Lecture 9

Question 1

What information does the measure of communication difficulty add from speech audiometry?

Answer 1

Individual and family counselling
Case management approach (hearing aid fittings)
How well they can communicate in society

Question 2

What information does the diagnostic information add from speech audiometry?

Answer 2

Site of lesion/differential diagnosis
More info about cochlear (sensory)/neural (retrocochlear) - getting sensorineural information, higher level processing can be analyzed.

Question 3

What information does the reliability check add from speech audiometry?

Answer 3

Everything should make more sense compared to other results in battery - part of our test battery

Question 4

What information does the “what might be leading to incongruent results” add from speech audiometry?

Answer 4

Reference point for supra-threshold measures what person should be able to hear:
Hearing aid fittings
Conversing with person - good sense of level should be comfortable and easiest for them to understand.

Question 5

What information does the information for young children or difficult to test populations add from speech audiometry?

Answer 5

May be only chance you get to test at certain levels
Within or out of normal range (lots of info)
Might be where you start - more informative of whether or not they can hear the tone

Question 6

What are the 5 questions of measuring communication difficulty do for speech audiometry?

Answer 6

How clear does speech sound to this client?
How loud must speech be to be audible?
How loud must speech be presented to be intelligible, and under what conditions?
What level of speech is comfortable for this client, and are some speech sounds inaudible even when speech is this loud?
When speech is at its typical conversational level, what speech sounds can the client hear, with and without hearing aids?

Question 7

For speech to be intelligible, what 3 criteria must be met?

Answer 7

It must be audible (loud enough)
It must be recognized (know definition)
It must be processed (and repeated back)

Audibility alone does not guarantee intelligibility.

Question 8

What are the two major tests used for speech audibility?

Answer 8

SRT: Speech recognition threshold
SAT: Speech awareness threshold

Question 9

What is the definition of SRT?

What does the task contain?

Answer 9

The lowest level at which the subject can correctly repeat test words 50% of the time.
Stimuli are spondee words
Closed set, subject is familiarized
Adult and child word lists
Live/recorded speech

Question 10

What are the benefits/drawbacks for live speech and recorded speech for SRT?

Answer 10

Live speech: faster ability to adjust (dialect change); more flexibility in delivery - timing, adapting to situation, pausing if need be and more variability between testers; audiologists may sound different; person may do better depending on voice - more room for error with your won voice.

Recorded: well established words, aren’t that many (may not be valid for different population), tend to be male voices from the USA.

Question 11

What does a SRT of 5, 45, and 75 dBHL tell us about the client’s daily communication function?

Answer 11

5: Pretty good communication
45: Don’t hear very well at conversation level
75: Can’t hear at conversation level

Question 12

What does CHL and SNHL tell us about speech?

Answer 12

CHL: makes things quieter, issue of amplitude. Sound loud enough, still clear for person
SNHL: sound louder - some distortion or lack of clarity

Question 13

What is the definition of SDT?

When might this be useful?

Answer 13

Speech detection threshold: the lowest level at which the subject can just discern the presence of speech 50% of the time. (Yes/No)
Tends to be 10dB better than SDT.

Useful: children may respond more readily to this than a pure tone - more likely to get a response. Just detecting should be better than repeating words. May provide information for what is going on.

Question 14

What does MCL, UCL, LDL, and SL mean?

Answer 14

MCL: most comfortable level
UCL: uncomfortable level
LDL: loudness discomfort level
SL: sensation level; based on threshold where person can detect above 50%. Usually 30-40dBSPL.

Question 15

What is the word recognition score? (WRS)

What is necessary for this test?

Answer 15

Defined as the % of correctly repeated words, usually presented at a supra-threshold level
Stimuli are phonetically balanced monosyllabic words
Open sent, no familiarization
Adult and child word lists
Carrier phrase is used: “say the word”
Live/recorded speech
In quiet or in noise

Need higher level of cognitive function - task to repeat

Question 16

What does the WRS tell us about communication function? (5)

What is PBMax?

Answer 16

Normal hearing typically obtain 100% correct at 30-35dB SL
PBMax = best someone can do at any level
SL assumed to equal SRT - score add 30dB, present word recognition and see how person does.
Look at person’s performance and compare it to the rest of the battery to see whole picture
Can they recognize well at level of average conversation?

Question 17

How does WRS relate to the speech banana?

Answer 17

Compare the hearing loss to the pitch - understanding speech will be shown in speech banana.
Can compare hearing loss shape to the speech banana to see what is missing for people.

Question 18

What is speech noise?

Answer 18

Amount put in for masking - when masking don’t know which ear is hearing (1st step); figure out which ear is contributing

Question 19

What can speech audiometry provide for us? (6)

Answer 19

More than just pure tone results
Basis to discuss HL
Make sense to person 
Ability to communicate
Provides interpersonal perspective
CHL vs. SNHL - word recognition levels

Question 20

PI Function for WRS: what can this tell us about SNHL, retrocochlear and PB rollover?

Answer 20

SNHL: Ceiling effect - louder will reach PBMax (so making it louder will not help, slight decline)
Retrocochlear: SNHL (doesn’t distinguish between cochlea and beyond cochlear) - louder it gets the worse they perform = PB rollover
PB Rollover -> easy to measure, gives clue (asymmetrical HL), worry about something that affects one side differently than the other.

Overall = way to see WRS at a bunch of levels, see where they perform optimally. See if they perform the sam at higher levels or if it gets worse.

Question 21

What information does WRS give us about communication function?

Answer 21

Depends on presentation level:
Levels of average conversation
Most comfortable listening level for client
Level necessary to achieve maximum performance
“PB Max”
May not ever be able to get 100% - how loud for the person to do the best they can
How loud is it and how well can they do?
Do they have a ceiling effect? Do they stop performing any better? Does it get worse as it increases?

Question 22

How should SRT fit in with other measures we do?

Answer 22

Compare with PTA (within 10dB)?

Question 23

How should WRS fit in with other measures we do?

Answer 23

Type of loss, how well they do at MCL, how well they do above 30-35dBSL.

Question 24

What is the relationship between SRT and PTA?

Answer 24

SRT should be within 6-8dB of PTA average at 500, 1000, and 2000Hz. Since we use 5dB steps it should be within +/- 10dB of PTA.

In case of sloping configuration, SRT should be compared to the two best PTA average in the range 500-2000Hz.

The single frequency with the highest correlation to SRT 1000HZ

Question 25

When is there an exception to the +/- 10dB PTA rule for SRT?

Answer 25

If steeply sloping, someone still getting enough speech cues - closed words (20 item list)…enough to get these correct.
Could be better than PTA, might look at best frequencies and see consistency? Enough to recognize which of those words…

Question 26

When does SRT masking need to happen?

Answer 26

Needed when the SRT thresholds in the TE exceeds the best BC threshold in any of the speech frequencies (500, 1000, or 2000Hz) by 45dB or more (for supra-aural) or 50dB (insert).

Question 27

When does WRS masking need to happen?

Answer 27

Rule for need to mask is same as SRT, however, masking is more likely to be needed for WRS than SRT - IA for speech using TDH earphones is 45dB and 65dB for insert