MINING THE BASICS OF TESTING - International Hearing Society · •Greater test consistency across presentation •Ideal for word recognition testing •Slower •Multiple studies

S H E L L Y B O E L T E R , A U D C C C - A

C . S C O T F R I N K , M S F A A A

MINING THE BASICS OF TESTING

These presentations slides will be available to download at

ihsinfo.org/convention

INTRODUCTION

• So why get back to the basics? Do they ever really

change?



GOODBYE TO THE WORD “LAUD”

• The International Committee of Speech Recognition

Measures (ICSRM) held their annual meeting March

4th, 2011, in conjunction with the American Auditory

Society Scientific and Audiology meeting.


• In an unprecedented move, this prestigious group

of researchers resolved to remove the word "laud"

from the Northwestern University List #6. ICSRM

President Richard Wilson stated: "Although we all

have a certain fondness for "laud," its usefulness has

run its course.

• At this point, it may be best to move on. The intent

of speech recognition testing is not to trick the

subject using archaic or unfamiliar test items".


• Following this action, a sub-group was formed,

which led to the recommendation of adding the

replacement word "broad” as this new item would

closely maintain the phonemic balance of the list.


• This was opposed, however, by some group

members, in that broad is not "gender-neutral" and

could be deemed offensive to females.


• This issue was forwarded to the ICSRM Word Review

working group, who also continue to study the

appropriateness of the word “but.”


• Until a suitable replacement for laud is approved,

the ICSRM recommends that clinicians conduct

testing with 49 rather than 50 word lists, and use the

multiplier of 2.041 to calculate percent correct

scores.


• Because the list is supposed to be phonemically

balanced, those who are used to using only 25

words at a time should instead use 24, and

therefore a multiplier of 4.166666666667.


• The ICSRM is seeking input on this issue from the

audiology community and the general public.

Comments and feedback can be submitted at

www.icsrm.org

http://www.audiologyonline.com/our_company/april_laud.asp


• Starting last Wednesday, March 28, a group of the

audiologists who considered themselves the

“2.041%” established a tent camp outside of the

Boston Convention Center to officially protest the

decision of the ICSRM.

• Many in particular are infuriated by the need to

revise office forms, often at great expense.


• To help support the movement, the website

www.SaveTheWordLaud.com has been created.

• It includes an online petition that can be “signed”

to forward to the ICSRM, started by audiologist Jack

Scott.

http://www.savethewordlaud.com/



• According to Scott, “If we continue down this path,

we might as well start removing all the nonsensical

things still hanging around since the inception of our

profession - like the Libby fitting formula. Why is it still

being provided in the Audioscan? Doesn't anybody

remember it was developed by an optometrist!”


• In order to raise funds for the cause, Dr. Scott and

AudiologyOnline founder Paul Dybala have started

a fundraiser through www.CafePress.com to sell

apparel to spread the word about the issue.

http://www.cafepress.com/


• Not being a fan of the Occupy movement,

however, I feel we should abide by the ICSRM

decision.

April 1, 2012.

• We need to expedite our transition since the

ICSRM made their decision effective…

OUTLINE

• The audiogram

• EXAMPLE:

Oregon state law audiometry requirements

• Pure tone audiometry

• Speech testing

• Masking

• Additional tests

THE AUDIOGRAM

OREGON STATE LAW

• Established minimum basic guidelines for testing required to fit hearing aids, September 2006.

• ORS 331-640-0050

• Additional Standards of Conduct • (b) Puretone Air Conduction Threshold testing (should include at a

minimum, the following frequencies - 250, 500, 1000, 2000, 3000, 4000, and 6000 or 8000 Hz);

• (c) Puretone Bone Conduction Threshold testing (should include at a minimum, the following frequencies - 500, 1000, 2000, and 4000 Hz);

• (d) Speech Recognition Threshold testing (SRT);

• (e) Word Recognition Score (WRS) also known as speech discrimination testing;

• (f) Most Comfortable Listening Level (MCL); and

• (g) Uncomfortable Listening Level (UCL).

