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153 Cards in this Set

  • Front
  • Back
This is the greatest complaint of hearing impaired patients:
Hearing and understanding speech
What is one of the first tests administered to a patient when they come to an audiologist?
A pure tone audiogram using pure tones as the stimulus.
What does a pure tone audiogram accomplish?
It allows us to make some judgments as to how well a person is hearing and some of the difficulties they may be having.
What does a pure tone audiogram NOT tell us?
The degree of handicap in speech communication.
What is another test that should be administered to a patient when they come to an audiologist?
Tests of hearing function with speech as the stimulus.
Why is speech audiometry necessary?
To completely assess basic auditory function.
What are the results of speech audiometry used for?
Therapy planning and counseling with the client and their family.
What are the five factors to be aware of when performing speech audiometric testing?
1. The test equipment
2. The test environment
3. The patient
4. The clinician
5. The test procedure
What equipment is used to test speech hearing?
A diagnostic audiometer. It includes a speech audiometer, as well as a pure tone audiometer.
List three different ways of introducing speech to the audiometer.
1. A microphone
2. A compact disk
3. A cassette tape
What do most modern diagnostic audiometers use for the speech stimulus?
Either CDs or built in recorded tests. Another option is a microphone for live speech input.
What are the components on a speech audiometer?
The speech input manner, the amplifier, the VU meter, the attenuator (hearing level dial), earphones or auxiliary amplifier for a loudspeaker.
What does the attenuator do?
It controls the intensity or nature of the input through the amplifier of the audiometer, live voice vs. recorded speech.
What is a sound field (SF)?
This means that the patient is sitting in a field of sound. Sound is delivered through a loud speaker and the patient hears with both ears simultaneously (binaural).
How does a patient hear with earphones?
With one ear at a time (monaural).
What does MLV refer to?
Monitored Live Voice. It refers to the fact that the audiologist is speaking into the microphone, monitoring the live voice through the VU meter and delivering the stimulus to the client.
What do you need to make sure of when testing speech using live voice?
That the patient is hearing the speech at the level you want them to. The testing needs to be consistent. We need to control the inputs so they don't have the variability of input and affect the output with great variability.
What is used to control the variability of input with monitored live voice?
The volume unit meter or VU meter.
Where is the VU meter located on the audiometer?
Between the amplifier and the attenuator.
What does the VU meter indicate?
The volume or intensity of the input prior to the time it reaches the attenuator.
How is input monitored using a VU meter.
The VU meter has a stylus that rises or falls depending on the intensity of the VU meter.
How might the VU meter help monitor intensity on the attenuator setting?
If we speak loudly into the the microphone and spike the VU meter over to plus 5, we have to add the plus 5 from the VU meter to the attenuator meter. If we speak too softly, the VU meter might only rise to minus 5. We would have to subtract 5 from the attenuator setting.
What do you need to do when using a microphone for input in speech testing?
Be sure to monitor yourself and make sure your speech does not get too intense or too soft. You must visually monitor the VU meter and speak so the complex input of the voice peaks on an average close to zero.
When is the attenuator giving a true indicator of the output?
When the VU meter is standing at or pointing to zero.
How are recorded speech inputs handy in testing?
They can be calibrated so that you can adjust the VU meter to zero.
What is the 0 dB hearing level for speech?
20 dB SPL. 0 dB on the audiometer dial will actually be a 20 dB sound pressure level.
What does 20 dB SPL indicate in speech testing?
It is the level needed for a person with normal hearing to repeat back correctly 50% of the speech material delivered to them.
What type of environment is needed when using monitored live voice?
A two-room suite is needed in order to be acoustically separated from the patient. Otherwise the patient hears your voice "live", even though the voice via the headphones is too quiet to hear, making the results invalid.
What is one disadvantage of monitored live voice testing?
You do not always speak the words the same way or with the same intensity. Different dialects or accents also affect the results.
What is one advantage of using prerecorded materials?
They can be delivered in a one or a two room suite. You can use the CD week after week and every person experiences the same examiner's voice and mannerism.
What delivery manner do most clinicians use in speech audiometry?
Monitored live voice because of the flexibility and the time it saves.
