MINING THE BASICS
OF TESTING
SHELLY BOELTER, AUD CCC-A
C. SCOT FRINK, MS FAAA
These presentations slides will be available to download at
ihsinfo.org/convention
INTRODUCTION
• So why get back to the basics? Do they ever really
change?
These presentations slides will be available to download at
ihsinfo.org/convention
GOODBYE TO THE WORD “LAUD”
• The International Committee of Speech Recognition
Measures (ICSRM) held their annual meeting March
4th, 2011, in conjunction with the American Auditory
Society Scientific and Audiology meeting.
GOODBYE TO THE WORD “LAUD”
• In an unprecedented move, this prestigious group
of researchers resolved to remove the word "laud"
from the Northwestern University List #6. ICSRM
President Richard Wilson stated: "Although we all
have a certain fondness for "laud," its usefulness has
run its course.
• At this point, it may be best to move on. The intent
of speech recognition testing is not to trick the
subject using archaic or unfamiliar test items".
GOODBYE TO THE WORD “LAUD”
• Following this action, a sub-group was formed,
which led to the recommendation of adding the
replacement word "broad” as this new item would
closely maintain the phonemic balance of the list.
GOODBYE TO THE WORD “LAUD”
• This was opposed, however, by some group
members, in that broad is not "gender-neutral" and
could be deemed offensive to females.
GOODBYE TO THE WORD “LAUD”
• This issue was forwarded to the ICSRM Word Review
working group, who also continue to study the
appropriateness of the word “but.”
GOODBYE TO THE WORD “LAUD”
• Until a suitable replacement for laud is approved,
the ICSRM recommends that clinicians conduct
testing with 49 rather than 50 word lists, and use the
multiplier of 2.041 to calculate percent correct
scores.
GOODBYE TO THE WORD “LAUD”
• Because the list is supposed to be phonemically
balanced, those who are used to using only 25
words at a time should instead use 24, and
therefore a multiplier of 4.166666666667.
GOODBYE TO THE WORD “LAUD”
• The ICSRM is seeking input on this issue from the
audiology community and the general public.
Comments and feedback can be submitted at
www.icsrm.org
GOODBYE TO THE WORD “LAUD”
• Starting last Wednesday, March 28, a group of the
audiologists who considered themselves the
“2.041%” established a tent camp outside of the
Boston Convention Center to officially protest the
decision of the ICSRM.
• Many in particular are infuriated by the need to
revise office forms, often at great expense.
GOODBYE TO THE WORD “LAUD”
• To help support the movement, the website
www.SaveTheWordLaud.com has been created.
• It includes an online petition that can be “signed”
to forward to the ICSRM, started by audiologist Jack
Scott.
GOODBYE TO THE WORD “LAUD”
GOODBYE TO THE WORD “LAUD”
• According to Scott, “If we continue down this path,
we might as well start removing all the nonsensical
things still hanging around since the inception of our
profession - like the Libby fitting formula. Why is it still
being provided in the Audioscan? Doesn't anybody
remember it was developed by an optometrist!”
GOODBYE TO THE WORD “LAUD”
• In order to raise funds for the cause, Dr. Scott and
AudiologyOnline founder Paul Dybala have started
a fundraiser through www.CafePress.com to sell
apparel to spread the word about the issue.
GOODBYE TO THE WORD “LAUD”
• Not being a fan of the Occupy movement,
however, I feel we should abide by the ICSRM
decision.
• We need to expedite our transition since the
ICSRM made their decision effective…
April 1, 2012.
OUTLINE
• The audiogram
• EXAMPLE:
Oregon state law audiometry requirements
• Pure tone audiometry
• Speech testing
• Masking
• Additional tests
THE AUDIOGRAM
OREGON STATE LAW
• Established minimum basic guidelines for testing required to fit
hearing aids, September 2006.
• ORS 331-640-0050
• Additional Standards of Conduct
• (b) Puretone Air Conduction Threshold testing (should include at a
minimum, the following frequencies - 250, 500, 1000, 2000, 3000, 4000,
and 6000 or 8000 Hz);
• (c) Puretone Bone Conduction Threshold testing (should include at a
minimum, the following frequencies - 500, 1000, 2000, and 4000 Hz);
• (d) Speech Recognition Threshold testing (SRT);
• (e) Word Recognition Score (WRS) also known as speech
discrimination testing;
• (f) Most Comfortable Listening Level (MCL); and
• (g) Uncomfortable Listening Level (UCL).
