1. Assessing Hearing Acuity & Speech Recognition
Chapter 3
Perry C. Hanavan, AuD

2. 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

3. Audiologic Evaluation
Information helpful to providing AR
Audibility
Dynamic Range
Frequency Resolution
Temporal Resolution

4. Audiologic Evaluation
Critical consideration in developing AR plan:
Time of Onset of loss
Degree of Loss
Etiology
Type of Loss
Other factors

5. 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.)

6. Pure Tone Results Degree of loss Type of loss
normal, minimal, mild, moderate, moderately severe, severe, profound
Type of loss
conductive
sensorineural
mixed

7. Functional Assessments
Ling 6
ELF
LIFE
SIFTER
COW
CHAPS
PEACH / TEACH

8. Stimulus
Units
Context
SNR
Distance/
Intensity
Familiarity
Audition
Only
Vision
Tactile
Plus
Equivalent
Lists
Many
Items
Stimulus
Units
Clinical
Significance
Listener
Variables
Test-Restest
Variability
Format
Response
Mode
Learning
Effects
Speech
Test
Factors
Within-
Subject
Statistical
Procedure
Paired
t-statistic
Open
Set
Closed
Auditory
Skill
Cognitive
Ability
Linguistic
Hearing
Loss
Com-
munication
Mode
Live
Recorded
Synthesized
Speech
Altered
Test
Reliability
Conditions

9. Stimulus Mode auditory alone vision alone tactile alone
Audition
Only
Vision
Tactile
Plus
auditory alone
vision alone
tactile alone
auditory and vision
auditory and tactile
tactile and vision
auditory, vision and tactile

10. Auditory Alone phoneme, syllable, word, phrase, sentence
open, closed set
high, low context cues
quiet, noise – signal to noise ratio (SNR)
recorded, live

11. Auditory Plus Vision 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)

12. 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.

13. Auditory Plus Vision Tye-Murray Eber CHIVE (adult) CAVET (children)
Audition plus vision
Vision only
Audition alone
Eber
Sent-Ident

14. 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)

15. Integration Enhancement
Measure of ability to integrate auditory and visual information
AV-[100-(100-A)+(100-V)]/100-[100-(100-V)+(100-A)]

17. Always put it back into hearing!
THE AUDITORY SANDWICH
First, listen.
HEAR
Visual cues:
lip-reading
printed word
cued speech
signs
Then, if need be,
watch or say it.
SEE - SAY
Then, listen again
(no visual cues)
HEAR-UNDERSTAND
Always put it back into hearing!

18. Back to “choices” AUDITORY VISUAL Auditory-Verbal Auditory-Oral
Cued Speech
Total Communication
ASL
Language
Communication
Cognition
AUDITORY
VISUAL

19. A Av AV VA V Choices reframed Fully Auditory Mostly Visual
Communicator
Mostly
Visual A Av AV VA V

20. Flexibility is essential
Fully
Auditory
Communicator
Mostly
Visual A Av AV VA V

21. Stimulus Unit
Stimulus
Units
Context
SNR
Distance/
Intensity
Familiarity
Units: phoneme, syllable, word, phrase, sentence, non-sense stimuli
Proximity: distant, near
Intensity: soft, comfortable, loud
Context: high, low context cues,
SNR: quiet, background sounds--signal to noise ratio
Familiarity: high, low familiarity with material, nonsense material

22. Case Study Test and Stimulus Type Patients’ Scores in % Al Tom Bob
Iowa Consonant Test (phoneme) 55 61 87
CAVET (word) 45 30
Iowa Sentence Test (sentences) 58 38 48

23. Question Familiarity with items, procedures…not change in ability is:
Equivalent list
Learning effect
Clinical significance
Statistical significance

24. Question
Contain items that are presumed to be equally difficult to recognize
Equivalent list
Learning effect
Clinical significance
Statistical significance

25. Learning Effects
Learning effect: familiarity with items, procedures…not a change in ability
Repeated Frame Test
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
Equivalent
Lists
Many
Items

26. Stimulus Items Live vs. Recorded Synthesized speech Altered speech
Voicing frequency
Intonation
Speech rate
Clarity of articulation
Physical characteristics
Synthesized speech
Altered speech
Time-compressed
Expanded
Filtered

27. Question Paired t-statistic: Equivalent list Learning effect
Clinical significance
Statistical significance

28. Significance Clinical significance
Within-
Subject
Statistical
Procedure
Paired
t-statistic
Clinical significance
When a small change in performance is clinically significant
When a real difference or change exists between two equivalent test results
Statistical design
Paired t-statistic
Within subject statistical significance

29. Significant Difference for NU-6 recorded speech tests SRA=86% SRA=62%

30. Listener Variables Degree of hearing loss Cognitive abilities
Ability
Linguistic
Hearing
Loss
Com-
munication
Mode
Degree of hearing loss
Cognitive abilities
Thinking, reasoning, remembering, imagining, or learning words
Linguistic abilities
Knowledge of language
Communication mode used
Multicultural

31. Effects Ceiling effect Floor effect Example study Score 100%
Perfect score
Floor effect
Score 0%
Miss all items
Example study

32. Test Reliability
Test reliability: degree to which a single test score approximates the true score
Test-retest variability: measure of 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
Test
Reliability
Conditions

33. Question Same-different essentially means: Detection Discrimination
Identification
Comprehension

34. Response Format Closed or limited set Open set Auditory skill
Detection
Discrimination
Identification
Comprehension
Open
Set
Closed
Auditory
Skill

35. Diversity Monolingual Bilingual Language appropriate tests
Nonsense syllable tests

36. Speech Recognition Tests

37. 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)

39. 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.

40. 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

41. 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

42. 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

43. 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.

44. 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

45. 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)

46. Auditory Numbers Test (ANT)1 2 3 4 5

47. 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)

48. Example of Iowa Consonant Confusion Test (example: auditory alone)
Response p t k b d g v z n m S im i l u s 2 6 1 3 4 5 7 8
Example of Iowa Consonant Confusion Test (example: auditory alone)

49. 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

50. IMSPAC Imitative tests of Speech Pattern Contrast Perception
Vowel–consonant–vowel (VCV) utterances
Developed by Arthur Boothroyd
Syllable level, 4 lists randomized
Choose odd one of 3 (forced choice)
Pointing, button-press or verbal response
Ages 7 years and up

51. 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

52. Question Test developed for assessing high frequency sounds? NU-6
CID Everyday Sentences
Quick SIN
BKB SIN
UWO Plurals Test

53. Hearing Tests for High Frequency
University of Western Ontario Plurals Test
Phonak Logatome Test
BKB-SIN
Recorded /sh/ and /s/, University Western Ontario

54. 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

55. UWO /s/--/sh/ Video Game

58. 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

59. 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

61. 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)

62. 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)

63. 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)

64. 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.

67. 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

68. 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

73. 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

75. Question Test that evaluates function of corpus callosum in adults?
Quick-SIN
BKB-SIN
DSI
UWO Plurals Test
NU-6

76. 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

77. Ling-6 Phoneme level detection and recognition test m, s, sh, e, a, u
Procedure
Detection and identification of phonemes

78. Further Auditory Evaluations
Mark C. Flynn—Evaluation of Individuals with hearing loss

82. 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

83. Speech Paradigm Detection Discrimination Recognition/ Identification
Comprehension
Non speech sounds
Phonemes
Syllables
Words
Phrases
Sentences
Connected speech