Understanding Speech Audiometry Techniques

Hi everyone, let's talk about speech audiometry today. So speech audiometry, speech audiometry is the patient's ability to hear and understand speech. So whether it is pure tone audiometry, we are trying to know how much is the hearing loss of the patient. Speech audiometry is the only place where we are having a much more like a practical aspect of it. Okay. pure tone audiometry, impedance audiometry, these are all more in the purview of the ENT surgeon and speech audiometry will go more in the purview of an audiologist and the primary purpose of speech audiometry is for a fitting of a hearing aid. That's what I understand from this. There may be other uses but this is not mostly that we as an ENT surgeon use it in our day-to-day basis. But it is important, it's an important topic from the NEET PG point of view. There are some topics which, this is a bit of a complicated topic. So before I really enter into this speech audiometry, I would like to introduce three concepts to you, three tests you can say. One is speech reception threshold, other is the speech discrimination score, other is the PV max. The thing to understand is these three are not separate. Okay, one leads into the other the other leads into the other so speech reception threshold will form the basis for speech discrimination Score speech discrimination score will form the basis for the PV max or phonetically balanced max So before I go into the topic proper, we will just have a brief overview. What is speech reception threshold? It is the threshold Threshold means what? It is an intensity. It is the intensity of sound at which the patient can hear and repeat back 50% of the words that are given to him. So speech reception threshold is an intensity at which 50% of the words are correctly heard and repeated by the patient. With that speech reception threshold, you go into speech discrimination score. Speech discrimination score, what do you do? you take the speech reception threshold and you add 30 decibels to it it is a supra threshold level so you are giving 30 decibels on top of the speech reception threshold and you ask the patient you give number of words to the patient and you calculate a percentage the speech description score is a percentage is a percentage of the sounds or the words sorry which are repeated correctly by the patient. So you give a number say 10 number of 10 words to the patient and out of them patient can repeat 80 percent, 90 percent, 100 percent, 70 percent depending on the patient's pathology. That becomes the speech discrimination score. In speech discrimination score what did we do? We took a single intensity. What is that intensity? 30 decibels above speech reception threshold. okay speech what is speech reception threshold as we already said 50 percent of the words at the intensity at which the patient can repeat 50 percent of the words given to him okay now you go one step further instead of taking one intensity that is the speed at the 30 plus speech reception threshold you chart it on all as this at various intensities from 0 decibels to 100 decibels so 0 10 20 30 40 50. so you are increasing the decibels of the sound and you are calculating at what intensity is the patient can repeat maximum number of words correctly so at what intensity you are getting the maximum sds score or the speech discrimination score which score at what at what intensity you are getting maximum uh speech discrimination score that becomes a pb max okay this will this will form a basis for differentiating cochlear from retrocochlear kind of hearing loss so let us now enter into the topic So, what is speech reception threshold? What is the definition? It is the threshold. Threshold means as I said it is the intensity in which the patient is able to identify 50% of the spoken words correctly. So, the entire speech audiometry as I said it is the patient's ability to hear and understand speech. Common problem that we keep seeing in our clinic is patient can hear and I can't understand. Characteristic of presbytosis which is a cochlear sometimes retrocochlear kind of hearing loss okay so what is the procedure here we do a set of spondy words what is a spondy word a spondy word is a word in which equal stress is placed on both the syllables that is like baseball daydream they are delivered to each year so speech reception pressure or every speech audiometry each year is tested separately is delivered to each year through the headphones of an audiometer you You keep on increasing the intensity by 5 decibel steps until the patient can repeat 50% of the words given to him correctly. That becomes the speech reception threshold. The intensity at which the patient can repeat 50% of the words given to him becomes speech reception threshold. Okay. So, what are the uses of speech reception thresholds? What is normal speech reception threshold should always be within 10 decibel range of the pure tone audiometry average. Okay. So, here is an example. So, here this is a patient with conductive hearing loss. So, the patient is having, you always take 500,000 and 2000. These are called speech frequencies, right? So, 500,000 and 2000, what is it? 50, 50 and 40. So, it becomes 140 divided by 3. Approximately 45 decibels of hearing loss this patient is having, conductive hearing loss because there is an ear bone gap. Okay. So, what is SRT? SRT should always be either 35 to 55. It should be within this range. 