What is the most common way for a patient to respond to an examiner?
A spoken response. For example, the clinician will instruct the patient to say a word when they hear it and the patient will repeat it back to the clinician.
What are the advantages of a spoken response between the clinician and the patient?
It's faster than other response modes and there's a rapport maintained between clinician and client.
What are the disadvantages of a spoken response between the clinician and the patient?
The client may have poor or unintelligible speech and therefore they may be hearing the stimulus correctly, but because of poor or unintelligible speech, they may repeat a distorted version of what they're hearing back to the clinician.
What is another way patients may respond to an examiner?
Written responses.
What are the advantages of using written responses?
The patient's poor speech would be eliminated and it provides a permanent record.
What are the disadvantages of using written responses?
It slows down the testing procedure and takes time to score the results.
What is the clinician's role in speech audiometry?
To make sure that the patient understands exactly what is going to happen and how they should respond.
How are instructions given to a patient?
Most of the instructions for adults are given through the microphone of the audiometer and heard in the headphones of the patient.
Why are proper instructions so important?
If proper instructions are not given the patient may not respond correctly and the testing results will be inaccurate.
How should the patient be seated for speech audiometry?
It is recommended that the patient sit at a right angle to the audiometer. If the patient can see the examiner saying the words they may be getting speech cues from the face and lips of the clinician.
What are the five different speech measures discussed in class?
1. Speech detection threshold (SDT), also referred to as Speech awareness threshold (SAT).
2. Speech recognition threshold (SRT).
3. Most comfortable loudness level (MCL).
4. Uncomfortable loudness level (UCL).
5. Word recognition score (WRS).
What is the speech detection threshold?
The lowest level in dB that a person can just detect the presence of speech and identify it as speech 50% of the time. (Not understand speech, just detect it.)
What is the stimulus used for speech detection threshold (SDT) or speech awareness threshold (SAT)?
Sentences or connected speech, referred to as cold running speech.
What does "cold" refer to in "cold running speech"?
It's a statement that has no particular meaning or interest to you.
What does "running" refer to in "cold running speech"?
The stimulus is continuous. We don't want a lot of breaks. It's monotonous, and of no consequence to the patient.
T/F: SDT is a popular measure for standard testing.
False. There is a lack of relevant information. It's more used when you can't get any other results. It doesn't give us a lot of information about the patient or how they are functioning.
What is the speech recognitions threshold (SRT)?
The SRT is defined as the lowest level in dB that a person can identify correctly 50% of the the time the speech material.

** You have to have an understanding of the material that's coming in and repeat it back correctly 50% of the time.
What is the purpose of the SRT?
To establish the lowest level that a patient can hear and understand speech.
What is another name for the SRT?
The speech reception threshold test.
Who (and when) investigated the best words to be used for SRT testing?
Hudgins and other in 1947.
What are the four criteria that words should satisfy for SRT testing?
1. familiarity
2. phonetic dissimilarity
3. normal sampling of English speech
4. homogeneity with respect to audibility
What does familiarity in SRT testing refer to?
The SRT is not a test of a person's intelligence or anything like that. The words used should be familiar to the patient. If needed, you can go into the booth, have the person look at these words, and make sure they're familiar with each word.
What does phonetic dissimilarity refer to in SRT testing?
We don't want the patient to be challenged, wondering if we said one thing and they heard another. The words should be distinctly phonetically dissimilar.
In SRT testing, what is meant by homogeneity with respect to audibility?
We expect each word to have the same audibility quotient or factor as the next word that comes along, so you don't have a lot of words on the list that have different audibility factors. This is to ensure that they are all understood and heard equally.
How many words were on the original list by Hudgins et al?
84
What happened to the original list of 84 words created by Hudgins et al?
In 1952 Hirch et al reduced the original 84 words to 36 words. Standardized word lists now include 36 spondees grouped into two lists of 18 words.
What are spondaic words or spondees?
The speech stimuli used to obtain the speech reception threshold (SRT). A spondee is defined as a 2-syllable word spoken with equal stress on both syllables and is an excellent choice for determining threshold in speech because it is easy to understand at faint hearing levels.
Do spondees occur naturally in spoken English?
