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Copyright2015AudiologyOnlineAllRightsReserved

BacktoBasics:SpeechAudiometry
JanetR.Schoepflin,PhD
July30,2012

Editor'sNote:ThisisatranscriptofanAudiologyOnlineliveseminar.Pleasedownloadsupplementalcoursematerials.
Speechistheauditorystimulusthroughwhichwecommunicate.Therecognitionofspeechisthereforeofgreatinteresttoallofusinthefieldsof
speechandhearing.SpeechaudiometrydevelopedoriginallyoutoftheworkconductedatBellLabsinthe1920sand1930swheretheywere
lookingintotheefficiencyofcommunicationsystems,andreallygainedmomentumpostWorldWarIIasreturningveteranspresentedwith
hearingloss.Themethodsandmaterialsfortestingspeechintelligibilitywereofinterestthen,andarestillofinteresttoday.Itisduetothis
ongoinginterestasseeninthequestionsthatstudentsaskduringclasses,byquestionsnewaudiologistsraiseastheybegintheirpractice,and
bythecommentsandquestionsweseeonvariousaudiologylistservsaboutthemostefficientandeffectivewaystotestspeechintheclinical
setting,thatAudiologyOnlineproposedthiswebinaraspartoftheirBacktoBasicsseries.Iamdelightedtoparticipate.Iampresentingareview
ofthearrayofspeechteststhatweuseinclinicalevaluationwithasummaryofsomeoftheoldandnewresearchthathascomeaboutto
supporttherecommendedpractices.ThetopicsthatIwilladdresstodayareanoverviewofspeechthresholdtesting,suprathresholdspeech
recognitiontesting,themostcomfortablelisteningleveltesting,uncomfortablelisteninglevel,andabriefmentionofsomenewdirectionsthat
speechtestingistaking.
Inthecontextoftestingspeech,IwillassumethattheenvironmentinwhichyouaretestingmeetstheANSIpermissiblenoisecriteriaandthatthe
audiometertransducersthatarebeingusedtoperformspeechtestingareallcalibratedtotheANSIstandardsforspeech.Iwillnotbetalking
aboutthosestandards,butit'sofcourseimportanttokeepthoseinmind.