45 is the puton audiometry average. SRT should be within 10 decibels range of puton audiometry average. If it is beyond that, the patient is malingering, patient is feigning or patient is lying that I am having deafness. So this is a way in which you can confirm or you can have a suspicion that the patient is not answering correctly. Speech reception threshold is important because it should be within 10 decibels range of PTA. If it is crossing that, you suspect that the patient is. having malingering or it suggests malingering basically it is not suspicion like you are like confirming almost confirming that this patient is malingering okay what is speech discrimination score what is the definition it is the patient's ability to understand speech that is speech argumentary okay it's the patient's ability to identify and repeat single syllable words given at supra threshold level patient's ability to identify and repeat single syllable words given at supra threshold level So what did we do? Okay, let us go through this also. What is the procedure? A list of phonetically balanced words. For example, phonetically balanced means PB. So phonetically balanced words like example PIN, SIN, they are delivered at 30 decibels above SRT. That is the supra-threshold level in each ear of the patient and the percentage of words heard correctly by the patient is recorded. So speech discrimination score, you are taking 30 decibels plus SRT at the 30 decibels more than the speech reception threshold and you are giving to each ear a number of words are given say 10 words are given to each ear separately and you calculate whether the patient can repeat eight words correctly nine words correctly six words correctly or it can be more also it is like 50 percentage or 100 percentage of words is given repeated correctly by the patient you record it and not only do you record this okay so that comes to pp max So you are going to just record the percentage of the words repeated correctly by the patient. This becomes the speech discrimination score. What is the basic understanding of speech discrimination score? In patients with normal and conductive hearing loss, then the high score of 90 to 100% will be obtained. That means if you take 30 decibels plus SRT, almost every word that you give to this patient, normal patients here and a patient with conductive hearing loss patient is going to repeat back to you hundred percent almost hundred percent ninety to hundred percent is almost hundred percent so that is the basic understanding with which we go now we just falling down say six seventy percent sixty percent fifty percent or forty percent so speech discrimination score so you're giving words only patient can repeat 70 only patient can repeat 60 only patient can repeat 50 only patient can repeat 40 you are giving it at a super threshold level the problem is not the intensity here the problem is not the intensity the problem is not the amplitude problem is not the decibel range problem is the patient's ability to process the information and that is what is what we see in breast bite users okay how do we use this practically in So, if the patient is having a 70% speech discrimination score, you can tell the patient that if there is a low voice like a whisper, you can understand a whisper when you are wearing a hearing aid. Basically, I took this from one of the hearing aid sites, one of the centers who gives hearing aids. So, they are telling that. If the patient's speech discrimination score is 70%, then he can hear a whisper while he's using a hearing aid. Even when there is a moderate level of background noise without looking at the patient's face, without needing to see the patient's face. Patient's face means what you need to do lip reading. Okay. So at 70% speech discrimination score till 70% speech discrimination score, patient's disability is very less. Okay. When it becomes 60 to 70%, patient will have to look at the speaker's face. and below 50% you will have great difficulty understanding the whisper. So as the speech discrimination scores fall down, your ability to hear well even with a hearing aid comes down. That is the basic use of a speech discrimination score. Now coming to pbmax. So what is pbmax? Let me just go through with this. In speech discrimination score what did we do? We gave a giving we are giving a single supra threshold level of 30 decibels above srt so we are giving it the one single we are testing at only one single decibel range one single intensity which is 30 decibels above srt instead of that it is better to chart pb scores against several levels of speech intensity so here is the score percentage you are trying to assess or chart the pb scores or the phonetical balance scores or the scores Score means the number of words repeated correctly the patient. Instead of a single intensity, you are going to test him across various intensities. you are trying to find out at which intensity will the patient reach his maximum score or the pb max that becomes a maximum score of the pb max the sts score is maximum at which intensity we are trying to find out by by charting this by charting this chart against a number of intensities okay so at one point you will reach at what at one intensity range you will reach the maximum that is the hundred that is hundred percent you are able to reach Here also you are able to reach at 100%. What level you are able to reach it. That is what we are trying to do with PB Max. Okay. Okay. Not only as I said, not only do we note at what intensity he is getting the maximum number of words correctly, also at maximum number of words correctly at the same time at what decibel range the intensity of the sound at which he is able to reach that maximum decibel range also is noted. So that becomes characteristic of certain diseases. And also, suppose this patient is having, say, conductive hearing loss and this cannot be rectified by surgery or the patient is not asking for surgery. Patient says, I don't want surgery. Then at 70 decibels, this patient is going to set his volume of the hearing aid at 70 decibels because at 70 decibels, he's getting PV max at 100. OK, so this is the use of PV max. OK, so what do we do in PV max? In SDS, we took a single supra threshold level. In PBmax, we tested against a range of amplitudes of range of decibels and we test where he is getting the maximum score and what is the maximum he can reach also. So, what are the results? How do we assess the results? PV score of a normal person is 100 decibels at 15 decibels. 