Speech Audiometry flashcards |

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Speech Reception Threshold (SRT)

-The quietest level they will say words back 50% of the time

-We use spondee words (EX: railroad, birdnest, highchair)

-NO carrier phrase

SRT: Purpose

-Used to confirm the results of pure-tone testing.

-Compare to the pure-tone average (PTA) to ensure "good" agreement

-Used to determine the softest level that speech can be understood and repeated approximately 50% of the time.

SRT: Procedure

1. Begin testing at a level that the patient can understand, approximately 30 dB SL above the PTA.

2. For the transducer use headphones, inserts, or sound field.

3. The mode of stimuli can be either CD or live-voice. When using live-voice, clinician must monitor the VU meter.

4. Use an age-appropriate spondaic word list. If the patient is unable to repeat words use a picture-pointing task.

5. Familiarize the patient with 10 words.

6. Using the Hughson-Westlake method, repeat the same 10 spondee words in a random order.

7. If the patient responds by repeating the word correctly decrease by 10 dB HL. If incorrect increase by 5 dB HL.

8. Repeat this process until 2 out of 3 words are correctly repeated at the same intensity level.

SRT: Interpretation

-Compare the SRT to the 3-frequency PTA:

0 to 7 dB HL = GOOD AGREEMENT

7 to 10 dB HL = FAIR AGREEMENT

>10 dB HL = POOR AGREEMENT

Speech Awareness Threshold (SAT)

-They just have to be aware, they don't have to say it back

-Same as pure-tone, so they don't have to respond by repeating words

-Use running speech

SAT: Population

-We use on people with diminished cognitive abilities or children

SAT: Purpose

Used for young children to determine the threshold or softest level that the patient is aware of speech.

SAT: Procedure

1. For the transducer use headphones, inserts, or sound field.

2. The mode of stimuli is live-voice.

3. Use the ascending method to determine the child's threshold.

4. Begin testing at a level below the assumed threshold.

5. Make sounds/noises to get the attention of the child.

6. By asking questions, singing, counting, etc. (i.e., "Where am I?", "Twinkle twinkle little star").

7. Increase in 10 dB HL steps until the patient responds.

8. Repeat this process until the patient responds 50% of the time at the same intensity level.

SAT: Interpretation

-Compare the SAT to the PTA-10dB:

0 to 7 dB HL = GOOD AGREEMENT

7 to 10 dB HL = FAIR AGREEMENT

>10 dB HL = POOR AGREEMENT

Word Recognition Scores (WRS)

-Use monosyllabic words

-Use carrier phase (e.g., "Say the word____)

WRS: Purpose

-Used to determine the patient's ability to understand speech at a comfortable level.

-Helps determine whether the loss is cochlear or retrocochlear.

WRS: Types of Lists

-Open set: I just say words and you say them back

-Closed set: I say a word and you have 4-8 pictures to choose from, or they could check it off from the word set you provide them

-Child List: picturing pointing, PBK-words

-Adult List: W-22, NU-6, etc.

-Special high-frequency list

-All sounds list

-Word Intelligibility by Picture Identification (WIPI): in color, 6 choices

-Northwestern University Children's Perception of Speech (NuChips): black and white, 4 choices; for children with disability (e.g., autism, etc.)

-Words vs. sentences

WRS: Presentation Levels

-30 to 40 dB SL of SRT (PTA)

-55 dB HL for hearing aids to see if they can do normal convo level.

-80 dB HL: give loud level for neurodiagnotics (don't typically use for neuro, may not actually be loud) - To see how they respond with hearing aids with loud speech

-UCL - 10dB

-Depends on what types of diagnostics info we are trying to get (we use 30 to 40)

WRS: Procedure

1. Begin testing at either 30 dB SL or 40 dB SL above SRT.

2. Use the same presentation level throughout test.

3. Do not familiarize patient.

4. Use an age-appropriate word list with phonetically balanced one-syllable words (e.g., PBK, NU-6, CID W-22).

5. Use a carrier phrase (i.e., "Say the word ____").

6. When to stop testing:
-If the patient gets all of the first 10 words correct, stop. If the patient misses all of the first 10 words, stop.
-If the patient misses 3 words or less, stop at 25 words. If the patient only gets 3 words or less correct, stop at 25 words.
-If the patient misses more than 3 words, present all 50 words.

WRS: Interpretation

4 Components

1. Functionality (good/fair/poor)

2. Compared to the PTA

3. Difference b/w ears (right to left ears)

4. Within the same ear (quitter and louder) if we add more than 30 to 40 dB SL to the SRT/PTA

WRS: Interpretation

1. Functionality

-Excellent: 96-100%

-Very Good: 88-95%

-Good: 08-87%

-Fair: 70-79%

-Poor: 50-69%

-Very Poor: < 50%

WRS: Interpretation

2. Compare with PTA

-Dubno table- has the discreet value you can have and still be consistent with the PTA

-EX: PTA = 40 and 76% (62% and up would be in agreement) (look at the chart on pg. 499)

-EX: PTA = 30 and 66%; It is not in agreement, so there may be a neurologic or retrocochlear problem

WRS: Interpretation

3. Difference b/w Ears

-Raffin and Thornton packet (on the front of packet she wrote what would be sig.)

-.00 = sig. (the more 00s it gets the more sig. it is)

-- = very sig.

-.integer = not sig.

-.01, .02, .03, .04 = sig.

-.06, .07, .08, or .09 = not sig.

-.05 = on the fence if it is sig.

WRS: Interpretation

4. Within the Same Ear

-If the second score gets worse when we turn up the intensity we are taxing the system, and we know that there is a neurological problem

-At a higher intensity, if the score gets significantly worse there is a neurologic or retrocochlear problem.

-Look at PI-PB

WRS: Retrocochlear Red Flags

-A significant difference between the PTA and WRS of the same ear.

-The WRS is significantly different between ears.

PI-PB: Purpose

-Helps determine whether the hearing loss is retrocochlear or cochlear.

-Checks for Rollover

PI-PB: Rollover

As the intensity increases, scores will significantly decrease.

PI-PB: PB Max

the highest score/best WRS

PI-PB: PB Min

the lowest score/worst WRS

Rollover Index (RI) Formula

(PB Max - PB Min) / PB Max

PI-PB: Procedure

1. WR Starting level: SRTTE + 10 dB SL

2. Increase intensity in 10 dB SL step

3. The patient's score should max out (PB Max) and begin to rollover (drop)

4. After the rollover, the lowest score is the PB Min.

5. Use the RI formula to determine if the results suggest a cochlear or retrocochlear loss.

6. Record results

PI-PB: RI Interpretation

-Retrocochlear: โ‰ฅ .45

-Cochlear: โ‰ค .40

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