Speech audiometry is a speech test or battery of tests performed to understand the client’s ability to discriminate speech sounds, detect speech in background noise, understand the signals being presented, and recall the information presented.

Speech recognition threshold (SRT) testing is often used to validate your pure tone audiometric results. In other words, does the lowest level an individual can detect speech correlate to the hearing loss obtained through pure tone audiometry? This score is also often used as a starting point in determining your presentation level when performing suprathreshold speech testing like word recognition scores (WRS). 

When obtaining an SRT, spondee words, or phonetically balanced words, like hotdog or baseball, are used. A list of these words is presented to the patient at a comfortable level first – this is called conditioning. Once the patient is familiar with the word list, those same words will be presented in a random order at a decreasing volume level. The patient will be asked to repeat back the words presented. The threshold is defined as the level at which 50% of the words are successfully repeated.  

Words can be presented through monitored live voice or recorded speech. With the Primus Pro audiometer, clinicians have the flexibility to use whichever they prefer. Recorded spondee word lists can be made available in the testing software for a seamless transition from pure tones to speech testing. When using monitored live-voice, a VU meter is clearly displayed so clinicians can observe the level of their voice. 

A speech detection threshold (SDT) describes the lowest intensity level that an individual can detect speech. An SDT is obtained in the same manner as a speech recognition threshold, but the patient is asked to respond to the words in a developmentally appropriate way, like when performing pure tone audiometry, rather than repeating them back. This is useful when testing young children or individuals with very poor speech discrimination who are unable to repeat back words.

A word recognition score (or a speech discrimination score) provides clinicians with valuable information regarding not only an individual’s hearing loss, but which treatment options will be the most appropriate.  

WRS information not only assists in determining whether an individual is a good candidate for hearing aids or if another device like a cochlear implant may be indicated, but it can also help determine if there is a neural component to the hearing loss. 

Scores are often classified into 1 of 5 categorized; excellent, good, fair, poor, and very poor. 

Excellent or within normal limits = 90 - 100% on whole word scoring

Good or slight difficulty = 78 - 88%

Fair to moderate difficulty = 66 - 76%

Poor or great difficulty = 54 - 64 %

Very poor is < 52%

During speech audiometry, an individual's speech recognition threshold is used to determine an appropriate presentation level for obtaining a word recognition score. Alternatively, clinicians can measure a patient’s most comfortable loudness level (MCL) and present there.  

Testing is most often performed in quiet but can be completed using background noise as well. Standardized word lists, like the W22 or NU-6 lists, are presented and the individual is asked to repeat back the words heard. A carrier phrase, for example “say the word” is often used. Having this phrase presented before the target word helps the patient prepare to listen and respond and helps the clinician adjust their voice to the proper level before the target word during monitored live-voice presentations. 

Note that like with speech reception threshold testing, a recorded word list or live voice can be used derive a word recognition score. When using live voice, a clinician can watch the VU meter included in the Primus software during the carrier phrase to check presentation level.  

While pure tones are an invaluable stimulus for measuring hearing loss, they don’t represent what individuals are experiencing day-to-day. Using speech stimuli helps to measure a client’s hearing using words they may encounter in everyday life. 

Additionally, a speech test assesses the client’s full auditory pathway. In other words, the question is, once sound is detected, is the ear able to accurately send that sound to the brain? At times, although able to hear the words presented, individuals may have difficulty processing those words. This is something that can only be detected by using speech audiometry.