No. They are definitely part of spoken English, but they're not spoken with equal stress on each syllable. That turns them into a spondee.
List some examples of spondees.
Airplane, toothbrush, hotdog, sidewalk, baseball, pancake, cowboy, armchair, eardrum

** They're spoken in the test environment with equal stress on each syllable.
What is the ASHA (1988) method for determining SRT?
1. Familiarize the listener with the spondaic words in the word list to be used.
2. Ensure that the vocabulary is familiar.
3. Establish that each word can be recognized auditorily.
4. Ascertain that the patient's responses can be understood by the clinician.
Did the ASHA SRT testing method gain wide acceptance?
No.
What is the Marin and Dowdy SRT test procedure similar to?
The ASHA (1978) method for determining pure tone thresholds.
How do Martin and Dowdy recommend conducting SRT testing?
The recommend presenting one spondee starting at 30 dB HL and at 10 dB decrements until an incorrect response is obtained. If the response is incorrect or absent at 30 dB HL, the stimulus should be increased to 50 dB HL, and use 10 dB increments until a correct response is obtained.
What is the bracketing technique used in SRT testing?
This requires presenting one word at each level by increasing the stimulus in 5 dB steps for an incorrect response and decreasing in 10 dB steps for correct responses until 3 correct responses have been obtained at a given level.
Why is the bracketing technique recommended for SRT testing?
I requires no knowledge of other test results. It can be given and stand by itself. You don't need a pure tone audiogram or other test results to compare to your SRT. It involves the use of 5 dB steps, which is the same as pure tone audiometry, and therefore, the procedure for finding SRT threshold can be the same, making it more familiar and easier to use.
What is a carrier phrase?
A phrase (usually "say the word....") that precedes much of the speech stimuli that are delivered to a patient.

** i.e. "Say the word toothbrush." "Say the word sidewalk."
T/F: There is a real advantage to using a carrier phrase with spondaic words.
False.
What is one of the reason to use a carrier phrase in SRT testing?
When you are using monitored live voice, you can monitor yourself through the VU meter so the output is correct. The carrier phrase is designed to monitor and adjust your voice to a zero VU setting.
When is a carrier phrase used?
When delivering single words to the patient.
Is a carrier phrase used in prerecorded materials?
No. A calibration tone is used. You set the VU meter at zero when the calibration tone is on. The need for a carrier phrase is not as important.
Give an example of patient instructions for SRT testing.
"You are going to hear a person ask you to say a series of words, like 'baseball' and 'schoolboy'. I'd like you to repeat each word you are asked to say. I'm going to turn the words quieter and quieter, until you can't hear them anymore. I want to find out how quietly you can hear speech. Don't be afraid to guess. Do you understand?
How are the SRT results used?
1. As a basis for setting a level for Word Recognition (WRS) testing.
2. As a check on pure tone results (SRT can be predicted from the PTA; SRT = PTA plus or minus 5 dB.
3. To categorize a hearing loss.
4. In hearing aid evaluations to determine the correct amount of gain (power).
Why are SRT scores needed to determine Word Recognition levels?
Word recognition testing in not a threshold test. The WR scores are scores indicating a person's ability to discriminate one word from another. These scores are found at levels above a person's SRT. We have to know a person's SRT before we can set a level to test word recognition testing.
What are the speech frequencies?
500-2000 Hz
What is the relationship between PTA (pure tone average) and SRT (speech recognition threshold)?
Since the PTA is calculated from the average threshold of 500-2000 Hz (the speech frequencies), the speech recognition threshold should be within a + or - 5 dB of the PTA.
Is masking required in speech testing?
It may be when there is a possibility that the speech stimulus has crossed over and is actually being heard by the non-test ear.
What does MCL stand for?
Most Comfortable Loudness level.
What is the purpose of the MCL?
To determine the best level for the patient to hear and understand speech. The MCL gives important information both with regard to the patient and to the fitting of a hearing instrument.
What is the most comfortable loudness level in a patient with normal hearing?
From 40-55 dB HL
What is the stimulus for finding MCL?
Cold running speech (An informative but non-emotional series of sentences, recorded at a constant level).
What method is used for determining the MCL?
A bracketing method.