100% at 15 decibels. So, this is an S-shaped curve. That is what you will get in normal people and in connective hearing loss, you will get a S-shaped kind of a curve. where in normal people you will be getting a pbmax of 100 at 15 decibels only. At 15 decibels only you will get 100 score. That is he is going to repeat every word correctly back to you at 15 decibels itself. So that becomes normal. In conductive hearing loss in this particular case he is repeating 100% of the words correctly at 70 decibels amplitude. At 70 decibels of intensity he is able to get the pb max or he is going to get 100% at 70 decibels. So here also the curve is S shaped but we do not get it. It is parallel to a normal person but you get it at a later intensity. Instead of getting it at 15 you may get it at 30 you may get it at 70 but in this particular case we are getting it at 70 decibels. So, PB score in conductive hearing loss is also 100% at 70 decibels and it runs parallel to a normal person. Now, coming to cochlear and retrocochlear hearing loss. What happens in cochlear sensor neural hearing loss? You get a PB max at 70 decibels and then attains a plateau. So, here we let us see. So, PB max, you are getting PB max at 70 decibels. That is, he is getting the maximum number of words that he can repeat correctly. He is at 70 decibels. And even if you observe, he is not able to reach 100% also. He is able to reach approximately like 75-80 decibels. He is able to reach 70-80% of words. Only he can repeat correctly. Only 80% of words can be repeated correctly by this cochlear hearing loss patient. And also, you are going to get it at 70 decibels. So, you have to raise the intensity to a great volume. Also, you are not getting maximum PV max. Okay. So, in cochlear hearing loss, you will get a plateau. But as you keep increasing the intensity... the PVmax will not increase and will not form an S-shaped kind of a curve. It will be like a plateau. So, this plateauing, that is, after this PVmax, as you keep on increasing the intensity, the PVmax will remain the same. The PVmax score, that is, the 80% score, is not going to have increase in the score or decrease in the score. It forms a plateau. The plateau is characteristic of cochlear hearing loss, cochlear sensor neural hearing loss. Okay. What happens in retrocochlear hearing loss? What happens in retrocochlear hearing loss? In retrocochlear hearing loss, he is attaining PV max at a much later amplitude. That is, you have to increase the sound even further. You have to increase the sound to 80 decibels. You have to increase the 80 decibels and also you are not able to reach it till 40 also. 40, 45, approximately 45% is the, suppose you are giving 100 words to the patient, patient is only able to repeat 45 words back to you. So that is a really great fall in the... speech discrimination score is falling down rapidly and has fallen down to a great level has gone fallen down to a severe level and also you have to raise the intensity to at 80 decibels but the but the interesting feature of this is as you keep increasing to 90 and 100 instead of maintaining a plateau it is falling down so at higher intensities of sounds the the thing is falling down there the curve is falling down he is able to hear less number of sounds he is able to repeat less number of sounds correctly. So at 80 decibels, at 90 decibels, she is able to hear like 38. At 100 decibels, she is going to hear much lesser. So there is a fall in the PP max as the intensity is increasing. In cochlear, what happened? As the intensity is increasing, there is a plateau. The PP max is remaining in constant. But in retro cochlear hearing loss, as the intensity is increasing, the PP max is actually falling down. The number of words repeated correctly is falling down. So that becomes what is called a rollover curve. That is what is called a rollover phenomenon. So with increase in speech intensity, increase in speech intensity above a particular level, above a particular level, 80 decibels in this case, PV score falls rather than maintaining a plateau. PV score will fall. PV score is falling down, right? Rather than maintaining a plateau, that is characteristic of, sorry, this is retrocochlear hearing loss. This is retrocochlear sensorineural hearing loss. Okay, so what are the uses of speech audiometry? We already discussed all of them. So, if you find the speech reception threshold, it correlates with the average of PTA. So, you can find out how much is the PTA average or how much is the hearing loss of this patient. Suppose it is not correlating, then you can say that the patient is having malingering or the patient is feening or patient is a malingerer, patient is having non-organic hearing loss. For the sake of pension or the sake of money he is lying for the sake of some benefit he is lying. To find the intensity at which the STS is best this helps in fitting a hearing aid we already said. So at which intensity patient is able to repeat the maximum number of words correctly that becomes the PB max. That is the volume at which you are going to fit the hearing aid and that is the volume in which the patient can get good hearing. How do you differentiate cochlear from retrocochlear hearing loss? If you chart these scores, that is the percentage, SDS scores, SDS scores on one side and the decibels on one side, as you keep on increasing the decibels, if you are going to reach a plateau, once you reach the highest, say 80%, and after that it is not increasing and it is maintaining a plateau, that becomes cochlear hearing loss. And then as you are increasing the intensity, if it is falling down, the PB score is falling down as the intensity increases, it is characteristic of retrocochlear hemorrhage. So, these are the uses of speech audiometry. So, speech audiometry means basically ability to hear and understand speech. Okay. So, thank you for the patient listening.

