b.

threshold estimation- thresholds hace been estimated using 2-Db or 5-db steps since most
audiometers are equipped with those step sizes. Previous studies have shown threshold differences as
a function of step size are too small to be clinically significant (Chaiklin and ventry, 1964; Wilson et al.,
1973)
(2-dB step size)- present two spondaic words at the starting level. Drop the level by 2 dB and
present two spondaic words. An individual should get the first five out of six words correct or
else the starting level needs to be increased by 4 to 10 Db. If at least five of the first six words
are correct, continue dropping the level by 2 dB until the indivudual misses five of six
presentations
(5-dB step size)- present five spondaic words at the starting level. An individual should get the first
five spondaic words correct at the starting level drop the level by 5 dB and present five
spondaic words. Continue dropping the level by 5 dB until the indivudual misses all five
spondaic words at the same level.

Step 4 : calculation of threshold
Calculation of an SRT is based on the spearman-karber equation (finney,1952). An SRT is calculated by
subtracting the number of the words repeated correctly from the starting level and adding a correction
factor of 1 dB when using the 2-dB step size and a correction of 2 dB whwn using the 5-dB step size. For
a 5-db step example, with a starting level of 40 Db, the patient got all five words; at 35 dB, three of the
words were correct; and at 30 dB none were correct. Eight of the 15 words were correct. Therefore, the
SRT calculation would be 40-8=32, + 2 for the correction, equals 34 dB HL.
Clinical Function of SRT
The most recent surveys of audiometric practices in the united states reported that 99,5% (Martin et al.,
1998) and 83% (ASHA, 2000) use SRT as part of their basic audiologic assessment. The reasons stated for
using SRT were : (1) cross validation for puretone threshold; (2) measurement of communication
disability; and (3) reference for supra- threshold measures. Unfortunately, most of the historitical
purposes lack scientific evidence to support routin clinical use of an SRT ( see Wilson and Margolis,
1983). In addition, only 58% of audiologists complete the familiarization step of the test protocol, and
60% do not follow the recommended ASHA protocol ( ASHA, 1988) but, instead, determine an SRT using
a modified hugson-westlake procedur with a two out of three criterion ( Martin et al., 1998). These
observations are of concern because the SRT is a valid and reliable procedure when standardized
recorded materials are used with a specified testing procedure. The SRT is also particularly useful when
assessing responses reliability in an individual who appears to be malingering (see chapter 31)


SPEECH RECOGNITION IN QUIET
The purpose of speech recognition in queit is to assess how well a person can understand a speech in a
quiet environment when the level of he speech is loud enough to obtain a maximum SRS (PB
max
). The
level necessary for a person with a hearing loss to perform maximally is highly variable from person to
person and is dependent on the materials used to obtain the SRS (Carhart, 1965; Jerger and Hayes,
1977). We feel that it is unfortunate that, in most audiology clinics, specch recognition testingis assessed
only at one presentation level (Wiley et al., 1995), the mayority of audiologists select a single
presentation level 30 to 40 dB SL re:SRT did not, meaning that the materials are presented 30 to 40 dB
above the SRT (Martin et al., 1998; Wiley et al., 1995). Kamm et al. (1983) found that speech recognition
testing 40 dB SL re:SRT did not aproximale maximal performance for 40 % of their 25 subjects with
hearing loss. Evidence suggests that evaluation speech recognition abilities at more than one evel
captures a portion of psychometric function and allows a better estimation of performance at PB
max.
A
procedure suggested byWilson (2005) suggests the use of at least two levels with 25 words presented at
each level. For erson with nirmal hearing or mild hearing loss as evidence by a puretone by average
(PTA) of 35 dB IIL for 500, 1000 and 2000 Hz, the first level should be 50 dB HL followed by the second
level of 70 dB HL. For person with greater hearing loss, the first level should be 10 dB greater than the
PTA of 500, 1000 and 2000 Hz and the second level should be 20 dB greater that the first level. If you
unable to raise the second level 20 dB greater than the first level because of loudness discomfort issues,
raise the second level as highas possible over the first level.

Several tyes of materials are used to assess speech recognition ability in quiet such us sentences,
nonsense syllables, and the most commonly used stimuli, monosyllabic words. Previous research has
shown that nonsense syllables are the most difficult of the three aforementioned materials for the
individuals to recognize, whereas sentence are the easiest (e.g., Miller, 1951). Recognition performance
of monosyllable falls on the performance continuum somewhere between nonsyllables and sentence.
Although monosyllables are the most commonly used stimuli in clinical setting for measuring speech
recognition performance in quiet, it is important to note that the empirical data (e.g., Bilger, 1984;
Boothroyd and Nittrouer, 1988) support that speech recognition performance is a single construct and
performance at one level of linguistic complexity ( e.g., sentences) can be predicted by performance at
another level (e.g., monosyllabic words).

