Podcast
Questions and Answers
Why is speech audiometry considered an important part of most audiological assessments?
Why is speech audiometry considered an important part of most audiological assessments?
- It's easier and less time-consuming compared to other tests.
- Speech is typically the most important sound for people to hear. (correct)
- Speech stimuli produce more reliable results than pure tones.
- It is more objective than pure-tone audiometry.
What is the MOST likely chief complaint of a patient undergoing speech audiometry?
What is the MOST likely chief complaint of a patient undergoing speech audiometry?
- Inability to hear high-frequency sounds.
- Experiencing tinnitus in quiet environments.
- Difficulty hearing music clearly.
- Struggling to hear speech. (correct)
A patient reports difficulty understanding conversations in noisy environments. Which type of audiometry would be MOST appropriate to assess this?
A patient reports difficulty understanding conversations in noisy environments. Which type of audiometry would be MOST appropriate to assess this?
- Tympanometry
- Otoacoustic emissions (OAEs)
- Speech audiometry (correct)
- Pure-tone audiometry
If a patient finds it challenging to discern spoken words, what is the MOST suitable type of audiological assessment to evaluate this specific issue?
If a patient finds it challenging to discern spoken words, what is the MOST suitable type of audiological assessment to evaluate this specific issue?
A sound booth operator notices a patient is struggling with the masking section of speech audiometry. What is the MOST appropriate next step?
A sound booth operator notices a patient is struggling with the masking section of speech audiometry. What is the MOST appropriate next step?
During speech audiometry, a patient consistently repeats the presented words incorrectly. What is the MOST likely cause?
During speech audiometry, a patient consistently repeats the presented words incorrectly. What is the MOST likely cause?
Which of the following scenarios would MOST warrant a speech audiometry assessment?
Which of the following scenarios would MOST warrant a speech audiometry assessment?
Imagine a patient reports difficulty understanding speech, especially in group settings. Besides speech audiometry, what other assessment would be MOST BENEFICIAL to understand their hearing difficulties better?
Imagine a patient reports difficulty understanding speech, especially in group settings. Besides speech audiometry, what other assessment would be MOST BENEFICIAL to understand their hearing difficulties better?
Why is speech audiometry used in conjunction with pure-tone audiometry, considering pure-tone tests establish hearing thresholds?
Why is speech audiometry used in conjunction with pure-tone audiometry, considering pure-tone tests establish hearing thresholds?
In speech audiometry, which aspect of language processing is typically NOT the primary focus?
In speech audiometry, which aspect of language processing is typically NOT the primary focus?
What does the 'word discrimination' test, despite its name, primarily assess?
What does the 'word discrimination' test, despite its name, primarily assess?
Why might someone with normal hearing thresholds still experience difficulty understanding speech?
Why might someone with normal hearing thresholds still experience difficulty understanding speech?
What is the most direct benefit of using speech audiometry to assess a patient's hearing?
What is the most direct benefit of using speech audiometry to assess a patient's hearing?
Which condition is most likely to cause poor temporal processing or frequency discrimination, affecting speech clarity despite potentially normal hearing thresholds?
Which condition is most likely to cause poor temporal processing or frequency discrimination, affecting speech clarity despite potentially normal hearing thresholds?
What aspect of hearing is analogous to assessing whether someone can 'make out the shapes of letters' in vision?
What aspect of hearing is analogous to assessing whether someone can 'make out the shapes of letters' in vision?
How does testing speech perception provide a more 'complex' assessment compared to pure tone audiometry?
How does testing speech perception provide a more 'complex' assessment compared to pure tone audiometry?
What is the primary purpose of the Speech Reception Threshold (SRT) in audiological testing?
What is the primary purpose of the Speech Reception Threshold (SRT) in audiological testing?
Why is the SRT often performed before pure-tone audiometry in some clinics?
Why is the SRT often performed before pure-tone audiometry in some clinics?
What does a significant discrepancy between the Pure Tone Average (PTA) and the Speech Reception Threshold (SRT) suggest?
What does a significant discrepancy between the Pure Tone Average (PTA) and the Speech Reception Threshold (SRT) suggest?
