Assessing

Hearing Acuity
&
Speech
Recognition
Chapter 3

Perry C. Hanavan, AuD

 Speech Test Applications
 obtain information for counseling
 illustrate benefits of visual cues
 determine hearing aid candidacy
– or determine candidacy for CI or ALDs
 predict hearing aid benefit
 determine when binaural aids might NOT be appropriate
– 80%, AD and 20% AS
 determine amplification characteristics and features
– whether high frequency beneficial
 demonstrate advantage of special hearing aid features
 demonstrate aided performance is better than undaided
 determine whether cognitive or APD exists
– older person may have cognitive problems, anyone may have APD
 demonstrate that understanding of speech is impaired
 Audiologic Evaluation
Information helpful to providing AR
Audibility
Dynamic Range
Frequency Resolution
Temporal Resolution
 Audiologic Evaluation
Critical consideration in developing AR plan:
Time of Onset of loss
Degree of Loss
Etiology
Type of Loss
Other factors
 Audiologic Evaluation
Observations
Interviews
Questionnaires
Otoscopic/Video Otoscopy examination
Pure tone results
Speech recognition
Speech in noise
Immittance
OAE
Electrophysiologic (ECochG, ABR, MLR, LR, etc.)
 Pure Tone Results
Degree of loss
– normal, minimal, mild, moderate, moderately
severe, severe, profound
Type of loss
– conductive
– sensorineural
– mixed
 Tactile
SNR
Only
Many Equivalent
Stimulus Items Lists
Audition
Familiarity Only
Audition
Stimulus
Distance/ Plus
Units
Intensity Vision Vision
Stimulus Learning Only
Audition
Context Effects
Plus
Stimulus Stimulus Tactile
Units Mode
Within-
Subject Open
Statistical Set
Procedure Speech Auditory
Clinical Response
Test Skill
Significance Format
Factors
Paired Closed
t-statistic Set

Listener Stimulus
Variables Format
Cognitive Test-Restest
Ability Live
Variability
Com-
munication Linguistic Synthesized Altered
Mode Ability Speech Speech

Hearing Test Test Recorded

Loss Reliability Conditions
 Stimulus Mode
Tactile

auditory alone Only

Audition
vision alone Audition Only
Plus

tactile alone Vision Vision

Only
Audition

auditory and vision Plus

Tactile

auditory and tactile

tactile and vision
auditory, vision and tactile
 Auditory Alone
phoneme, syllable, word, phrase, sentence
open, closed set
high, low context cues
quiet, noise – signal to noise ratio (SNR)
recorded, live
 Auditory Plus Vision
Speechreading enhancement
– speechreading enhancement
– speechreading enhancement ratio
• vision only / auditory plus vision = SE
– Children –Craig Sentence and Craig Words and CHIVE
– Adults –Iowa Sentence Test and CUNY Sentences
– Erber (vision and hearing assessment)
Auditory Plus Visual Information
Sumby and Pollack (1954) demonstrated
that the addition of visual speech
information could significantly improve
speech perception performance and that the
importance of visual speech information
increased as the listening situation became
more difficult.
 Auditory Plus Vision
Tye-Murray
– CHIVE (adult)
– CAVET (children)
– Audition plus vision
– Vision only
– Audition alone

Eber
– Sent-Ident
 Speechreading Enhancement/
Auditory Enhancement
 Benefit from adding a visual signal to an auditory signal
 Refers to the benefit obtained from seeing and hearing a
speaker compared with auditory alone
– Difference or ratio between speech recognition performance in an
vision-only condition and an audition plus-vision condition
– Difference Score (AV-V)
– Normalized Difference (AV-V/100-V)
 Sam J. (V=50% AV score = 75%)
– 75-50=25% enhancement (difference score AV-V)
– (75-50)/(100-50)=__% (normalized difference score)
 Max H. (V score = 10% AV score = 55%)
– 55-10=45% visual enhancement
– (55-10)/(100-10)=__% (normalized difference score)
 Integration Enhancement
Measure of ability to integrate auditory and
visual information
AV-[100-(100-A)+(100-V)]/100-[100-
(100-V)+(100-A)]
 THE AUDITORY SANDWICH

First, listen.
HEAR
Visual cues:
• lip-reading
• printed word Then, if need be,
• cued speech SEE - SAY watch or say it.
• signs

Then, listen again

HEAR-UNDERSTAND (no visual cues)

Always put it back into hearing!

