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Amplification II > 2 - Speech Testing > Flashcards

2 - Speech Testing Flashcards

1
Q

What are 5 reasons why speech in noise testing is a valuable tool?

A

1) it may address patient’s complaints, providing speech in noise testing conveys that we understand the reason out patients are seeking services
2) it may impact the level of technology, the arrangement (unilateral or bilateral fitting), or the recommendation of additional accessories (remote microphone) we select
3) it can establish a baseline or monitor progress over time
4) it can help us in counselling or establishing realistic expectations with HA use
5) it can facilitates decision making for the patient

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2
Q

How often do audiologists perform SIN testing?

A

15% = always (76-100% of the time)
39% = seldom (1-25% of the time)
16% = never

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3
Q

What 8 pieces of information do we want to know from speech testing?

A

1) how patients recognize speech in quiet?
2) how they recognize speech in noise?
3) how they get annoyed by noise when listening to speech?
4) how well they can process speech?
5) how well they use contextual cues when listening to speech in noise?
6) how do they perceive their ability to understand speech? does this match their measured speech perception abilities?
7) how much benefit is provided by a technology feature (DM)?
8) how much effort (or concentration) is required to understand speech?

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4
Q

What are the 4 testing considerations for speech testing?

A

1) single words or sentences?
2) competing noise?
3) presentation level?
4) earphones or sound field?

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5
Q

Monosyllables vs sentences

A
  • single monosyllabic words, target words embedded in sentences, single sentences, sentence lists with context
  • sentences are more representative of real life listening situations
  • sentences provide closer approximation of how conversational speech is understood (sentences have syntactic and semantic context)
  • drawback os using sentences: people with cognitive decline may show worse performance using sentence tests (more working memory effort required)
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6
Q

What are 5 examples of competing noise?

A

1) speech noise
2) multi-talkers
3) multi-talker babble
4) cocktail party/cafeteria noise
5) speech

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7
Q

What is speech noise (speech shaped noise)?What SIN test uses this?

A

broadband, non-modulated, shaped to be consistent with the LTASS (HINT uses this)

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8
Q

What is multi-talker noise? Which SIN tests use this?

A

meaningful words or a string of words may be detected (QuickSIN and BKB-SIN uses this)

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9
Q

What is multi-talker babble noise? Which SIN tests use this?

A

True babble, the competing speech is virtually unrecognizable (WIN and R-SPIN uses this)

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10
Q

What is cocktail party/cafeteria noise work?

A

like multi-talker babble, but may also have transient noises like a glass clinking or dishes

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11
Q

What is speech noise? What SIN test uses this?

A

for higher level of auditory processing testing, a single talker is used to compete against another (the target) talker, and the patient is trying to focus on a voice (the SSI uses this)

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12
Q

Presentation levels

A
  • choose PL recommended by the test if you want to compare the patient’s scores to norms
  • choose PL that addresses a patient’s specific complaint (difficulty hearing soft speech)
  • consider the patient’s comfort levels
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13
Q

Earphones or sound field? Why sound field?

A
  • there are some compelling reasons to use earphones, primarily with reliability, consistence, and calibration
  • reasons to use SF? testing of directional microphone systems in a functional setting
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14
Q

Listening effot

A
  • listening is tiring
  • people with hearing loss have to work harder cognitively to process speech
  • increased listening effort related to mental fatigue
  • individuals with similar scores on speech recognition in noise measures may vary on the listening effort that was needed to achieve those scores
  • more listening effort = greater daily challenges
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15
Q

How can listening effort be measured?

A
  • some issues: lack of goof clinical tools and no widely accepted definition of listening effort
  • interviewing patients
  • self-assessment questionnaires
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16
Q

What are the 4 SIN tests?

A

1) the quick speech in noise test (QuickSIN)
2) bamford-kowal-bench sentences in noise (BKB-SIN)
3) words in noise test (WIN)
4) acceptable noise level (ANL)

17
Q

What are 4 factors about the QuickSIN?

A

1) aiming to quantify speech understanding in noise
2) progressively difficult in design
3) can be very useful in pre-fitting and in counselling discussions
4) designed to be short enough to administer in clinic and with ease

18
Q

What are the 6 steps of the QuickSIN?

A

1) measure speech intelligibility with sentences spoken by female talker, in multi-talker noise
2) deliver at 70 dB HL (or PTA > 45 dB, set audiometer to loud but okay), unilateral or bilateral delivery
3) lists of 6 sentences (1 sentence at each S/N: 25, 20, 15, 10, 5, 0), 5 key words/sentence
4) best to do at least 2 lists of 6 sentences
5) score = 25.5 minus # key words repeated correctly in 6 sentences
6) score reflects SNR loss

19
Q

What are the QuickSIN instructions to the patient?

A

1) patient is asked to repeat the sentence of the female talker
2) patient is told that this will be gradually more difficult as the test progresses
3) guessing the sentence is encouraged

20
Q

How does a QuickSIN in soundfield work?

