SPEECH AUDIOMETRY

Question 1

SPEECH
AUDIOMETRY

Answer 1

▪Pure tone testing
▪Degree and type of hearing loss
▪Speech testing
▪Communication ability

Question 2

SLP CLINICAL RELEVANCE

Answer 2

SLP CLINICAL RELEVANCE
▪ SLP and Speech Audiometry
▪ Provides functional
audiometric information
▪ Planning therapy goals
▪ Counseling purposes

Question 3

SPEECH DYNAMICS
Most important Frequencies for speech

Answer 3

▪ Intensity
▪ whisper - 20 dB HL
▪ normal conversational speech - 50 to 60 dB
▪ loud speech - 70 dB
▪ shouting - 90 dB

▪ Frequency
▪ about 250 to 8000 Hz
▪ most important speech sounds
>▪ 500 through 6000 Hz

▪ Suprasegmental
▪ duration, intonation, pitch (DIP)

Question 4

SPEECH AUDIOMETRY tests

Answer 4

THRESHOLD TESTS
▪ Speech Recognition Threshold
(SRT)
▪ Speech Detection or Awareness
Threshold
(SDT) or (SAT)

SUPRA THRESHOLD TESTS
▪ Word Recognition Score (WRS)
▪ Most Comfortable Loudness
Level (MCL)
▪ Uncomfortable Loudness Level
(UCL)

Question 5

SPEECH RECOGNITION THRESHOLD (SRT)

Answer 5

▪ Minimum hearing level for speech at which an individual can recognize
50% of the speech material (ASHA, 1988)
▪ Spondee Words – 2 syllable words with equal stress on each syllable
▪ Validates pure tone findings
▪ SRT is within +/- 7 dB of 3 –Frequency PTA or average of best 2
thresholds for precipitously sloping HFSNHL
▪ Baseline for word recognition testing

Question 6

SRT AND PTA RELATIONSHIP –
VALIDATION OF PURE TONE FINDINGS

Answer 6

SRT should agree with the 3-
frequency PTA + 7dB
▪Cross check principle
▪Right ear – SRT of 35 dB HL
supports 3 Frequency PTA
of 40 dB HL
RE: SRT: 35
3 F-PTA: 40

▪ When does the SRT not agree with the 3 F-PTA
▪ Steeply sloping HL
▪ LE: SRT of 15 dB HL does not equal the 3 F-PTA
of 40 dBHL
▪ Use 2 F-PTA
▪ LE: SRT of 15 dB HL supports the 2 F-PTA of
20 dB HL
▪ Functional HL
▪ There is disagreement between the SRT and
PTA which cannot be explained by audiogram
configuration

Question 7

DIFFICULT TO TEST POPULATION

Answer 7

•Nonverbal
•Severe HL
•Speech-Language Deficits

Question 8

RECOMMENDED SRT
PROCEDURE

Answer 8

▪Familiarize patient with spondee list at MCL
▪Begin 30 dB above PTA
▪Down 10 dB for each correct response and up 5 for incorrect
response
▪ Threshold – softest level at which 3 out of 6 spondees are
correctly repeated (50% level)

Question 9

PRESENTATION OF SPEECH STIMULI

Answer 9

Monitored Live Voice (MLV)
▪Must monitor level of signal
(vu meter)
▪ Offers greater flexibility
▪Quicker than recorded

Recorded Material
▪Greater test consistency
across presentation
▪Slower
▪Best for word recognition
testing comparison

Question 10

SPEECH DETECTION OR AWARENESS
(SDT OR SAT)

Answer 10

▪Minimum hearing level for speech at which an individual can just
discern the presence of a speech material 50% of the time. (ASHA,
1988)
▪Used if SRT cannot be obtained due to:
▪Severity of hearing loss
▪Limited language reception or expressive skills
▪ Nonverbal developmentally delayed population
▪ Infants and small children
▪SDT is 5 - 10dB better than SRT

Question 11

DO WE PERFORM BONE CONDUCTION
SRT / SDT?

Answer 11

Only if using speech stimuli to determine TYPE of HL.
▪Compare speech thresholds by air conduction vs.
bone conduction
▪Children or Low Functioning Population may respond
more reliablely to speech vs tonal stimuli.

Question 12

WORD RECOGNITION SCORE (WRS)

Answer 12

▪Assesses ability to understand speech when
presented at supra-threshold levels.
▪ Reported in percentage of words correctly
identified.
▪Measured scores are predictable from degree,
configuration and type of loss

▪ Speech Material
• Phonetically balanced (PB) word list
• Contain all the phonetic elements of speech
• 4 lists of 50 words each.
• CID W-22
• NU-6
• Consonant-Nucleus-Consonant words
▪ Additional WR Tests

Question 13

WRS TEST METHOD
Test Procedure

Answer 13

WRS TEST METHOD
Test Procedure
▪Presentation Level
• 30-40dB above SRT (30-40dBSL) = PB Max
➢ PB Max = level at which maximum word recognition score
is obtained
• MCL if 30-40dBSL is too loud

Question 14

WRS TEST METHOD
Test Considerations

Answer 14

WRS TEST METHOD
Test Considerations
▪Half list (25 words)vs. whole (50 words)lists
•½ lists are as diagnostically reliable as whole lists.
•Less time consuming
•Each word has weight of 4%
▪Carrier phrase – “Say the word”

Question 15

RECORDING WORD RECOGNITION SCORES

Answer 15

▪Calculate and record percentage of correct responses
▪Scoring Word Recognition
•90-100% Excellent
•80 – 90% Good
•70 - 80% Fair
•50 - 70% Poor
•< 50% Very poor

Question 16

WRS INTERPRETATION

Answer 16

▪Conductive HL – very good to excellent
▪Sensorineural HL – very good to poor depending on
degree and configuration of HL
▪Retrocochlear HL – Poor compared to pure tone
thresholds

Question 17

PI-PB FUNCTION

Answer 17

PERFORMANCE INTENSITY-PHONEMICALLY BALANCED
PI Function: Word recognition scores obtained at a range of stimulus levels
Pbmax – Maximum WRS obtained
▪ Normal hearing
▪ Highest word recognition score of 100% is reached at 30-40 SL RE: SRT
▪ High score is maintained at high intensity levels.
▪ Cochlear hearing loss
▪ Highest word recognition score achieved below Pbmax of 100%.
▪ Score is maintained or may see slight deterioration at higher intensity levels
▪ Retrocochlear pathology
▪ Highest word recognition scores achieved below Pbmax of 100%
▪ Word recognition scores demonstrate Rollover
▪ Scores decrease significantly or roll over at high intensity levels

Question 18

UNCOMFORTABLE LOUDNESS LEVEL

Answer 18

UCL AKA:
• TD = Threshold of Discomfort
• LDL = Loudness Discomfort Level
•Level of speech or tones that is uncomfortably loud
•Determines upper limit for speech
•Hearing aid evaluation
•Maximum tolerable amplification

Question 19

DYNAMIC RANGE FOR SPEECH

Answer 19

▪Range of Useful Hearing
▪Difference between threshold for
soft sounds and tolerance for loud
sounds
▪UCL – SRT = DR
▪SNHL (cochlear origin)
Narrow DR due to recruitment