Conformities and gaps of clinical audiological data with the international classification of functioning disability and health core sets for hearing loss.

OBJECTIVE: The International Classification of Functioning Disability and Health (ICF) is a classification of health and health-related domains created by the World Health Organization and can be used as a standard to evaluate the health and disability of individuals. The ICF Core Set for Hearing Loss (CSHL) refers to the ICF categories found to be relative to Hearing Loss (HL) and the consequences of it on daily life. This study aimed to adapt the content of a database gathered in Hörzentrum Oldenburg gGmbH that included HL medical assessments and audiological data to the ICF. DESIGN: ICF linking rules were applied to these assessment methods including medical interviews, ear examinations, pure-tone audiometry, Adaptive Categorical Loudness Scaling, and speech intelligibility test. STUDY SAMPLE: 1316 subjects. RESULTS: In total, 44% of the brief and 18% of the comprehensive CSHL categories were addressed. The hearing functions were broadly evaluated. "Activities and Participation" and "Environmental Factors" were poorly examined (17% and 12% of the comprehensive CSHL categories, respectively). CONCLUSIONS: The HL correlation with day-to-day activities limitation, performance restriction, and environmental conditions were poorly addressed. This study showed the essence of incorporating these methodologies with approaches that assess the daily-life challenges caused by HL in rehabilitation.

The development of a Self-Rated ICF-based questionnaire (HEAR-COMMAND Tool) to evaluate Hearing, Communication, and Conversation disability: Multinational experts' and patients' perspectives.

Objective: An instrument that facilitates the advancement of hearing healthcare delivery from a biomedical model to a biopsychosocial one that underpins the International Classification of Functioning, Disability, and Health framework (ICF) brief and comprehensive Core Sets for Hearing Loss (CSHL) is currently unavailable. The objective is to describe the process of developing and validating a new questionnaire named the HEAR-COMMAND Tool created by transferring the ICF CSHL into a theory-supported, practically manageable concept. Design: A team from Germany, the USA, the Netherlands, and Egypt collaborated on development. The following ICF domains were considered; "Body Functions" (BF), "Activities and Participation" (AP), and "Environmental Factors" (EF). The development yielded English, German, and Arabic versions. A pilot validation study with a total of 109 respondents across three countries, Germany, Egypt, and the USA was conducted to revise the item terminology according to the feedback provided by the respondents. Results: The questionnaire included a total of 120 items. Ninety items were designed to collect information on the functioning and 30 items inquiring about demographic information, hearing status, and Personal Factors. Except for the "Body Structures" (BS) domain, all the categories of the brief ICF CSHL were covered (a total of 85% of the categories). Moreover, the items covered 44% of the comprehensive ICF CSHL categories including 73% of BF, 55% of AP, and 27% of EF domains. Overall, the terminology of 24 ICF-based items was revised based on the qualitative analysis of the respondents' feedback to further clarify the items that were found tod be unclear or misleading. The tool highlighted the broad connection of HL with bodily health and contextual factors. Conclusions: The HEAR-COMMAND Tool was developed based on the ICF CSHL and from multinational experts' and patients' perspectives with the aim to improve the execution of audiological services, treatment, and rehabilitation for adult patients with HL. Additional validation of the tool is ongoing. The next step would be to pair the tool with BS categories since it was excluded from the tool and determine its effectiveness in guiding hearing health care practitioners to holistically classify categories influencing hearing, communication, and conversation disability.

The Concurrent OLSA Test: A Method for Speech Recognition in Multi-talker Situations at Fixed SNR.