 Back to “choices”

Auditory Auditory Cued Total ASL

-Verbal -Oral Speech Communication

Language
Communication
AUDITORY Cognition VISUAL
 Choices reframed

Fully Mostly Mostly Fully

Auditory Auditory Visual Visual
Communicator Communicator Communicator Communicator

A Av AV VA V
 Flexibility is essential

Fully Mostly Mostly Fully

Auditory Auditory Visual Visual
Communicator Communicator Communicator Communicator

A Av AV VA V
 Stimulus Unit SNR

Units: phoneme, syllable, word, Stimulus

Familiarity
phrase, sentence, non-sense stimuli Distance/
Stimulus
Units
Proximity: distant, near Intensity
Stimulus

Intensity: soft, comfortable, loud Context

Context: high, low context cues,

SNR: quiet, background sounds--
signal to noise ratio
Familiarity: high, low familiarity
with material, nonsense material
 Case Study
Test and Stimulus Type Patients’ Scores in %
Al Tom Bob

Iowa Consonant Test (phoneme) 55 61 87

CAVET (word) 45 45 30

Iowa Sentence Test (sentences) 58 38 48

 Question
Familiarity with items, procedures…not
change in ability is:
A. Equivalent list
B. Learning effect
C. Clinical significance
D. Statistical significance
 Question
Contain items that are presumed to be equally
difficult to recognize
A. Equivalent list
B. Learning effect
C. Clinical significance
D. Statistical significance
 Learning Effects
Learning effect: familiarity with
items, procedures…not a change in
ability
– Repeated Frame Test Many
Items
Equivalent
Lists
– Cinderella-Brahman Speech
Recognition Test
Equivalent lists: lists that contain
items that are presumed to be
equally difficult to recognize
– PB, sentences
– Repeated Frame Sentences Test
– QuickSIN
– AzBio Sentence Test
Numerous stimuli
– Full lists rather than half lists
 Stimulus Items
Live vs. Recorded Live

– Voicing frequency
– Intonation Synthesized
Speech
Altered
Speech
– Speech rate
– Clarity of articulation Recorded

– Physical characteristics
Synthesized speech
Altered speech
– Time-compressed
– Expanded
– Filtered
 Question
Paired t-statistic:
A. Equivalent list
B. Learning effect
C. Clinical significance
D. Statistical significance
 Significance
Within-
Subject
Clinical significance Statistical
Procedure
When a small change in performance
is clinically significant
Paired
When a real difference or change t-statistic

exists between two equivalent test

results
Statistical design
Paired t-statistic
Within subject statistical significance
Significant
Difference
for NU-6 recorded
speech tests

SRA=86%
SRA=62%
 Listener Variables
Cognitive
Degree of hearing loss Ability

Com-
Cognitive abilities munication
Mode
Linguistic
Ability

– Thinking, reasoning, Hearing

remembering, imagining, or Loss

learning words
Linguistic abilities
– Knowledge of language
Communication mode used
Multicultural
 Effects
Ceiling effect
– Score 100%
– Perfect score
Floor effect
– Score 0%
– Miss all items
Example study
 Test Reliability
 Test reliability: degree to which a single
test score approximates the true score
Test Test
 Test-retest variability: measure of Reliability Conditions
consistency from one test presentation to
the next
 Test conditions: Variables affecting test-
retest variability:
– mode of presentation—live vs recorded
– location—test booth vs classroom
– talker—familiar vs unfamiliar, male vs female
– number times item repeated—once, twice,
etc. leads to better performance
 Question
Same-different essentially means:
A. Detection
B. Discrimination
C. Identification
D. Comprehension
 Response Format
Closed or limited set
Open
Open set Set

