Preliminary Guidelines for Replacing Word-Recognition in Quiet With Speech in Noise Assessment in the Routine Audiologic Test Battery.
Matthew B Fitzgerald, Steven P Gianakas, Z Jason Qian and 2 others
PMID 37703127WHAT IT FOUND
Speech-in-noise scores and high-frequency hearing thresholds accurately predict word-recognition in quiet.
For patients with high-frequency thresholds under 40 dB and speech-in-noise loss under 7 dB, word-recognition in quiet is almost always excellent, so it may not need to be tested.
Key findings
01Patients with high-frequency pure-tone averages below 40 dB HL and QuickSIN SNR losses below 7 dB SNR had word-recognition in quiet scores above 88% in 99.8% of cases.
02High-frequency pure-tone averages and QuickSIN SNR losses predicted word-recognition in quiet classifications with high accuracy, with area under the curve values ranging from 0.87 to 0.90.
03Word-recognition in quiet and high-frequency pure-tone averages were poor predictors of significant speech-in-noise deficits, with area under the curve values of 0.56 to 0.67.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was conducted at a tertiary medical center, so the population had a higher prevalence of complex auditory and vestibular pathologies than a typical community clinic. QuickSIN testing was not completed for all patients due to time constraints, potentially excluding those who could not perform the test reliably. The analysis focused on monaural testing to align with traditional word-recognition in quiet protocols, which may not fully reflect binaural hearing advantages in real-world listening. The study design was retrospective, relying on existing clinical records rather than a controlled experimental setup.
Declared interests
The authors declare no conflicts of interest. The study used data from the Stanford Ear Institute, and all data and code are publicly available.
The easy way to misread this
Do not assume that a normal word-recognition in quiet score means the patient has normal speech-in-noise ability. The study found that 23.8% of patients with normal high-frequency hearing thresholds had abnormal speech-in-noise losses, and word-recognition in quiet was a poor predictor of these deficits.