• Other states may vary, but this is an example

PURE TONE AUDIOMETRY

• Recommended test frequencies are 250, 500, 1000,

2000, 3000, 4000 and 6000 or 8000

• Industry standards recommend testing interoctaves

(750, 1500, 3000, 6000) if there is a 15dB or greater

difference between the octaves.

• Descending method is preferred (down 10, up 5)

with a repeat response at two levels for

confirmation.

• Mask as needed (interaural difference of 40dB when using

TDH39 headphones, 70dB using insert earphones)


• Effects on hearing aid frequency responses…







SPEECH AUDIOMETRY

• Monitored live voice (MLV) vs Recorded

• MCL= Most comfortable loudness

• UCL= Uncomfortable loudness

• SRT= Speech recognition threshold

• Word recognition/ discrimination

MLV VS RECORDED

• Monitored Live Voice (MLV) • MUST be carefully monitored

• Offers greater flexibility for the patient (i.e. pediatrics, Alzheimers)

• Sometimes quicker

• Recorded • Greater test consistency across presentation

• Ideal for word recognition testing

• Slower

• Multiple studies found satisfactory test/ re-test reliability for carefully monitored live voice and recorded (Katz, 2002)

• However, there are potential legal implications when using MLV…

MCL AND UCL

• Most comfortable loudness (MCL)

• For normal hearing acuity: 45-50 dB HL

• Uncomfortable loudness (UCL)

• For normal hearing acuity: ~100 dB HL

• MCLs:

• Discrimination testing

• Determining hearing aid candidacy

• Counseling

• Speech UCLs:

• Hearing aid fitting

• Counseling

SRT

• Speech recognition threshold

• Use spondee words

• ‘Approved’ list of words went from 84 20 most common

Airplane Birthday Cowboy Farewell

Greyhound Hardware Iceberg Mousetrap

Mushroom Northwest Oatmeal Playground

Railroad Sidewalk Stairway Sunset

Toothbrush Whitewash Woodwork Workshop

SRT

• Purpose of SRT Test:

• Check puretone results for consistency

• PTA of 500, 1000, and 2000 Hz (+/-10dB)

• Determine hearing sensitivity for speech

• Indicator of amount of impairment

• Normal/ slight/ mild/ moderate/ severe

• Determine suprathreshold test levels to use for

other tests

RECOMMENDED SRT PROCEDURE

• Test better ear first

• No carrier phrase needed

• Most use MLV, but can use recorded

• Get the first syllable of test word to 0 on the VU meter

• Equal stress on each syllable

• Familiarize patient with spondee list at MCL

• Descending volume approach until a score of 50%

is obtained at one level (2 of 4 words per test level)

• Mask as needed (interaural difference of 40 dB or

more)

WORD RECOGNITION

• Word Recognition Score= WRS

• Phonetically balanced (PB) words used

• Speech sounds occur with the same relative frequency as

they do in a sample of running speech

• Consonant-vowel-consonant (CVC)

• ‘Open set’ words

WRS WORD LISTS

• PB-50 • Lists of 50 words • First recorded list available • Focused on the CVC syllable

• W-22 • Uses 120 commonly used words from the PB-50 plus another 80 extra • Four lists of 50

• Carrier phrase: ‘You will say’

• NU-6 • Focused on phonemic balancing • Four lists of 50 (1st 10 words of each 25 are weighted)

• Carrier phrase: ‘say the word’

• Maryland CNC • Focuses on the transitional shifts between consonants and vowels • Carrier phrase: ‘Say the _____ again’ • Used frequently with some GSA evaluations (i.e. VA candidacy)

RECOMMENDED WRS PROCEDURE

• Recorded voice

• Test at these levels:

• PB-Max= SRT + 30 dB HL

• If different than the PB-Max, also test at:

• Normal conversational speech= 45/ 50 dB HL (optional)

• MCL (required)

• Mask NTE if needed

• Full list vs Partial list

• ORS minimum is 25 words

• Mask as needed (interaural difference of 40 dB or

more)

RECOMMENDED WRS PROCEDURE

• OPTIONAL: Testing at normal conversational speech (45/50) • If you only test at MCL, you’re only getting the patient’s

results at an amplified level and not defining the patient’s impairment.