SpeechThresholdTesting
SpeechThresholdtestinginvolvesseveralconsiderations.Theyincludethepurposesofthetestorthereasonsforperformingthetest,the
materialsthatshouldbeusedintesting,andthemethodorprocedurefortesting.
PurposesofSpeechThresholdTesting
Anumberofpurposeshavebeengivenforspeechthresholdtesting.Inthepast,speechthresholdswereusedasameanstocrosscheckthe
validityofpuretonethresholds.ThispurposelackssomevaliditybecausewehaveotherphysiologicandelectrophysiologicprocedureslikeOAEs
andimittancetestresultstohelpusinthatcrosscheck.However,thespeechthresholdmeasureisatestofhearing.Itisnotentirelyinvalidtobe
performedasacrosscheckforpuretonehearing.Ithinksometimesweareanxioustogetridofthingsbecausewefeelwehaveabetterhandle
fromothertests,butinthiscase,itmaynotbethewisestthingtotossout.
Alsoinpastyears,speechthresholdswereusedtodeterminethelevelforsuprathresholdspeechrecognitiontesting.Thatalsolacksvalidity,
becausethelevelatwhichsuprathresholdtestingisconducteddependsonthereasonyouaredoingthetestitself.
Itisnecessarytotestspeechthresholdsifyouaregoingtobill92557.Asidefromthat,thecurrentpurposeforspeechthresholdtestingisinthe
evaluationofpediatricanddifficulttotestpatients.Clinicalpracticesurveystellusthatthemajorityofcliniciansdotestspeechthresholdsforall
theirpatientswhetheritisforbillingpurposesornot.
Itisalwaysimportantthattestingisdoneintherecommended,standardizedmanner.Theacceptedmeasuresforspeechthresholdsarethe
SpeechRecognitionThreshold(SRT)andtheSpeechDetectionThreshold(SDT).Thosetermsareusedbecausetheyspecifythematerialor
stimulus,i.e.speech,aswellasthetaskthatthelistenerisrequiredtodo,whichisrecognitionoridentificationinthecaseoftheSRT,and
detectionornoticingofpresenceversusabsenceofthestimulusinthecaseofSDT.Thetermsalsospecifythecriterionforperformancewhichis
thresholdorgenerally50%.TheSDTismostcommonlyperformedonthoseindividualswhohavebeenunabletocompleteanSRT,suchasvery
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youngchildren.Becauserecognitionisnotrequiredinthespeechdetectiontask,itisexpectedthattheSDTwillbeabout5to10dBbetterthan
theSRT,whichrequiresrecognitionofthematerial.
MaterialsforSpeechThresholdTesting
Thematerialsthatareusedinspeechthresholdtestingarespondees,whicharefamiliartwosyllablewordsthathaveafairlysteeppsychometric
function.Coldrunningspeechorconnecteddiscourseisanalternativeforspeechdetectiontestingsincerecognitionisnotrequiredinthattask.
Whatevermaterialisused,itshouldbenotedontheaudiogram.Itisimportanttomakenotationsontheaudiogramabouttheprotocolsandthe
materialsweareusing,althoughincommonpracticemanyofusarelaxindoingso.
MethodsforSpeechThresholdTesting
Themethodsconsiderationinspeechthresholdtestingishowwearegoingtodothetest.Thiswouldincludewhetherweusemonitoredlive
voiceorrecordedmaterials,andwhetherwefamiliarizethepatientwiththematerialsandthetechniquethatweusetoelicitthreshold.Monitored
livevoiceandrecordedspeechcanbothbeusedinSRTtesting.However,recordedpresentationisrecommendedbecauserecordedmaterials
standardizethetestprocedure.Withlivevoicepresentation,themonitoringofeachsyllableofeachspondee,sothatitpeaksat0ontheVU
metercanbefairlydifficult.Theconsistencyofthepresentationislostthen.Usingrecordedmaterialsisrecommended,butitislessimportantin
speechthresholdtestingthanitisinsuprathresholdspeechtesting.AsImentionedwiththematerialsthatareused,itisimportanttonoteonthe
audiogramwhatmethodofpresentationhasbeenused.
Asfarasfamiliarizationgoes,wehaveknownforabout50years,sinceTillmanandJerger(1959)identifiedfamiliarityasafactorinspeech
thresholds,thatfamiliarizationofthepatientwiththetestwordsshouldbeincludedaspartofeverytest.Severalclinicalpracticesurveyssuggest
thatfamiliarizationisnotoftendonewiththepatients.Thisisnotagoodpracticebecausefamiliarizationdoesinfluencethresholdsandshouldbe
partoftheprocedure.
Thelastconsiderationundermethodsisregardingthetechniquethatisgoingtobeused.Severaldifferenttechniqueshavebeenproposedfor
thedeterminationofSRT.Clinicalpracticesurveyssuggestthemostcommonlyusedmethodisabracketingprocedure.Thetypicaldown10dB,
up5dBisoftenusedwithtwotofourwordspresentedateachlevel,andthethresholdthenisdefinedasthelowestlevelatwhich50%oratleast
50%ofthewordsarecorrectlyrepeated.ThisisnottheprocedurethatisrecommendedbyASHA(1988).TheASHArecommendedprocedureis
adescendingtechniquewheretwospondeesarepresentedateachdecrementfromthestartinglevel.Thereareothermodificationsthathave
beenproposed,buttheyarenotwidelyused.

SuprathresholdSpeechTesting
Suprathresholdspeechtestinginvolvesconsiderationsaswell.Theyaresimilartothosethatwementionedforthresholdtests,buttheyaremore
complicatedthanthethresholdconsiderations.Theyincludethepurposesofthetesting,thematerialsthatshouldbeusedintesting,whetherthe
testmaterialshouldbedeliveredviamonitoredlivevoiceorrecordedmaterials,thelevelorlevelsatwhichthetestingshouldbeconducted,
whetherafulllist,halflist,oranabbreviatedwordlistshouldbeused,andwhetherornotthetestshouldbegiveninquietornoise.
PurposesofSuprathresholdTesting
Thereareseveralreasonstoconductsuprathresholdtests.Theyincludeestimatingthecommunicativeabilityoftheindividualatanormal
conversationalleveldeterminingwhetherornotamorethoroughdiagnosticassessmentisgoingtobeconductedhearingaidconsiderations,
andanalysisoftheerrorpatternsinspeechrecognition.Whenthepurposeoftestingistoestimatecommunicativeabilityatanormal
conversationallevel,thenthetestshouldbegivenatalevelaround50to60dBHLsincethatisrepresentativeofanormalconversationallevelat
acommunicatingdistanceofabout1meter.Whilemonosyllabicwordsinquietdonotgiveacompletepictureofcommunicativeabilityindaily
situations,itisaprocedurethatpeopleliketousetogivesomebroadsenseofoverallcommunicativeability.Ifthepurposeofthetestingisfor
diagnosticassessment,thenapsychometricorperformanceintensityfunctionshouldbeobtained.Ifthereasonforthetestingisforhearingaid
considerations,thenthetestisoftengivenusingwordsorsentencesandeitherinquietorinabackgroundofnoise.Anotherpurposeisthe
analysisoferrorpatternsinspeechrecognitionandinthatsituation,atestotherthansomeopensetmonosyllabicwordtestwouldbe
appropriate.
MaterialsforSuprathresholdTesting
Thechoiceofmaterialsfortestingdependsonthepurposeofthetestandontheageandabilitiesofthepatients.Theissuesinmaterialsinclude
thesetandthetestitemsthemselves.

