Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Ear Hear. 2019 Mar/Apr;40(2):426-436. doi: 10.1097/AUD.0000000000000635.
The clinical evaluation of hearing loss, using a pure-tone audiogram, is not adequate to assess the functional hearing capabilities (or handicap) of a patient, especially the speech-in-noise communication difficulties. The primary objective of this study was to measure the effect of elevated hearing thresholds on the recognition performance in various functional speech-in-noise tests that cover acoustic scenes of different complexities and to identify the subset of tests that (a) were sensitive to individual differences in hearing thresholds and (b) provide complementary information to the audiogram. A secondary goal was to compare the performance on this test battery with the self-assessed performance level of functional hearing abilities.
In this study, speech-in-noise performance of normal-hearing listeners and listeners with hearing loss (audiometric configuration ranging from near-normal hearing to moderate-severe hearing loss) was measured on a battery of 12 different tests designed to evaluate speech recognition in a variety of speech and masker conditions, and listening tasks. The listening conditions were designed to measure the ability to localize and monitor multiple speakers or to take advantage of masker modulation, spatial separation between the target and the masker, and a restricted vocabulary.
Listeners with hearing loss had significantly worse performance than the normal-hearing control group when speech was presented in the presence of a multitalker babble or in the presence of a single competing talker. In particular, the ability to take advantage of modulation benefit and spatial release from masking was significantly affected even with a mild audiometric loss. Elevated thresholds did not have a significant effect on the performance in the spatial awareness task. A composite score of all 12 tests was considered as a global metric of the overall speech-in-noise performance. Perceived hearing difficulties of subjects were better correlated with the composite score than with the performance on a standardized clinical speech-in-noise test. Regression analysis showed that scores from a subset of these tests, which could potentially take less than 10 min to administer, when combined with the better-ear pure-tone average and the subject's age, accounted for as much as 93.2% of the variance in the composite score.
A test that measures speech recognition in the presence of a spatially separated competing talker would be useful in measuring suprathreshold speech-in-noise deficits that cannot be readily predicted from standard audiometric evaluation. Including such a test can likely reduce the gap between patient complaints and their clinical evaluation.
纯音听力图对听力损失的临床评估，不足以评估患者的功能性听力能力（或障碍），尤其是在噪声环境下的言语交流困难。本研究的主要目的是测量听力阈值升高对各种功能性噪声下言语测试的识别性能的影响，这些测试涵盖了不同复杂程度的声场景，并确定（a）对听力阈值个体差异敏感和（b）为听力图提供补充信息的测试子集。次要目标是将该测试组合的性能与功能性听力能力的自我评估表现进行比较。
在这项研究中，正常听力受试者和听力损失受试者（听力配置从接近正常听力到中度至重度听力损失）的噪声下言语表现，通过一系列 12 种不同的测试进行测量，这些测试旨在评估各种言语和掩蔽条件下的言语识别能力，以及听力任务。听力条件旨在测量定位和监测多个说话者的能力，或利用掩蔽调制、目标和掩蔽器之间的空间分离以及受限词汇的能力。
当言语在多说话者背景噪声或单一竞争说话者存在下呈现时，听力损失的受试者的表现明显比正常听力对照组差。特别是，即使在轻度听力损失的情况下，利用调制益处和空间掩蔽释放的能力也受到显著影响。听力阈值升高对空间感知任务的表现没有显著影响。所有 12 项测试的综合评分被视为噪声下整体言语表现的综合指标。受试者的感知听力困难与综合评分的相关性优于与标准化临床噪声下言语测试的相关性。回归分析表明，这些测试的子集（可能需要不到 10 分钟的时间进行管理）的分数，当与较好耳纯音平均值和受试者年龄结合时，可解释综合评分中高达 93.2%的方差。
测量在空间上分离的竞争说话者存在下的言语识别的测试，将有助于测量不能从标准听力评估中轻易预测的阈上噪声下言语缺陷。包括这样的测试可能会缩小患者的抱怨与其临床评估之间的差距。