The 'cross-check principle' refers to what aspect of the Speech Reception Threshold?
The 'cross-check principle' refers to what aspect of the Speech Reception Threshold?
A patient's SRT is significantly better than their Pure Tone Average (PTA). What condition might this suggest?
A patient's SRT is significantly better than their Pure Tone Average (PTA). What condition might this suggest?
Why is it important to assess speech perception abilities beyond what the audiogram predicts?
Why is it important to assess speech perception abilities beyond what the audiogram predicts?
In audiology, what does 'differential sensitivity' refer to?
In audiology, what does 'differential sensitivity' refer to?
What is the clinical significance of differentiating between cochlear and retrocochlear hearing loss?
What is the clinical significance of differentiating between cochlear and retrocochlear hearing loss?
Why is it important to use standardized recordings for speech tests instead of a clinician's own voice?
Why is it important to use standardized recordings for speech tests instead of a clinician's own voice?
What is the primary reason for using speech test recordings in the same language and dialect as the patient?
What is the primary reason for using speech test recordings in the same language and dialect as the patient?
When administering speech tests to individuals who speak different languages, what is the ideal approach?
When administering speech tests to individuals who speak different languages, what is the ideal approach?
Why might a speech test with a clinician who has a strong regional accent (e.g., a Southern drawl) be considered 'bad' for general use?
Why might a speech test with a clinician who has a strong regional accent (e.g., a Southern drawl) be considered 'bad' for general use?
What is a common method for determining the presentation level of speech testing, and what is a limitation of this method?
What is a common method for determining the presentation level of speech testing, and what is a limitation of this method?
A patient has a pure tone average of 70 dB. According to one rule of thumb, at what level would you present speech? What is a key consideration regarding this approach?
A patient has a pure tone average of 70 dB. According to one rule of thumb, at what level would you present speech? What is a key consideration regarding this approach?
Besides a standardized recording, what else is highly beneficial when administering speech tests to patients from diverse linguistic backgrounds?
Besides a standardized recording, what else is highly beneficial when administering speech tests to patients from diverse linguistic backgrounds?
What is an alternative approach to determine speech presentation level when the '40 dB above pure tone average' method is unsuitable?
What is an alternative approach to determine speech presentation level when the '40 dB above pure tone average' method is unsuitable?
Why is word recognition score NOT a perfect measure when determining appropriate aural rehabilitation strategies?
Why is word recognition score NOT a perfect measure when determining appropriate aural rehabilitation strategies?
A clinician performs a word recognition test using only 10 words and the patient scores 100%. What is the most appropriate next step?
A clinician performs a word recognition test using only 10 words and the patient scores 100%. What is the most appropriate next step?
Why are shorter word lists (e.g., 10 words) less reliable than longer word lists for word recognition testing?
Why are shorter word lists (e.g., 10 words) less reliable than longer word lists for word recognition testing?
A patient scores 50% on a 10-word recognition test. Given that the standard deviation for 10-word lists is approximately 15%, what is the range within which the patient's 'true' score likely falls, considering two standard deviations?
A patient scores 50% on a 10-word recognition test. Given that the standard deviation for 10-word lists is approximately 15%, what is the range within which the patient's 'true' score likely falls, considering two standard deviations?
What is the primary benefit of using a longer word list (e.g., 100 words) in word recognition testing compared to a shorter list?
What is the primary benefit of using a longer word list (e.g., 100 words) in word recognition testing compared to a shorter list?
In the context of audiology, what does the term 'standard deviation' represent in relation to word recognition scores?
In the context of audiology, what does the term 'standard deviation' represent in relation to word recognition scores?
Which of the following scenarios would MOST strongly suggest the need for cochlear implants?
Which of the following scenarios would MOST strongly suggest the need for cochlear implants?
How does the primary function of a hearing aid differ from the potential benefit of a cochlear implant concerning word recognition?
How does the primary function of a hearing aid differ from the potential benefit of a cochlear implant concerning word recognition?
When calculating the pure tone average (PTA), which frequencies are typically used?
When calculating the pure tone average (PTA), which frequencies are typically used?
