What does my QuickSIN score mean?

Hi can someone please explain the quick sin test to me.

I have a mild high sensory neural frequency hearing loss caused by ageing but had a quick sin score of 9.

What does this mean? Apparently it’s the quick sin shows I have some difficulty hearing in noise. But I don’t understand as my hearing test shows my hearing is mild.

Could someone help explain it to me please. The more detail the better.

Thanks :slightly_smiling_face:

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The short answer is that as folks age, they not only tend to lose the ability to just plain hear sounds, usually more loss at higher frequencies, less at lower, but they also lose the secondary ability to process the sounds they hear in their brain and separate speech from noise or the speech that they want to hear from other voices in the background. So just because you haven’t lost that much hearing doesn’t mean that your ability to interpret the sounds you do hear won’t also be reduced a bit. In the worst possible case, the ability to recognize speech in noise can get so bad that hearing aids won’t do a person any (much) good because even when hearing sounds is “restored,” the person can’t interpret the sounds that they hear adequately.

Another way of thinking about it:
80% of the “power” of speech is in the low-frequencies. It is easy to “hear” that people are speaking, especially vowel sounds like “a”, “e”, “i”, “o” or “u” which originate in the chest and throat.

However, 80% of the “understanding” in speech is in the consonants which occur predominantly in the high-frequencies and are produced by the lips and tongue. A good example here are the words “night”, “knife” and “nice”. It may be easy to hear the “ni” sound but more difficult to understand what is being said, especially in a noisy environment (which further masks out the consonant beginnings and endings of words).

Even with a mild loss, the fact that yours is concentrated more in the high-frequencies (very common as we age) means that you might struggle for understanding, especially in the presence of background noise. The QuickSin is designed specifically to test this out and also as a way of demonstrating the difference between hearing without hearing aids and the benefit they do provide when worn by the patient.

Hope this is helpful.
Chris

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Thank you for your helpful reply.

I didn’t realise the quick sin test is a measure of how the brain interprets sound. I thought it was all in the ears - so thank you for that.

I’m trying to read more about this as I find it interesting. Have you come across any good websites/ reading material which explains this in more detail? I’ve tried looking but have been unsuccessful. I’ve just found information on how to do the test not about the brain side of thing.

Thanks

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Here’s a quote from an Audiology Online course on Speech-in-Noise testing: https://www.audiologyonline.com/articles/using-speech-in-noise-tests-832

Hearing loss can be generally categorized into two types: loss of audibility and loss of clarity. We know from basic hearing science that the loss of audibility, or volume, can be attributed to damage of the outer hair cells. We also know that there is a fairly predictable relationship between the thresholds and the amount of gain a patient needs to restore audibility. Loss of clarity, on the other hand, is attributed to damage of the inner hair cells or central auditory nervous system. We also know that, for the most part, there is a pretty unpredictable relationship between the audiometric thresholds and that loss of clarity. Loss of clarity is distortion-based and is not remedied by additional gain or volume. It can, however, be quantified with SIN testing that directly measures something called signal to noise ratio loss (SNR loss).

(emphasis mine)

Dr. Cliff has a good video on the importance and implications of speech-in-noise testing but it doesn’t discuss auditory apparatus vs. CNS involvement:


One can learn a lot, both at Audiology Online (can sign up and audit courses even though intended for hearing care professionals) and at Dr. Cliff’s YouTube channel. If you subscribe to Dr. Cliff, as I do, you’ll be notified by e-mail every time he creates a fresh video.

Actually: the wires ear to brain have very low information capacity. But there are several nerve-centers along the way for pre-processing. Your brain “tells” these lumps what it wants to hear. It does more processing inside the brain. (This intermediate processing is still mysterious.)

Think why we have ears at all. There’s tasty prey in the leaves. Or a tiger-toe behind us. Or our cave-mate describes a better way to lash a spear. Your brain tells the preprocessor to prioritize leaf-rustles, tiger-toe, spear-speech sounds.

So the doc tells you to listen to a tone, you hear a tone, fine. Easy job.