Closedsetvs.Openset.Thefirstconsiderationiswhetheraclosedsetoranopensetisappropriate.Closedsettestslimitthenumberof
responsealternativestoafairlysmallset,usuallybetween4and10dependingontheprocedure.Thenumberofalternativesinfluencesthe
guessrate.Thisisaconsiderationaswell.TheWordIntelligibilitybyPictureIdentificationortheWIPItestisacommonlyusedclosedsettestfor
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childrenasitrequiresonlythepicturepointingresponseandithasareceptivelanguagevocabularythatisaslowasabout5years.Itisvery
usefulinpediatricevaluationsasisanotherclosedsettest,theNorthwesternUniversityChildren'sPerceptionofSpeechtest(NUCHIPS).
Incontrast,theopensetprotocolprovidesanunlimitednumberofstimulusalternatives.Therefore,opensettestsaremoredifficult.Theclinical
practicesurveysavailablesuggestforroutineaudiometrictestingthatmonosyllabicwordlistsarethemostwidelyusedmaterialsin
suprathresholdspeechrecognitiontestingforroutineevaluations,butsentencesinnoisearegainingpopularityforhearingaidpurposes.

CIDW22vs.NU6.Themostcommonmaterialsforspeechrecognitiontestingarethemonosyllabicwords,theCentralInstituteofthe
DeafW22andtheNorthwesternUniversity6wordlist.Thesearethemostcommonopensetmaterialsandtherehasbeensomediscussion
amongaudiologistsconcerningthedifferencesbetweenthose.Fromahistoricalperspective,theCIDW22listcamefromtheoriginalHarvard
PALPB50wordsandtheW22sareagroupofthemorefamiliarofthose.Theyweredevelopedintofour50wordlists.Theyarestillcommonly
usedbyaudiologiststoday.TheNU6listsweredevelopedlaterandinsteadoflookingforphoneticbalance,theyconsideredamorephonemic
balance.Thearticulationfunctionforbothofthoseusingrecordedmaterialsisaboutthesame,4%perdB.TheNU6testsareconsidered
somewhatmoredifficultthantheW22s.Clinicalsurveysshowthatbothmaterialsareusedbypracticingaudiologists,withusageoftheNU6lists
beginningtosurpassusageofW22s.
Nonsensematerials.Thereareothermaterialsthatareavailableforsuprathresholdspeechtesting.Thereareothermonosyllabicword
listsliketheGardnerhighfrequencywordlist(Gardner,1971)thatcouldbeusefulforspecialapplicationsorspecialpopulations.Therearealso
nonsensesyllabictaskswhichwereusedinearlyresearchincommunication.Anadvantageofthenonsensesyllablesisthattheeffectsofword
familiarityandlexicalconstraintsarereducedascomparedtousingactualwordsastestmaterials.AfewthatareavailablearetheCityUniversity
ofNewYorkNonsenseSyllabletest,theNonsenseSyllabletest,andothers.
Sentencematerials.Sentencematerialsaregainingpopularity,particularlyinhearingaidapplications.Thisisbecausespeechthat
containscontextualcuesandispresentedinanoisebackgroundisexpectedtohavebetterpredictivevaliditythanwordsinquiet.Thetwo
sentenceproceduresthatarepopulararetheHearingInNoiseTest(HINT)(Nilsson,Soli,&Sullivan,1994)andtheQuickSIN(Killion,Niquette,
Gudmundsen,Revit&Banerjee,2004).OthersentenceteststhatareavailablethathaveparticularapplicationsaretheSyntheticSentence
Identificationtest(SSI),theSpeechPerceptionandNoisetest(SPIN),andtheConnectedSpeechtest.
MonitoredLiveVoicevs.Recorded.Aswithspeechthresholdtesting,theuseofrecordedmaterialsforsuprathresholdspeechtesting
standardizesthetestadministration.Therecordedversionofthetestisactuallythetestinmyopinion.Thisgoesbacktoastudyin1969where
thefindingssaidthetestisnotjustthewrittenwordlist,butratheritisarecordedversionofthosewords.
Interspeakerandintraspeakervariabilitymakesusingrecordedmaterialsthemethodofchoiceinalmostallcasesforsuprathresholdtesting.
Monitoredlivevoice(MLV)isnotrecommended.Inyearsgoneby,recordedmaterialsweredifficulttomanipulate,buttheeaseandflexibilitythat
isaffordedusbyCDsanddigitalrecordingsmakesrecordedmaterialstheonlywaytogofortestingsuprathresholdspeechrecognition.
Anotherissuetoconsideristheuseofthecarrierphrase.Sincethecarrierphraseisincludedonrecordingsandrecordedmaterialsarethe
recommendedprocedure,thatissueissettled.However,Idoknowthatmonitoredlivevoiceisnecessaryincertainsituationsandifmonitored
livevoiceisusedintesting,thenthecarrierphraseshouldprecedethetestword.Inmonitoredlivevoice,thecarrierphraseisintendedtoallow
thetestwordtohaveitsownnaturalinflectionanditsownnaturalpower.TheVUmetershouldpeakat0forthecarrierphraseandthetestword
thenisdeliveredatitsownnaturalornormallevelforthatwordinthephrase.