• Other states may vary, but this is an example
PURE TONE AUDIOMETRY
• Recommended test frequencies are 250, 500, 1000,
2000, 3000, 4000 and 6000 or 8000
• Industry standards recommend testing interoctaves
(750, 1500, 3000, 6000) if there is a 15dB or greater
difference between the octaves.
• Descending method is preferred (down 10, up 5)
with a repeat response at two levels for
confirmation.
• Mask as needed (interaural difference of 40dB when using
TDH39 headphones, 70dB using insert earphones)
PURE TONE AUDIOMETRY
• Effects on hearing aid frequency responses…
PURE TONE AUDIOMETRY
• Effects on hearing aid frequency responses…
PURE TONE AUDIOMETRY
• Effects on hearing aid frequency responses…
PURE TONE AUDIOMETRY
• Effects on hearing aid frequency responses…
SPEECH AUDIOMETRY
•
•
•
•
•
Monitored live voice (MLV) vs Recorded
MCL= Most comfortable loudness
UCL= Uncomfortable loudness
SRT= Speech recognition threshold
Word recognition/ discrimination
MLV VS RECORDED
• Monitored Live Voice (MLV)
• MUST be carefully monitored
• Offers greater flexibility for the patient (i.e. pediatrics,
Alzheimers)
• Sometimes quicker
• Recorded
• Greater test consistency across presentation
• Ideal for word recognition testing
• Slower
• Multiple studies found satisfactory test/ re-test reliability
for carefully monitored live voice and recorded (Katz,
2002)
• However, there are potential legal implications when
using MLV…
MCL AND UCL
• Most comfortable loudness (MCL)
• For normal hearing acuity: 45-50 dB HL
• Uncomfortable loudness (UCL)
• For normal hearing acuity: ~100 dB HL
• MCLs:
• Discrimination testing
• Determining hearing aid candidacy
• Counseling
• Speech UCLs:
• Hearing aid fitting
• Counseling
SRT
• Speech recognition threshold
• Use spondee words
• ‘Approved’ list of words went from 84 20 most common
Airplane
Birthday
Cowboy
Farewell
Greyhound
Hardware
Iceberg
Mousetrap
Mushroom
Northwest
Oatmeal
Playground
Railroad
Sidewalk
Stairway
Sunset
Toothbrush
Whitewash
Woodwork
Workshop
SRT
• Purpose of SRT Test:
• Check puretone results for consistency
• PTA of 500, 1000, and 2000 Hz (+/-10dB)
• Determine hearing sensitivity for speech
• Indicator of amount of impairment
• Normal/ slight/ mild/ moderate/ severe
• Determine suprathreshold test levels to use for
other tests
RECOMMENDED SRT PROCEDURE
• Test better ear first
• No carrier phrase needed
• Most use MLV, but can use recorded
• Get the first syllable of test word to 0 on the VU meter
• Equal stress on each syllable
• Familiarize patient with spondee list at MCL
• Descending volume approach until a score of 50%
is obtained at one level (2 of 4 words per test level)
• Mask as needed (interaural difference of 40 dB or
more)
WORD RECOGNITION
• Word Recognition Score= WRS
• Phonetically balanced (PB) words used
• Speech sounds occur with the same relative frequency as
they do in a sample of running speech
• Consonant-vowel-consonant (CVC)
• ‘Open set’ words
WRS WORD LISTS
• PB-50
• Lists of 50 words
• First recorded list available
• Focused on the CVC syllable
• W-22
• Uses 120 commonly used words from the PB-50 plus another 80 extra
• Four lists of 50
• Carrier phrase: ‘You will say’
• NU-6
• Focused on phonemic balancing
• Four lists of 50 (1st 10 words of each 25 are weighted)
• Carrier phrase: ‘say the word’
• Maryland CNC
• Focuses on the transitional shifts between consonants and vowels
• Carrier phrase: ‘Say the _____ again’
• Used frequently with some GSA evaluations (i.e. VA candidacy)
RECOMMENDED WRS PROCEDURE
• Recorded voice
• Test at these levels:
• PB-Max= SRT + 30 dB HL
• If different than the PB-Max, also test at:
• Normal conversational speech= 45/ 50 dB HL (optional)
• MCL (required)
• Mask NTE if needed
• Full list vs Partial list
• ORS minimum is 25 words
• Mask as needed (interaural difference of 40 dB or
more)
RECOMMENDED WRS PROCEDURE
• OPTIONAL: Testing at normal conversational
speech (45/50)
• If you only test at MCL, you’re only getting the patient’s
results at an amplified level and not defining the patient’s
impairment.