What is the reason for using a bracketing method to determine MCL?
The MCL is a little hard for a patient to identify. A person could be 5 or 10 dB on the high or low side. We'd like to narrow that a bit and try to get a finite dB level that represents MCL.
How can the MCL be found?
monaurally, binaurally, or in a sound field.
T/F: Most Comfortable Loudness Level is most often used in the evaluation of hearing aids.
True.
Give an example of patient instructions for the MCL.
"Now you are going to hear continuous speech. You do not have to repeat any of the words. I want to find the most comfortable level for you to listen. I will increase the volume slowly, so you can listen at different levels. You can help me by pointing your thumb up if you want it louder, or down if you want it quieter. Please let me know when we find the volume you prefer. Do you understand?
What is the first bracketing level used for MCL?
We present a stimulus to the patient that we know will be below their comfortable listening level or too soft.
What level will some audiologists begin the MCL?
Some audiologists start at a 40 dB sensation level or 40 dB above SRT.
How is the bracketing method used in MCL?
Once you start speaking, the patient will raise their thumb that the sound needs to be increased. We're not going to increase it by 5 or 10 dB and then say a word like we did in finding SRT. Instead we'll continue with cold running speech and quickly increase in 5 dB steps until the speech is being presented above their threshold but just below their uncomfortable loudness level.
What happens when the patient indicates they want the volume lower when testing MCL?
Decrease the speech in 10 dB steps until they say it is comfortable. You can go up 5 or down 10 until you find the comfortable level for them.
Describe the forced choice method.
Always advance the attenuator dial to a point a little above where the patient reports speech as comfortable. While really listening quietly, realization may come to the patient that speech can be louder and perhaps more comfortable. Continue to increase slowly in 5 dB steps until the patient decides that speech was better lower, then return to that level. This level is noted on the audiogram as the MCL.
T/F: When testing for MCL, have the patient think about how they'd listen to TV.
True. Have them think about whether they'd like the volume louder or softer.
What is the UCL?
The Uncomfortable Listening Level. It is not the threshold of pain; it is the level where speech becomes uncomfortably loud.
What is the purpose of the UCL?
To determine the point where no further amplification will be permitted in a hearing instrument or accepted by the patient.
What is the UCL for a patient with normal hearing?
Usually 100-110 dB. Levels exceeding 110 dB have the power to damage hearing.
What is the stimulus used to determine UCL?
Cold running speech.
T/F: hearing losses extend the UCL.
False.
T/F: People with sensorineural hearing losses can tolerate louder hearing levels than people with normal hearing.
False. Often the opposite condition is true. Instead of being able to tolerate 100-110 dB, they may be able to only tolerate 80-90 dB, so their ceiling is lowered.
What are some other names for the UCL?
TD: Threshold of Discomfort
Tolerance Level
LDL: Loudness Discomfort Level
Give an example of patient instructions for the UCL.
"Now I want to find a level where sound starts to bother you, not where it is just a little too loud. I want to find where it is uncomfortable for you, but not painful. I don't want you to hold your ears in pain. Please raise your hand or say 'stop' whenever the sound starts to bother you to the point where you couldn't listen to it or when exceeding the loudness level would be intolerable."
How is the UCL test administered?
We begin by delivering the speech at a comfortable loudness level. We'd then begin extending the dB or the intensity, making the cold running speech more and more intense. They'd raise their hand eventually. You don't just stop and turn it off when they say that's as loud as they tolerate. You would then take the hearing level dial back down and increase it again back to an uncomfortable level, noting the highest level they could tolerate and record that as their uncomfortable loudness level
What is another use for the UCL?
To help define the dynamic range (DR) of a patient. This is also known as the range of comfortable loudness (RCL).
What is the dynamic range?
The range of usable hearing, between the SRT and the UCL. This is calculated by subtracting the SRT from the UCL. Usable hearing takes place within this dynamic range, or are of comfortable loudness.
Why is it important to know dynamic range?
If the frequency and intensity of a sound are inside the area of dynamic range, we readily hear it. Any sound that falls below or outside this area remains unheard.
What is speech recognition testing?
Testing to determine the accuracy of received messages or the clarity of those messages. Do you understand what is being said to you?
