Message from the Editor-in-Chief
Speech-in-Noise Testing… but what speech and in what noise?
While reading the current journal articles and attending audiology conferences, a topic that seems to be making a resurgence is speech-in-noise testing. There are very few reliable statistics about the prevalence of speech-in-noise testing- casual surveys with a show of hands at a conference would indicate that more than 90% of clinicians use speech-in-noise testing but this is of course quite biased… it would be embarrassing not to put your hand up. “Confidential” online surveys are not that much better- it's almost as if speech-in-noise testing is a “mother and apple pie” situation, but I suspect that their usage is quite limited.
Speech-in-noise testing takes clinical time and can be frustrating for some of our hard of hearing clients. And I am not sure what we can do about a poor result in any event. Clearly, improving the SNR either by communicating in a quieter environment or enhancing the speech signal makes clinical and real sense, but this is typically done in any event. Most of my hard of hearing clients obtain at least one Bluetooth enabled “accessory” when they are fit with hearing aids, along with noise-stripping apps. And this is done with or without speech-in-noise testing.
Tests such as the QuickSIN and the HINT have been around for decades and many clinicians have found them to be very useful; even if it's only to educate the family of the hard of hearing person, but what are the limitations?
Our lead-off cover feature article by Negar Salehi and Dr. Brandon Paul take on this important topic. In their article they state that “standard tests used in research … require patients to listen, remember, and repeat entire sentences verbatim from a pre-recorded playlist as they sit alone in sound booths. In daily life, however, it is rare to replicate the speech of another person while isolated from them. Listening and communicating in the real world is embedded in an active social context in which conversation partners can influence each other, see each other’s perspective, and collectively pursue complex goals.”
Speech-in-noise testing, in its clinical essence, makes sense and is a major step closer to reality than speech testing in quiet, but in the absence of reality and social interaction there are severe limitations, especially in predicting how a hard of hearing person may be able to interact with others in a social relationship.
Speech-in-noise testing based on memorizing sentences to repeat back and using noise that is different than typical environmental background noise replete with reverberation, still needs much work. Using tests such as QuickSIN and the HINT may provide some insight but, in my opinion, should not be used as measures to predict how people will be able to communicate in real life situations.
In Ontario, the Police Constable Selection program for prospective applicants to the police, and emergency response forces require these speech-in-noise tests if an individual’s pure tone thresholds fall below a certain point. But this makes little sense. Regulations that require these “slightly-better-but-still-not-good-enough” tests should be questioned, and it is good to see that many members of the Canadian Academy of Audiology across the country are bringing this view up to their provincial and territorial policy-makers and regulators.
In this issue, CanadianAudiologist.ca has many other articles which are just as incisive and, in some cases, provide great clinical insight to the clinical problems that we may face in our field. Here are the other articles in this issue - A Comprehensive, Evidence-Based Approach to Tinnitus Management; What Do Hearing Aids Sound Like?... using a skull simulator; How Chronic Illnesses Impact Hearing, Balance, and Cognition; Horizontal Canal Benign Paroxysmal Positional Vertigo: Diagnostic Challenges and the Kurtzer-Hybrid Maneuver; and Redefining Impulse Noise Hazards Using Kurtosis.
I hope that you all had a pleasant holiday season and hope that this issue of CanadianAudiologist helps to get your recharged for the new year.
Marshall Chasin, AuD
Editor-in-chief
CanadianAudiologist.ca