Levels.Thelevelatwhichtestingisdoneisanotherconsideration.Thepsychometricorperformanceintensityfunctionplotsspeech
performanceinpercentcorrectontheYaxis,asafunctionofthelevelofthespeechsignalontheXaxis.Thisisimportantbecausetestingat
onlyonelevel,whichisfairlycommon,givesusinsufficientinformationaboutthepatient'soptimalperformanceorwhatwecommonlycallthePB
max.Italsodoesnotallowustoknowanythingaboutanypossibledeteriorationinperformanceifthelevelisincreased.Asareminder,normal
hearersshowafunctionthatreachesitsmaximumaround25to40dBSL(re:SRT)andthatisthereasonwhysuprathresholdtestingisoften
conductedatthatlevel.Fornormals,theperformanceremainsatthatlevel,100%orso,asthelevelincreases.Peoplewithconductivehearing
lossalsoshowasimilarfunction.Individualswithsensorineuralhearingloss,however,showaperformancefunctionthatreachesitsmaximumat
generallylessthan100%.Theycaneithershowperformancethatstaysatthatlevelasintensityincreases,ortheycanshowacurvethatreaches
itsmaximumandthendecreasesinperformanceasintensityincreases.Thisisknownasrollover.Asinglelevelisnotthebestwaytogoaswe
cannotanticipatewhichpatientsmayhaverolloverduringtesting,unlesswetestatalevelhigherthanwherethemaximumscorewasobtained.I
recognizethatthereareoftentimeconstraintsineverydaypractice,buttwolevelsarerecommendedsothattheperformanceintensityfunction
canbeobservedforanindividualpatientatleastinanabbreviatedway.
Recently,GuthrieandMackersie(2009)publishedapaperthatcomparedseveraldifferentpresentationlevelstoascertainwhichlevelwould
resultinmaximumwordrecognitioninindividualswhohaddifferenthearinglossconfigurations.Theylookedatanumberofpresentationlevels
rangingfrom10dBabovetheSRTtoalevelattheUCL(uncomfortablelisteninglevel)5dB.Theirresultsindicatedthatindividualswithmildto
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moderatelossesandthosewithmoresteeplyslopinglossesreachedtheirbestscoresataUCL5dB.Thatwasalsotrueforthosepatientswho
hadmoderatelyseveretoseverelosses.ThebestphonemerecognitionscoresfortheirpopulationswereachievedatalevelofUCL5dB.Asa
reminderaboutspeechrecognitiontesting,maskingisfrequentlyneededbecausethetestisbeingpresentedatalevelabovethreshold,inmany
caseswellabovethethreshold.Maskingwillalwaysbeneededforsuprathresholdtestingwhenthepresentationlevelinthetestearis40dBor
greaterabovethebestboneconductionthresholdinthenontestearifsupraauralphonesareused.