What is the Fletcher average used for in audiology?
What is the Fletcher average used for in audiology?
Why might the Speech Reception Threshold (SRT) match the best two frequencies instead of the typical pure tone average?
Why might the Speech Reception Threshold (SRT) match the best two frequencies instead of the typical pure tone average?
In a scenario where a person is suspected of faking a hearing loss, why is it difficult to determine what words they should or shouldn't hear during an SRT test?
In a scenario where a person is suspected of faking a hearing loss, why is it difficult to determine what words they should or shouldn't hear during an SRT test?
What does a collapsing of bone conduction thresholds towards SRT suggest?
What does a collapsing of bone conduction thresholds towards SRT suggest?
If a patient's pure-tone audiometry shows thresholds of 35 dB HL at 500 Hz, 40 dB HL at 1000 Hz, and 55 dB HL at 2000 Hz, what is their approximate pure tone average (PTA)?
If a patient's pure-tone audiometry shows thresholds of 35 dB HL at 500 Hz, 40 dB HL at 1000 Hz, and 55 dB HL at 2000 Hz, what is their approximate pure tone average (PTA)?
A patient presents with the following audiometric results: 500 Hz at 20 dB HL, 1000 Hz at 25 dB HL, and 2000 Hz at 60 dB HL. Which thresholds would you use to calculate the Fletcher average?
A patient presents with the following audiometric results: 500 Hz at 20 dB HL, 1000 Hz at 25 dB HL, and 2000 Hz at 60 dB HL. Which thresholds would you use to calculate the Fletcher average?
During speech testing, spondee words are used. What is the primary purpose of using spondee words in Speech Reception Threshold (SRT) testing?
During speech testing, spondee words are used. What is the primary purpose of using spondee words in Speech Reception Threshold (SRT) testing?
Flashcards
Speech Audiometry
Speech Audiometry
Audiometry using speech as the stimulus.
Importance of Speech Audiometry
Importance of Speech Audiometry
Assessing hearing ability using speech stimuli. It's a core part of audiological evaluations because most patients seek help due to speech-related hearing difficulties.
Speech vs. Pure Tones
Speech vs. Pure Tones
Unlike pure tones, speech audiometry directly assesses understanding of everyday communication.
Tests measure comprehension
Tests measure comprehension
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Audiogram
Audiogram
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Speech Threshold Testing
Speech Threshold Testing
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Speech Reception Threshold (SRT)
Speech Reception Threshold (SRT)
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SRT and Pure Tone Average (PTA) comparison
SRT and Pure Tone Average (PTA) comparison
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Differential Diagnosis
Differential Diagnosis
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Complete Speech Perception Diagnosis
Complete Speech Perception Diagnosis
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Absolute vs. Differential Sensitivity
Absolute vs. Differential Sensitivity
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SRT Units
SRT Units
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Pure Tone Average (PTA)
Pure Tone Average (PTA)
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SRT Cross-Check Principle
SRT Cross-Check Principle
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Pseudohypacusis
Pseudohypacusis
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Speech Identification
Speech Identification
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Word Discrimination Task
Word Discrimination Task
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Purpose of Speech Audiometry
Purpose of Speech Audiometry
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Thresholds vs. Clarity
Thresholds vs. Clarity
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Poor Clarity, Normal Thresholds
Poor Clarity, Normal Thresholds
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Auditory Neuropathy
Auditory Neuropathy
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Direct Assessment of Speech
Direct Assessment of Speech
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Clarity in Speech
Clarity in Speech
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Dialect Matching in Speech Tests
Dialect Matching in Speech Tests
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Standardized Speech Test Recordings
Standardized Speech Test Recordings
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Multilingual Speech Test Recordings
Multilingual Speech Test Recordings
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Speech testing presentation level
Speech testing presentation level
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Most comfortable speech level
Most comfortable speech level
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SRT/PTA Match
SRT/PTA Match
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Fletcher Average
Fletcher Average