In the tavern you have a dozen voices spraying all frequencies and levels. Most people have some skill at telling the ear system “I want Mary’s words with emphasis on s and f and th sounds.” But with years of high-loss, the oo and ee of the general crowd sound “mask” Mary’s fricatives, and the ability to pre-select that one sound in the crowd declines. Your preselection system gets out of practice.

Like: I used to be good at wiring-up small electronics. I got away from it, and then was OK on a large project, but got away from it again (in part because of declining eyes and fat fingers). I know if I started a project now (with magnifier and tweezers) I would fumble 100 joints before I got good at it again. And this is a fairly simple and “visible” skill compared to the complex and invisible skill of sorting-out sounds.

So the application of hearing aids is only a part of the rehabilitation. You need to get the processing systems back up to speed, nimble and clever again. This (along with “everything sounds strange”) is part of why new HA users are told to use their aids daily for a month or more before coming to a conclusion. Just bringing up the sound level, and a little programatic noise-filtering, is not all it takes to “hear good” again. (It seems likely that age and the chaos of a long life also reduce our processing generally.)

more detail the better.

The clinician’s instructions for QuickSIN (a more practical SIN suite) give more details on the test, though not so much background of why (Quick)SIN was developed.

Book snippet on SIN and other S/N tests

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That was a really good explanation of hearing disorders.
Thanks for sharing.

Two main things lead people to hearing aids:

  • I can’t understand my spouse, kids, TV across the room
  • I can’t understand in a noisy place (office, restaurant)

“Noise” (all unwanted sound) is part of both problems; worse when noise is high.

I’ve done a lot of sound recording. “Noise” is one of the problems. Records and tapes hissss. If the speech/music drops too small, it is hidden in the hiss. Sometimes this becomes the major problem. I was asked to recover some old 78rpm records from a friend’s childhood. Naturally the grooves were full of dust: shsssksssskshssssskTssss. The loud parts (vowels) boomed through; the consonants were buried in hiss. In that case (working with recording and sound files on PC) I was able to use off-line processing, teach it a snip of bare “shsss” and ask it to remove it from the rest of the track. But doing that in real-time and with “babble” noise is much tougher, for people and for aids.

In lecture-hall acoustics we are taught to strive for 25dB signal to noise for very-good intelligibility. At 10dB S/N many lecture-words will be missed even in young ears.

What does (Quick)SIN test?

You hear a primary talker, and 3-4 other talkers much softer. You are asked to repeat what the primary talker says and ignore the others. Then the other talkers get louder. When you can’t get half of what the primary talker says, because the other talkers get in the way, the loudness difference between primary and others is noted as your score.

The SIN tests aim for 50% mistakes because that point is easier to find than say 10% mistakes (which would be preferred in lecture listening).

So if you have 50% mis-hears at 9dB S/N, when lecture-hall experience suggests less than 10% mis-hears at 10dB S/N, it says you could hear better. (However lecture-hall acoustic “noise” is more random, ventilation and chair-creaks; SIN and restaurant “noise” is speech, which is a harder discrimination task.)

Also the SIN 50% level for “normal” folks is 0db to 3dB. The voice you want to hear half of can be very nearly same level as the other voices. A SIN of 9 means the voice you want needs to be twice as loud as others. In a crowd, that can’t happen (we can’t all be twice as loud as everybody else).

Killion (father of SIN and QuickSIN) wrote some on intelligibility in noise and why it does not correlate well with pure loss.

SIN Report: click PDF link top right (open this link in new tab)

The Etymotic SIN tests are in “English” (and perhaps Mid-West American?), so must be adapted for other linguistic populations. This paper (in English!) on SIN for Mandarin starts with a good overview, and rationale for calibrating scores with “normal” people.

The QuickSIN is actually simpler (by using more refined testing). You start with 25 “points”. You listen to 25 examples at various S/N ratios. At the end the tester counts your mis-heard examples and subtracts that from 25. Good listeners get most right and score 0-5. Poor listeners mis-hear most and get 20-25. A score of 9 is a significant problem.

The S/N of the various samples is selected so this simple count gives a very close estimate of hearing S/N required for intelligibility, 0dB-25dB, without hours of tedious testing. (Hence “Quick”.)
The actual number is not 25, for obscure reasons; Killion has a paper on that.)

Sounds like my hearing!

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