The systemic relationship between recognition performance at various level of linguistic complexity by
adult with acquired hearing loss was demonstrated by Olsen et al. (1997). Oerformance for phonemes,
words in isolation, and words in sentence with measured for 875 listeners with sensory-neural hearing
loss. They found that the scores for words in isolation and in sentences were predictable from the
phoneme recognition scores, with mean prediction errors 0f only 6 % and 12 %, respectively. Thus for
the examples, a person scoring 60% correct on a phoneme recognition tast would be predicted to score
22% (6%) for recognition of words in isolation and 42 % (12%) fr the recognition of words in
sentences.

Monosyllabic Words
Historically, word lists, such as the northwestern University Auditory test number 6 (NU No. 6; Tillman
and callhar, 1966) the CID Auditory test W-22 (CID W-22; Hirsh et al., 1952) and the phonetically-
Balanced 50 (PB-50; Egan, 1948) have been used to assess wprd recognition performance in a quiet
background during audiologic evaluation

The initial work of Egan (1994) outlined six principal citeria that the psychoacoustics lab at Harvard used
develop the PB-50 word lists. The six criteria were: (1) monosyllabic structure, (2) equal average
difficulty of lists, (3) equal range difficulty of lists, (4) equal phonetic composition of lists, (5)
representative sample of America English, and (6) familiar word. Ccording to Hood and Poole (1980) , it
was assumed by Egan that meeting criteria 1, 4, 5, and 6 would onsured criteria 2 and 3. Further work to
revise the PB-50 wod lists by Hirsh et al. (1952) and Tilman et al., (1963) utilizes the six criteria to
created the W-22 word lists and the NU No. 6 word lists, respectively.

PB-50
The initial used of the monosyllabic words for speech recognition testing is attributed to Egan (1948)
who worked in the Psychoacoustic Laboratories (PAL) at arvard university. His riginal pool of 1000 words
was devided into 20 lists of 50 words, which collectively are known as the PAL PB-50 word lists. Each lists
was considered to be phonetically balanced such that the 50 words that composed a list were a
proportionally correct representation of the phonetic elements in English discourse.

CID W-22
Hirsh et al. (1952) have five judges rate the familiarity of the 1000 monosyllabic words selected by Egan
for the PB-50 word lists and 120 of the PB-50s were selected along 80 other words to compose the bew
word lists. These 200 very common word were selected ad honetically balanced into four 50-word lists
known as the CID W-22 word lists. The CID w-22 word lists were recorded onto magnetic tape as spoken
by Ira Hirsh who monitored his voice on a VU meter stating the carrier phrase you will say and letting
each the target word naturally fall at the end the phrase. The CID W-22 word lists are some of the most
popular word lists used by audiologists for measuring supra-threshold word recognition ability in quiet.

NU No. 6
Lehiste and Peterson (1959) devised lists of CNCs (consonant-syllable nucleus (vowel)-consonant) that
were phonemically balanced versus phonetically balanced. That is, lists that were developed to be
phonetically balance did not take into account the position of the sound in a word and how the acoustic
realization of the sound would be affected by coarticulary factor. Lehiste and Peterson argued that
phonemic baance could be accomplished by allowing fpr the frequency the occurrence of easch initial
consonant, vowel nucleus and final consonant to be similar across CNC word lists. The lehiste and
eterson lists were condensed into four lists of 50 words known today as the NU No. 6

Historically, 50 words were inclue in each test list in order to facilitate phonetic balancing and to allow
for a simple conversion from number correct to percent correct following testing. Tudies have examined
the benefits of abbreviating the number of the words used per list from 50 to 25with mixed results in
term of test-retest reliability (Elpern 1961; Beattie et al., 978). The most important work regarding this
issue of half versus full lists was the examination of speech recognition data as a binomial variable by
thrton and raffin (1978). As discussed in the earlier section on psychometric function, performance
ability between 20% and 80% is the most variable, while performance ability is least variable at either
extreme of the function (Egan, 1978). The results of thirnton and raffin (1978) support these early view
on performance using the binoila distribution to mathematically model word recognition performance.
It indicates that the accuracy between scores for the same listener depends on the number of words
used per list and the listeners level of performance. In addition, Thornton and Raffin crated a table of
the lower and upper lilits of the 95% critical differences for percentage scores as a function of test items.
Table 5.2 shows the critical difference a retest score would need to excced to be considered statistically
different for the original test scred. As seen in table 5,2 as the number of items increases, the variability
in the scores decreases, allowing for detection of more subte differences in performance. One way to
increase set size without increasing test time is to move from whole-word scoring the phoneme scoring
(Boothroyd, 1968). In a 25-word list of monosyllables, you have 25 items to score using whoe-word
scoring, whereas you would have 50 to 75 possible items to score using phoneme scoring.