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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 • • • • • • • 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: – – – – 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 • • 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 – – – – – Case Hx Immittance AC & BC OAEs Speech audiometry • Procedure – Presentation 80 dB HL – SSI SNR: 0dB – Timing measure taken • Materials – – – – 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 – – – – 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 • Purpose • • Method • • • • 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 – – – – • 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 z 50 25 0H z 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 2 1 0 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 • • • • 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). Integrity First Service Before Self Excellence In All We Do