Very Important Test Your Audi Should Do With Every Hearing Aid Fitting

There are 2 tests that your audi or hearing aid dispenser must use.

If I were a hearing aid user, I would insist they use at least one of the two tests to determine how well you are hearing with hearing aids on in noise.

Here’s a little background.

The HINT Test, developed in part or in full by the House Ear Clinic is one of the premier tests to determine how well patients are able to hear and understand in noisy environments. With hearing aids today, pretty much any hearing aid can help patients understand in quiet environments, such as in an audi’s office. Yet, the minute they walk outside or go to a restaurant, they cannot hear and understand anymore.

This is where the HINT and Quick SIN come in. Even in a quiet audi’s office, they can use an audio setup to simulate backround noise and measure exacltly what signal to noise ratio you are able to get with your hearing aids in the ear.

With normal hearing, we can typically hear and understand at around negative 4-6 db, basically the voice being 4-6 db softer than the noise. With hearing impaired individuals with analog hearing aids, the voice would have to be at least 2db or more louder than the noise, or a positive SNR (signal to noise ratio).

With today’s directional and digital hearing aids, we are sometimes able to get back down into the -2 sometimes -4 db SNR.

Now if your audi with your hearing aids can prove that your hearing in noise with either the HINT or Quick SIN is around -2 or even 0 db SNR, then you have a great set of hearing aids.

If the results are +4db or more, basicallly the voice has to be louder than the noise, then you may not be getting optimal results.

Sonic Innovations is one of the companies that love this test, because their hearing aids typically do very well on this test and in the real world. Yet, there are other manufacturers that can do well also. But the main factor is the skill of your professional. They can have access to the best hearing aids, yet not have good results because they are not goot at merging all of the information.

That said, this is how this test is supposed to be used (and if I were a prospective hearing aid buyer, I would quiz your professional to ensure they know this):

HINT

  • Calibrate both the noise and voice channel to 65 db SPL
  • Once that is done, the noise is kept at a steady 65 db SPL.
  • Typically you start the voice at +10 db SPL or less and start lowering down the voice steadily to determine the signal to noise ratio or SNR.
  • For example if you lower the voice channel down to 65 db spl, then we have a 0 db SNR, which is just ok.

    But if he/she can lower the voice down to, let’s say 61 db, then that creates a -4 db SNR which is awesome.

    Thus, the more negative the SNR number, the better. You should demand 0 db SNR or better if you have speech discrimination scores of 75% or better.

    Now if your speech discrimination scores are less than 75%, then we cannot expect negative snr scores.

    If you have any questions on this, feel free to post and myself or Admin or a couple of the other professionals can answer your questions.

    The more information about your hearing loss you can give you, the more specific we can be.

    With normal hearing, we can typically hear and understand at around negative 4-6 db, basically the voice being 4-6 db softer than the noise. With hearing impaired individuals with analog hearing aids, the voice would have to be at least 2db or more louder than the noise, or a positive SNR (signal to noise ratio).

    With today’s directional and digital hearing aids, we are sometimes able to get back down into the -2 sometimes -4 db SNR.

    I guess I am dumber than I thought. This sounds backwards to me. Why would a normal hearing person not hear a voice to the positive in noise? They can hear the speech so why is it a negative number? Are you saying that normal hearing people can pull softer speech out of more noise? That is the way I take it.
    I want to learn about my hearing so I thank you for the information. I think I will e-mail my local Audiologist and ask what test she uses to check the effectiveness of my aid settings. I only hope I get a correct response as she is the only one in our town.

    With regard to negative SNR, normal hearing people can hear both positive and down to the negative 4-6 db SNR. That means they can hear a loud voice in a crowd (positive snr) and also a soft voice in a crowd (negative snr). With negative snr, it becomes more difficult to hear, whether we have perfect hearing or impaired hearing.

    The more negative snr you can hear through with hearing aids, the better you are hearing. In fact, if you can get hearing aids to help an individual hear voices that are softer than the noise, negative snr, then you have a great set of hearing aids and a good fitting.

