Standardization of the Prosody in Use Battery (PUB): a speech prosody perception test in Danish.

Assessment of prosody perception may be useful in a number of clinical scenarios, including the rehabilitation of cochlear implant recipients. It is with this group in mind that we have derived and standardized a battery of tests that assess speech prosody perception in the Danish language. The prosodic contrasts included in the battery are vowel length, compounds and phrases, emotions, questions and statements, prominence and pronoun reference, all of which are commonly encountered in everyday communication. Lists of candidate stimuli were compiled and recorded by a representative speaker of Danish. All candidate stimuli were presented to normal hearing subjects (n = 12) in both unprocessed and 8-channel noise vocoded conditions. Subjects performed closed-set identification and the results were used to derive the final stimulus set. We report the results of the six subtests, in which we observed a bias to compounds in the compound/phrase subtest, and to statements in question/statement subtest. The pronoun reference subtest assessed the ability of a listener to infer a referent from the stress status of a pronoun, and we found high accuracy rates on this task indicating that it is suitable for inclusion in the battery. We discuss the possible uses of the Prosody in Use Battery in cochlear implant mapping and device verification. We also consider the role of the results from the test battery in guiding clinicians to material suitable for aural rehabilitation.

Diagnostic Accuracy of the Sampling Utterances and Grammatical Analysis Revised (SUGAR) Measures for Identifying Children With Language Impairment.

Purpose The purpose of this study was twofold: (a) to determine the diagnostic accuracy of the four Sampling Utterances and Grammatical Analysis Revised (SUGAR) metrics, including total number of words, mean length of utteranceSUGAR, words per sentence, and clauses per sentence in differentiating children with language impairment (LI) from those with typical language development, and (b) to compare the average time to collect, transcribe, and analyze 50-utterance language samples for children with LI to those with typical language development. Method Participants were 306 children (LI, 36; typical language development, 270) who ranged in age from 3;0 (years;months) to 7;11. Fifty-utterance conversational language samples were obtained using a conversational protocol. The four SUGAR metrics were calculated from the samples. Results Cut scores of -1 SD for mean length of utteranceSUGAR and -1.25 cut score for clauses per sentence resulted in sensitivity of 97.22%, specificity of 82.96%, a positive likelihood ratio of 5.71, and a negative likelihood ratio of 0.03. On average, it took a total time of 20:20 min ( SD = 4:37, range: 13:11-30:25) to collect, transcribe, and analyze language samples for children with LI. Children with LI took significantly less time to produce 50 utterances, when compared to their typically developing peers. There were no significant differences in the time to transcribe and analyze language samples of children with LI compared to their typically developing peers. Conclusions The SUGAR metrics, in combination with other data sources (e.g., standardized testing, dynamic assessment, observation), can be used to identify preschool- and early elementary-aged children with LI. Furthermore, for children with LI, language sampling and analysis using the SUGAR method can be completed in approximately 20 min. The results of this study indicated the SUGAR measures can effectively and efficiently help in identifying LI. Supplemental Material https://doi.org/10.23641/asha.7728638.

[The adaptive Freiburg monosyllabic test in noise : Development of a procedure and comparison of the results with the Oldenburg sentence test]. / Die adaptive Messung des Freiburger Einsilbertests im Störschall : Entwicklung einer Messmethode und Vergleich der Ergebnisse mit dem Oldenburger Satztest.

BACKGROUND: Whereas sentence tests are commonly performed using an adaptive procedure, this method has not yet been transferred to the Freiburg monosyllabic speech test, the most important word test. When using different procedures, a comparison of results between sentence and word tests is not possible. Therefore, an adaptive procedure which has proven itself in sentence tests was transferred to the Freiburg monosyllabic test in noise. The results of the new procedure were compared to the standard of sentence tests, i.e., the Oldenburg sentence test. METHODS: The adaptive Freiburg monosyllabic speech test and the Oldenburg sentence test were applied in 40 otologically normal subjects in a randomized order. Results were analyzed with respect to time requirements, possible gender differences, the influence of test order, and correlation of test results. RESULTS: The time required for the adaptive Freiburg monosyllabic speech test was significantly higher than for the Oldenburg sentence test. No significant impact of gender or test order could be shown. The mean signal-to-noise ratio for 50% speech discrimination of the Oldenburg sentence test was significantly smaller than for the adaptive Freiburg monosyllabic speech test. No correlation could be shown between the results of the two tests CONCLUSION: The Freiburg monosyllabic test can not only be used for quantifying discrimination loss in percentage terms, but also to measure the 50% speech recognition threshold with an adaptive algorithm. However, the procedure of the adaptive Freiburg monosyllabic test is more time consuming than that of the Oldenburg sentence test. Concerning a possible missing correlation between the results for 50% speech discrimination, further studies with hearing-impaired persons are needed.