• Example #1: WRS @ 70dBHL is 96%, but WRS @ 45 is 92%--an
improvement of only 4%--limited improvement suggests you
should test for performance in noise!
• Example #2: WRS @ 70dBHL is 96%, but WRS @ 45 is 44%--an
improvement of 52%--significant improvement. Good
candidate!
• Testing at 45dBHL, where appropriate, helps reduce returns
for credit.
INTERPRETING WRS
% Correct
Degree of Impairment
Word Recognition
Ability
100-90
None
Excellent/ Normal
89-75
Slight
Good
74-60
Moderate
Fair
59-50
Poor
Poor
<50
Very Poor
Very Poor
Source: Lawson, G. &Peterson, M. (2011)
UCL TESTING
• Question: Speech UCLs or Tone UCLs?
• Advantages / Disadvantages for Speech UCLs
• Quicker than tone UCLs (+)
• Broadband response, real-world relavance (+)
• Less accurate in hearing aid response, flat UCL (-)
• Advantages / Disadvantages for Tone UCLs
• Graduated approach (+)
• More accurate than speech UCLS with aid response (+)
• Takes longer than speech UCLs (-)
UCL TESTING
• Method—General
• Start at MCL
• Increase in 5-10dB increments until UCL is reached.
• Speech UCLs:
• Typically, use MLV, with patient responding “soft, medium,
loud, too loud.”
• Tone UCLs:
• Typically start at threshold (500, 1000, 2000, 4000), with
patient responding “soft, medium, loud, too loud.”
UCL TESTING
• Effects of frequency response (no UCLs)
UCL TESTING
• Effects of frequency response (Tone Specific, average)
UCL TESTING
• Effects of frequency response (Tone Specific, recruiting)
UCL TESTING
• Effects of frequency response
(speech average)
SPEECH IN NOISE TESTS
• HINT is more traditional.
• Presentation of words, +5dB SNR
• Scored similar to WRS
• Takes about the same amount of time as WRS (5m per ear
with 25 words)
SPEECH IN NOISE TESTS
• QuickSIN is more practical and has been
demonstrated to be just as accurate.
Presentation of sentences, varying SNR
Scored based on 5 key words in each sentence
Progressively worse SNR
Generates a score indicating the patient’s “signal-to-noise
loss” (-4.5 to 25.5dB)
• Each dB is equal to ~10% difference in WRS in comparison to
quiet when tested at an equivalent level. Example:
•
•
•
•
• WRS @ 45dBHL: 96%
• QuickSIN score of 5.5 @ 45dBHL estimates 55% worse
performance in background noise, or 41%.
• Only 60 seconds per ear (hence: Quick!)
QUESTIONS
Please complete
an Evaluation Form for this seminar
These presentations slides will be available to download at
ihsinfo.org/convention
CONTACT INFORMATION
• C. Scot Frink
• [email protected]
• (503) 588-1039
These presentations slides will be available to download at
ihsinfo.org/convention
REFERENCES
• Lawson, G. & Peterson, M. (2011). Speech Audiometry. San
Diego, CA: Plural Publishing Inc.
• Katz, J. (Ed.). (2002). Handbook of Clinical Audiology (5th ed.).
Baltimore, MD: Lippincott Williams & Wilkins.
• Turner, R. (2004). Masking Redux I: An Optimized Masking
Method. Journal of the American Academy of Audiology, 15:
17-28.
• Turner, R. (2004). Masking Redux II: A Recommended Masking
Protocol. Journal of the American Academy of Audiology, 15:
29-46.