Speech-In-Noise Testing for Adults

Speech perception is defined as a process “between the reception of the acoustic signal at the eardrum and any conscious introspection about the quality of the percept it evokes or the mnemonic, affective, or semantic associates it arouses.” (Phillips, 1998). Several factors can affect an individual’s perception of speech: the type of speech, type of noise, binaural versus monaural listening, age, male or female speaker, listener or speaker of a non-native language, cognition, central nervous system neuroanatomical differences, and hearing loss. While just a single one of these factors in isolation can create adverse conditions to perceive speech, it is typically a complex interaction of several factors that occurs. In audiology, assessing a patient’s ability to understand speech in background noise can provide crucial information about their capabilities in noisy situations encountered in the real world. Using speech-in-noise testing (SIN) testing not only provides crucial information about an individual’s capabilities in noisy situations encountered in the real world but also allows audiologists to address the patient’s complaint and use their scores ability as a counseling tool (Wilson, 2004). There are generally three adult clinical populations that may benefit from SIN testing: those who express difficulty understanding speech beyond what is expected from their audiogram, those who are hearing aid candidates and users, and those who are cochlear implant candidates and users. There are several factors to consider when choosing the appropriate SIN test for a patient: the platform the testing is administered through, signal type and how it is scored, type of background noise, how the test is administered (including the time it takes), what type of response is expected from the patient, reliability and validity of the test, presence or absence of normative data and which population it is based upon, and lastly, the type of patient who is being tested. There are many limitations to the generalizability of SIN testing due to restrictions on the population who can participate. Gaps in the current literature on SIN testing with insufficient research include the correlation between type and degree of hearing loss with SIN test results, a lack of diversity in the patient population, and SIN testing in tele-audiology. Expanding the types of noise available to use during SIN testing could further help audiologists understand how patients function in real-world listening environments. It would also be beneficial to address the lack of normative data on the current SIN tests available to help improve the usefulness of the testing. Due to the disproportionate number of audiologists who execute SIN testing during their appointments, it is pivotal that more audiologists include it in their test battery with all patients who report difficulty understanding speech in noisy environments.