Fulllistsvs.halflists.Anotherconsiderationiswhetherafulllistorahalflistshouldbeadministered.Originallistswerecomposedof50
wordsandthose50wordswerecreatedforphoneticbalanceandforsimplicityinscoring.Itmadeiteasyforthetesttobescoredif50words
wereadministeredandeachwordwasworth2%.Because50wordliststakealongtime,peopleoftenusehalflistsorevenshorterlistsforthe
purposeofsuprathresholdspeechrecognitiontesting.Let'slookintothispracticealittlefurther.
AnearlystudywasdonebyThorntonandRaffin(1978)usingtheBinomialDistributionModel.Theyinvestigatedthecriticaldifferencesbetween
onescoreandaretestscorethatwouldbenecessaryforthosescorestobeconsideredstatisticallysignificant.Theirfindingsshowedthatwithan
increasingsetsize,variabilitydecreased.Itwouldseemthatmoreitemsarebetter.
MorerecentlyHurleyandSells(2003)conductedastudythatlookedatdevelopingatestmethodologythatwouldidentifythosepatientsrequiring
afull50itemsuprathresholdtestandallowabbreviatedtestingofpatientswhodonotneedafull50itemlist.TheyusedAuditecrecordingsand
developed10wordand25wordscreeningtests.TheyfoundthatthefourlistsofNU610wordandthe25wordscreeningtestswereableto
differentiatelistenerswhohadimpairedwordrecognitionwhoneededafull50wordlistfromthosewithunimpairedwordrecognitionabilitywho
onlyneededthe10wordor25wordlist.Ifabbreviatedtestingisimportant,thenitwouldseemthatthiswouldbetheprotocoltofollow.These
screeninglistsareavailableinarecordedversionandtheirfindingswerebasedonarecordedversion.Onceagain,itisimportanttouse
recordedmaterialswhetheryouaregoingtouseafulllistoruseanabbreviatedlist.

Quietvs.Noise.Anotherconsiderationinsuprathresholdspeechrecognitiontestingiswhethertotestinquietorinnoise.Theeffectsof
sensorineuralhearinglossbeyondthethresholdloss,suchasimpairedfrequencyresolutionorimpairedtemporalresolution,makesspeech
recognitionperformanceinquietapoorpredictorforhowthoseindividualswillperforminnoise.Speechrecognitioninnoiseisbeingpromotedby
anumberofexpertsbecauseaddingnoiseimprovesthesensitivityofthetestandthevalidityofthetest.Givingthetestatseverallevelswill
provideforabetterseparationbetweenpeoplewhohavehearinglossandthosewhohavenormalhearing.Weknowthatindividualswithhearing
losshavealotmoredifficultywithspeechrecognitioninnoisethanthosewithnormalhearing,andthatthosewithsensorineuralhearingloss
oftenrequireamuchgreatersignaltonoiseratio(SNR),10to15better,thannormalhearers.
Monosyllabicwordsinnoisehavenotbeenwidelyusedinclinicalevaluation.Howeverthereareseveralwordliststhatareavailable.Oneofthem
istheWordsinNoisetestorWINtestwhichpresentsNU6wordsinamultitalkerbabble.ThewordsarepresentedatseveraldifferentSNRs
withthebabbleremainingataconstantlevel.Oneoftheadvantagesofusingthesekindsoftestsisthattheyareadaptive.Theycanbe
administeredinashorterperiodoftimeandtheydonotrunintothesameproblemsthatweseewithceilingeffectsandflooreffects.
AsImentionedearlier,sentencetestsinnoisehavebecomeincreasinglypopularinhearingaidapplications.Testingspeechinnoiseisoneway
tolookatamplificationpreandpostfitting.TheHearinginNoiseTestandQuickSin,havegainedpopularityinthoseapplications.TheHINTwas
developedbyNilssonandcolleaguesin1994andlatermodified.ItisscoredasthedBtonoiseratiothatisnecessarytogeta50%correct
performanceonthesentences.ThesentencesaretheBKB(BamfordKowalBench)sentences.Theyarepresentedinsetsof10andthelistener
listensandrepeatstheentiresentencecorrectlyinordertogetcredit.IntheHINT,thespeechspectrumnoisestaysconstantandthesignallevel
isvariedtoobtainthat50%point.TheQuickSinisatestthatwasdevelopedbyKillionandcolleagues(2004)andusestheIEEEsentences.Ithas
sixsentencesperlistwithfivekeywordsthatarethescoringwordsineachsentence.Allofthemarepresentedinamultitalkerbabble.The
sentencesgetpresentedoneatatimein5dBdecrementsfromahighpositiveSNRdownto0dBSNR.Againthetestisscoredasthe50%point
intermsofdBsignaltonoiseratio.TheguideproposedbyKillionontheSNRisifanindividualhassomewherearounda0to3dBSNRitwould
beconsiderednormal,3to7wouldbeamildSNRloss,7to15dBwouldbeamoderateSNRloss,andgreaterthan15dBwouldbeasevere
SNRloss.