A

1) administer QuickSIN at 50 dB HL in soundfield, using lists recorded on separate tracks
2) patient faces loudspeaker that delivers speech, and noise is delivered from loudspeaker at patients back
3) test with the HA in omni mode and then in DM mode
4) benefits of DM if lower QuickSIN score is obtained when in DN mode

21
Q

Interpretation of QuickSIN scores

A
22
Q

How long does it take to administer a QuickSIN list?

A

1 minute

23
Q

What are the 6 steps of the bamford-kowal-bench sentences in noise (BKB-SIN)

A

1) can be used for adults or children (“they are looking at the clock”)
2) sentence lists spoken by male talker, in 4-talker babble noise
3) presentation level 70 dBHL (PTA is 45 or better)
4) lists of 10 sentences with S/N changing in 3 dB steps (1 sentence at each S/N: 21, 18, 15, 12, 9, 6, 3, 0. -3, -6) or lists of 8 sentences with S/N from 21 to 0
5) uses two lists minimally
6) score = 23.5 - # key words repeated

24
Q

How long does it take to administer the BKB-SIN?

A

3x longer to do the BKB-SIN than the QuickSIN (it is more challenging to do and takes a bit more time)

25
Q

Interpretation of BKB-SIN scores

A
  • patients receive a correct credit for every key word they repeat back correctly
  • the number of key words is subtracted from 23.5 and this determines the SNR-50 (what is the SNR at which patients are expected to correctly identify 50% of the words)
  • those results can be compared to population norms
26
Q

How does the words in noise test (WIN) work? Who is it best for?

A
  • speech in multi-talker babble noise test using traditional word stimuli (NU-6 word lists)
    -background noise of 3 male and 3 female speakers remains constant throughout the testing
  • may be better for older patients or those with cognitive impairmen
  • normative data available for children 6 years of age
27
Q

WIN presentation levels

A
  • 60 dB HL (noise) / 84 dB HL (words) for patients with PTAs less than 40
  • 70 dB HL (noise) / 94 dB HL (words) for patients with PTAs greater than 40
  • not recommended for those with PTA of 60 dB HL or greater
28
Q

What are the 5 steps in WIN testing?

A

1) 35 Nu-6 monosyllabic words recorded by a female speaker
2) background multi-talker babble noise consists of 3 male and 3 female speakers
3) level of multi-talker babble noise is constant; level of words varies (in 4 dB steps)
4) 5 words per 7 S/B levels
5) S/B: 24, 20, 16, 12, 8, 4, 0

29
Q

WIN scoring sheet

A
  • scored in terms of S/B ratio at the 50% threshold (what is the point at which patients are expected to correctly identify 50% of the words)
  • 50% = 26-80% of the total correct score (for example, patient scores 30/35 words correct, S/B 50% = 26-0.8(30) = 26-24 = 2)
  • can also look at the percentage of each bucket of words the patient got correct
30
Q

What is the acceptable noise level test looking at?

A
  • how can we quantify the acceptability of background noise for a patient?
  • how much background noise is a patient willing to put up with?
  • acceptable noise level = annoyance
31
Q

What are the 7 steps of the ANL test?

A

1) measures highest level of noise that a person is willing to put up with while listening to a story without feeling tense or tired
2) story is a travel log to Grand Canyon recorded by a male
3) noise is multi-talker babble
4) MCL first obtained while listening to the story in quiet
5) story delivered at MCL; noise is introduced and gradually increased to the highest level that the person is willing to accept (BNL)
6) ANL = MCL - BNL
7) The score is a difference value, not a set level, per se

(once you have the MCL, start to introduce the background noise, when they can no longer handle an increase of background noise, that is the BNL, we want a small difference for better acceptability)

32
Q

ANL score interpretation

A
  • ANL shown to be a predictor of successful use of HAs
    • small ANL = better noise tolerance, may suggest better HA acceptance (<7)
    • large ANL = less noise tolerance, thus more liekly to be dissatisfied with HAs (>13)
  • information may be used in pre-fitting counselling and a discussion of realistic expectations
33
Q

Why is measuring ANL important?

A

HAs amplify environmental noise, and if they have low acceptance of this, they may be dissatisfied for their hearing aids. Need to have a discussion with this patient on what HAs amplify.

34
Q

Red flag matrix

A
  • Q1= someone who will do well with amplification
  • Q2= need to council on adjusting to BN
  • Q3= these patients take the most work
  • Q4= may benefit from the use of accessories (partner mic)
35
Q

What are the 5 important values of SIN measures for HA fittings?

A

1) to help determine hearing candidacy for mild high frequency loss
2) to help decide on unilateral or bilateral fitting
3) to help select desired technology (remote mic)
4) to monitor performance over time
5) to help with counselling (demonstrate the benefit of a technology feature).

Amplification II (13 decks)

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