Measuring speech-in-noise abilities as part of the standard audiometric protocol

Abstract

Many apsects of the audiologic test battery have remained unchanged for decades, and do not assess the real-world communicative abilities of the patient. For example, word-recognition in quiet is the default test of speech recognition, despite difficulties understanding speech in noise being the primary complaint of most patients. Our goal is to adjust the audiologic test protocol to better assess the communicative abilities of the patient. Towards that goal, we are devising a new clinical protocol in which speech-in-noise testing, rather than word-recognition in quiet, is the default speech test in the audiologic test battery. We have data on over 1500 adults, which indicate normal audiometric thresholds with abnormal speech in noise results for many patients. Perhaps more important, our data also suggest that most instances in which word-recognition in quiet is excellent can be predicted with a combination of audiometric thresholds and speech-in-noise abilities. These data have been used to create clinical recommendations in which speech in noise testing becomes the default clinical test, with guidelines for when word-recognition in quiet is likely to have diagnostic significance and should be conducted. Making subtle, but fundamental shifts of this sort in clinical testing may have significant research and clinical implications.