CSD 309 Basic Audiology Week 6 Day 1 PDF

9/25/24 CSD 309: Basic Audiology Week 6 Day 1 Speech Audiometry 1 General definition Speech perception testing is the Detection – the level at which one...

9/25/24 CSD 309: Basic Audiology Week 6 Day 1 Speech Audiometry 1 General definition Speech perception testing is the Detection – the level at which one becomes aware of the presence of speech presentation of standardized Discrimination – the level at which one Increasing intensity samples of speech through a is able to distinguish between individual calibrated system in an attempt to speech stimuli quantify the patient’s ability to Identification – the level at which one is perceive complex information at able to label what has been heard Reception – threshold measure: focus is threshold and suprathreshold on assessing audibility, not vocabulary levels. Recognition – suprathreshold measure: focus is on intelligibility. Not a test of vocabulary, although this can certainly impact performance 2 1  9/25/24 Why would we do this? Communication is essential to living High face validity Rehabilitation Cross check for pure-tone measures Differential diagnosis 3 Types of speech perception tests 1. Speech Detection/Awareness Thresholds (SDT/SAT) 2. Speech Reception Thresholds (SRT) 3. Speech Recognition in Quiet 4. Speech Recognition Noise 4 2  9/25/24 Types of speech perception tests 1. Speech Detection/Awareness Thresholds (SDT/SAT) 2. Speech Reception Thresholds (SRT) 3. Speech Recognition in Quiet 4. Speech Recognition Noise 5 Speech Detection/Awareness Thresholds Purpose To determine the lowest level that Spondaic (spondee) words the patient can just detect the Two-syllable word where both presence of speech 50% of the time. syllables are stressed Used primarily with children or Two monosyllable words put together those with very severe hearing to make a third word losses Stimuli Spondaic words 6 3  9/25/24 Speech Detection/Awareness Thresholds Procedure The patient is instructed (or trained) to listen for a word presented at a level above threshold and respond in some fashion. If the response is given, the level is decreased 10 dB and the next word is presented. If no response occurs, the level is increased 5 dB and the next word is presented. This continues until the patient responds half the time at the same low presentation level. This is the patient’s threshold for speech detection. It is especially difficult to determine the presence of hearing loss on the basis of the SDT/SAT. 7 Speech Reception Threshold (SRT) Purpose Procedure To determine the lowest level at which the patient can perceive (repeat) words The patient listens to and repeats a word with 50% accuracy presented at a level above threshold. Used to: Check validity of pure tone results If the response is correct, the level is Provide reference level for speech- decreased 10 dB and the next word is recognition testing presented. Evaluate ‘difficult-to-test’ population (hearing in speech frequencies) If the response is incorrect, the level is increased 5 dB and the next word is presented. Stimuli This continues until the patient responds Spondaic Words correctly half the time at the same low presentation level. This is the patient’s threshold for speech perception. 8 4  9/25/24 Speech Reception Thresholds (SRT) Interpretation The SRT should be within 5 dB of the patients PTA for most types/configurations of hearing loss For some steeply sloping loss: the SRT should be within 5 dB of best hearing threshold (any frequency). It is difficult to determine the presence of hearing loss on the basis of the SRT alone. 9 Speech Reception Thresholds (SRT) 10 5  9/25/24 Word Recognition Testing (WRS) in Quiet Purpose To determine how well a patient perceives Monosyllabic Words (PB words) speech at levels experienced in day-to-day CID W-22, NU-6, PB-Ks, NU-CHIPS, communication. Used to: WIPI Estimate degree of hearing handicap Determine site-of-lesion (PIPB rollover) Monitor progress of aural rehabilitation Assess hearing aid performance Assess central auditory function Stimuli Words or sentences Phonetically balanced lists - comprised of phonemes in the frequency with which they generally occur in conversational speech. 11 Word Recognition Testing (WRS) in Quiet Procedure Expectations The patient repeats each word or sentence At comfortable listening levels, most presented. The stimuli are presented at patients, even patients with hearing loss, specific level(s) above threshold. do well on these tests – 80 to 100% Predetermined SL (30 or 40 dB SL): These tests are often insensitive to diagnostics performance differences for listeners with Conversational level (45 dB HL): rehab or without hearing loss or for listeners with The percentage of words correctly differing degrees and configurations of repeated by the patient is recorded along hearing loss. with the presentation level. However, these tests are very sensitive to Performance for one or more presentation pathologies that disrupt the integrity of the levels can be determined. acoustic signal that have little impact on Descriptors (excellent: 90-100%, good: pure-tone thresholds. 78-88%, fair (66-76%), poor: 54-64%, very poor: below 52%) 12 6  9/25/24 Word Recognition Testing (WRS) in Quiet Performance-Intensity function testing (PI-PB) Speech materials presented at several levels above threshold. Performance increases to some maximum and remains there at higher presentation levels. In some cases, performance may decrease after a maximum is reached (rollover) Rollover is more prevalent in patients Softer Louder with neural disorders (e.g., 8th nerve tumors). 13 Relationship between hearing loss and speech understanding 14 7  9/25/24 Effects of hearing loss on speech intelligibility Audibility Distortion Any type of hearing loss will cause Comes from altered this problem frequency/temporal processing Accompanies sensorineural hearing loss 15 Back to audibility Frequency in Hz 125 250 500 1000 2000 4000 8000 -10 0 10 20 f, s, th Hearing Threshold in dB HL 30 k 40 m, n I sh 50 u, e o, a 60 r 70 80 90 95% speech 95% speech 100 intensity intelligibility 110 16 8  9/25/24 Frequency in Hz 125 250 500 1000 2000 4000 8000 -10 0 10 20 Hearing Threshold in dB HL 30 f, s, th k 40 m, n I sh 50 u, e o, a 60 r 70 80 90 95% speech 95% speech 100 intensity intelligibility 110 17 Speech Audibility 125 250 500 1000 2000 4000 8000 125 250 500 1000 2000 4000 8000 -10 -10 0 0 10 10 20 f th 20 f th m k s m k s 30 I e sh 30 I e sh 40 a 40 a u o i u o i 50 50 60 60 70 70 80 80 Sloping Configuration (SN): Rising Configuration (Cond): 90 90 100 PTA=30 SRS=72% 100 PTA=30 SRS=92% 110 110 18 9  9/25/24 Experience it yourself! Try the hearing loss simulators linked in the Week 6 folder Starkey Simulator: Compare the different degrees of hearing loss/sound environments CDC Simulator: Compare three configurations of hearing loss In top right box select “manual adjustment by frequency”; try the following conditions Flat hearing loss: set all sliders around -50 High frequency hearing loss: set 125 to 0, set 1000 and 1500 to -40, set 2000 and above to -55 Rising hearing loss: set 125 to -55, set 1500-3000 to -40, set 4000 and above to 0 Note the differences in sound quality/clarity between the three and report back in class on Thursday. 19 10