I disagree. Testing with individual words rely on what you actually hear. A phrase or sentence also relies on how well your brain can fill in the missing word(s). To me the individual words would be a more accurate representation of what you actually hear rather than how well your brain fills in the missing bits. jmo
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I definitely agree with you, I use to spend a lot of time that delayed my response to question just filling in the gaps in the sentence or questions. I have to say with my More1 aids I respond to those questions much faster and more accurate.
While that may be true, I’d like to have the noise voice related rather than white noise.
WH
It doesn’t matter - the noises from one or two small transducers in an office are a far cry from multiple noise sources moving a LOT of air in different vectors with different room acoustics, sympathetic vibrations, delays, and overtones, such as are present in a big, live room. All on top of a puny human voice …
This recorded test is just marketing hype, IMO. YMMV… [Having a BIG transducer array like they have in the Oticon lab is another story.]
Agree to disagree then. Simply because single words in a noisy place is not realistic. We’re not testing what we actually hear in a vacuum. That’s what the original Word Recognition Test in a quiet soundproof booth is for, and of course it has its usefulness and that’s why it’s done.
But what we’re talking about here is in the context of the signal to noise separation performance in a real world test with surrounding noise. We don’t need to do another Word Recognition Test in noise. It’s useless to me because in this context, it’s not about what you actually “hear” (like you said), it’s about what you “understand”. I actually don’t really care what I “hear”, as long as I “understand” what is being said to me in a noisy place. If it involves my brain filling in the missing words, that’s fine with me.
It’s because your brain uses MANY things to isolate and understand speech, not just one thing. It’s not just what it hears, but how it hears it, like the tonal distinction between the speaker’s voice (like low for male or high for female), the loudness (or softness) of the speaker’s voice compared to others, and maybe the frequency of the speaker’s speech (how fast or slow they speak), and even what the babbles sound like differently from the speaker’s speech. All of that helps the brain isolate and formulate and arrive at an understanding.
In fact, if you simply do single word test in noise like you propose, chances are the result you achieve may fare worse than the result of a real-life complete sentences testing. That’s because the adjustment to improve what you “hear” can be overly corrected more than necessary for you to “understand”, possibly toward a more detrimental result instead of a more helpful result.
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Sorry - I’m getting mixed up as to who’s responding to whom!
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I don’t know about everyone else but if I set in a noisy restaurant, or lecture with a bunch talking all at once it all sounds like very loud white noise to me.
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To me it sounds like my white noise machine that I sleep with but much louder. But what is interesting if I am in a really noisy restaurant and I take out my aids the noise is 10 times louder then with my aids on and functioning.
Sorry too, I didn’t include the quote originally but by the time I was done writing apparently there were several posts in between so it was not obvious whom I was replying to anymore. I’ve since included the original quote to clarify.
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With all due respect, you’re a little too quick to confidently dismiss a valuable clinical tool. QSiN is an excellent assessment that has allowed me, more often than not, to confidently prescribe lower end devices, rather than simply suggest to all clients that the more they spend, the better they’ll hear. In that way, it achieves the exact opposite of a marketing tool.
Furthermore, regardless of how complex a given soundscape is, all those “noise sources moving a LOT of air in different vectors with different room acoustics, sympathetic vibrations, delays, and overtones” are only perceived when they ultimately arrive at two small ear drums in your head. Therefore, capturing any given environment with a stereo pair of mics (that are positioned in such a way as to emulate a person’s ears), captures much of the important detail and complexity of any given environment - particularly when that recodring is played back through stereo inserts/earbuds (as I do in my clinic). It’s not perfect, but it’s a pretty damn good simulacrum for the real thing. The test and test scores are standardised, and are far more sophisticated than a trivial marketing tool.
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Fair enough explanation, @Louie - I’ll retract the marketing gimmick part, but not the issues I have with the physics.
How’s that? 
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Yeah, it’s not obvious to me if QSiN has some kind of setup requirement on the speaker array in a test booth or not. If there’s no requirement and everything can come from just a single speaker, it doesn’t really test the HAs for how they handle surrounding noise at all. For traditional HAs which block out surrounding sounds to focus only in front, a single front speaker emanating all sounds including noise set in front of a patient doesn’t do any good for them because the HAs wouldn’t be able to separate the sounds anyway to help out because there’s no surrounding sounds, there’s only front sounds.
