5

What are the methods of presentation of the speech materials?

Answer 5

1. Live voice
2. Recorded speech

Question 6

What is the advantage and disadvantage of using live voice as a method of presentation?

Answer 6

It is more reflective of a real world situation but you have less control over it

Question 7

What are the advantages of using recorded speech as a method of presentation?

Answer 7

Use of recorded speech gives you more control over the stimulus and it can be standardised which increases precision and stability

Question 8

Name the three types of speech testing

Answer 8

1. Speech detection threshold (SDT)- assesses if an individual perceives speech to be present
2. Speech recognition threshold (SRT)- estimates the level at which the listener is able to repeat back a word or phrase
3. Speech in noise tests- provide an impression of the patient’s functioning in everyday communication situations which involve some degree of background noise

Question 9

What does the speech detection threshold tell us and not tell us?

Answer 9

-Tells us the lowest level at which speech can be detected and identified as speech
-Does not imply that speech was understood, just that its presence is detected

Question 10

When might speech detection threshold (SDT) testing be used?

Answer 10

-Patients who are too young to understand or repeat words
-Patients who speak another language
-Patients who have impaired language function or a speech disorder

Question 11

What is the test procedure for speech detection threshold (SDT)?

Answer 11

-Present sentences monotonously and continuously
-Use the bracketing procedure (down 10 dB, up 5 dB)
-Ask patients to respond verbally or by pressing a button

Question 12

How are speech detection threshold results interpreted?

Answer 12

-The result is likely to be closely related to PTA threshold for lower frequencies
-However it will not indicate a sloping loss in the higher frequencies
-Can be misleading regarding identifying overall degree of hearing loss

Question 13

What is the speech recognition threshold (SRT)?

Answer 13

-The lowest level of sound at which 50% of the words can be recognised
-Patients needs to hear, recognise and repeat the word

Question 14

What are the conditions that SRT test materials should fulfill?

Answer 14

-The words/ sentences should be phonetically balanced
-Patient should be familiar with the test words
-Carrier phrase may precede each word e.g. “Say the word” followed by the word

Question 15

Name some examples of SRT test materials

Answer 15

1. AB word lists (commonly used words)
2. Manchester Junior Word Lists- picture presented and child matches the word to the picture
3. Spondee lists- two syllable words with equal stress on both syllables e.g. hotdog, baseball

Question 16

What is the recommended starting level of presentation for SRT testing and what frequencies should be presented?

Answer 16

-Recommended starting level: 30 dB SPL
-Frequencies: 500 Hz, 1000 Hz, 2000 Hz

Question 17

How are SRT results scored? Use the AB word list as an example.

Answer 17

1. The common word is presented to the patient and they are then asked to repeat it
2. If the word ‘fish’ is presented and ‘fish’ is repeated back the patient gets a score of 3 because all three phonemes are correct
3. If the word ‘duck’ is presented and ‘buck’ is repeated the patient gets a score of 2 because two of the phonemes are correct
4. If the word ‘gap’ is presented and ‘pop’ is repeated then only the ‘p’ is correct and the patient gets a score of 1
5. This is repeated for the whole list e.g. of 10 words and then at the end the scores are summed and converted to a percentage

Question 18

How are speech recognition scores plotted on a graph?

Answer 18

-Speech recognition score plotted against the level at which speech is presented
-Get an S shape which is important for psychometric function
-This is known as a performance- intensity function graph

Question 19

What is the relationship between presentation level and speech recognition score for someone with normal hearing?

Answer 19

-As the presentation level increases (gets louder) the percentage of correct score increases
-The highest score is recorded as the PB (phonetically balanced) max
-Over the PBmax the curve flattens as a plateau is reached- increasing the presentation level does not have a impact on the performance score
-Then we read off the 50% speech recognition score off the graph

Question 20

Is speech detection or speech recognition easier for someone with a mild to severe sloping hearing loss? What might their performance intensity graph look like for SRT?

Answer 20

-Speech detection would be easier than speech recognition
-They likely would not reach 100% correct for PBmax but at a certain point increasing the presentation level would not change the correct score

Question 21

Explain why the shape of the performance intensity function differs for each of these

Answer 21

1. Normal hearing- 100% speech recognition level achieved at speech presentation level of about 30 dB above the pure tone average
2. Conductive hearing loss- 100% correct speech recognition is achieved but only at an increase presentation level causing the curve to shift to the right
3. Cochlear (lesion in the cochlea) hearing loss- shape of the curve changes since the patient is unable to reach 100% speech recognition
4. Retrocochlear (lesion beyond the cochlea) problems- deterioration of speech as the presentation level is increased known as rollover

Question 22

What is rollover and why does it occur?

Answer 22

-Rollover is when the speech recognition score starts to deteriorate after a certain presentation level
-At high volumes of speech presentation the words become distorted
-This is due to lesions of the VIIIth nerve

Question 23

In which cases does the 50% SRT level and PTA average not correlate +/- 6dB?

Answer 23

1. Severely sloping hearing loss- the correlation will not as robust
2. Retrocochlear lesion
3. Non-organic hearing loss (it is more difficult to exaggerate speech testing compared to PTA)

Question 24

Why are speech in noise tests used?

Answer 24

-The results can be used to provide information for levels of hearing aid amplification maximum
-Can help indicate if someone needs signal processing to manage effects of background noise
-Provides a valid post-fitting measurement to evaluate intervention and quantify improvement

Question 25

How are speech in noise tests advantageous over pure tone audiometry?