Variability of word discrimination scores in clinical practice and consequences on their sensitivity to hearing loss.

Speech perception scores are widely used to assess patient's functional hearing, yet most linguistic material used in these audiometric tests dates to before the availability of large computerized linguistic databases. In an ENT clinic population of 120 patients with median hearing loss of 43-dB HL, we quantified the variability and the sensitivity of speech perception scores to hearing loss, measured using disyllabic word lists, as a function of both the number of ten-word lists and type of scoring used (word, syllables or phonemes). The mean word recognition scores varied significantly across lists from 54 to 68%. The median of the variability of the word recognition score ranged from 30% for one ten-word list down to 20% for three ten-word lists. Syllabic and phonemic scores showed much less variability with standard deviations decreasing by 1.15 with the use of syllabic scores and by 1.45 with phonemic scores. The sensitivity of each list to hearing loss and distortions varied significantly. There was an increase in the minimum effect size that could be seen for syllabic scores compared to word scores, with no significant further improvement with phonemic scores. The use of at least two ten-word lists, quoted in syllables rather than in whole words, contributed to a large decrease in variability and an increase in sensitivity to hearing loss. However, those results emphasize the need of using updated linguistic material for clinical speech score assessments.

[Characteristics, advantages, and limits of matrix tests]. / Eigenschaften, Leistungen und Grenzen von Matrixtests.

BACKGROUND: Deterioration of communication abilities due to hearing problems is particularly relevant in listening situations with noise. Therefore, speech intelligibility tests in noise are required for audiological diagnostics and evaluation of hearing rehabilitation. OBJECTIVE: This study analyzed the characteristics of matrix tests assessing the 50 % speech recognition threshold in noise. What are their advantages and limitations? METHODS: Matrix tests are based on a matrix of 50 words (10 five-word sentences with same grammatical structure). In the standard setting, 20 sentences are presented using an adaptive procedure estimating the individual 50 % speech recognition threshold in noise. At present, matrix tests in 17 different languages are available. RESULTS: A high international comparability of matrix tests exists. The German language matrix test (OLSA, male speaker) has a reference 50 % speech recognition threshold of -7.1 (± 1.1) dB SNR. CONCLUSION: Before using a matrix test for the first time, the test person has to become familiar with the basic speech material using two training lists. Hereafter, matrix tests produce constant results even if repeated many times. Matrix tests are suitable for users of hearing aids and cochlear implants, particularly for assessment of benefit during the fitting process. Matrix tests can be performed in closed form and consequently with non-native listeners, even if the experimenter does not speak the test person's native language. Short versions of matrix tests are available for listeners with a shorter memory span, e.g., children.

[Examination of a training effect in the Freiburg monosyllabic test]. / Untersuchung zum Trainingseffekt des Freiburger Einsilbertests.

BACKGROUND: The Freiburg monosyllabic test (FBE) was introduced into clinical routine almost 60 years ago. Recently, there has been renewed scientific interest in the FBE. Nevertheless, neither the earlier nor the later publications showed any evidence for a training effect. For this reason, this aspect is examined in more detail in the present study. METHODOLOGY: All 20 test lists of the FBE were presented in a fixed, predetermined order to 40 suitable otologically normal subjects. According to DIN 45626-1, the 50 % speech discrimination score is expected at a level of 29.3 dB SPL (Sound Pressure Level). In this study, the test material was presented at a level of 29 dB SPL. The speech discrimination scores were analyzed depending on the particular test run. RESULTS: The mean speech recognition score (43.2 %) depended on the test run. An increase in speech recognition by 13 percent points was observed in the first three test runs. After two test runs, no further increase in speech recognition was observed. CONCLUSION: When using the FBE in clinical routine, two test lists should be heard by the patients before the actual test starts. This procedure helps to improve the quality of the FBE.

