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Audiology Speech Testing

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Title: Audiology Speech Testing


1
Audiology Speech Testing Reflex Testing
  • CEP ACAud , 2008
  • Joyce M Dalgleish
  • BSpThyHons(Aud) FACAud MAudSA.CC

2
Speech
  • Is a secondary to hearing developmentally
  • Humans are biologically programmed to learn
    speech and language
  • It is an, ephemeral, supra-threshold signal
  • It is highly redundant but highly dependent on
    prior learning and contextually based
  • What is an awl? / What is a owl?

3
Phoneme
  • Smallest unit of sound that alters the meaning of
    a word
  • /c/ /a/ /t/ a pet- has staff
  • /c/ /a/ /p/ head apparel

4
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5
The Introduction of Speech Testing
  • Suprathreshold speech-recognition testing, also
    referred to as speech discrimination testing, has
    been used for 50 years.
  • Five main uses of word recognition tests include
    (Gelfand, 1997 Silman Silverman, 1997)
  • To assess the degree of hearing handicap as it
    relates to communication ability.
  • To determine the site of lesion.
  • To determine the need for, and to monitor
    progress in aural rehabilitation.
  • To compare hearing aid performance.
  • To monitor patient performance over time.

6
Speech Materials
  • Wordlists
  • PB Wordlists 50 items - whole word score
  • AB Wordlists 10 items phoneme score
  • Spondee Words down town SRT .SAT SSW
  • Time Compressed Words Central Processing
  • Sentence Material
  • Go change your car colour is red site of
    lesion - SSI
  • SPIN HP/LP context / high frequency
    audition

7
Appropriate Selection
  • Selection of materials must be appropriate to the
    task.
  • Some speech material are not appropriate for
    evaluation of hearing aid performance.
  • Word lists need to be culturally and age
    appropriate
  • They must reflect know vocabulary and may
    need forms that avoid speech problems e.g. to
    use a pointing response to overcome articulation
    problems with children or CP clients.

8
PB Wordlists
  • Most of the speech research has been done on PB
    words 50 items in each list and the whole word
    is either wrong or right
  • Has a gradual performance curve so that there is
    not such a strong ceiling effect.
  • Takes a long time to do
  • Half lists are popular but still take time if you
    perform a full discrimination function.

9
PB Wordlist
  • bat least oils or peck pert pinch pod race rack
    rave raw rut sage scab shed shin sketch slap sour
    starve strap test tick touch bee blonde budge
    bus bush cloak course court dodge dupe earn eel
    fin float frown hatch heed hiss hot how kite
    merge lush neat new

10
Speech Function Curves
11
AB Wordlists
  • Boothroyd and Nittrouer (1988) developed twelve
    lists each consisting of ten phonetically
    balanced CVC words with similar structure to the
    isophonemic lists developed by Boothroyd (1968,
    1984).
  • Boothroyds original lists were termed
    "isophonemic" because they each contained the
    same 30 phonemes in different meaningful word
    combinations.
  • The term "phonetic balance" indicates that speech
    material has a phonemic composition equivalent to
    that of everyday speech. Though phonemic
    balance is a better term.
  • For their CVC lists Boothroyd and Nittrouer
    (1988) selected words that appeared in the
    Thorndike-Lorge word count based on 4,500,000
    words appearing in American literature,
    magazines, etc (Lyregaard, 1987).
  • .

12
AB Lists 1 -15
  • Each word is scored on phonemes.
  • Three per word and the results are
  • recorded as a percentage at
  • presentation level.
  • Routinely three lists is needed to
  • indicate a speech function curve.
  • List 1
  • Rug
  • Ship
  • Fan
  • Cheek
  • Haze
  • Dice
  • Both
  • Well
  • Jot
  • Move

13
Curves for AB and PB Lists
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15
What Do You Do ?
16
A Speech Function Assessmentminimum fuss
  • Perform PTA . Instruct patient.
  • Calculate predicted AB MAX (consider SPL or HL)
  • ( OTEN or, 30dB above 1KHz threshold or 20dB
    above 3FAHL. (Use of MCL not appropriate here )
  • Test at that level ABMax 100 or 95
  • Next Increase by 10/20/30/40dB and retest
    looking for ABMax (if not achieved) or rollover.
  • Rollover assessed at high intensity and must be
    greater than 20 decrease in score.
  • Decrease from AB Max to establish SRT.
  • Plot on Speech graph and observe the curve
    obtained.
  • Masking in the non test ear should be standard.
    Consider using the best bone conduction threshold
    of the non test ear. For masking select a speech
    band noise.