Okay. pure tone audiometry, impedance audiometry, these are all more in the purview of the ENT surgeon and speech audiometry will go more in the purview of an audiologist and the primary purpose of speech audiometry is for a fitting of a hearing aid. That's what I understand from this.

There may be other uses but this is not mostly that we as an ENT surgeon use it in our day-to-day basis. But it is important, it's an important topic from the NEET PG point of view. There are some topics which, this is a bit of a complicated topic. So before I really enter into this speech audiometry, I would like to introduce three concepts to you, three tests you can say. One is speech reception threshold, other is the speech discrimination score, other is the PV max.

The thing to understand is these three are not separate. Okay, one leads into the other the other leads into the other so speech reception threshold will form the basis for speech discrimination Score speech discrimination score will form the basis for the PV max or phonetically balanced max So before I go into the topic proper, we will just have a brief overview. What is speech reception threshold? It is the threshold Threshold means what?

It is an intensity. It is the intensity of sound at which the patient can hear and repeat back 50% of the words that are given to him. So speech reception threshold is an intensity at which 50% of the words are correctly heard and repeated by the patient.

With that speech reception threshold, you go into speech discrimination score. Speech discrimination score, what do you do? you take the speech reception threshold and you add 30 decibels to it it is a supra threshold level so you are giving 30 decibels on top of the speech reception threshold and you ask the patient you give number of words to the patient and you calculate a percentage the speech description score is a percentage is a percentage of the sounds or the words sorry which are repeated correctly by the patient. So you give a number say 10 number of 10 words to the patient and out of them patient can repeat 80 percent, 90 percent, 100 percent, 70 percent depending on the patient's pathology.

That becomes the speech discrimination score. In speech discrimination score what did we do? We took a single intensity.