A multi-talker paradigm is introduced that uses different attentional processes to adjust speech-recognition scores with the goal of conducting measurements at high signal-to-noise ratios (SNR). The basic idea is to simulate a group conversation with three talkers. Talkers alternately speak sentences of the German matrix test OLSA. Each time a sentence begins with the name "Kerstin" (call sign), the participant is addressed and instructed to repeat the last words of all sentences from that talker, until another talker begins a sentence with "Kerstin". The alternation of the talkers is implemented with an adjustable overlap time that causes an overlap between the call sign "Kerstin" and the target words to be repeated. Thus, the two tasks of detecting "Kerstin" and repeating target words are to be done at the same time. The paradigm was tested with 22 young normal-hearing participants (YNH) for three overlap times (0.6 s, 0.8 s, 1.0 s). Results for these overlap times show significant differences, with median target word recognition scores of 88%, 82%, and 77%, respectively (including call-sign and dual-task effects). A comparison of the dual task with the corresponding single tasks suggests that the observed effects reflect an increased cognitive load.

Development and evaluation of video recordings for the OLSA matrix sentence test.

OBJECTIVE: The aim was to create and validate an audiovisual version of the German matrix sentence test (MST), which uses the existing audio-only speech material. DESIGN: Video recordings were recorded and dubbed with the audio of the existing German MST. The current study evaluates the MST in conditions including audio and visual modalities, speech in quiet and noise, and open and closed-set response formats. SAMPLE: One female talker recorded repetitions of the German MST sentences. Twenty-eight young normal-hearing participants completed the evaluation study. RESULTS: The audiovisual benefit in quiet was 7.0 dB in sound pressure level (SPL). In noise, the audiovisual benefit was 4.9 dB in signal-to-noise ratio (SNR). Speechreading scores ranged from 0% to 84% speech reception in visual-only sentences (mean = 50%). Audiovisual speech reception thresholds (SRTs) had a larger standard deviation than audio-only SRTs. Audiovisual SRTs improved successively with increasing number of lists performed. The final video recordings are openly available. CONCLUSIONS: The video material achieved similar results as the literature in terms of gross speech intelligibility, despite the inherent asynchronies of dubbing. Due to ceiling effects, adaptive procedures targeting 80% intelligibility should be used. At least one or two training lists should be performed.

Speech Audiometry at Home: Automated Listening Tests via Smart Speakers With Normal-Hearing and Hearing-Impaired Listeners.

Speech audiometry in noise based on sentence tests is an important diagnostic tool to assess listeners' speech recognition threshold (SRT), i.e., the signal-to-noise ratio corresponding to 50% intelligibility. The clinical standard measurement procedure requires a professional experimenter to record and evaluate the response (expert-conducted speech audiometry). The use of automatic speech recognition enables self-conducted measurements with an easy-to-use speech-based interface. This article compares self-conducted SRT measurements using smart speakers with expert-conducted laboratory measurements. With smart speakers, there is no control over the absolute presentation level, potential errors from the automated response logging, and room acoustics. We investigate the differences between highly controlled measurements in the laboratory and smart speaker-based tests for young normal-hearing (NH) listeners as well as for elderly NH, mildly and moderately hearing-impaired listeners in low, medium, and highly reverberant room acoustics. For the smart speaker setup, we observe an overall bias in the SRT result that depends on the hearing loss. The bias ranges from +0.7 dB for elderly moderately hearing-impaired listeners to +2.2 dB for young NH listeners. The intrasubject standard deviation is close to the clinical standard deviation (0.57/0.69 dB for the young/elderly NH compared with 0.5 dB observed for clinical tests and 0.93/1.09 dB for the mild/moderate hearing-impaired listeners compared with 0.9 dB). For detecting a clinically elevated SRT, the speech-based test achieves an area under the curve value of 0.95 and therefore seems promising for complementing clinical measurements.

Can You Hear Out the Melody? Testing Musical Scene Perception in Young Normal-Hearing and Older Hearing-Impaired Listeners.