    I love using this test in real time, while patients are hooked up to the computer and software so that I can fine tune the instruments to optimize their hearing and understanding in noise.

    Here is an exerpt from the California Ear Institute about the HINT test…It explains the test better than I can:

    Hearing in Noise Test (HINT)
    WHAT IS THE HINT TEST?
    The Hearing in Noise Test (HINT) measures a person’s ability to hear speech in quiet and in noise. During the test, the patient uses both ears together (binaural hearing) to repeat sentences. Binaural hearing ability is essential for communication in noisy settings and for other aspects of functional hearing, such as sound localization and recognition of environmental sounds. In this test, the patient is required to repeat sentences both in a quiet environment and with competing noise being presented from different directions.
    WHO TAKES THIS TEST?
    This test is primarily used for three populations. The first group is those patients with normal hearing or a very mild hearing loss who report persistent difficulty understanding conversation amid background noise. This test provides some objective measure of how much difficulty an individual is having compared to persons that have normal hearing in quiet and in noise. The second group is peace officers who have hearing impairment. They are required by the California Peace Officer Standards training (POST) guidelines* to have the HINT test because even minor degrees of hearing impairment can make it increasingly difficult for an officer to effectively carry out his/her duties. The third group is our hearing aid users who wish to assess how different types of hearing aids benefit them in noisy situations.
    WHAT IS INVOLVED IN TAKING THIS TEST?
    The HINT battery consists of four test conditions. For each test, speech is located directly in front of the subject at 0° azimuth, and all sound sources are one meter from the center of the subject’s head. For each of the four conditions, the subject is required to listen to a sentence and repeat it. The four test conditions are: (1) sentences with no competing noise, (2) sentences with competing noise presented directly in front of the patient, (3) noise presented at 90° to the right of the patient, and (4) noise presented at 90° to the left of the patient. In all conditions, the competing noise is presented at a steady loudness of 65dB(A). The loudness of the sentences presented is varied throughout the test, depending on whether the patient repeats it correctly or not.
    HOW IS THE HINT TEST SCORED?
    The tester scores each sentence repeated as either correct or incorrect. All words in the sentence must be repeated correctly. At the end of the test, a signal-to-noise ratio (SNR) is generated for each test condition. A signal-to-noise ratio equals how loud the sentences needed to be turned up above the noise floor so that the patient could repeat them correctly 50% of the time. For example, an SNR of 5dB indicates that the sentences had to be presented at 70dB (or 5dB above the 65dB noise floor) in order to be repeated correctly 50% of the time. The higher the SNR, the more difficulty the patient has hearing in noise. The HINT test is scored as a “pass” or “fail” in each condition and the cut-off criteria are based on the scores from a group of more than 50 subjects with normal hearing. These scores were provided bu House Ear Institute who developed the HINT test.
    HINT test results show three things:

    1. Subject’s signal to noise ratio threshold (e.g. 5dB)
    2. Subject’s threshold as a percentile in reference to the normal distribution of the data (e.g. 95th %ile)
    3. Subject’s maximum percent change in intelligibility. This is the predicted maximum difference in intelligibility in reference to the mean normal performance (e.g. the subject’s predicted intelligibility is 23% poorer than normal hearing intelligibility)
    [Click here for an example of HINT results](http://www.californiaearinstitute.com/images/hint.gif).After the HINT test is complete the results are discussed with the patient. The patient will then follow up with the referring physician or the referring law enforcement agency. For referring agencies, a cover letter will be sent with the HINT results to both the patient and the agency within one week. * Requires Adobe Reader®. [Click here](http://www.adobe.com/products/acrobat/readstep2.html) to download the PDF plugin.

    Do audis really take these tests?

    I prefer the Quicksin as it is very quick and very usefull in determining which aid migh perform best for a particular client and it is also integrated into my MEdRX audiometer and scores electronically. I won’t prescribe a client without doing the test anymore, now that I have been using it consistently.

