Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA.
Department of Speech-Language-Hearing, Boys Town National Research Hospital, Omaha, Nebraska, USA.
Ear Hear. 2024;45(4):816-826. doi: 10.1097/AUD.0000000000001472. Epub 2024 Feb 28.
Self-assessment of perceived communication difficulty has been used in clinical and research practices for decades. Such questionnaires routinely assess the perceived ability of an individual to understand speech, particularly in background noise. Despite the emphasis on perceived performance in noise, speech recognition in routine audiologic practice is measured by word recognition in quiet (WRQ). Moreover, surprisingly little data exist that compare speech understanding in noise (SIN) abilities to perceived communication difficulty. Here, we address these issues by examining audiometric thresholds, WRQ scores, QuickSIN signal to noise ratio (SNR) loss, and perceived auditory disability as measured by the five questions on the Speech Spatial Questionnaire-12 (SSQ12) devoted to speech understanding (SSQ12-Speech5).
We examined data from 1633 patients who underwent audiometric assessment at the Stanford Ear Institute. All individuals completed the SSQ12 questionnaire, pure-tone audiometry, and speech assessment consisting of ear-specific WRQ, and ear-specific QuickSIN. Only individuals with hearing threshold asymmetries ≤10 dB HL in their high-frequency pure-tone average (HFPTA) were included. Our primary objectives were to (1) examine the relationship between audiometric variables and the SSQ12-Speech5 scores, (2) determine the amount of variance in the SSQ12-Speech5 scores which could be predicted from audiometric variables, and (3) predict which patients were likely to report greater perceived auditory disability according to the SSQ12-Speech5.
Performance on the SSQ12-Speech5 indicated greater perceived auditory disability with more severe degrees of hearing loss and greater QuickSIN SNR loss. Degree of hearing loss and QuickSIN SNR loss were found to account for modest but significant variance in SSQ12-Speech5 scores after accounting for age. In contrast, WRQ scores did not significantly contribute to the predictive power of the model. Degree of hearing loss and QuickSIN SNR loss were also found to have moderate diagnostic accuracy for determining which patients were likely to report SSQ12-Speech5 scores indicating greater perceived auditory disability.
Taken together, these data indicate that audiometric factors including degree of hearing loss (i.e., HFPTA) and QuickSIN SNR loss are predictive of SSQ12-Speech5 scores, though notable variance remains unaccounted for after considering these factors. HFPTA and QuickSIN SNR loss-but not WRQ scores-accounted for a significant amount of variance in SSQ12-Speech5 scores and were largely effective at predicting which patients are likely to report greater perceived auditory disability on the SSQ12-Speech5. This provides further evidence for the notion that speech-in-noise measures have greater clinical utility than WRQ in most instances as they relate more closely to measures of perceived auditory disability.
自我评估感知交流困难已在临床和研究实践中使用了几十年。此类问卷通常评估个体理解言语的感知能力，尤其是在背景噪声中。尽管强调了在噪声中的感知表现，但常规听力学实践中的言语识别是通过安静环境中的单词识别（WRQ）来衡量的。此外，令人惊讶的是，很少有数据比较噪声下言语理解（SIN）能力与感知交流困难之间的关系。在这里，我们通过检查听力阈值、WRQ 分数、QuickSIN 信噪比（SNR）损失以及通过专门用于言语理解的 12 项言语空间问卷（SSQ12）的 5 个问题（SSQ12-Speech5）测量的感知听觉障碍，来解决这些问题。
我们检查了在斯坦福耳研究所接受听力评估的 1633 名患者的数据。所有个体都完成了 SSQ12 问卷、纯音测听和言语评估，包括耳特异性 WRQ 和耳特异性 QuickSIN。仅包括高频纯音平均（HFPTA）听力阈值不对称性≤10 dB HL 的个体。我们的主要目的是：（1）检查听力变量与 SSQ12-Speech5 评分之间的关系；（2）确定听力变量可以预测 SSQ12-Speech5 评分的方差量；（3）根据 SSQ12-Speech5 预测哪些患者更有可能报告感知听觉障碍更大。
SSQ12-Speech5 上的表现表明，随着听力损失程度的加重和 QuickSIN SNR 损失的增加，感知听觉障碍程度更大。在考虑年龄因素后，发现听力损失程度和 QuickSIN SNR 损失可解释 SSQ12-Speech5 评分中适度但显著的差异。相比之下，WRQ 分数对模型的预测能力没有显著贡献。听力损失程度和 QuickSIN SNR 损失也被发现对确定哪些患者更有可能报告 SSQ12-Speech5 评分表明感知听觉障碍更大具有中等的诊断准确性。
综上所述，这些数据表明，包括听力损失程度（即 HFPTA）和 QuickSIN SNR 损失在内的听力因素可预测 SSQ12-Speech5 评分，但在考虑这些因素后，仍有明显的差异无法解释。HFPTA 和 QuickSIN SNR 损失——而不是 WRQ 分数——解释了 SSQ12-Speech5 评分中的大量差异，并且在很大程度上能够预测哪些患者更有可能在 SSQ12-Speech5 上报告感知听觉障碍更大。这进一步证明了在大多数情况下，噪声下的言语测量比 WRQ 更具临床效用，因为它们与感知听觉障碍的测量更密切相关。