Auditory skill
Auditory
Skill

– Detection Closed
Set

– Discrimination
– Identification
– Comprehension
 Diversity
Monolingual
Bilingual

Language appropriate tests

Nonsense syllable tests
Speech Recognition Tests
 WIPI
Word Intelligibility by
Picture Identification
(WIPI)
closed-set picture-pointing
(six pictures per plate)
appropriate for children
whose language age is
between 5 and 10-11
comprised of four 25-
monosyllabic word lists
contains 26 color plates
(one for practice), six
pictures per page. (A, V,
A-V)
 NU-CHIPS
NORTHWESTERN UNIVERSITY--
CHILDREN’S PERCEPTION OF SPEECH (NU-
CHIPS)
closed set picture pointing word recognition test
children whose language age is as low as three
50 words familiar to three-year-old children in
four randomizations
includes two picture books with 50 monochrome
plates, four pictures per plate. Book A is used for
forms A & B, book B for C & D.
There are two recordings, one male and one
female talker.
 MAC
The Minimal Auditory Capabilities (MAC) (2nd
Edition) battery specifically targeted to CI patient
Consists of a series of tasks which are graded in
difficulty
Most of the MAC battery sub-tests assume patient’s
hearing loss has occurred post-lingual, but can be
employed as a means of evaluating the hearing abilities
of persons for whom traditional speech materials are
too difficult
Second edition has been standardized.
The recorded materials include gross sound
identification, inflection detection, contrast detection,
accent discrimination, and word identification
14 sub-tests, 13 audio and one video
 SERT
SOUND EFFECTS RECOGNITION TEST
(SERT) developed for those instances where
conventional word recognition measures are not
appropriate, such as when language limitations due
to hearing impairment
Certain children who are unable to recognize even
simple speech can perceive correctly environmental
sounds to which they are exposed in their daily
lives
Under these circumstances, the SERT can provide
valuable information about the integrity of the
auditory system.
Closed set, picture-pointing tasks
10 sounds plus a practice sound
 CID Every Day Sentences
EVERYDAY SPEECH
10 sets of 10 sentences each with 50
"target" words in each set for word
recognition assessment under contextual
conditions
Can be employed in auditory training
Sentences vary in length and are spoken
with minimal inflection
Normative data on recording lacking
 BKB Sentences
Bench, Koval, & Bamford (BKB)
 Open set sentences
 Appropriate for linguistic abilities of most 8-15 years of
age with hearing loss
 Lists of 16 simple sentences, including 50 key words were
devised to include vocabulary, grammar and sentence
length for 8-15 year olds
 The sentences are presented in an open-set format and the
child imitates as much of the sentence as possible.
Responses are recorded word-for-word and scored by
percent of key words correctly repeated.
 NU-6
NORTHWESTERN UNIVERSITY
AUDITORY TEST NUMBER SIX (NU-6)
Phonetically balanced CNC monosyllabic
open set word recognition test
Four lists of 50 words each recorded in four
randomizations
Talker has a General American dialect
Standardized
 Auditory Numbers Test
ANT
Test helps identify tactile from auditory
listeners
Word closed set recognition auditory alone
test
Appropriate for 3-8 year old children with
severe to profound hearing loss
Simple auditory alone test to measure
ability to perceive simple auditory cues
– (Erber, 1980)
Auditory Numbers Test (ANT)