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Spondee Words
Spondee Words
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Bone Conduction Testing
Bone Conduction Testing
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Air Conduction Testing
Air Conduction Testing
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Faking a Hearing Loss
Faking a Hearing Loss
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Cochlear Implants
Cochlear Implants
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Word Recognition Score
Word Recognition Score
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Word List Length
Word List Length
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Short Word List Limitations
Short Word List Limitations
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Short List Score Stability
Short List Score Stability
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Standard Deviation
Standard Deviation
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Two Standard Deviations
Two Standard Deviations
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Example of Score Range
Example of Score Range
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Study Notes
Speech Audiometry
- Speech audiometry is an important part of every audiological assessment
- Most people seeking audiological help have difficulty hearing speech
- Measurements of speech help determine reasons for hearing issues
Levels of Speech Perception
- There exist four levels of speech perception
- These levels are:
- Awareness
- Discrimination
- Identification
- Understanding
- Awareness is the most basic level
- Awareness involves knowing someone is talking and hearing speech
- In awareness, the listener cannot make out what is being said
- Discrimination is the next level
- Discrimination is the ability to tell two sounds apart
- Identification is the ability to know what a sound is
- In Identification, the listener can identify Beetlejuice
- However in Identification, the listener does not necessarily understand it
- Understanding is ability to comprehend
- Understanding is the ultimate goal in audiology
- Audiology rarely looks at understanding
- linguistic experience plays a bigger role when going from awareness to understanding
- Tests performed are mostly at the identification level
Reasons for Performing Speech Audiometry
- Speech differs for frequencies
- This determines range
- Speech is more complex than pure tones and vision
- You need to pick up differences over both time and frequency
- Speech assess clarity
- People with normal hearing thresholds can struggle with speech sounds due to a lack of clarity
- Causes of lack of clarity include poor temporal processing, poor frequency discrimination, and auditory neuropathy
Speech in Noise
- People may complain about not understanding others
- Speech tests can directly reveal these problems
- Best to measure speech perception with background noise
- There is a loose correlation between speech in quiet and speech in noise
Differential Diagnosis
- Speech measures can help in differential diagnosis
- Can help in determining if issues are conductive or sensory neural
- Speech results reveal if a patient is trying to fake hearing loss
- Speech results often reveal hearing loss is not what it seems
- Speech results are a cross-check for pure tone tests
Speech Reception Threshold (SRT)
- The speech reception threshold (SRT) is a threshold
- This is for identifying a speech sound
- The SRT is measured in decibels hearing level (dB HL)
- Pure tone average and SRT should match
- SRT is cross check principle
- Discrepancies can flag something wrong with the hearing test
- Audiologists do this before thresholds
Falsified Hearing Tests
- SRT helps reveal falsified hearing tests
- This is when people may not be lying due to psychological issues
- SRT establishes a baseline for other speech tests
- SRT should be within 10 dB of the pure tone average (500, 1000, 2000 Hz)
- Discrepancies may indicate faking, equipment issues, or misunderstanding
Abnormal Thresholds
- If 500 and 1000 Hz are good, but there is precipitous drop to 2000 Hz, speech can still match the average
- Speech is harder to understand than pure tone
- Calibration can occur between the two
- Speech is not one level
Measuring Speech
- Speech levels constantly fluctuate across frequencies
- Speech has different short-term levels
- These are never just one level
- Speech is measured in 1/8 of a second windows
- This matches human perception
- Human auditory system averages sounds
- The auditory does this with a smoothing window
- Also in narrow frequency bands, about a third of an octave
- This approximates a critical band
- Critical band helps perceive level across frequency
Measuring Short-Term of Speech Levels
- Measurements are typically done every eighth of second in time
- Also every third of an octave in frequency
- Divide like a grid into the perceptual units of auditory system
- This shows how humans perceives level across frequency and over time
- Should follow human perception