Scoring.Scoringisanotherissueinsuprathresholdspeechrecognitiontesting.Itisgenerallydoneonawholewordbasis.However
phonemescoringisanotheroption.Ifphonemescoringisused,itisawayofincreasingthesetsizeandyouhavemoreitemstoscorewithout
addingtothetimeofthetest.Ifwholewordscoringisused,thewordshavetobeexactlycorrect.Inthissituation,beingclosedoesnotcount.
Thewordmustbeabsolutelycorrectinordertobejudgedasbeingcorrect.Overtime,differentscoringcategorizationshavebeenproposed,
althoughthepercentagesthatareattributedtothosecategoriesvaryamongthedifferentproposals.
Thetraditionalcategorizationsincludeexcellent,good,fair,poor,andverypoor.Thesecategoriesaredefinedas:

Excellentorwithinnormallimits=90100%onwholewordscoring
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Goodorslightdifficulty=7888%
Fairtomoderatedifficulty=6676%
Poororgreatdifficulty=5464%
Verypooris<52%
MostComfortableListeningLevel
Averyusefultestroutinelyadministeredtothosewhoarebeingconsideredforhearingaidsisthelevelatwhichalistenerfindslisteningmost
comfortable.Thematerialsthatareusedforthisareusuallycoldrunningspeechorconnecteddiscourse.Thelistenerisaskedtoratethelevelat
whichlisteningisfoundtobemostcomfortable.Severaltrialsareusuallycompletedbecausemostcomfortablelisteningistypicallyarange,nota
specificlevelorasinglevalue.Peoplesometimeswantsoundsalittlelouderoralittlesofter,sotherangeisamoreappropriatetermforthisthan
mostcomfortablelevel.Howeverwhateverisobtained,whetheritisamostcomfortableleveloramostcomfortablerange,shouldberecordedon
theaudiogram.Again,thematerialusedshouldalsobenotedontheaudiogram.AsImentionedearlierthemostcomfortablelevel(MCL)isoften
notthelevelatwhichalistenerachievesmaximumintelligibility.UsingMCLinordertodeterminewherethesuprathresholdspeechrecognition
measurewillbedoneisnotagoodreasontousethistest.MCLisuseful,butnotfordeterminingwheremaximumintelligibilitywillbe.ThestudyI
mentionedearliershowedthatmaximumintelligibilitywasreachedformostpeoplewithhearinglossataUCL5.MCLisusefulhoweverin
determiningANLoracceptablenoiselevel.

UncomfortableListeningLevel
Theuncomfortablelisteninglevel(UCL)isalsoconductedwithcoldrunningspeech.Theinstructionsforthistestcancertainlyinfluencethe
outcomesinceuncomfortableoruncomfortablyloudforsomeindividualsmaynotreallybetheirUCL,butratherapreferenceforlisteningata
softerlevel.Itisimportanttodefineforthepatientwhatyoumeanbyuncomfortablyloud.TheutilityoftheUCLisinprovidinganestimateforthe
dynamicrangeforspeechwhichisthedifferencebetweentheUCLandtheSRT.Innormals,thisrangeisusually100dBormore,butitis
reducedinearswithsensorineuralhearinglossoftendramatically.BydoingtheUCL,youcangetanestimateoftheindividual'sdynamicrange
forspeech.

AcceptableNoiseLevel
AcceptableNoiseLevel(ANL)istheamountofbackgroundnoisethatalisteneriswillingtoacceptwhilelisteningtospeech(Nabelek,Tucker,&
Letowski,1991).Itisatestofnoisetoleranceandithasbeenshowntoberelatedtothesuccessfuluseofhearingaidsandtopotentialbenefit
withhearingaids(Nabelek,Freyaldenhoven,Tampas,&Muenchen,2006).ItusestheMCLandameasureknownasBNLorbackgroundnoise
level.Toconductthetest,arecordedspeechpassageispresentedtothelistenerinthesoundfieldfortheMCL.Againnotetheuseofrecorded
materials.Thenoiseisthenintroducedtothelistenertoalevelthatwillbethehighestlevelthatthatpersonisabletoacceptor"putupwith"
whiletheyarelisteningtoandfollowingthestoryinthespeechpassage.TheANLthenbecomesthedifferencebetweentheMCLandtheBNL.
IndividualsthathaveverylowscoresontheANLareconsideredsuccessfulhearingaidusersorgoodcandidatesforhearingaids.Thosethat
haveveryhighscoresareconsideredunsuccessfulusersorpoorhearingaidcandidates.
Obviouslytherearenumberofotherapplicationsforspeechinaudiologicpractice,nottheleastofwhichisintheassessmentofauditory
processing.Manyseminarscouldbeconductedonthistopicalone.Anotherapplicationorfuturedirectionforspeechaudiometryistomore
realisticallyassesshearingaidperformancein"realworld"environments.Thisisanareawhereresearchiscurrentlyunderway.

