Speech Audiometry

When did assessing audition with speech stimuli begin?

1804

What did early studies in assessing audition assess?

Person’s ability to hear vowels, un voiced and voiced consonants

When was the first speech audiometer used for hearing screenings?

1920s, the Western Electric 4A

Why is speech audiometry important for kids?

oral language development

Why is speech audiometry important for adults?

able to detect and understand speech for understanding speech in everyday communication (foundation of many activities)

What is speech audiometry?

Procedures using speech stimuli to determine auditory function

What is the speech audiometry measure for audibility?

SRT

What does SRT Assess?

Sensitivity of speech rec in quiet, measured in dB HL

What is the speech audiometry measure of distortion?

Word Rec

What does Word Rec Assess?

Clarity of speech at suprathreshold levels, sometimes in quiet sometimes in noise, measured by PERCENT CORRECT OR signal to noise ratios

What is used instead of SRT for peds?

SDT/SAT (we use SDT in our clinic)

What test is used instead of SRT for infants, children, adults who cannot respond verbally, and those with poor thresholds?

SDT

What does SDT measure?

level where one can detect speech 50% of the time, in dB HL

What does SRT estimate?

Level where one can repeat words 50% of the time, in dB HL

What does Word Rec (WRS) assess?

speech recognition score, the suprathreshold dB HL relative to SRT or PTA, the dB HL relative to 2k Hz

How is Word Rec Measured?

% correct

What standards must we meet for speech stimuli?

ANSI

How do we meet standards for speech stimuli in our clinic?

Calibrate, understand proper presentation techniques, instruct patients properly, and use proper response methods

What is a VU meter?

voice energy monitor for speech testing

What did ASHA say about speech stimuli in 1988?

Recorded stimuli is preferred. (note, we use MLV for SRT/SDT in our clinic, and many others do as well)

FOR WORD REC, MOST TESTING IS RECORDED

Psychometric function

understanding how presentation level affects performance

What axis is presentation level represented on?

x-axis

what axis is percent correct represented on?

y-axis

What is relationship between presentation level and percent correct?

Percentage correct is low when presentation level is low, and percentage increases with increases in presentation level

What is the highest % correct called?

PB (phonetically balanced) max

Where do listeners with NORMAL hearing acuity usually attain PB Max?

30-40 dB sensation levels in regard to SRT

What may be warranted to determine PB Max for a patient with SNHL?

multiple presentation levels

Floor effect

Word rec scores below 20% may be too difficult for patient, changes in performance may be challenging to capture

Ceiling effect

scores greater than 80% may be too easy to show improvements in performance

What test do we use at ISU for word rec?

NU-6 Ordered by Difficulty word lists

What are alternative lists for word rec?

different vocab, maybe picture pointing

How do you choose the level to present in word rec?

40 dB above SRT (start in better ear first)

When may masking be needed for word rec

MHL or CHL suspected, may need to establish BC thresholds first

How do you score word rec?

determine percent correct based

Why might you use the SPRINT chart after word rec?

when the scores are poorer than expected to check their norms

How do you score NU6 OBD?

Present 10 most difficult words first… if they miss none or just one stop testing for that ear.

How do you score NU6 when patient misses more than one word?

present the next 15 words. Out of the now 25 total, stop for that ear if they only miss 3 or fewer.

What if a patient misses more than three words on NU6?

Present the full 50-word list

90-100% WR

excellent WR

75-89% WR

Good WR

60-74% WR

fair WR

50-59% WR

poor WR

Less than 50% WR

Very poor WR

what are spondee words?

two syllable words (nouns) where both syllables are equaly stressed, familiar words and phonetic dissimilarity

SRT Protocol order

1. instruct

2. familiarize

3. determine threshold

4. calculate threshold

How do you familiarize for SRT?

use mic in both ears, choose 10 spondees and present with proper VU (toss word out if they don’t get it at loud level) your face not covered

how do you determine threshold for SRT testing?

the lowest level where they respond correctly at least 50% of time after two ascending runs going down ten up five

what are four reasons we use SRT in our test battery?

1. cross check with PT thresholds

2. measure difficulty hearing sounds

3. use as reference for word rec ability (suprathreshold)

4. helpful when assessing a malingerer

What types of words are used in NU6?

Monosyllabic, CNC, phonemically balanced

What is a frequent report by people with HL?

trouble hearing in background noise

What are 3 HA featuers that improve listening in background noise?

1. Directional microphones

2. noise reduction

3. digital signal processing

How much higher does the SNR ratio for those with HL need to be from listeners with normal hearing?

10-15 dB greater

How much can a 10 dB improvement in SNR improve speech intelligibility by?

30%

To score at least 50% SNR on word rec in noise, people with SNHL need how much of a dB boost?

10-12 dB boost

How much dB boost do normal hearing individuals need to obtain at least 50% SNR for word rec in noise?

2-6 dB boost

What are 3 facts about Quick SIN?

1. six sentences with increased amounts of multi-talker babble

2. five key words in each sentence

3. patients get credit for individual words stated correctly