4 - Speech Threshold Testing Flashcards
When did speech audiometry begin to complement PT audiometry?
After WWII
Name 2 common complaints from patients regarding hearing and understanding speech
- speakers mumble or talk too fast
- female or children’s voices unclear
- cannot follow conversation, especially with background noise
- difficulty in group situations
Name one criticism of PT audiometry
- not “real world” sounds
- limited measure of hearing ability (detection only)
How are speech detection and perception usually assessed (4 broad categories)?
Awareness/Detection
Identification
- repeat speech stimulus
- match to label or picture
Discrimination (detect change)
- same/different
- change (yes or no)
Comprehension
- attach meaning to stimulus by answering questions
What are the 4 types of speech stimuli?
Nonsense syllables
- CVC “bod” “dod”
- ID acoustic features
Spondaic words
- familiar, 2 syllable words (“hotdog”)
- SPEECH RECOGNITION THRESHOLD (SRT)
Phonetically balanced word lists
- single syllable words (“hit””, “up”, “shoe”)
- predictive of sentence level performance in quiet
- WORD RECOGNITION SCORE (WRS)
Sentences
- use of context
Patients are better able to guess when _____ (single words/sentences) are used, than when ______ (single words/sentences) are used
Sentences
Single Words
Speech Audiometry Procedures use what two types of assessment?
Threshold
- Speech Detection (awareness) Threshold (SAT/SDT)
- Speech Recognition Threshold (SRT)
Suprathreshold
- Word Recognition Score (WRS)
- Sentence Recognition Score (SRS)
What is the purpose of speech audiometry (name 2)
- evaluate the audibility of speech
- determine the threshold for speech stimuli
- cross-check pure tone audiogram
Which speech stimuli measures are used in conventional speech audiometry?
SRT/SDT - Speech Reception/Detection Threshold
WRS - Word Recognition Score
Which basic components on the audiometer are used for speech testing?
- input selector (recorded materials or microphone for live voice)
- talk back (monitor patient response)
- input level control (VU meter) (monitor intensity)
- attenuator (control the level of speech presented from -10-110 dB HL)
- output selector (TDH headphones, insert earphones, sound field)
What level on the VU meter should both syllables be peaking at for speech audiometry?
0
What are 2 benefits of monitored live voice?
- convenient
- flexible
Name 2 positive or negative considerations for using a recorded voice presentation mode
Pros:
- standardization
- increased reliability
Cons:
- more equipment needed
- accent of recorded voice
- little control over the amount of time between presentations
What are 2 disadvantages of live voice mode?
- between speaker differences
- within speaker variability
- consistency within/between test sessions
- gender differences (female speaker level must be greater to achieve same test outcome)
What are the two different types of assessment in speech audiometry, and name one example of each
Threshold
- Speech Detection (awareness) Threshold (SAT/SDT)
- Speech Recognition Threshold (SRT)
Suprathreshold
- Word Recognition Score (WRS)
- Sentence Recognition Score (SRS)
Name one patient factor that you should consider when choosing your method of presentation and response format
- age
- general health
- cognitive status
What are the two threshold measures in speech audiometry?
Speech Detection Threshold (SDT) - measure of threshold for detection of speech
Speech Recognition Threshold (SRT) - measure of the threshold for identification of speech
Both use 2 syllable, familiar spondaic words
True or False: SRT can be affected by whether English is someone’s second language and by neurological disorders
True
What is another name for “Speech Detection Threshold”?
Speech Awareness threshold (SAT)
With SDT (SAT), what percent correct is the threshold set at?
50%
True or False: The SDT Threshold search uses the bracketing method (down 10, up 5)
True
Which threshold measure assesses the most simple level of speech processing?
SDT
When measuring SDT in pediatric or special populations, what are some behavioural responses we might watch for?
Orienting to the sound (head turn)
Change in behaviour (body movement, sucking, eye widening)
What does SRT stand for, and what does it signify?
Speech Recognition (or Reception) Threshold
- signifies the lowest level at which a speech signal is RECOGNIZED and REPEATED 50% of the time
Describe the SRT Procedure
Familiarize patient with the words
- select 10 and ask them to repeat them back
- no carrier phrase
Measure SRT
- begin threshold procedure by presenting spondees (recorded or live voice)
- different ascending, descending and bracketing procedures available to use
What are the instructions for SRT?
- You are going to hear a list of words
- Repeat each word. Take a guess if you are not sure
- (Familiarize at comfortable level)
- The words will become very soft. Repeat each word. Take a guess if you are not sure
The most commonly used SRT Threshold search is Martin & Dowdy’s Bracketing procedure. Describe it
Present spondee word at 30 dB HL
- if patient does not respond, increase to 50 dB, then up 10 dB until positive response
Once patient responds, use 10 down, 5 up procedure with 1 spondee presented at each level
Threshold at 50% words correct at lowest intensity level (2/4 or 3/6)
The Downs and Minard SRT Threshold search is another ascending method, but is more time consuming. Describe it
- familiarize with spondees
-present 1 spondee at lowest attenuator setting
-ascend in 10 dB steps presenting 1 word at each level until client responds correctly
-descent 15 dB
-present 2-4 spondees/level and ascend in 5 dB steps - If 3 spondees are missed, ascend 5 dB and try again
If 2 spondees are correct, stop
Explain how SRT Procedures can be modified for children
Ask them to point to the object (e.g. hotdog) on a chart
If an SRT is used to confirm pure tone test results, the SRT should be within +/- 10 dB of ____
PTA3
*If it does not match the PTA 3, consider the hearing loss configuration (sharply sloping or rising? PTA 2 using best 2 thresholds of 500, 1000, and 2000 may provide better match)
SRTs can be used to confirm pure tone test results and determine the threshold reference for presentation of __________
Suprathreshold Speech Recognition Tests
If a client shows SRTs better than PTAs, they may have a differential diagnosis of _________ (non-organic HL/CNS Dysfunction)
Non-organic HL
If a client shows SRTs worse than PTAs, they may have a differential diagnosis of _________ (non-organic HL/CNS Dysfunction)
CNS Dysfunction (e.g. brainstem lesion, cortical deafness)
True or False: Bone conduction SRT may assist you in determining a conductive component
True
True or false: SRT is easier than SDT, and results in a better threshold
False; SDT is easier (detection vs recognition), and may result in a ~10 dB better threshold
When might SDT be used instead of SRT?
- when client unable to recognize speech stimuli (e.g. repeat, write, or point)
- pediatric and special populations
- SDT reflects best PT threshold