Speech recognition testing is also referred to as...
Word Recognition Testing (WRS)
What other terms are used to refer to speech recognition testing?
Word Discrimination Testing
Speech Discrimination (SD) testing
"Discrimination" or "Discrim" testing
What is the measurement of speech discrimination referred to as?
Speech recognition score (SRS), Word recognition score (WRS), or the speech discrimination score.
What is the purpose of speech recognition testing?
The quantitative determination of a patient's ability to discriminate speech.
How does speech recognition testing help the audiologist?
1. to determine the extent of the speech-recognition difficulty.
2. to aid in diagnosis of the site of the disorder in the auditory system.
3. To assist in the determination of the need for and proper selection of hearing instruments.
4. To help the clinician make a prognosis for the outcome of treatment efforts.
What is the most common approach in testing speech recognition?
present the patient with a list of phonetically balanced (PB) test words.
What does phonetically balanced mean?
The percent of time any given sound appears on the word list is equal to its occurrence in the English language.
What are some different word lists used in speech recognition testing?
CID Auditory Test W-22
NU-6
What does CID stand for?
Central Institute for the Deaf
What did Hirsch et al do in 1952 with the word lists for speech recognition testing?
They brought together the CID word lists. They put 50 words in a list and had four lists. There are six versions of each list with the words in a different order. These lists provide an adequate number of words for finding word recognition scores.
What are the NU-6 lists?
Four 50-word lists scrambled into 4 randomizations developed at Northwestern University.
Describe the word lists used for speech recognition testing?
All of the words are one-syllable words. They are designed to be common words that should be within the vocabulary of the average person.
How many words should be used in speech recognition testing?
It is recommended that the full 50 word list is used. Sometimes only a 1/2 list is used. It is permissible to use a half list if an individual's score is greater than 90% on the first 25 words. Sometimes it may be necessary to administer more than one list.
Is the patient familiarized with the word list before testing?
NO. In fact, a new list of words has to be used each time the test is conducted (on the same day).
Is the use of a carrier phrase advised in speech recognition testing?
Yes.
T/F: The clinician should use a rising intonation when delivering the word list.
False. The goal is for the words to have natural inflection. The inflection should drop slightly at the end.
Why is it preferable to use recorded materials in speech recognition testing?
Because "live voice" testing by individual audiologists creates variability in the test presentation. When recorded materials are use, if patient performance differs from one test date to another, it's easier to interpret that those differences are because of the patient rather than because of the person administering the test.
In speech recognition testing what is the standard presentation level?
40 dB sensation level (SL) above SRT. If too loud, present at 30 dB. If still too loud, present at MCL.
T/F: Once the sensation level is established for each patient, the intensity is not changed during the test.
True.
Why would the presentation levels be lower for patients with sensorineural hearing loss?
Some patients with moderate sensorineural losses or worse probably have significant recruitment (can't tolerate loud sounds), and would find even 30 dB SL too loud.
The textbook discusses performing speech recognition testing at a minimum of two levels. What are they?
1. 5 to 10 dB above the patient's MCL.
2. A higher level (90 dB)
Discuss speech recognition testing at conversational levels.
If the audiologist wishes to know how well a person understands words when they are presented at a conversational loudness, they may present the test items at a level of 45 to 50 dB HL.
How many words should be used in speech recognition testing?
It is recommended that the full 50 word list is used. Sometimes only a 1/2 list is used. It is permissible to use a half list if an individual's score is greater than 90% on the first 25 words. Sometimes it may be necessary to administer more than one list.
Is the patient familiarized with the word list before testing?
NO. In fact, a new list of words has to be used each time the test is conducted (on the same day).
Is the use of a carrier phrase advised in speech recognition testing?
Yes.
T/F: The clinician should use a rising intonation when delivering the word list.
False. The goal is for the words to have natural inflection. The inflection should drop slightly at the end.
Why is it preferable to use recorded materials in speech recognition testing?
Because "live voice" testing by individual audiologists creates variability in the test presentation. When recorded materials are use, if patient performance differs from one test date to another, it's easier to interpret that those differences are because of the patient rather than because of the person administering the test.