- There is distribution of about 30 dB from top to bottom across all frequencies for human speech
Speech Level Considerations
- Typically measure for at least 10 seconds or more
- Sentence is measured, short term levels show portion someone can hear of speech sounds
- Top red line are the peaks in speech spectrum on a graph of speech
- Bottom red line are the softest ones, 80th percentile
- Gray line in the middle is the average
- Referred to the long-term average the speech spectrum (LTAS)
- Peaks for speech are 12 dB above average level
- Troughs are 18 dB below
Average Speech Level
- If the hearing threshold matched the average speech level, you would only hear the top 12 dB
- You would be missing half of it since it's the softest
- This is speech is calibrated to around +12 dB on audiometer so it can match
- So if a speech level measures 0 dB, it is actually like 12.5 dB
- Calibration balances pure tones with the speech threshold
Calibrating Puretones
- The test environment calibrates the pure tones and speech
- This makes it easier for clinicians to assess
- Measures in HL for speech are different in SPL
- Set the speech level to around 40 dB HL (soft)
- This is more like 52.5 dB SPL
- Calibration values for tones/speech are same, audiometer is raised so people understand
- It says 10 on the dial speech in dB HL, it's actually higher
Speech Level
- Speech at 50 dB SPL would be 38.5 dB HL
- It reads lower on the dial so tones match speech
- Speech levels in dB HLs are lower than dB SPL
- Calibration matchs by "lying" the tone levels
- Using a lower number
- Goal is to make it easy by matching
Using Spondees
- Spondees are words with equal emphasis on both syllables
- These are used with the SRT
- Examples include Batman, hotdog, and toothbrush
- Spondees are used because they are easy to hear
- Familiarize those words with the patient first
- Ability to hear the vowels is critical
The Importance of Vowels
- It's important to hear the /t/ and /d/
- Match tone average because pure tone average is 500, 1000, 2000 Hz where the vowels are
- Formants are little below 500 with it above 2000 Hz
- Want to have good pure tone averages due to vowels matching where the formants are
- Drop the word if a person misses it at a high level to remove clarity/language issues
Thresholds
- Want easy words to do thresholds with
- Easy words match average since frequencies match formants with speech
- Monitor voice recording was common since it helped to present individual words
- The old day had problems, but a microphone gives flexibility
- For monitoring, make sure voice/speech hits 0 on VU meter for each syllable to match audiometer's level on dial
Testing Monotone
- Practice speaking at a monotone to hit 0 with speech level repeatedly
- Don't use easy words to drop
- Let face be seen when familiarizing it, but covered when testing unless using audiometer which removes that requirement
- This helps so machine LEDs don't affect testing
- It is known that there is a VU meter
- It is best an audiologist conducts the speech test and has a strong accent
Procedure for Testing
- The test procedure is very simple
- It involves familiarizing words to the patient
- Similar to a hearing test
- The common procedure is the Martin and Dowdy procedure
- Test spondees like you would test tones
- SRT should be within 10 dB of average, or the Fletcher average
- Fletcher average is best 2/3
- Fletcher average is preferred if there's a precipitous
Pure Tone Averages
- People guess vowels if they're only hearing 500 and 1000 Hz
- Those match just upper frequencies
- With the Fletcher average, the patient can ignore the one frequency that is way worse
- It is the best 2 out of 3 of the average
- If the average goes wrong, then match the Fletcher average
- Pure averages allow you to know some type of hearing loss
- Should also be 10 dB within the average
- This isn't uncommon if using TBH/supraoral closing canals
Pure Tones
- Pure bone conduction thresholds should match the same with air
- Collapse that's giving a conductive loss
- Can depend on orders of tests
- With misunderstanding, the client would misunderstand air; it helps with fake tests
- A guideline: air thresholds should get closer
- Conduct test to see collapsing canal issues and placements of items
- If there's eustachian tube problems, then the conductive loss helps the hearing
Speech Awareness Threshold
- Speech awareness/detection threshold is the same thing
- This involves the cases where the client cannot repeat back the word/is a young kid
- If they're pre/very linguistic, they might not be able to repeat the words/language
- Use speech awareness threshold with body language
- It isn't the same as an SRT, so tend to get +2 to 5 dB better with 5dB steps since no need to repeat
- You's typically expect a little higher pure tones
Suprathreshold Speech Testing
- Are like pure tones but will have words in the audiometer
- Madeline will then show that in the clinic
- It is reading it off a list with face covered
- Use the list printed out
- Other tests are above threshold
- Not Threshold tests