[Evaluation of the perceptual equivalence of test lists in the Freiburg monosyllabic speech test]. / Untersuchungen zur perzeptiven Äquivalenz der Testlisten im Freiburger Einsilbertest.

BACKGROUND: In the past, the perceptual balance of test lists for the Freiburg monosyllabic speech test (FBE) was frequently evaluated without producing consistent results. Until now, the studies used very diverse methods and did not accurately follow the standardized specifications. In this study, therefore, the perceptual equivalence of test lists was verified with a large group of participants according to the standard ISO EN 8253-3. METHODS: A total of 160  suitable otologically normal subjects were recruited at two institutions, each of whom listened to all test lists of the FBE using predefined measurement conditions. The subjects were divided in three groups depending on the transducer used for test list presentation (headphones "HDA 200" and "TDH 39", as well as free-field loudspeaker, "FF"). Lists that deviated were identified using the approaches specified in the standard. RESULTS: The reference curve for FBE was not met by any group. While the "HDA 200" group indicated 4.6 dB lower thresholds, results for the "TDH 39" and "FF" groups showed 1.2 and 2.5 dB higher thresholds, respectively. For an average speech recognition score of 44.3 %, test lists 5, 11, 12, and 15 lay outside the calculated tolerance range of 4.5 to -4.4 percent points. The same lists also deviated when calculating discrimination functions and therefore do not fulfill the criteria for perceptual equivalence. DISCUSSION: In the future, lists identified as deviating from the norm should not be used. The results of this study only partly agree with results from former studies.

[The Freiburg monosyllable word test in postoperative cochlear implant diagnostics]. / Der Freiburger Einsilbertest in der postoperativen CI-Diagnostik.

BACKGROUND: The Freiburg monosyllable word test represents a central tool of postoperative cochlear implant (CI) diagnostics. OBJECTIVES: The objective of this study is to test the equivalence of different word lists by analysing word comprehension. For patients whose CI has been implanted for more than 5 years, the distribution of suprathreshold speech intelligibility outcomes will also be analysed. PATIENTS AND METHODS: In a retrospective data analysis, speech understanding for 626 CI users word correct scores were evaluated using a total of 5211 lists with 20 words each. RESULTS: The analysis of word comprehension within each list shows differences in mean and in the kind of distribution function. There are lists which show a significant difference of their mean word recognition to the overall mean. The Freiburg monosyllable word test is easy to administer at suprathreshold speech level for CI recipients, and typically has a saturation level above 80 %. CONCLUSION: The Freiburg monosyllable word test can be performed successfully by the majority of CI patients. The limited balance of the test lists elicits the conclusion that an adaptive test procedure with the Freiburg monosyllable test does not make sense. The Freiburg monosyllable test can be restructured by resorting all words across lists, or by omitting individual words of a test list to increase the reliability of the test. The results show that speech intelligibility in quiet should also be investigated in CI recipients al levels below 70 dB.

[Phonemic balance of the Freiburg monosyllabic speech test]. / Phonemische Ausgewogenheit des Freiburger Einsilbertests.

BACKGROUND: ISO 8253-3 [4] describes the requirements for speech tests with respect to their phonemic balance. The fulfillment of these requirements by the Freiburg monosyllabic speech test were examined. METHODS: The Freiburg monosyllables were phonologically transcribed and analyzed with respect to their structural types, vowels and consonants, as well as phonological classes, and compared to reference values. RESULTS: The phonemic distribution of the Freiburg monosyllables differs slightly from the reference values for the German language. The differences are presumably related to the restriction to monosyllabic substantives. Most test lists (except for 12) contain similar proportions of different phonem classes for vowel and consonants according to Hahlbrock and ISO 8253-3 [4]. CONCLUSION: The deviations of test lists 5, 11, and 15 in a study for perceptual equivalence cannot be explained by phonemic imbalance in comparison to other test lists. Only the lower recognition rates for test list 12 might be explained by its deviant phonemic distribution.