What is that intensity? 30 decibels above speech reception threshold. okay speech what is speech reception threshold as we already said 50 percent of the words at the intensity at which the patient can repeat 50 percent of the words given to him okay now you go one step further instead of taking one intensity that is the speed at the 30 plus speech reception threshold you chart it on all as this at various intensities from 0 decibels to 100 decibels so 0 10 20 30 40 50. so you are increasing the decibels of the sound and you are calculating at what intensity is the patient can repeat maximum number of words correctly so at what intensity you are getting the maximum sds score or the speech discrimination score which score at what at what intensity you are getting maximum uh speech discrimination score that becomes a pb max okay this will this will form a basis for differentiating cochlear from retrocochlear kind of hearing loss so let us now enter into the topic So, what is speech reception threshold?

What is the definition? It is the threshold. Threshold means as I said it is the intensity in which the patient is able to identify 50% of the spoken words correctly. So, the entire speech audiometry as I said it is the patient's ability to hear and understand speech.

Common problem that we keep seeing in our clinic is patient can hear and I can't understand. Characteristic of presbytosis which is a cochlear sometimes retrocochlear kind of hearing loss okay so what is the procedure here we do a set of spondy words what is a spondy word a spondy word is a word in which equal stress is placed on both the syllables that is like baseball daydream they are delivered to each year so speech reception pressure or every speech audiometry each year is tested separately is delivered to each year through the headphones of an audiometer you You keep on increasing the intensity by 5 decibel steps until the patient can repeat 50% of the words given to him correctly. That becomes the speech reception threshold.

The intensity at which the patient can repeat 50% of the words given to him becomes speech reception threshold. Okay. So, what are the uses of speech reception thresholds?

What is normal speech reception threshold should always be within 10 decibel range of the pure tone audiometry average. Okay. So, here is an example. So, here this is a patient with conductive hearing loss. So, the patient is having, you always take 500,000 and 2000. These are called speech frequencies, right?

So, 500,000 and 2000, what is it? 50, 50 and 40. So, it becomes 140 divided by 3. Approximately 45 decibels of hearing loss this patient is having, conductive hearing loss because there is an ear bone gap. Okay. So, what is SRT? SRT should always be either 35 to 55. It should be within this range.

45 is the puton audiometry average. SRT should be within 10 decibels range of puton audiometry average. If it is beyond that, the patient is malingering, patient is feigning or patient is lying that I am having deafness. So this is a way in which you can confirm or you can have a suspicion that the patient is not answering correctly. Speech reception threshold is important because it should be within 10 decibels range of PTA.

If it is crossing that, you suspect that the patient is. having malingering or it suggests malingering basically it is not suspicion like you are like confirming almost confirming that this patient is malingering okay what is speech discrimination score what is the definition it is the patient's ability to understand speech that is speech argumentary okay it's the patient's ability to identify and repeat single syllable words given at supra threshold level patient's ability to identify and repeat single syllable words given at supra threshold level So what did we do? Okay, let us go through this also. What is the procedure? A list of phonetically balanced words.

For example, phonetically balanced means PB. So phonetically balanced words like example PIN, SIN, they are delivered at 30 decibels above SRT. That is the supra-threshold level in each ear of the patient and the percentage of words heard correctly by the patient is recorded. So speech discrimination score, you are taking 30 decibels plus SRT at the 30 decibels more than the speech reception threshold and you are giving to each ear a number of words are given say 10 words are given to each ear separately and you calculate whether the patient can repeat eight words correctly nine words correctly six words correctly or it can be more also it is like 50 percentage or 100 percentage of words is given repeated correctly by the patient you record it and not only do you record this okay so that comes to pp max So you are going to just record the percentage of the words repeated correctly by the patient.

This becomes the speech discrimination score. What is the basic understanding of speech discrimination score? In patients with normal and conductive hearing loss, then the high score of 90 to 100% will be obtained.