17
Assessment by the book
  • Conduct full PTA with ULL bilaterally
  • Calculate speech and masking levels
  • Speech eHPL 19dB
  • Masking MwDs-9-BBCnt
  • Where eHPL average of best two AC thresholds of
    test ear for 250Hz 4KHZ
  • Mw threshold for speech noise in test ear
  • Ds speech dial setting
  • BBCnt best BC threshold in non-test ear

18
Continued
  • Instructions You are going to hear someone
    speaking single words, at the beginning the words
    will be at a comfortable level but they will
    gradually become quieter and finally louder.
    Please listen carefully and repeat after each
    word what you think you have heard, even if it is
    only part of a word. Ignore and sounds that may
    be present in your other ear.

19
Continued
  • Play fist list and score the correct phonemes in
    each word.
  • Reduce speech and masking by 10db and repeat
    lists until the total score is less than 10.
  • Present at 20dB above initial settings and repeat
    until ULL is reached.
  • Calculate optimal discrimination score (ODS),
    determine half peak level (HPL)dB
  • Calculate half peak level elevation (HPLE )
    HPL-HPLn
  • where HPLn normal HPL for that
    equipment
  • (subjective calibration curve)
  • Compare ODS and HPLE with PTA and investigate
    possibility of Rollover effect
  • THE END except to do it again for the other ear

20
Relationship of ST /SRT and SAT to PTA and
3FAHL
  • SAT Speech Awareness Threshold .
  • This is the level at which the person is aware
    that the signal is speech . They do not have to
    understand the words. This will usually be 10dB
    lower than the ST and the 3FAHL unless the loss
    is steeply sloping .
  • ST /SRT Spondee Threshold / Speech Reception
    Threshold
  • This is the lowest intensity at which a person
    can repeat two syllable words with 50 accuracy  
  • What is the relation ship between the ST /SRT and
    the 3FAHL?
  • The ST and 3FAHL are very similar
  • TAKE HOME MESSAGE ST and SAT can be used as an
    internal test of the validity of the pure of the
    audiogram where you doubt the responses given.  

21
What is a "good" score? How do you interpret a
word recognition score?
  • Normal scores are near 100, if the stimulus is
    presented at 30 dB SL or above, at MCL or above. 
  • Cochlear losses and significant hearing losses
    will not have a normal score, but we want to know
    how well they hear with amplification.  
  • A score of 20 is poor and we will need to
    consider why it is poor. Is it the level of the
    hearing loss? Is it consistent with the history
    e g Active Menieres
  • Is it too poor for the audiogram in which case we
    wonder if there is a retro-cochlear lesion.
  • Is the score the same for air and bone
    conduction, if much better by bone is the
    patient eligible for BAHA?  

22
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23
Why is this testing conducted?
  • Word recognition testing provides a relative
    indicator of the difficulty the person has, and
    alerts the audiologists to persons who have
    unusually poor (or unusually good check for
    malingering) scores. 
  • Very poor scores are a sign of possible
    retrocochlear involvement, and further testing is
    needed. 
  • Low scores when testing is conducted at a
    comfortable level indicate that the person may
    have limited benefit from hearing aids.

24
Dymanic Range for Speech Testing what does it
mean ?
  • If the spondee threshold is 10 dB HL, and the UCL
    for speech is 90 dB HL, what is the speech
    dynamic range? Answer 80dBHL - Fitting
    not too much of a worry with intelligibility vs
    UCL
  • But what if its 30dBHL?
  • that is t he threshold is 60 dB HL and the UCL
    is 90dBHL
  • It is good to know this before you go into a
    fitting situation , although the aids may try and
    counter this the more the dynamic range is
    squashed the more likely that distortion will
    occur. Yes even in wonderful digital aids.

25
If you suspect a client is having central
problems
  • Use some of the central speech tests to show
    that there is central involvement (not just a
    poor fitting!).
  • Try some time compressed speech
  • 30 and 60 compression lists and check the
    client against norms.

