Transcript Slide 1

Wilford Hall Medical Center
Lackland AFB, Texas
Word Recognition Scores:
Sentences, PB Words or Both
1Lt Malisha Patel, USAF
1Lt Matthew Williams, USAF
Clinical Fellows Audiology
DSN Phone: 554-6641
Overview
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Introduction
Background
Rationale
Methodology
Preliminary Findings
Conclusions
Recommendations
Background
• Traditional WRS testing presents challenges
– PB words: not consistent with real life communication
– PB words: open message set, does not account for
linguistic status
– Done in a quiet/controlled environment: not reality
• Need for more realistic tests that can:
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Alleviate emphasis on linguistic load
Give us performance in noise measures
Give us an idea of auditory processing
Be more representative of real world situations
Background
Purpose
• Measure efficiency and value of using
sentence tests in our test battery
• Contrast scores of PB words & sentences
• Determine contribution to diagnostic
outcome
– Is the juice worth the squeeze
Critical Frequency Regions
Sentences vs Words
COMPARISON OF PERFORMANCE vs CUTOFFS FOR SENTENCES &
MONOSYLLABLES (French & Steinberg 1947)
100%
750Hz
80%
1900Hz
Correct
Critical for Sentence Recognition
Critical for Word Recognition
60%
WORDS
40%
SENTENCES
20%
0%
200Hz
500Hz
1KHz
2KHz
Cutoff Frequency
4KHz
8KHz
Case Sample
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Sentences can show a truer picture of speech recognition ability
Monosyllables penalizes pt. for peripheral hearing loss
WORDS % PERFORMANCE
100
SENTENCES % PERFORMANCE
LE CASE THRESHOLDS
HL dB & % Correct
80
60
Dynamic
Range
40
20
0
250Hz
500Hz
1KHz
2KHz
3KHz
4KHz
6KHz
8KHz
Method/Procedures
• Subjects 37
• Audiologic Battery
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Case Hx
Immittance
AC & BC
OAEs
Speech audiometry
• Procedure
– Presentation 80 dB HL
– SSI SNR: 0dB
– Timing measure taken
• Materials
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AB words
SSI-CCM & ICM
Quick SIN
BKB SIN
SSI
• Purpose
• Measurement of sentence identification in both
Contralateral Competing Message (CCM) or Ipsilateral
Competing Message (ICM)
• Central auditory processing
• Method
• Closed set
• 10 third order sentences done at 0 SNR
• Norms
– Developed in the late 1960s
• Source: Auditec St Louis
Quick SIN
Purpose
• Measure hearing impaired performance in noise
• 1 min estimate of SNR loss
Method
• Open set
• 6 sentence lists - 5 key words per sentence in 4-talker babble
• SNRs: 25, 20, 15,10, 5, 0 (25 very easy to 0 extremely difficult)
Norms
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0-2 dB Normal/near normal SNR Loss
2-7 dB Mild SNR loss
7-15 dB Moderate SNR loss
>15 dB Severe SNR
• Source/Cost: Etymotic Research/$160
BKB SIN
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Purpose
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Method
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10 sentence lists and 8 sentence lists – 3 to 4 key words per sentence in 4talker babble
Administer two word lists to each ear
SNRs: +21 to -6 dB (21 very easy to -6 extremely difficult)
BKB Norms
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Speech-in-noise test uses Bamford-Kowal-Bench sentences to estimate
SNR loss in children, adults for whom Quick SIN is too difficult and CI
patients
0-3 dB Normal SNR loss
3-7 dB Mild SNR loss
7-15 dB Moderate SNR loss
>15 dB Severe SNR loss
Source/Cost: Etymotic Researcc/$195
Average Hearing Loss
Mean Hearing Loss (N=37)
250Hz
0
dB HL
20
40
60
80
100
500Hz
1KHz
2KHz
3KHz
4KHz
6KHz
8KHz
Hearing Loss Range
Hz
8K
Hz
6K
Hz
4K
Hz
3K
Hz
2K
Hz
1K
0H
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50
25
0H
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Comparison Worst vs Best Sensitivity
0
20
RE Best
dB HL
40
60
80
100
120
RE Worst
LE Best
LE Worst
Worse Hearing Loss at 2 KHz
Avg Worse Hearing Loss Low 20% (N=8)
250Hz 500Hz 1KHz
2KHz 3KHz
4KHz
6KHz 8KHz
0
20
dB HL
40
Mean Hearing Loss RE
Mean Hearing Loss LE
60
80
100
SNR Loss or
Speech in Noise Index
Mean Data (Jerger, JAAA Sep 05)
Quick SIN & BKB Mean SNR Data N=16
10
6
5.15
7.44
Speech Index
5
dB SNR Loss
4
5.01
Quick-SIN
3
2.56
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1
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0
Quick-SIN
Quick-SIN Speech Index
BKB-SIN
BKB Sin Speech Index
BKB-SIN
Test Time Data
3
Minutes
2
1
0
PB% (AB Words)
Quick-SIN
SSI-ICM
SSI-CCM
BKB-SIN
Performance Comparison
Mean Peformance (10 Subjects)
Correct
100%
50%
0%
PB% (AB Words)
SSI-CCM%
SSI-ICM %
BKB SIN %
Quick-SIN%
SSI DATA
SSI Performance
93%
Correct
76%
SSI-ICM %
SSI-CCM%
Conclusions
• These sentence tests provide meaningful data
– Auditory figure ground measure
– Speech recognition measure
– Replicates real world situations
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Easy for pt. and examiner
Materials easily available
Modest time investment 1-2 min/ear (@80dB HL
Juice is worth the squeeze-SRVU
Recommendations
• Quick SIN
– Adults when you want to determine SNR Loss for HA vs FM
systems
• BKB SIN
– Children where primary complaint is Auditory Figure Ground
– Children with SNHL (not pre-lingual deaf)
– Cochlear Implant candidates or CI users
• SSI
– Adults & mature children (must be able to read)
– Adults - to determine performance with HA/FM systems
– Pt. suspected of APD (ICM and CCM)
Sources
• French, N.R. & Steinberg, JC. Factors governing
intelligibility of speech sounds. J Acoustical Society of
America 19: 90-119, 1947
• Jerger, J., Speaks, C. and Trammell, JA. New
approach to speech audiometry. Journal of Speech
Hearing Disorders 33: 318-29,1968.
• Jerger, J., When up is down. Journal of Academy of
Audiology 16(8): 528-529, Sept 2005.
• Speech audiometry in Mueller, G. and Hall, J.
Audiology Desk Reference Vol 1, Singular Publishing
(1997).
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