QuestionsandAnswers
Question:ArethereanymorespecificinstructionsfortheUCLmeasurement?
Answer:Instructionsareveryimportant.Weneedtomakeitcleartoapatientexactlywhatweexpectthemtodo.Ipersonallydonotlikethings
loud.IfIamaskedtoindicatewhatisuncomfortablyloud,IammuchbelowwhatisreallymyUCL.Ithinkyouhavetobeverydirectininstructing
yourpatientsinthatyouarenotlookingforalittleuncomfortable,butwheretheyjustdonotwanttohearitorcannottakeit.
Question:Canyousumupwhatthebestmethodsaretotesthearingaidperformance?Iassumethismeanswithspeechsignals.
Answer:IthinktheuseoftheHINTortheQuickSinwouldbethemostusefulonabehavioraltest.Wehaveotherwaysoflookingatperformance
thatarenotbehavioral.

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Question:Whataboutdialects?Inmyarea,someofthelocaldialectshaveclippedwordsduringspeechtesting.IamnotsureifIshouldcount
thoseascorrectorincorrect.
Answer:Italldependsonyoursituation.Ifapatient'sproductionisreallyreflectiveofthedialectofthatregionandtheyaresayingthewordas
everyoneelseinthatareawouldsayit,thenIwouldsaytheydohavethewordcorrect.Ifnecessary,ifyouarereallyunclear,youcanalwaysask
thepatienttospellthewordorwriteitdown.Thisextratimecanbeinconvenient,butthatisthebestwaytobesurethattheyhavecorrectly
identifiedtheword.
Question:Isthereareferenceforthebracketingmethod?
Answer:ThebracketingmethodisbasedontheoldmodifiedHughsonWestlakethatmanypeopleuseforpuretonethresholdtesting.Itisvery
similartothattraditionaldown10dB,up5dB.Iamsuretherearemorereferences,buttheHughsonWestlakeiswhatbracketingisbasedon.
Question:OnceyougetanSRTresult,ifyouwanttocompareittothethresholdstovalidateyourpuretones,howdoyoucompareittothe
audiogram?
Answer:Ifitisaflathearingloss,thenyoucancomparetothe3frequencypuretoneaverage(PTA).Ifthereisahighfrequencyloss,where
audibilityatperhaps2000Hzisgreatlyreduced,thenitisbettertousejusttheaverageof500Hzand1000Hzasyourcomparison.Ifitisa
steeplyslopingloss,thenyoulookforagreementwiththebestthreshold,whichwouldprobablybethe500Hzthreshold.Thereverseisalsotrue
forpatientswhohaverisingconfigurations.ComparetheSRTtothebesttwofrequenciesofthePTA,ifthelosshaseitherasteepslopeora
steeprise,orthebestfrequencyinthePTAifitisareallyprecipitouschangeinconfiguration.
Question:WherecanIfindspeechlistsinRussianorotherlanguages?
Answer:AuditechassomematerialavailableinlanguagesotherthanEnglishitwouldbebesttocontactthemdirectly.Youcanalsoviewtheir
catalogatwww.auditec.com
CarolynSmaka:ThisraisesaquestionIhave.Ifanaudiologistisnotfluentinaparticularlanguage,suchasSpanish,isitoktoobtainawordlist
orrecordinginthatlanguageandconductspeechtesting?
JanetSchoepflin:Idonotthinkthatisagoodpractice.Ifyouarenotfluentinalanguage,youdonotknowallthesubtletiesofthatlanguage
andtheallophonicvariations.Peoplewanttogetanestimationofsuprathresholdspeechrecognitionandthiswouldbeanattempttodothat.
Thisgoesalongwithdialect.Whetheryouareusingarecording,ordoingyourbesttosaythesewordsexactlyastherearesupposedtobesaid,
andyourpatientisfluentinalanguageandtheysaythewordbacktoyou,sinceyouarenotfamiliarwithallthevariationsinthelanguageitis
possiblethatyouwillscorethewordincorrectly.Youmaythinkitiscorrectwhenitisactuallyincorrect,oryoumaythinkitisincorrectwhenitis
correctbasedonthedialectorvariationofthatlanguage.
Question:Inschoolwewereinstructedtousethefull50wordlistforanyworddiscriminationtestingatsuprathreshold,butifwearepressedfor
time,ahalfwordlistwouldbeokay.However,myprofessorwarnedusthatweabsolutelymustgoinorderonthewordlist.Canyouclarifythis?
Answer:I'mnotsurewhythatmighthavebeensaid.Iwastrainedinthemodeltousethe50wordlist.Thiswasbecausethephoneticbalance