I think at a minimum, there should be a “surround” sound type setup with 5 speakers, a front center, front left, front right, rear left and rear right. Another rear center would also be ideal.
Another thing we don’t know about the QSiN test is whether they can route different noise sources separately into different speakers to simulate the origins of the noise sources, or whether it’s a mono setup and all noises come from 1 channel. If the later, then it’s not going to be as realistic and effective either.
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This test comes BEFORE the fitting of an aid. I don’t use it to assess how people perform with a hearing aid for exactly the reason you both have mentioned. I use it as an unaided test to measure their natural ability to focus on a voice in background noise. The test provides a measure of the client’s required signal-to-noise ratio - I.e how much separation between the vol. of noise and the vol. of speech in order to hear well. We then use that score to recommend an appropriate tech level. If they have a good signal-to-noise ratio I can confidently tell them they don’t need to spend extra thousands for a premium device. Alternatively if they score poorly, I recommend more advanced devices, remote microphones, and I counsel on setting up realistic expectations.
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Oh-h-h-h-h ka-a-a-y! Now you’re talking, I can see the value in both. The first value is like you said, to ascertain what tier level of hearing aid would be sufficient to the listener. BUT, I don’t see why it should not be used again after the hearing aids have been fitted, to VERIFY/CONFIRM that your assessment of the appropriate hearing aid tier level is correct and the result is achieved as intended.
To use it only before fitting the hearing aids then not use it again to confirm would be achieving only half the usefulness of the test.
To use it before fitting requires no additional equipment other than what’s already required to do standard audiometry. To do it accurately as a verification method (post-fitting) you need a surround sound free-field set-up in an acoustically treated room. And although it would be very cool, it wouldn’t give you much more info than what the client can give you after trialling the devices for a week or so. I guess the benefit would be the immediacy of the results. However, it would be a significant expense to the provider to purchase and calibrate the additional equipment and sound-treat the room.
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Seriously, full respect for doing this. “The more you spend, the better you hear” is all I’ve ever hearc from an audiologist.
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I would suggest that it is not quite as fine-grained as that.
Some patients with hearing loss still have normal scores on the QuickSIN, which allows you to say “you don’t really need much help in noise, so feel free to get this cheaper hearing aid”. Re-testing after the fitting doesn’t add much value because of the floor effect; their scores are already at the bottom (low is good on the QuickSIN) so you won’t improvement from there. Others do so poorly on the QuickSIN under headphones that you know in advance that even the most expensive hearing aid is not going to be enough to support their hearing in noise and you need to talk about remote mics and realistic expectations, etc… Both of those situations are useful information for fitting decisions.
Some people score sort of in the middle, but Spud isn’t wrong–the test is a little bit too artificial to track precisely onto real-world situations. Under headphones, the QuickSIN does NOT provide the cues we use for spatial hearing and so does not replicate that sound scape that Spud is imagining. It’s also variable enough that it’s hard to say “Okay, you need exactly a 6 dB boost in all situations, go with the More 2” (if we even trusted the manufacturer’s assessments of the real world SNR improvement of their devices, which we do not). For aided testing, you can run it with spatial separation in the soundfield, but you’re still only typically looking at one babble source and one target speech source (it’s common for audiologists to have a two speaker soundfield but usually only researchers have a calibrated array $$$$$$). And that two equi-distant speech-source set-up might not be a great test of the particular hearing aid’s function. The Opn/More strategy, for example, could be expected to detect a near-field speech source from the rear (if you’re running front to back) and turn off, which is not representative of its real-world function. So . . . I also agree with Spud’s instinct that when a test being used to validate hearing aid function doesn’t have a lot of construct validity it starts to feel more like a marketting gimmick. But as Louie said, that’s not how they are using it.
So in sum, results at either end of the QuickSIN give us very clear information and results in the middle are not as clear. (Similar to the WRS, come to think of it, which is also less varible for edge results than middle results.) But still a very useful test and I’m surprised people are saying they’ve never had it done because I thought it was pretty standard. Where I am, it’s standard practice even in Costco, but I’ve also said before that I think Canadian Costco is better than American Costco when it comes to standard of hearing care.
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