That means if you take 30 decibels plus SRT, almost every word that you give to this patient, normal patients here and a patient with conductive hearing loss patient is going to repeat back to you hundred percent almost hundred percent ninety to hundred percent is almost hundred percent so that is the basic understanding with which we go now we just falling down say six seventy percent sixty percent fifty percent or forty percent so speech discrimination score so you're giving words only patient can repeat 70 only patient can repeat 60 only patient can repeat 50 only patient can repeat 40 you are giving it at a super threshold level the problem is not the intensity here the problem is not the intensity the problem is not the amplitude problem is not the decibel range problem is the patient's ability to process the information and that is what is what we see in breast bite users okay how do we use this practically in So, if the patient is having a 70% speech discrimination score, you can tell the patient that if there is a low voice like a whisper, you can understand a whisper when you are wearing a hearing aid. Basically, I took this from one of the hearing aid sites, one of the centers who gives hearing aids. So, they are telling that.

If the patient's speech discrimination score is 70%, then he can hear a whisper while he's using a hearing aid. Even when there is a moderate level of background noise without looking at the patient's face, without needing to see the patient's face. Patient's face means what you need to do lip reading.

Okay. So at 70% speech discrimination score till 70% speech discrimination score, patient's disability is very less. Okay.

When it becomes 60 to 70%, patient will have to look at the speaker's face. and below 50% you will have great difficulty understanding the whisper. So as the speech discrimination scores fall down, your ability to hear well even with a hearing aid comes down.

That is the basic use of a speech discrimination score. Now coming to pbmax. So what is pbmax? Let me just go through with this.

In speech discrimination score what did we do? We gave a giving we are giving a single supra threshold level of 30 decibels above srt so we are giving it the one single we are testing at only one single decibel range one single intensity which is 30 decibels above srt instead of that it is better to chart pb scores against several levels of speech intensity so here is the score percentage you are trying to assess or chart the pb scores or the phonetical balance scores or the scores Score means the number of words repeated correctly the patient. Instead of a single intensity, you are going to test him across various intensities.

you are trying to find out at which intensity will the patient reach his maximum score or the pb max that becomes a maximum score of the pb max the sts score is maximum at which intensity we are trying to find out by by charting this by charting this chart against a number of intensities okay so at one point you will reach at what at one intensity range you will reach the maximum that is the hundred that is hundred percent you are able to reach Here also you are able to reach at 100%. What level you are able to reach it. That is what we are trying to do with PB Max.

Okay. Okay. Not only as I said, not only do we note at what intensity he is getting the maximum number of words correctly, also at maximum number of words correctly at the same time at what decibel range the intensity of the sound at which he is able to reach that maximum decibel range also is noted.

So that becomes characteristic of certain diseases. And also, suppose this patient is having, say, conductive hearing loss and this cannot be rectified by surgery or the patient is not asking for surgery. Patient says, I don't want surgery.

Then at 70 decibels, this patient is going to set his volume of the hearing aid at 70 decibels because at 70 decibels, he's getting PV max at 100. OK, so this is the use of PV max. OK, so what do we do in PV max? In SDS, we took a single supra threshold level.

In PBmax, we tested against a range of amplitudes of range of decibels and we test where he is getting the maximum score and what is the maximum he can reach also. So, what are the results? How do we assess the results?

PV score of a normal person is 100 decibels at 15 decibels. 100% at 15 decibels. So, this is an S-shaped curve.

That is what you will get in normal people and in connective hearing loss, you will get a S-shaped kind of a curve. where in normal people you will be getting a pbmax of 100 at 15 decibels only. At 15 decibels only you will get 100 score. That is he is going to repeat every word correctly back to you at 15 decibels itself.

So that becomes normal. In conductive hearing loss in this particular case he is repeating 100% of the words correctly at 70 decibels amplitude. At 70 decibels of intensity he is able to get the pb max or he is going to get 100% at 70 decibels. So here also the curve is S shaped but we do not get it. It is parallel to a normal person but you get it at a later intensity.

Instead of getting it at 15 you may get it at 30 you may get it at 70 but in this particular case we are getting it at 70 decibels. So, PB score in conductive hearing loss is also 100% at 70 decibels and it runs parallel to a normal person. Now, coming to cochlear and retrocochlear hearing loss. What happens in cochlear sensor neural hearing loss?

You get a PB max at 70 decibels and then attains a plateau. So, here we let us see. So, PB max, you are getting PB max at 70 decibels.

