midterm 1 Flashcards
PBmax
highest percent correct score
-the best they can do
3 components of evidence based practice
client perspective, clinical experience and external scientific evidence
word recognition score (WRS)
percent correct of a given word list at a supra threshold level
-PBmax, discrimination
-presented above threshold
diagnostic uses of word recognition testing
site of lesions testing (cochlear vs. retrocochlear) and to compare ability over time
-only if tested correctly
treatment uses of word recognition testing
sense of impact of HL on speech understanding, monaural vs. binaural amplification, unaided vs. aided and CI candidacy
how is WRS administered?
calibrate materials, determine presentation level, confirm not too loud, determine if masking is needed, instruct patient what they will hear and what they should do (try their best, no repeating of the words)
-keep track of correct and incorrect responses
speech material for WRS
single words (monosyllabic)
-phonetically balanced
-often with carrier phase
-homogeneous
-closed or open set
what does it mean to say a word list is phonetically balanced
the word list encompasses all the sounds of the language
open-set and closed- set
open - choices are one of many words with no context, not familiar, single syllable words
closed - choices are limited, single digits, familiarized
what type of set is easier (gaining a higher percent correct score)
closed set
why is WRS not a test of communicative function
it can overestimate : obtained in quiet can have higher hearing levels than normal conversational levels
it can underestimate : no cues that are found in conversational speech, often obtained in auditory only rather than bimodal conditions and is monaural whereas speech is binaural
PI-PB function
performance intensity phonetically balanced function
-shows that word recognition performance increases as presentation level increases up until a maximum point, then will steady off/decrease
importance of finding the PBmax
able to compare their abilities over time
-must test correctly
how to use the SPRINT chart to determine if you did find the PBmax
using the PTA and % correct, follow the box’s to find the intersection
-if it falls within the shaded area score was too low and will have to retest
-if it falls within the unshaded area the score is close to their PBmax
how to find the WRS presentation level
+40 dB above SRT, consider audibility at 2000 Hz, MCL and UCL-5
class protocol for finding WRS presentation level
-add 40 dB to SRT level (ensure audible at every level, so at least 10 dB above all levels)
-if level is not audible at higher, present at the 2000 Hz frequency +15
-if level is not audible at lower levels increase so it is audible
-if patient has severe to profound and cannot achieve audibility, present UCL-5
what level to not exceed with WRS presentation
100 dB
is it okay to repeat words when administering a WRS test
no. move the word list between ears and sets to ensure different words
what site of lesions can be differentiated based on WRS
retrocochlear vs. cochlear
how to use the SPRINT chart to find significant asymmetries between two scores?
take one score on the Y and one on the X and trace them on the graph
-of they are within the arrow, they are symmetrical
-if they are outside the arrow line, there is a significant asymmetry (significantly different)
how to interpret WRS scores for site of lesion testing
asymmetry in scores, PI-PB rollover and low scores relative to PTA
-we use these to rule out a retrocochlear pathology
asymmetry in scores (using SPRINT chart)
comparing two scores with both ears, 2 ears 2 levels
use when : you have symmetrical HL (within 15 dB)
how to : using both WRS on the SPRINT chart to if it is within the arrow line
what it tells us : if the scores are statistically different (retrocochlear) or equivalent (cochlear)
PI-PB rollover
compares scores at two levels within the same ear, 1 ear 2 levels
use when : PBmax was presented below UCL-5 and can test at two levels, so cannot test for this if you are already at UCL-5
how to : present at a moderate level and present at UCL to gain both PBmax and PBmin and then calculate the RI
what it tells us : low is cochlear and high is retrocochlear
low scores relative to PTA
single presentation level WRS, 1 ear 1 level
use when : PTA is 30 dB HL or better (smaller number)
how to : use PBmax and PTA level (if below 80% PBmax with a PTA greater than 30, it’s at risk for retrocochlear)
what it tells us : suggestive for a retrocochlear pathology
PI-PB function for each type of loss
image from slides
rollover
when speech performance gets worse as you increase the presentation level above their PBmax
-this is what we are checking for
-normally it would not decrease after PBmax
how to screen for rollover
gain WRS and WRS at UCL-5 and find the rollover index
rollover index
RI = (PBmax-PBmin) / PBmax
-indication of retrocochlear sign with a RI of .25 or greater
how can a single score be used to identify a retrocochlear pathology
using low scores relative to the PTA
-if score is less than 80% and PTA is 30 dB or greater this is a retrocochlear sign
are single level WRS a strong or weak tool for differentiating cochlear from retrocochlear?
weak because with a cochlear loss you can score anything from 0 to 100 so by having a low score that does not automatically mean it is retrocochlear
what is a potential problem of giving a short word list
variability will increase as the word list decreases
what is the potential problem with giving half of a 50 word list?
list is no longer phonetically balanced and the list could house harder words in the beginning half or final half
-meaning could be testing the patient with only easy or with only hard
why do we want to minimize variability when testing word recognition
variability is the measure of what we are actually testing for
-minimizing this ensures we are getting accurate results for the right testing
conditions where variability is high
MLV or recorded voice and with a score that is in between 0 and 100
-scores of 40 or 60 have high variability, but when the score is 0 or 100 we are more sure that it is their accurate level
how can using MLV affect word recognition scores when compared to recorded materials
it can introduce variability
-could result in higher scores due to slow talking
what gender voice is easier to understand typically
male voices
why does using MLV introduce variability into the test scores
every speaker has different accent’s, intonations, and other variables that alter how they say the word every time
-it is impossible to replicate exactly how you said a word for a second time
most comfortable loudness level (MCL)
hearing level at which a patient experiences speech to be most comfortable
-a range
uncomfortable loudness level (UCL)
hearing level at which patient experiences speech to be uncomfortably loud
-“louder than you would ever choose on your radio no matter what mood you are in”
difference between a quick UCL and a UCL measurement for treatment
quick : to gain an idea, more broad
for treatment : running speech and do at every frequency
why would we measure UCL for speech
to ensure no rollover and that the PBmax is actually the PBmax
procedure for a quick UCL
-instruct the patient that they will hear some words and the loudness with gradually increase (spondee’s)
-the test it to find the level that is uncomfortable not the level that you can endure
-begin at around 40dB above SRT and increase in 5dB steps
-stop when the patient indicated it has become uncomfortable
-complete a second run, if UCL is within 5 d Bake the average
when is masking needed for speech testing
PL - IA > BB
-if it is greater, then you will need to mask
masking levels for SRT
conductive : PL-10+ ABG, PL-30+ABG
SNHL : PL-10, PL-30
-supra’s are 10, inserts are 30
-ABG in NTE
process for masking SRT
get unmasked SRT in both ears, decided if we need to mask, present masking in NTE, present 5 spondees at the PL
-increase speech 5 dB is missed 3 times
-we want 2 out of 4 correct so continue presenting until this is achieved
masking level for WRS
PL-30+ABG (conductive) and PL-30 (SNHL)
-ABG in NTE
process for masking WRS
instruct patient, put PL in test ear and masking noise in NTE and conduct test
-record amount correct as well as PL and masking level
-ensure the noise is not too loud
