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An accurate test for measuring the speech reception threshold (SRT) for sentences in quiet or in noise has been developed. It is shown that with ten carefully selected lists of only 13 sentences each, a high test-retest reliability can be obtained. The standard deviation of SRT measured with the different lists is approximately 1 dB.
Traditional peripheral hearing tests (pure-tone thresholds, speech reception thresholds, and speech discrimination) and selected "central" hearing tests were administered to three commissurotomized patients. One patient was tested both pre-and postoperatively, whereas the remaining two were tested only postsurgery. Results indicated that commissurotomy had no apparent effects on performance on the peripheral tests. However, various tests in the central battery showed definite abnormal results. Most significant were the results from dichotically presented speech stimuli which repeatedly showed total absence of responses for stimuli presented to the left ear. Additional experimentation indicated this monaural deficit could be overcome by reducing the intensity level of right ear stimuli. Results for low-redundancy, monotically presented speech stimuli also indicated a left ear deficit; however, these results were not as consistent as the dichotic data.
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Two aspects of speech audiometry, namely, the speech reception threshold and the speech discrimination scores, have been discussed in the light of their development and present day administration. Evidence was presented to forego the concept of phonetic balance in discrimination test messages for the preferable attributes of familiarity and equated list difficulty. Campbell's redistribution of the W-22 word lists was proposed as an available solution to one of these parameters. Some delineation of the single "maximal" discrimination score's relation to the prediction of the hearing impaired individual's ability to understand continuous discourse was offered. Diagnostic implications of speech audiometry were not treated.
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Twelve adults with unilateral hearing losses were tested to determine interaural attenuation for spondaic words. Low-pass and band-pass filters were used to simulate hearing loss at the normal ear. Results suggest that in deciding on the possibility of cross hearing, the spondee threshold at the test ear should be compared to the most sensitive bone-conduction threshold at the nontest ear, excluding .25 kc/s.
The surgical results in 78 recent cases of total removal of unilateral acoustic neuroma in which an attempt was made to preserve cochlear function have been added to the authors' previous series of 66 cases to evaluate the factors influencing the ability to preserve useful hearing. Useful hearing was defined by speech reception threshold no poorer than 70 dB and a discrimination score of at least 15%. Analysis using a logistic regression model showed that certain preoperative clinical parameters such as tumor size, speech discrimination score, and gender were significantly correlated with hearing outcome. Favorable outcome was significantly correlated with smaller tumor size, higher preoperative speech discrimination score, and male sex. From this data, an explicit formula was devised for predicting hearing outcome for an individual patient. In four cases with useful hearing preserved, there was improvement of greater than 15 percentage points in speech discrimination scores. While preoperative auditory brainstem responses were not predictive of hearing preservation, monitoring of intraoperative auditory evoked potentials was predictive of hearing outcome in selected cases. Specifically, when wave V was unchanged at the end of the operation, even if it may have been transiently lost during surgery, useful hearing was invariably preserved.
The reliability of SRT and speech intelligibility tests has been studied on adults. Reliability estimates for SRT are between .60 and .90, with standard error estimates from 1.5 to over five dB. For speech intelligibility tests the reliability estimates range from .50 to 90, with standard error of estimates from 2.5% to over 10%. Little has been reported on test reliability with children. For this study the TIP and DIP tests, for threshold and discrimination, respectively, were given to 295 normal and 138 hypacusic children three through twelve years of age. Subjects were retested within one week. TIP test-retest reliability was .72 for normals, and .89 to .99 for hypacusics. DIP test-retest reliability was .46 to .51 for normals and .60 to .93 for hypacusics. Standard error of estimate was about 3 dB for TIP, and 10% for DIP. These values are about the same as the reliability values for adults.
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We found that a relationship existed between degree of sensorineural hearing loss and discrimination score obtained in free field with convenient hearing aids against background noise. However, the standard deviation was so great that we could not elaborate a diagram from which, with any reasonable degree of accuracy the expected discrimination score with suitable hearing aids could be predicted for each individual patient. Then 20 patients with sensorineural hearing losses tried different hearing aids under everyday listening conditions, and simplified speech audiometry against background noise was performed. We found that none of the patients achieved better discrimination scores with aids they rejected under everyday listening conditions than with aids they preferred. This indicates that we need to pay attention to the patient's experience with hearing aids under everyday listening conditions in each individual case, when a hearing aid is to be selected.
Multichannel cochlear implants currently provide the only modality for successful auditory rehabilitation of patients with bilateral profound sensorineural hearing loss who derive no benefit from amplification. We have developed a protocol for patients with neurofibromatosis and bilateral acoustic neuromas in which every effort is made to preserve hearing in at least one ear. Failing that, the cochlear nerve is spared, potentially allowing for the insertion of a cochlear implant. We present our data on one such patient whose auditory function was restored with a Nucleus mini 22-channel cochlear implant following removal of his acoustic neuroma.
The development of tests for measuring speech reception in the hearing impaired is reviewed. The rationale for a new closed-response-set nonsensesyllable test is presented followed by a description of the test. Preliminary normative and comparative data for this Nonsense Syllable Test are reported. Current work on the development of related tests for young, profoundly deaf children, and measuring reception of the prosodic features of speech is also described.
Ascending and descending procedures were used to obtain speech reception thresholds from 32 normal-hearing subjects whereas digits and spondee words were used as test materials. Comparisons of thresholds were made for the two procedures and materials. Results indicated that slightly lower (less SPL) speech thresholds resulted from the use of a descending procedure with both types of material. In addition, digit material was found to yield generally lower threshold values than spondees. Advantages to the use of the two procedures and materials are discussed.
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Decompression and drainage of the endolymphatic sac is a surgical procedure which was developed to relieve vertigo and hopefully to maintain or improve hearing in patients with Meniere's disease. In this study, 16 medically diagnosed Meniere's disease patients who underwent endolymphatic sac surgery were followed audiometrically for a period of up to three years. Pre- and postoperative audiometric and other symptomatic findings were reported. Results indicated that in the greatest majority of cases hearing remained essentially unchanged or was improved. Poorer hearing was found in 26.3% of the cases for pure tones and in 15.8% of the cases for speech reception thresholds and speech discrimination scores. Due to the fluctuating nature of auditory thresholds in Meniere's disease, it was found to be essential that patients be followed postoperatively for a period of at least three years.
Subjects suffering from noise-induced hearing loss (NIHL) with or without hearing loss at 2 kHz were examined by speech audiometry with a three-digit test, bisyllabic and monosyllabic PB word lists in silence, and in USASI noise with a masking effect of 44 dB and 68 dB at 1 kHz. Subjects with up to 20 dB hearing loss at 2 kHz had almost the same speech comprehension in noise as normal hearing subjects. Subjects with hearing loss greater than 20 dB at 2 kHz had increasing discrimination loss at increasing noise levels. They also needed a signal-to-noise ratio better than normal-hearing persons would yield at the noise levels used. The evaluation of hearing disablement in occupational noise-included hearing loss should therefore be based for one-half on the results of speech audiometry in silence, and for the other half, in noise.
Thirteen subjects with normal hearing and thirteen with sensorineural hearing loss were tested with spondaic words to determine their spondee thresholds in the presence of several levels of contralateral noise. Results indicate that the threshold shift ascribed to central masking is a function of the sensation level of the noise. Recommendations for clinical application are made.