[Evaluation of hearing aid rehabilitation using the Freiburg Monosyllabic Test]. / Hörgeräteerfolgskontrolle mit dem Freiburger Einsilbertest.

The benefit of hearing aids is not always directly subjectively perceivable. Therefore, objective and quantifiable speech audiometric measurements are required. Beside acoustic gain measurements and structured interviews, speech audiometry in quiet and in noise is one of the three pillars of hearing aid evaluation.The Freiburg monosyllabic test has been used for decades for hearing aid prescription and evaluation in German speaking countries. Relative and absolute targets can be individually defined for the rehabilitation of speech perception by hearing aids as assessed by the Freiburg monosyllabic test in quiet and at conversational levels.The general applicability of speech audiometric measurements in noise is limited. Alternative ("modern") methods and the definitions of noise situations relevant to everyday life have been discussed for years. However, the introduction of these methods into everyday use has proven difficult. On one hand, there is comparatively little practical experience; on the other, it has not yet been demonstrated what additional benefits these more complicated measurements might have for standard hearing aid evaluations and hearing aid users.

[Use of Freiburg monosyllabic test words in the contemporary German language : Currentness of the test words]. / Verwendungshäufigkeit der Freiburger Einsilber in der Gegenwartssprache : Aktualität der Testwörter.

The Freiburg monosyllabic test has a word inventory based on the word frequency in written sources from the 19th century, the distribution of which is not even between the test lists. The median distributions of word frequency ranking in contemporary language of nine test lists deviate significantly from the overall median of all 400 monosyllables. Lists 1, 6, 9, 10, and 17 include significantly more very rarely used words; lists 2, 3, 5, and 15, include significantly more very frequently used words. Compared with the word frequency in the contemporary spoken German language, about 45 % of the test words are practically no longer used. Due to this high proportion of extremely rarely or no longer used words, the word inventory is no longer representative of the contemporary German language-neither for the written, nor for the spoken language. Highly educated persons with a large vocabulary are thereby favored. The reference values for normal-hearing persons should therefore be reevaluated.

[Test-retest reliability of the Freiburg monosyllabic speech test]. / Test-Retest-Reliabilität des Freiburger Einsilbertests.

BACKGROUND: ISO 8253-3 describes the requirements for speech tests used in audiology. One aspect is the test-retest reliability, which was here examined for the Freiburg monosyllabic speech test. METHODS: Speech recognition scores were examined for 30 listeners with normal hearing ability. All 20 lists of the Freiburg monosyllabic speech test were tested at four different presentation levels. The retest was carried out 7-9 months later. RESULTS: The test-retest reliability of the Freiburg monosyllabic speech test in this study is between 13 percentage points for a speech recognition score of 95 %, and 24 percentage points for a speech recognition score of 39 %. The measurement accuracy can be estimated using binomial distribution. CONCLUSION: The reproducibility of the results is limited by the small number of test items (20 words) in each list. This does not fulfill the requirements for speech tests in diagnostics and rehabilitation. An improvement of the test-retest reliability can be achieved using several test lists.

[The Freiburg speech intelligibility test : A pillar of speech audiometry in German-speaking countries]. / Der Freiburger Sprachtest : Eine Säule der Sprachaudiometrie im deutschsprachigen Raum.

The Freiburg speech intelligibility test according to DIN 45621 was introduced around 60 years ago. For decades, and still today, the Freiburg test has been a standard whose relevance extends far beyond pure audiometry. It is used primarily to determine the speech perception threshold (based on two-digit numbers) and the ability to discriminate speech at suprathreshold presentation levels (based on monosyllabic nouns). Moreover, it is a measure of the degree of disability, the requirement for and success of technical hearing aids (auxiliaries directives), and the compensation for disability and handicap (Königstein recommendation). In differential audiological diagnostics, the Freiburg test contributes to the distinction between low- and high-frequency hearing loss, as well as to identification of conductive, sensory, neural, and central disorders. Currently, the phonemic and perceptual balance of the monosyllabic test lists is subject to critical discussions. Obvious deficiencies exist for testing speech recognition in noise. In this respect, alternatives such as sentence or rhyme tests in closed-answer inventories are discussed.

