Lecture 3.0 - Speech Audiometry Flashcards
Overview of use with adults*
What is the rationale behind using speech audiometry?*
Whilst pure tone audiometry provides information around hearing thresholds and audibility, it has very poor face/ecological validity.
One of the most common complaints clients have is the difficulty understanding speech.
Therefore, speech audiometry is a crucial tool for both diagnostic and rehabilitative purposes.
It can be used as a cross-check for pure tone audiometry.
What different purposes could speech audiometry be used for?*
True/false: there is only one type of speech audiometry test.
False, speech audiometry is an umbrella term for a wide variety of different tests that can be used to assess an individual’s ability to hear speech.
The types of tests can vary by:
- Speech material
- Mode of testing (sound field, ear specific, unaided)
- Parameter being measured (detection, discrimination or recognition)
- Purpose (diagnostic or outcome measure)
- Population
What are the different purposes of speech audiometry?
In the past, it was used to differentiate between a sensory and neural hearing loss. However, it is not common to do this today.
Today it is used to cross-check with other tests and is helpful for specialist diagnosis’s (APD).
Most importantly, speech audiometry is used for rehabilitation (counseling patients and assessing outcomes after hearing aid fittings).
Speech audiometry gives more information around communications skills than the audiogram.
List and rank the definitions of speech intelligibility from most complex to least.
- Speech comprehension
- The highest level of speech understanding - Speech recognition
- The ability to understand speech items (syllables, words, sentences or phrases) - Speech discrimination
- The ability to hear differences between speech items even if the material is meaningless (requires no understanding) - Speech detection
- Related to hearing sensitivity only
How can we visualise the different dimensions of speech and what are they?
A spectrogram allows us to see:
- Frequency
- Amplitude
- Temporal (time information)
What is the long term average spectrum of speech?
A way to measure the intensity of different frequency components of average conversational speech over a long period of time.
What is the average level of “soft” speech?
50 dB SPLeq
What is the average level of “normal” speech?
60 dB SPLeq
What is the average level of “loud” speech?
70 dB SPLeq
True/false: the LTASS differs significantly across languages
False, it is relatively the same across all languages
What is speech mapping?
A rehabilitation technique where you describe what speech sounds are affected using the speech banana.
What are some different modes of assessment?
- Open or closed set questions
- With/without carrier phrase
- Single words
- Sentences
- Nonsense words
- Speech sounds
- Quiet or background noise
What is the speech detection threshold?
- Audiometry with words instead of pure tones
- Can be used as a fall back for E2L or very shy children who do not want to repeat words
What is the speech recognition threshold?
- The lowest level at which speech is intelligible enough to be identified 50% of the time
- Client usually asked to repeat spondee words (two syllable words with equal emphasis)
- Primary purpose is to cross-check with the audiogram
- Scores at multiple different levels allows us to plot a performance intensity (PI) function
What is a phonemically balanced word set?
Reflects how frequent certain frequencies are in the natural world
Identify different patterns of loss on PI function charts
See kahoot
What can help to differentiate between a retrocochlear loss and a cochlear loss?
Calculating a rollover index:
(PI max - PI min) / PI max
Result of >0.4 means ??
True/false: Speech tests are just as adaptive as puretone audiometry
False, they are less adaptive. This is because we already have their thresholds from puretone audiometry
What can occur in speech testing with someone who has a retrocochlear loss?
- Distortion may occur as a result of x-talk
- This can be because of demyelination, space occupying lesions and auditory neuropathies
True / false: cross hearing is not an issue in speech testing.
False. As we are testing at supra-thresholds, masking is often necessary even if it was not needed at pure tone levels.
When do we need to mask speech testing?
What type of noise/tone is used in masking speech testing?
Wide band noise is used as this covers the whole speech spectrum, as opposed to a narrow range that occurs in NBN.
When might we test in quiet vs. in noise?
Testing in quiet can:
- Give a speech detection threshold and/or performance intensity function
- This can help with retrocochlear suspicion
Testing in noise can:
- Give you a speech recognition threshold with information on the signal-to-noise ratio
- Give a better idea of cochlear distortion and potential benefit from hearing aids
What are some common speech in noise tests?
- R-SPIN (revised speech in noise) Test
- HINT (hearing in noise test) available in NZE
- Words in noise (WIN)
- QuickSin
- BKB-SIN (Available in NZE)
How do speech in noise tests work?
- Typically scored based on keywords correct
- Signal-to-noise ratio is adapted by changing either the background noise or the speech
What is the Speech Intelligibility Index (SII)?
- A way to predict speech intelligibility using puretone results
- Does not replace speech testing, but can be used when time is short or speech audiogram is contraindicated (E2L)
- It is calculated by looking at the pure-tone thresholds and judging which sounds in the speech banana will be audible and we assign different weighting to the different speech sounds in terms of importance (mid-frequency region carries the most information for intelligibility)
