Speech-in-Noise Testing: An Introduction for Audiologists

Abstract

Speech-in-noise testing has been proposed as a useful part of the audiometric test battery dating back to the earliest years of the field of audiology. Many speech-in-noise tests have been developed and used to varying degrees. However, multiple barriers have prevented speech-in-noise testing from being used widely in the clinic. The purpose of this article is to provide a resource to audiologists and other hearing health professionals who want to know (1) what tests are available for use, (2) the rationale behind specific tests, and (3) important considerations when selecting one or more tests to use clinically. In addition, data are presented for four speech-in-noise tests with the purpose of comparing outcomes as a function of age and hearing status. The four tests (QuickSIN, Words in Noise [WIN], Listening in Spatialized Noise-Sentences [LiSN-S], and Coordinate Response Measure [CRM]) were completed by 30 individuals from three groups: 10 young adults with normal hearing, 10 older adults with normal hearing, and 10 older adults with hearing loss. The results suggest that, despite significant differences in performance between groups, group overlap was present such that some individuals from one group performed similar to some individuals of other groups; therefore, individual performance was more important than associated group. When selecting an appropriate speech-in-noise test to use clinically, audiologists should carefully consider the purpose of their testing and the type of information they desire as an outcome. A quick-resource table and appendix is provided to aid audiologists and other health professionals in their selection of an appropriate speech-in-noise test.

Keywords: Coordinate Response Measure; Listening in Spatialized Noise-Sentences; QuickSIN; Words in Noise; aging; audiology; audiometry; background noise; hearing loss; speech-in-noise testing.

Figure 1

Signal-to-noise ratios (SNRs) measured in everyday life. Measurements across several studies dating from 1977 to 2015 reveal general trends regarding typical SNRs in each environment, although some environments (e.g., classroom, public transportation) demonstrate more variability than others. (Figure used with permission of Hearing Research [see Billings & Madsen 2018, for details of measured settings]).

Figure 2

Variability in speech-in-noise listening performance. Performance on the WIN for 18 individuals over the age of 65 years with symmetrical hearing loss. Panel A shows the average (thick blue line) and individual (thin gray lines) pure-tone thresholds. Panels B and C reveal the group-mean (diamond/square) and individual (triangles/circles) percent correct and SNR50 scores, illustrating the wide range of variability across individuals. Panel D shows the modeled group (thick blue line) and individual (thin gray lines) psychometric functions.

Figure 3

Psychometric functions (bottom) and SNR50 values (top) for CRM testing as a function of Noise Type and Group. Error bars are present for SNR50s but are small compared with the symbol size (all standard errors were less than 1 dB). SSC, speech spectrum continuous noise; 4TB, four-talker babble noise; 1TM, one-talker-modulated noise; YNH, young normal hearing; ONH, older normal hearing; OHI, older hearing impaired.

Figure 4

SNR50 values for the four different speech-in-noise tests as a function of participant group. The overall difficulty posed by each test is reflected by the “center of gravity” of each cluster, with WIN and QuickSIN resulting in the worst SNR50 values and the CRM and LiSN resulting in the best SNR values. Variability within a test is also demonstrated by the spread of SNR50 values within and across participant groups. The separation between groups was most pronounced for the LiSN.

Figure 5

SNR50 values for LiSN-S test results plotted as a function of Group and Condition. Notice the larger spread of performance for the older hearing-impaired group. Effects of spatial separation and talker are also apparent.