26
With Hearing Aid Assessment
  • What are you using now?
  • What are we trying to do?
  • What else could we use?

27
SPIN Testing
  • Using the SPIN in conjunction with your hearing
    aid fittings/adjustments will give you useful
    information
  • Check the difference with HP and LP Lists
  • If the fitting is poor on LP consider
  • doing more fine tuning Please!

28
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29
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30
Using Speech with REAR
31
Speech Testing Can be Your Friend!
  • Thanks for listening.

32
Reflex Testing
  • Review of anatomy
  • Equipment and testing
  • Test profiles
  • Interpretaion

33
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34
Reflexes happen simultaneously in both ears
  • If a loud sound is presented to just one ear
    (monaural presentation), the reflex in normal
    hearers will occur bilaterally.  Since the
    reflex pathway has decussations (the neural
    pathways cross the head), the reflex can occur
    in both ears, even though the stimulus was just
    to one ear.

35
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36
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37
Three parts need to be working Input ear
Hearing Stimulus / Crossover in Brainstem/
Output Stapedius muscle innervation
38
What Muscles Contract in Reflexes
  • Primarily, the stapedius muscle innervated by the
    facial nerve twig in the middle ear. 
  • Most research says that the tensor tympani is not
    active in humans.
  • Contraction of the stapedial muscle stiffens the
    middle ear system, and the added stiffness
    reduces the transmission of low-frequency
    sound.  

39
When does it happen?
  • When a loud sound occurs a stapedial
    musclereflex occurs.  Loud sounds are sounds
    about 70 dB HL and louder. 
  • Some normal listeners will not have a reflex
    until the sound is as high as 95 or 100 dB HL.
  • You can also have a reflex to non-auditory
    stimuli.  For example, a puff air to the eye will
    cause a stapedial reflex.  

40
What is recruitment ?
  • Recruitment is when a person with hearing loss
    still has normal perception of loud sounds.  This
    is an odd phenomenon - the person does not hear
    soft sounds but loud sounds are perceived
    relatively normally. We can theorize that the
    loss of the active mechanism of the inner ear is
    responsible for this phenomenon. 
  • The outer hair cells are suppose to
    shrink/elongate to accentuate the movement of
    basilar membrane, which causes greater shearing
    of the inner hair cell cilia and thus aids in
    the perception of very soft sounds.  If the outer
    hair cells are dead, then the active mechanism
    cannot occur. When sound is loud enough, though,
    the movement of the basilar membrane directly
    stimulates the inner hair cell cilia. So, loud
    sounds are heard, and perceived as loud!  That is
    recruitment.
  • So, a sound at 55 dB above threshold in a
    cochlear impaired person, the sound is perceived
    as loud and therefore
  • triggers an acoustic reflex.

41
Cochlear , Conductive and Retrocochelar, Who
has reflexes ?
  • All cochlear losses will have reflexes depending
    upon the level of the hearing loss.
  • Conductive losses do not have reflexes
  • Retrocochoclear losses often have absent reflexes
    as the first sign of involvment, but they are not
    always absent in the presence of a small CPA
    tumor

42
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43
Probe Tip
  • Manometer
  • Probe tone
  • Receiver
  • Sound reflected

44
What are the parts of the acoustic reflex
measurement system?
  • The device, just like the tympanometery, has a
    sound generator to produce the 226 Hz probe
    tone.  It has a pressure pump, and a manometer to
    measure the pressure in the hermetically
    (air-tight) sealed ear canal. It has a measuring
    microphone that measures the intensity of the
    sound in the ear canal.
  • Additionally, there is a sound generator to
    create the loud reflex eliciting sounds, and a
    way to control the intensity and frequency of the
    reflex eliciting sounds.
  • The reflex eliciting sounds can be channeled to
    the probe, or can be sent to the earphone or the
    other ear. 

45
Reflexes are measuredat the Point of Maximum
Compliance
  • This is important if you have a leaking seal or
    the equipment has not stored the correct pressure
    for the performance of acoustic reflexes

46
Reflexes are Tested at the Point of Maximum
Compliance.
47
Distribution of Tympanogram in Different
Pathologies p26Jerger Jerger Maudlin Anthony 1973
48
  • Bilateral super-threshold activation.
  • Depends on the integrity of
  • The hearing in the stimulus ear
  • The middle ear status of the probe ear
  • The integrity of the central reflex arc

49
Normal Reflex Pattern
50
Right Stimulus Ear
51
Left Probe Ear
52
Left Stimulus Ear
53
Possible Brainstem
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