In speech recognition testing what is the standard presentation level?
40 dB sensation level (SL) above SRT. If too loud, present at 30 dB. If still too loud, present at MCL.
T/F: Once the sensation level is established for each patient, the intensity is not changed during the test.
True.
Why would the presentation levels be lower for patients with sensorineural hearing loss?
Some patients with moderate sensorineural losses or worse probably have significant recruitment (can't tolerate loud sounds), and would find even 30 dB SL too loud.
The textbook discusses performing speech recognition testing at a minimum of two levels. What are they?
1. 5 to 10 dB above the patient's MCL.
2. A higher level (90 dB)
Discuss speech recognition testing at conversational levels.
If the audiologist wishes to know how well a person understands words when they are presented at a conversational loudness, they may present the test items at a level of 45 to 50 dB HL.
Give an example of patient instructions for speech recognition testing.
"You are going to hear a series of words. Please repeat each of the words you are asked to say. If you have difficulty understanding the words, it helps me if you guess. I have a better idea what part of the word was difficult for you. If the volume is not comfortable for you, or you would like the words louder or quieter, please let me know. Do you understand?”
How are results recorded in speech recognition testing?
Results are recorded in terms of the % of correctly identified words. Each correct response is worth 2% if using a 50-word list and 4% is using a 25-word list.
What else is noted on the audiogram for speech recognition testing?
The list used and the level at which the testing was performed.
What do the speech recognition testing results provide?
A relative indicator of the difficulty the person has understanding speech. The WRS suggests the approximate degree of difficulty the individual will experience understanding speech for each ear in a quiet listening condition.
How do you interpret a word recognition score?
92-100% Excellent
82-90% Good
72-80% Fair
52-70% Poor
22-50% Very Poor
0-20% Extremely Poor
What are normal scores for speech recognition testing?
Normal scores are near 100%, if the stimulus is presented at 30 dB SL or above, at MCL or above.
What information is critical to be included in the report for speech recognition testing?
The intensity of presentation. It is simply not true that a score of X% means that a person hears that percentage of speech.
Why can't speech recognition tests predict real world communication problems?
Even if the testing was conducted at a conversational loudness, speech understanding is different from understanding single words presented in quiet in a test room. Speech has linguistic redundancy – the listener does not need to hear each word in order to understand the message. Word recognition testing uses single words, not contextual speech. Also, note that testing is conducted in a quiet test booth. The everyday world is usually rather noisy. Speech is usually only 8 dB louder than the background noise!
What is the expected WRS based on the degree of hearing loss?
Normal hearing - the score should be 90% or greater.
Cochlear disorders - the score is usually consistent with the degree of hearing loss; the greater the loss, the poorer the WRS.
Retrocochlear disorders - the score is usually considerably poorer than the expected based on the degree of hearing loss.
What is another use for speech recognition testing?
Assessing the PI function; also known as the performance intensity function and the PB max.
What would be expected when assessing the PI function and increasing the presentation level to a higher intensity level?
Normally, the word understanding would remain essentially the same, if not improve. In some cases, the word understanding will decrease and be abnormal. This is a sign of possible retrocochlear hearing loss.
What is retrocochlear hearing loss?
This means that there may be some damage beyond the cochlea, such as lesions in the higher auditory centers. When the ear with a damaged nervous system is stimulated with a very loud sound, the nerves may be unable to handle the increased signal load.
Why might the VIII nerve "tire out"?
The damaged VIII nerve may be able to transmit a conversational level speech signal, but "tire out" when faced with the demand of sending strong, sustained messages.
What is the PB max?
The peak on the WRS or the maximum phonetically balanced score using PB word lists. If you see PB max written, you know we've done a word recognition score on an individual, and they've reached a maximum level. If we continued to increase intensity, word recognition scores diminish.
What is the rollover effect?
The point on the WRS where the scores begin to decrease. This occurs in some ears when there are lesions in the higher auditory centers.
What does each speech test help the audiologist with?
Verification of the accuracy of the audiogram.

i.e. the SRT verifies the PTA

**When testing, you need to ensure that each of your tests are supporting the audiogram, they type of loss, the case history, the tympanogram and the visual inspection of the ear.