thatwasproposedforthosewordswasbasedonthe50words.Ifyouonlyused25words,youwerenotgettingthephoneticbalance.Ithinkthe
morecurrentfindingsfromHurleyandSellsshowusthatitispossibletouseashorterlistdevelopedspecificallyforthispurpose.Itshouldbethe
recordedversionofthosewords.TheselistsareavailablethroughAuditec.
Question:OntheNU6list,thewords'tough'and'puff'arenexttoeachother.'Tough'isoftenmistakenfor'puff'sothenwhenwereads'puff',
thepersonlooksconfused.Isitokaytomixuptheorderonthewordlist?
Answer:Ithinkinthatcaseitisperfectlyfinetomovethatoneworddown.
Question:Whendoyourecommendconductingspeechtesting,beforeorafterpuretonetesting?
Answer:Ihavealwaysbeenapersonwholikestointeractwithmypatients.MyownprocedureistodoanSRTfirst.FrequentlyforanSRTIdo
uselivevoice.Idonotusemonitoredlivevoiceforsuprathresholdtesting.Itgivesmeatimetointeractwiththepatient.Peoplefeelcomfortable
withspeech.Itisacommunicativeact.ThenIdopuretonetesting.PersonallyIwouldnotdosuprathresholduntilIfinishedpuretonetesting.My
sequenceisoftenSRT,puretone,andsuprathreshold.Ifthisisnotagoodprotocolforyoubasedontime,thenIwouldconductpuretone
testing,SRT,andthensuprathreshold.
Question:Someofthespondeewordsareoutdatedsuchasinkwellandwhitewash.Isitokaytosubstituteotherwordsthatweknowarespondee
words,butmaynotbeonthelist?Orifwefamiliarizepeople,doesitmatter?
Answer:Thewordsthatareonthelistwereputtherefortheirsocalledfamiliarity,butalsobecausetheyweresomewhathomogeneousand
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equalinintelligibility.Ithinkinkwell,drawbridgeandwhitewashareoutdated.Ifyoufollowaprotocolwhereyouareusingarepresentativesample
ofthewordsandyouarefamiliarizing,Ithinkitisperfectlyfinetoeliminatethosewordsyoudonotwanttouse.Youjustdonotwanttoendup
onlyusingfiveorsixwordsasitwilllimitthetestset.
Question:Atwhatageisitappropriatetoexpectachildtoperformsuprathresholdspeechrecognitiontesting?
Answer:Ifthechildhasareceptivelanguageageofaround4or5years,even3yearsmaybe,itispossibletousetheNUCHIPSasameasure.
Itreallydoesdependonlanguagemorethananythingelse,andthefactthatthechildcansitstillforaperiodoftimetodothetest.
Question:Regardingmasking,whenyouaregoing40dBabovetheboneconductionthresholdinthenontestear,whatfrequencyareyou
lookingat?Areyoucomparingspeechpresentedat40aboveapuretoneaverageoftheboneconductionthreshold?
Answer:Thebestboneconductionthresholdinthenontesteariswhatreallyshouldbeused.
Question:WhenseeingapatientinfollowupafteranENTprescribesasteroidtherapyforhydrops,doyourecommendusingthesamewordlist
tocomparetheirsuprathresholdspeechrecognition?
Answer:Ithinkitisbettertouseadifferentlist,personally.Wordfamiliarityaswesaidcaninfluenceeventhresholdanditcertainlycanaffect
suprathresholdperformance.Ithinkitisbesttouseadifferentwordlist.
CarolynSmaka:Thankstoeveryonefortheirquestions.Dr.Schoepflinhasprovidedheremailaddresswiththehandout.Ifyourquestionwas
notansweredorifyouhavefurtherthoughtsafterthepresentation,pleasefeelfreetofollowupdirectlywithherviaemail.
JanetSchoepflin:Thankyousomuch.ItwasmypleasureandIhopeeveryonefoundthepresentationworthwhile.

References
AmericanSpeech,LanguageandHearingAssociation.(1988).DeterminingThresholdLevelforSpeech[Guidelines].Availablefrom
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Guthrie,L.&Mackersie,C.(2009).Acomparisonofpresentationlevelstomaximizewordrecognitionscores.JournaloftheAmericanAcademy
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Hurley,R.&Sells,J.(2003).Anabbreviatedwordrecognitionprotocolbasedonitemdifficulty.Ear&Hearing,24(2),111118.
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