    It is greatly beneficial if they can, but not all booth/office/equipment setups allow for this test to be PROPERLY administered.

    In offices where I have had the proper setup, I prefer the Quicksin also.

    dr. amy

    There are MANY tests out there.

    Some stray into the medical world, which is not where dispensers should be.

    Some even predict if your new client will buy a hearing aid or not!

    “Sorry Mr Smith, Test #4 indicates that you will never sign the cheque. The door is over there. Have a great day.”

    More seriously, surely the testing that we have today is the ‘optimum’ for society? Evolution works in the social context as well as in genetics.

    We could have NO testing - POINTLESS.

    We could have 50 tests per client - POINTLESS as only a handful of clients would ever receive hearing aids.

    So we end up with exactly the number & type of tests that suits society best. Enough test to help identify problems and to fit aids - but maybe not enough to reach perfection. An 80% satisfaction figure probably is adequate to make the whole system work.

    I agree.

    And I think it is a slippery slope when we start telling people that their professional (audi, dispenser) MUST do this or MUST do that or the patient should walk. Walk where exactly?? I see no problem at all asking if your professional performs certain testing or assessments. And if they don’t - ask why! They may have a perfectly reasonable explanation, and find fault with certain tests that other professionals swear by.

    Its been my experience that while some tests can give myriads of information, we have to figure out how helpful it is to the patient’s success. Speech in Noise testing can certainly be helpful. But it’s more helpful in assessing my medical patients than my hearing aid patients. Especially when there are VERY specific noisy situations that tests as these cannot replicate.

    dr. amy

    First, I’m asking quite a few questions because of your thorough answers about speech discrimination. I have worn hearing aids for 8 years, am in my 70s. Recently while I was in the US (I live in Mexico) an audiologist told me I had speech discrimination scores in the mid-50s. (1) Does this mean he was using one of the tests you mention? I mention where I live because my choices of HAs here may be limited and not of the most recent generation. I have a ski slope loss with my freq scores now around 90, slightly above and below. (2) is it possible to improve speech discrimination (like strengthening a muscle) or not? (3) How much does binaural communication between aids help or is it unnecessary? (4) My lifestyle is: much time spent alone but as I am a cultural journalist and also for social reasons, understanding others and not avoiding long conversations is important. (5) also, it’s important I hear consonants as well as possible to comprehend Spanish. (6) If you know anything about Unitron, I would be interested as I have gone to an audiologist here who carries that brand & who seems capable. Hope to hear from you soon.

    As much as I hate to agree with any ‘slippery slope’ argument, I agree here.

    It is simply silly to say that if the hearing professional misses out test X they are obviously a tardypants and you should run from their office to perform a quirkafleeg.

    Having said all that, I do think there is an essential component of any good hearing consultation and that is listening to some REAL hearing aids. I think only an idiot would routinely meet with patients and then try and ‘sell’ hearing aids without discovering how a patient responds to listening to real hearing aids, ideally with a familiar voice (such as spouse). An aid demo can also be done with artificial generated background noise to see how they do. If the patient likes the sound, can hear well, can hear in background noise, bingo we’ve learned what works with real hearing aid technology. To me this is the most useful thing you can learn as a hearing professional. Can you improve the hearing of your patient, and if so what kind of sound do they like? Once you’ve answered that question, you now know how to solve their problem in real life with real hearing aids. Isn’t that really the purpose of testing their hearing to begin with?

    This is my new favorite word.
    Love. It.

    You sir, are quite welcome :wink:

    ZCT,
    I think it should have been Yes Ma’am, you are quite welcome. Just thought you would like to know.

    Oops :eek:

    My bad.

    That’s okay…lol.
    I think it’s a natural assumption that someone replying is a man…

    Agreed :wink:

    dr.amy

    Well your handle is gender neutral, and I don’t recall you ever saying your gender in a post. So I took a coin flip and lost!

    Really…it’s okay. I’m not offended…
    I was kinda getting a kick out of people thinking I was a man actually…