1 2 3 4 5

5
 Iowa Consonant Confusion Test
Closed set consonant (phoneme) recognition test
test can also be analyzed in terms of the listener's
ability to identify phonetic features:
– Chance performance for consonant voicing, manner, and
place of articulation identification is 50%, 33%, and 20%
respectively
– Example: Mr. S achieved a total score of 79% correct,
96% on voicing, 94% on manner, and 85% on place
10 consonants presented 12 times in VCV context
– p, t, k, b, d, g, v, z, n, m
– Presentation examples: aba, ada, aga, etc
– Each consonant presented 12 times in random order
– Presented with carrier phrase “The next word is”
• (Tyler et al, 1983)
 Response
p t k b d g v z n m Example
p 0 2 6 2 1 0 0 0 0 1 of Iowa
S t 0 3 2 1 1 0 1 4 0 0 Consonant
t k 0 1 3 0 0 3 1 2 1 1
Confusion
i b 1 1 2 2 0 3 1 0 1 1
m d 1 0 3 2 0 0 1 2 3 0
Test
i g 1 0 5 0 2 0 0 0 0 4
l v 1 2 1 0 3 0 2 1 2 0 (example:
u z 1 2 0 2 0 0 3 0 2 2 auditory
s n 0 1 0 0 0 0 0 0 4 7
alone)
m 0 0 0 0 0 0 0 0 4 8
 Children’s Auditory Test
CAT
Auditory alone limited set
test assessing ability to
perceive stress patterns and
word recognition
Consists of 12 words
– Monosyllabic words
– Trochees
– Spondees
– Trisyllabic words
 IMSPAC
Imitative tests of Speech Pattern Contrast
Perception
Developed by Arthur Boothroyd
Syllable level, 4 lists randomized
Choose odd one of 3 (forced choice)
Pointing, button-press or verbal response
Age 7 years and up
 AB Short Word List
Isophonemic Word List
Developed in 1968 by Arthur Boothroyd
Speech recognition open set test
Each list consists of ten words, and each word is
constructed as consonant - vowel – consonant
30 phonemes, 10 vowels and 20 consonants
present in each list
CNC words
Score is based on the phonemes correct out of 30
 Question
Test developed for assessing high frequency
sounds?
A. NU-6
B. CID Everyday Sentences
C. Quick SIN
D. BKB SIN
E. UWO Plurals Test
 Hearing Tests for High
Frequency
University of Western Ontario Plurals Test
Phonak Logatome Test
BKB-SIN
Recorded /sh/ and /s/, University Western
Ontario
 UWO Plurals Test
 Scollie & et al at the University of Western Ontario (UWO)
 Recorded test
 Open set test, auditory only, with female speaker
 Tests perception of high frequency sounds (English only)
 Consists of five randomized lists of 30 words familiar to school-
aged children that have simple plural forms with the addition of a
final /s/ or /z/.
– Skunk/skunks
– Book/books
– Fly/flies
– Crayon/crayons
 Presented at 50 dB SPL from loudspeaker 1 meter directly in front
UWO /s/--/sh/ Video Game
 Phonak Logatom Test
Adaptive, computer controlled test
Developed by Phonak
Female speaker: “My name is…”
– ASA
– ASA (filter to 6 kHz)
– ADA
– AKA
– AFA
– ASHA
– ATA
Software track level in dB SPL that corresponds to
50% correct performance
 Larsen Recorded Test
Auditory word discrimination test
Pairs of phonemes in words
– few vs. chew
– bill vs. mill
– nice vs. vice
Lists represent an attempt to present the phone in
the initial, medial and final position of a word
Limited choice—select one of two words by
drawing line through printed word heard
 CAVET
Children’s Audiovisual Enhancement Test
 Assesses speechreading enhancement in children within
the vocabulary level of 7-9 year olds with profound
prelingual hearing loss
 Designed to minimize ceiling and floor effects, eliminate
syntactic factors, and minimize semantic factors
 3 lists of 20 words each with half of words easy to
recognize in a vision-only condition and half are less likely
to be recognized in each list but presented in random order
 Each list is designated for auditory alone, visual alone, or
auditory-visual only mode
 Test available in CD-ROM and VHS format
– (Tye-Murray & Geers, 2002)
 CUNY Sentences Test
The City University of New York (CUNY)
Topic Related Sentence Sets consist of 25
equivalent sets of 12 sentences of varying length
Each sentence is related to one of 12 topics
Open set sentence recognition test
Listener is presented with sentences in three
listening conditions: A, V and AV