• Example #1: WRS @ 70dBHL is 96%, but WRS @ 45 is 92%--an improvement of only 4%--limited improvement suggests you should test for performance in noise!

• Example #2: WRS @ 70dBHL is 96%, but WRS @ 45 is 44%--an improvement of 52%--significant improvement. Good candidate!

• Testing at 45dBHL, where appropriate, helps reduce returns for credit.

INTERPRETING WRS

% Correct Degree of Impairment Word Recognition

Ability

100-90 None Excellent/ Normal

89-75 Slight Good

74-60 Moderate Fair

59-50 Poor Poor

<50 Very Poor Very Poor

Source: Lawson, G. &Peterson, M. (2011)

UCL TESTING

• Question: Speech UCLs or Tone UCLs?

• Advantages / Disadvantages for Speech UCLs

• Quicker than tone UCLs (+)

• Broadband response, real-world relavance (+)

• Less accurate in hearing aid response, flat UCL (-)

• Advantages / Disadvantages for Tone UCLs

• Graduated approach (+)

• More accurate than speech UCLS with aid response (+)

• Takes longer than speech UCLs (-)

UCL TESTING

• Method—General

• Start at MCL

• Increase in 5-10dB increments until UCL is reached.

• Speech UCLs:

• Typically, use MLV, with patient responding “soft, medium,

loud, too loud.”

• Tone UCLs:

• Typically start at threshold (500, 1000, 2000, 4000), with

patient responding “soft, medium, loud, too loud.”

UCL TESTING

• Effects of frequency response (no UCLs)

UCL TESTING

• Effects of frequency response (Tone Specific, average)

UCL TESTING

• Effects of frequency response (Tone Specific, recruiting)

UCL TESTING

• Effects of frequency response (speech average)

SPEECH IN NOISE TESTS

• HINT is more traditional.

• Presentation of words, +5dB SNR

• Scored similar to WRS

• Takes about the same amount of time as WRS (5m per ear

with 25 words)

SPEECH IN NOISE TESTS

• QuickSIN is more practical and has been demonstrated to be just as accurate. • Presentation of sentences, varying SNR

• Scored based on 5 key words in each sentence

• Progressively worse SNR

• Generates a score indicating the patient’s “signal-to-noise loss” (-4.5 to 25.5dB)

• Each dB is equal to ~10% difference in WRS in comparison to quiet when tested at an equivalent level. Example:

• WRS @ 45dBHL: 96%

• QuickSIN score of 5.5 @ 45dBHL estimates 55% worse performance in background noise, or 41%.

• Only 60 seconds per ear (hence: Quick!)

QUESTIONS



Please complete

an Evaluation Form for this seminar

CONTACT INFORMATION

• C. Scot Frink

• [email protected]

• (503) 588-1039



mailto:[email protected]



REFERENCES

• Lawson, G. & Peterson, M. (2011). Speech Audiometry. San

Diego, CA: Plural Publishing Inc.

• Katz, J. (Ed.). (2002). Handbook of Clinical Audiology (5th ed.).

Baltimore, MD: Lippincott Williams & Wilkins.

• Turner, R. (2004). Masking Redux I: An Optimized Masking

Method. Journal of the American Academy of Audiology, 15: 17-28.

• Turner, R. (2004). Masking Redux II: A Recommended Masking

Protocol. Journal of the American Academy of Audiology, 15:

29-46.

Documents

MINING THE BASICS OF TESTING - International Hearing Society · •Greater test consistency across presentation •Ideal for word recognition testing •Slower •Multiple studies