Answer 25

-Audiograms are poor indicators of speech recognition in noise -PTA should therefore not be used solely for hearing aid selections and counselling -Speech in noise assessment could also be used for suspected auditory processing disorder, cochlear implantation criteria and noise induced hearing loss

Question 26

What are the two factors that may influence an individual's ability to understand speech in noise?

Answer 26

1. Age- as hearing thresholds worsen due to age, the ability to understand speech in background noise also declines (syllables, words, sentences) 2. Cognition- deficits in peripheral and central processing factors cause problems with speech intelligibility

Question 27

What is the second most stated reason for not wearing hearing aids?

Answer 27

Limitations in background noise- cannot be predicted from PTA but can be predicted from speech in noise tests more accurately

Question 28

What are some examples of where speech in noise assessments could be undertaken prior to treatment?

Answer 28

1. Patient presents with thresholds on a PTA falling within normal but report difficulties in background noise 2. Pre-cochlear implantations to reduce ceiling effects 3. With hearing aid options where a range of quality of hearing aids are available including analogue aids and those with minimal features

Question 29

How can speech in noise tests be used after a hearing aid has already been fitted?

Answer 29

Can be used to verify and validate the effectiveness of the fitting and be used to improve performance of the hearing aid

Question 30

Name some examples of speech in noise tests

Answer 30

1. The Quick Speech in noise test (QuickSIN) 2. Hearing in Noise test (HINT) 3. Bamford-Kowal- Bench SIN test (SIN) 4. City University of New York Sentences (CUNY)

Question 31

What is the procedure for the QuickSIN test?

Answer 31

-18 unique, 6-sentence lists -Sentences spoken by a female talker at a constant level in a background of 4-talker babble -Target sentence either presented through the same loudspeaker as the babble or through two loudspeakers -The babble increases in 5 dB steps from +25 to 0 dB -The patient is asked to repeated the sentences presented -Each correctly repeated word is awarded one point -22.5- score of total words correct= SNR loss

Question 32

What are the advantages and limitations of the QuickSIN test?

Answer 32

Advantages: Easily available, easy to set up and administer, easy calibration, quick completion, straightforward scoring method, can be adapted for assessing benefits of directional microphones Limitations: Certain lists are only appropriate for American English, 2-3 lists need to be used to obtain an average test score

Question 33

What is the signal to noise ratio required for a normally hearing person and a hearing impaired person to hear the target talker over the background babble?

Answer 33

Normally hearing individual: Requires +2 dB SNR (target speaker needs to be 2 dB louder than the background babble to correctly repeat 50% of the key words) Hearing-impaired person: +12 dB corresponds to 10 dB SNR loss

Question 34

What amount of SNR loss constitutes a normal hearing, mild hearing loss, moderate hearing loss and severe hearing loss (QuickSIN test)?

Answer 34

Normal: 0-2 dB Mild: 3-6 dB Moderate: 7-12 dB Severe: >12 dB

Question 35

Describe the test procedure for the hearing in noise test (HINT)

Answer 35

-250 Bench-Kowal- Bamford (BKB) sentences -Sentences of 5-7 syllables presented by a male speaker -Presented either from the front, right or left -Competing noise held constant at 65 dB -Ascending approach used to determine the presentation level and subsequent presentation levels are increased/ decreased in 4 dB steps and then 2 dB steps -dB SNR= RTS (level at which listener can correctly repeat 50% of the sentences)- dB noise

Question 36

What are the advantages and limitations of the HINT test?

Answer 36

Advantages: Can differentiate small differences amongst people and products, one of the most researched speech tests Limitations: More complicated set up, test administration and scoring, clinics need to obtain their own sound field norms

Question 37

What is the test procedure for the Bamford-Kowal-Bench SIN test?

Answer 37

-10 short sentences in each list with 18 equivalent pairs -Multi-talker babble ranging from +21 dB to -6 dB in 3 dB steps for the 10 sentences -Target sentences presented with the babble in one loudspeaker or separately from two loudspeakers -Goal is to track improvements in SNR at which listener can achieve 50% sentence recognition -SNR-50: 23.5- number of key words in each sentence, then average values for both lists

Question 38

What are the advantages and limitations of the Bamford-Kowal-Bench SIN test?

Answer 38

Advantages: Quick and easy to administer and score, separate lists for cochlear implant users and those with severe hearing loss or significant SNR loss, can be used for all adults Limitations: Less normative data

Question 39

What are the SNR loss values associated with normal hearing, mild hearing loss, moderate hearing loss and severe hearing loss (Bamford-Kowal-Bench SIN test)?

Answer 39

Normal: 0-3 dB (might hear better in noise than those with normal hearing with hearing aids) Mild: 3-7 dB (may hear almost as well in noise as those without hearing loss) Moderate: 7-15 dB Severe: >15 dB

Question 40

Describe the procedure for the City University of New York Sentences (CUNY) test

Answer 40

-24 sentences varying from 3-14 words in 12 lists -Visual component available -SNR during testing is presented at +10 dB to represent an environment more typical of everyday listening conditions -Score is given for how many words, keywords and full sentences are correctly identified

Question 41

What are CUNY tests most traditionally used for?

Answer 41

-As an assessment tool within cochlear implant clinics to assess the ability of lip-reading -Used to help compare pre- and post- fitting information with service users including additional rehabilitative strategies to amplification

Question 42

What are the advantages and limitations of the CUNY test?

Answer 42

Advantages: Easy to score, has audio-visual component Limitations: Ceiling effects more common, can be too easy, lengthy test (24 sentences per list) with several conditions