That is, he is getting the maximum number of words that he can repeat correctly. He is at 70 decibels. And even if you observe, he is not able to reach 100% also. He is able to reach approximately like 75-80 decibels.

He is able to reach 70-80% of words. Only he can repeat correctly. Only 80% of words can be repeated correctly by this cochlear hearing loss patient.

And also, you are going to get it at 70 decibels. So, you have to raise the intensity to a great volume. Also, you are not getting maximum PV max. Okay.

So, in cochlear hearing loss, you will get a plateau. But as you keep increasing the intensity... the PVmax will not increase and will not form an S-shaped kind of a curve.

It will be like a plateau. So, this plateauing, that is, after this PVmax, as you keep on increasing the intensity, the PVmax will remain the same. The PVmax score, that is, the 80% score, is not going to have increase in the score or decrease in the score.

It forms a plateau. The plateau is characteristic of cochlear hearing loss, cochlear sensor neural hearing loss. Okay.

What happens in retrocochlear hearing loss? What happens in retrocochlear hearing loss? In retrocochlear hearing loss, he is attaining PV max at a much later amplitude.

That is, you have to increase the sound even further. You have to increase the sound to 80 decibels. You have to increase the 80 decibels and also you are not able to reach it till 40 also.

40, 45, approximately 45% is the, suppose you are giving 100 words to the patient, patient is only able to repeat 45 words back to you. So that is a really great fall in the... speech discrimination score is falling down rapidly and has fallen down to a great level has gone fallen down to a severe level and also you have to raise the intensity to at 80 decibels but the but the interesting feature of this is as you keep increasing to 90 and 100 instead of maintaining a plateau it is falling down so at higher intensities of sounds the the thing is falling down there the curve is falling down he is able to hear less number of sounds he is able to repeat less number of sounds correctly.

So at 80 decibels, at 90 decibels, she is able to hear like 38. At 100 decibels, she is going to hear much lesser. So there is a fall in the PP max as the intensity is increasing. In cochlear, what happened?

As the intensity is increasing, there is a plateau. The PP max is remaining in constant. But in retro cochlear hearing loss, as the intensity is increasing, the PP max is actually falling down.

The number of words repeated correctly is falling down. So that becomes what is called a rollover curve. That is what is called a rollover phenomenon.

So with increase in speech intensity, increase in speech intensity above a particular level, above a particular level, 80 decibels in this case, PV score falls rather than maintaining a plateau. PV score will fall. PV score is falling down, right?

Rather than maintaining a plateau, that is characteristic of, sorry, this is retrocochlear hearing loss. This is retrocochlear sensorineural hearing loss. Okay, so what are the uses of speech audiometry?

We already discussed all of them. So, if you find the speech reception threshold, it correlates with the average of PTA. So, you can find out how much is the PTA average or how much is the hearing loss of this patient.

Suppose it is not correlating, then you can say that the patient is having malingering or the patient is feening or patient is a malingerer, patient is having non-organic hearing loss. For the sake of pension or the sake of money he is lying for the sake of some benefit he is lying. To find the intensity at which the STS is best this helps in fitting a hearing aid we already said. So at which intensity patient is able to repeat the maximum number of words correctly that becomes the PB max.

That is the volume at which you are going to fit the hearing aid and that is the volume in which the patient can get good hearing. How do you differentiate cochlear from retrocochlear hearing loss? If you chart these scores, that is the percentage, SDS scores, SDS scores on one side and the decibels on one side, as you keep on increasing the decibels, if you are going to reach a plateau, once you reach the highest, say 80%, and after that it is not increasing and it is maintaining a plateau, that becomes cochlear hearing loss.

And then as you are increasing the intensity, if it is falling down, the PB score is falling down as the intensity increases, it is characteristic of retrocochlear hemorrhage. So, these are the uses of speech audiometry. So, speech audiometry means basically ability to hear and understand speech. Okay. So, thank you for the patient listening.

Transcript for:Understanding Speech Audiometry Techniques

Transcript for:
Understanding Speech Audiometry Techniques