Preliminary assessment of the feasibility of using AB words to assess candidacy in adults.

BACKGROUND: Adult cochlear implant (CI) candidacy is assessed in part by the use of speech perception measures. In the United Kingdom the current cut-off point to fall within the CI candidacy range is a score of less than 50% on the BKB sentences presented in quiet (presented at 70 dBSPL). GOAL: The specific goal of this article was to review the benefit of adding the AB word test to the assessment test battery for candidacy. RESULTS: The AB word test scores showed good sensitivity and specificity when calculated based on both word and phoneme scores. The word score equivalent for 50% correct on the BKB sentences was 18.5% and it was 34.5% when the phoneme score was calculated; these scores are in line with those used in centres in Wales (15% AB word score). CONCLUSION: The goal of the British Cochlear Implant Group (BCIG) service evaluation was to determine if the pre-implant assessment measures are appropriate and set at the correct level for determining candidacy, the future analyses will determine whether the speech perception cut-off point for candidacy should be adjusted and whether other more challenging measures should be used in the candidacy evaluation.

[Influence of hearing aids on monosyllabic test score and subjective everyday hearing]. / Einfluss einer Hörgeräteversorgung auf das Einsilberverstehen und das subjektiv erlebte Alltagshören.

BACKGROUND: Pure tone and speech audiometry are essential methods for examining the indication for hearing aids, as well as for hearing aid evaluation. Additionally, the subjective benefit of hearing aids has to be evaluated with appropriate questionnaires. The aim of the present study was to investigate the correlation between speech audiometry data and the results of a simple and user-friendly questionnaire, as well as to provide normative data for subjective benefit. MATERIALS AND METHODS: Data from 136 hearing aid users with bilateral sensorineural hearing loss were analyzed retrospectively. Pure tone thresholds and Freiburg monosyllabic speech perception in the binaural situation were measured at 65 dB in quiet and in noise (signal-to-noise ratio, SNR = +5 dB), with and without hearing aids. Additionally, subjective hearing in everyday life was recorded using the 12-item Oldenburg Inventory. RESULTS: Improvement of speech perception with hearing aids for the Freiburg monosyllabic test in quiet was 32.0 percentage points on average; in noise, there was an average improvement of 16.4 percentage points. There was a strong correlation between the results of pure tone and speech audiometry. With hearing aids, patients scored their everyday hearing using the Oldenburg Inventory on average 1.4 scale points better than without hearing aids. Results of the Oldenburg Inventory correlate with both pure tone and speech audiometry. CONCLUSION: Hearing aid evaluation should include both speech audiometry and systematic measurement of the subjective benefit using a suitable questionnaire. In combination, the Freiburg monosyllabic test and the Oldenburg Inventory allow for quick and comprehensive evaluation.

Speech Understanding in Children With Normal Hearing: Sound Field Normative Data for BabyBio, BKB-SIN, and QuickSIN.

OBJECTIVE: The primary goal was to establish normative data for the Pediatric AzBio "BabyBio," QuickSIN, and BKB-SIN measures in the sound field for children with normal hearing. SETTING: Tertiary care hospital; cochlear implant (CI) program. PATIENTS: Forty-one children with normal hearing were recruited across four age groups (5-6, 7-8, 9-10, and 11-12 yr). INTERVENTIONS: Sentence recognition testing was assessed at four different signal-to-noise ratios (SNRs, +10, +5, 0, and -5 dB) for BabyBio sentences as well as for the BKB-SIN and QuickSIN tests. All measures were presented in the sound field at 60 dBA except QuickSIN, which was presented at 70 dBA. MAIN OUTCOME MEASURES: BabyBio sentence recognition, BKB-SIN SNR-50, and QuickSIN SNR-50 were analyzed to establish sound field norms. RESULTS: BabyBio sentence recognition approached ceiling at all SNRs with mean scores ranging from 86% at -5 dB SNR to 99.3% at +10 dB SNR. Mean QuickSIN SNR-50 was 6.6 dB. Mean BKB-SIN SNR-50 was 1.6 dB with sound field data being consistent with insert earphone normative data in the BKB-SIN manual. Performance for all measures improved with age. CONCLUSION: Children with normal hearing achieve ceiling-level performance for BabyBio sentence recognition at SNRs used for clinical CI testing (≥ 0 dB SNR) and approach ceiling level even at -5 dB SNR. Consistent with previous reports, speech recognition in noise improved with age from 5 to 12 years in children with normal hearing. Thus, speech recognition in noise might also increase in the CI population across the same age range warranting age-specific norms for CI recipients. Last, the QuickSIN test could be substituted for the BKB-SIN test with appropriate age-normative data.