The test is scored with the total number of words
correctly identified
(Boothroyd, Hannin, & Hnath, 1985)
 Lexical Neighborhood Test (LNT)
Lexical neighbors--words that sound similar to a target item.
Often defined as words that differ by a single phoneme from
target word
Open-set test that requires child to imitate stimulus words
immediately after they are presented
Each list consists of 50 monosyllabic words, 25 of which
are high-frequency words with few lexical neighbors (easy)
and 25 of which are lower frequency words with many
lexical neighbors (hard)
Words were selected to be familiar to children with limited
vocabularies.
– Easy Words: juice, good, drive, time, hard, gray, foot, orange, count
– Hard Words: thumb, pie, wet, fight, toe, cut, pink, hi, song, fun, use, mine,
 Alternate version of test, the Multisyllabic Lexical Neighborhood
Test (MLNT) consists of 50 words with two to three syllables.
– (Kirk, Pisoni, & Osberger, 1995)
 QuickSIN
 Provides a one-minute estimate of SNR loss for adults
 A quick method to quantify patient’s ability to hear in noise
 Can determine if extended high frequency emphasis improves or
degrades understanding of speech in noise
 Assist in choosing appropriate amplification and/or other hearing
assistance technologies
 Demonstrates directional microphones may improve speech
intelligibility in noise
 Open set test recognition test
 Consists of list of six sentences with five key words per sentence
presented in four-talker babble noise.
 Sentences are presented at pre-recorded signal-to-noise ratios which
decrease in 5dB steps from 25 (very easy) to 0 (extremely difficult).
 The SNR's used are 25, 20, 15, 10, 5, 0, encompassing normal to
severely impaired performance in noise.
 BKB-SIN
BKB-SIN
10 sentences presented
twice
Increasing noise with each
sentence
Indicates ability to
understand speech in noise
Helps audiologist select
appropriate hearing aid and
hearing assistance
technologies
 BKB - SIN
Similar to Quick-SIN but can be utilize
with children
Sentence recognition using BKB sentence
material
Open set sentence recognition test
BKB SIN test
Test score sheets
 HINT
 The HINT is a prerecorded test that measures
sentence speech recognition abilities in quiet or in
noise accurately, reliably and efficiently
 The HINT demonstrated the substantial role that
binaural, directional hearing plays in a normal hearing
individual's ability to communicate in noise
 Any degree of hearing impairment, therefore, reduces
the benefits of directional hearing in noise and
increases communication inadequacy
 Used to evaluate functional hearing capabilities of HI
users, CI users and those in listening-critical jobs
 Copyrighted by the House Institute and is available
for purchase on a compact disc recording to hearing
clinics and research laboratories nationwide.
 A children's version of the HINT is also available
 Question
Test that evaluates function of corpus
callosum in adults?
A. Quick-SIN
B. BKB-SIN
C. DSI
D. UWO Plurals Test
E. NU-6
 DICHOTIC SENTENCE
IDENTIFICATION (DSI)
 Dichotic listening task minimally affected by
peripheral HL
 Synthetic Sentence Identification (SSI) test
presented dichotically
 Onsets and offsets of sentences aligned with
accuracy of 100 msec
 Less susceptible to hearing loss than SSW test
 Viable test of central auditory function with
hearing loss
 Test applicable for auditory assessment of
(PTAs) up to 50 dBHL
 Closed set identification test
 Normative data available
 Ling-6
Phoneme level detection and
recognition test
m, s, sh, e, a, u
Procedure
Detection and identification
of phonemes
 Further Auditory Evaluations
Mark C. Flynn—Evaluation of Individuals
with hearing loss
 Assignment

Assign each test discussed in this section on

the following grid, thus,
Be able to correctly indicate on the
following template, each of the auditory
tests discussed earlier
 Speech Paradigm
Detection Discrimination Recognition/ Comprehension
Identification

Non speech
sounds

Phonemes

Syllables

Words

Phrases

Sentences

Connected
speech