- Used to find how clear speech is and if you expect one ear higher thresholds, if right SRT is high, that means SRT is expected better
Expectations for Diagnosis
- The above SRT should just be 10 within the average
- List the words to do speech test, then can see in speech audiometry that you should expect if not a neural issue
Scores and Hearing test
- If speech is audible, you will only get 4% of it
- A hearing aid isn't needed with 75% of words
- If pure tones are much worse that means neural issue
- Speech may be better due to the sounds in quiet not getting a ton of fine details
- If hearing in speech sounds so low that means bad
- Speech is not a great way to see damaged parts
Audiology & Testing
- Know how bad/well certain ears still understand speech
- Speech in noise/noise alone is a little more sensitive
- If not hearing anything there is no big need to get more details
- Speech test underestimate the damaged areas
- Phonological/language issues can cause problems
- It depends on speech test type, CVC will interfere and what you should expect after
- There can also be reasons to local SLPS to see how much worse it can get
- Is there an expected disorder? So, if nothing there and just hearing loss 75%
- More moderate loss if making all the levels loud enough when checking 4
- This is what speech does due to studies
Published Lowest Max Score
- Judy Debno helped lower max word score relative to pure tones
- Made a test called PB Max
- Reason for the name is if the terms stand for phonetically or phonemically balance
- Multiple max scores you get the best score overall
- If a test is a done and you get 80 it remains with that same value like 80% since sounds like peanut butter
- Is the word list and measure clarity for the words the client needs to hear
- In the end use open set monosyllables
Consonant Vowel Consonant
- CVC is a words the client needs to recognize with the tester saying, "say the word"
- It is for more realistic carrier phrases at once constant level
- Word recognition leads to percent correct on the audiometer since there's buttons to tap
- Don't monitor the live voice since it is enunciated a lot
- Testing accent should vary
- One way to know where the undergrads get it
- Old audiometers were cumbersome to use
- Time shouldn't stop administering tests
Dialect Considerations
- This can also show with recorded accent too but should be done carefully with standardized exact recordings of the test
- Speech gets there can be an easier use of dialect there
- Ideal conditions can exist but aren't optimal
- You shouod ideally have recordings correspondent with different tests in all different clinic
- Clinician speak test should also be able to score correctly
- Don't mix southern accent with different language mixes
Tests Tips
- Do tests at 40dB with pure tone averages if they have high level hearing
- Can break can then
- Always defensible with what is upper range most with level
- Start a few dB and add to see till say level is comfortable
- The best hearing score would be at their PB Max as well so that the speech not get confused
- Easy to make mistakes with this in PB because only that will have test right number
Best Speech Score
- PB Max is 80% and level doesn't affect it since PB is score not the level
- Can test recognition on profound here and if get less than 5 there's a small chance the aid will help
- Where test is in cochlear with eligibility with it.
- Speech will shape fit and frequencies to different levels on the test and what there a level change decision
1st Week Consideration
- If the person getting above 5% or less than hearing ad will not do it
- Love picture
- What more and table score help the test so the amount get higher with repeated use to see percent
Score Considerations
- Use ten words which might use
- Should then stop after if think any there's
- May have do score to fix and use
- Score should -2 - +2 from other or deviate score for deviations
- So if get 405 and 110 get for different a is in the list
- More items should be tested
Range Testing
- When in the range they say that nothing is really wrong
- Sprint Charts done in formal test list can change that and know can have more list there
- Tibodoex 1999
- List 2 list
- So 1 is the speech but 1 score is like they had and the one is when did the hearing test again to see
- Compare 2 change and will use pervious test as other one
List Testing
- They can do the scores
- If its and the chart its ok is ok
- This 2 list you and what level would
- The chart is if you the 100% means they should get all
- Below that point means there be some
- Is for that the they should above one for level with 0
- Some test and use this with the Ys and look which to for the change is with the chart
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Description
Explore speech audiometry's role in audiological assessments. Understand its application for patients reporting difficulty understanding speech, especially in noisy environments. Learn about troubleshooting challenges during the assessment, and the likely causes of errors.