Development and preliminary evaluation of a new test of ongoing speech comprehension.

OBJECTIVE: The overall goal of this work is to create new speech perception tests that more closely resemble real world communication and offer an alternative or complement to the commonly used sentence recall test. DESIGN: We describe the development of a new ongoing speech comprehension test based on short everyday passages and on-the-go questions. We also describe the results of an experiment conducted to compare the psychometric properties of this test to those of a sentence test. STUDY SAMPLE: Both tests were completed by a group of listeners that included normal hearers as well as hearing-impaired listeners who participated with and without their hearing aids. RESULTS: Overall, the psychometric properties of the two tests were similar, and thresholds were significantly correlated. However, there was some evidence of age/cognitive effects in the comprehension test that were not revealed by the sentence test. CONCLUSIONS: This new comprehension test promises to be useful for the larger goal of creating laboratory tests that combine realistic acoustic environments with realistic communication tasks. Further efforts will be required to assess whether the test can ultimately improve predictions of real-world outcomes.

Recording and evaluation of an American dialect version of the Four Alternative Auditory Feature test.

BACKGROUND: The Four Alternative Auditory Feature test (FAAF) is a word-based closed-set speech recognition test. Because the original test materials were recorded in British English dialect, it is not appropriate for use in the United States. PURPOSE: The purpose of this study was to produce an American dialect FAAF (AFAAF). RESEARCH DESIGN: The AFAAF materials spoken by a native American-English speaking male were recorded and digitally edited. In the validation study, the AFAAF was administered monaurally at five signal-to-noise ratios (SNRs) in both ears for each listener. STUDY SAMPLE: A total of 20 young adults with normal hearing participated in the validation study. DATA COLLECTION AND ANALYSIS: For each participant, speech recognition scores were collected in one session. The speech level was fixed at 70 dB SPL and the steady-state talker-matched noise level was varied, resulting in five SNRs from -15 to -5 dB. One full list (80 words) was used for each SNR. For each participant, a performance-intensity (PI) function was fit to the discrete mean percent correct scores for the five SNRs according to a best-fit, three-parameter sigmoid function. In addition, scores for the left and right ears were compared to examine test-retest reliability. RESULTS: RESULTS show that the slope of the PI function is 6% per dB, the mean test-retest difference scores for the five SNRs are within 3 rationalized arcsine units (rau), and the 95% critical difference for the 80-word scores is 12 rau. Compared with the FAAF, the slope of the PI function for the AFAAF is slightly less steep. Test-retest reliability of the AFAAF is at least equal to that of the FAAF. CONCLUSIONS: It is concluded that the AFAAF is similar but not identical to the FAAF. The AFAAF is now available for measuring speech recognition performance in listeners who use American English as a native language.

[Scoring formula research and equivalence evaluation of mandarin quick speech-in-noise test materials in mainland China].

OBJECTIVE: To discuss the scoring formula and evaluate the lists equivalence of Mandarin Quick Speech-in-Noise (M-Quick SIN) test materials in mainland China, and for standardizing our research. METHOD: Double 39 subjects with normal hearing were participated in part one and part two of our experiments, respectively. 20, 18, 15, 13, 10, 8, 5, 3, 0, -2, -5, -7, -10 dB SNR were presented in part one; and 20, 15, 10, 5, 0, -5 dB SNR were presented in part two. The results were analyzed by SPSS 13.0. RESULT: SNR-50 was -2.24 dB SNR and "SNR loss = 24.5--correct words" was defined as the scoring formula. All the 13 lists had the e quivalent difficulty. CONCLUSION: Defined "SNR loss = 24.5--correct words" as the scoring formula of M-Quick SIN, and the 13 lists had better difficulty equivalence, which could be used in our further clinical research.