It is well known that hearing loss compromises auditory scene analysis abilities, as is usually manifested in difficulties of understanding speech in noise. Remarkably little is known about auditory scene analysis of hearing-impaired (HI) listeners when it comes to musical sounds. Specifically, it is unclear to which extent HI listeners are able to hear out a melody or an instrument from a musical mixture. Here, we tested a group of younger normal-hearing (yNH) and older HI (oHI) listeners with moderate hearing loss in their ability to match short melodies and instruments presented as part of mixtures. Four-tone sequences were used in conjunction with a simple musical accompaniment that acted as a masker (cello/piano dyads or spectrally matched noise). In each trial, a signal-masker mixture was presented, followed by two different versions of the signal alone. Listeners indicated which signal version was part of the mixture. Signal versions differed either in terms of the sequential order of the pitch sequence or in terms of timbre (flute vs. trumpet). Signal-to-masker thresholds were measured by varying the signal presentation level in an adaptive two-down/one-up procedure. We observed that thresholds of oHI listeners were elevated by on average 10 dB compared with that of yNH listeners. In contrast to yNH listeners, oHI listeners did not show evidence of listening in dips of the masker. Musical training of participants was associated with a lowering of thresholds. These results may indicate detrimental effects of hearing loss on central aspects of musical scene perception.

What Keeps Older Adults With Hearing Impairment From Adopting Hearing Aids?

The aim of this study was to compare elderly individuals who are hearing impaired but inexperienced in using hearing aids (hearing aid non-users; HA-NU) with their aided counterparts (hearing aid users; HA-U) across various auditory and non-auditory measures in order to identify differences that might be associated with the low hearing aid uptake rate. We have drawn data of 72 HA-NU and 139 HA-U with a mild-to-moderate hearing loss, and matched these two groups on the degree of hearing impairment, age, and sex. First, HA-NU and HA-U were compared across 65 auditory, cognitive, health-specific, and socioeconomic test measures as well as measures assessing technology commitment. Second, a logistic regression approach was performed to identify relevant predictors for using hearing aids. Finally, we conducted a sensitivity analysis for the matching approach. Group comparisons indicated that HA-NU perceive their hearing problem as less severe than their aided counterparts. Furthermore, HA-NU showed worse technology commitment and lower socioeconomic status than HA-U. The logistic regression revealed self-reported hearing performance, technology commitment, and the socioeconomic and health status as the most important predictors for using hearing aids.

Effect of Hearing Aid Directionality and Remote Microphone on Speech Intelligibility in Complex Listening Situations.

Remote microphones (RMs) have been developed to support hearing aid (HA) users in understanding distant talkers. In traditional clinical applications, a drawback of these systems is the deteriorated speech intelligibility in the near field. This study investigates advantages and disadvantages of clinical RM usage and the effects of different directionality settings of the HAs in complex listening situations in the laboratory. Speech intelligibility was investigated in 15 experienced severely hearing impaired participants in a noisy environment using a dual-task test paradigm where the tasks were presented from either a near field or a far field loudspeaker. Primary and secondary tasks were presented simultaneously so attention had to be shared on both tasks. In a second experiment, two speech intelligibility tests were presented from either the near field or the far field loudspeaker. The tests were interleaved to simulate a complex listening situation with shifting attention. Directional HA microphones yielded better performance than omnidirectional microphones (both combined with a RM) in near field when analyzing both tasks of the dual-task experiment separately. Furthermore, the integrated dual-task test results showed better performance with directional HA microphones compared with the omnidirectional setting (both cases in combination with a RM). These findings were confirmed by the results of the interleaved speech intelligibility test.

Hearing aid noise suppression and working memory function.

OBJECTIVE: Research findings concerning the relation between benefit from hearing aid (HA) noise suppression and working memory function are inconsistent. The current study thus investigated the effects of three noise suppression algorithms on auditory working memory and the relation with reading span. DESIGN: Using a computer simulation of bilaterally fitted HAs, four settings were tested: (1) unprocessed, (2) directional microphones, (3) single-channel noise reduction, and (4) binaural coherence-based noise reduction. Settings 2-4 were matched in terms of the speech-weighted signal-to-noise ratio (SNR) improvement. Auditory working memory was assessed at +6 dB SNR using listening span and N-back paradigms. STUDY SAMPLE: Twenty experienced HA users aged 55-80 years with large differences in reading span. RESULTS: For the listening span measurements, there was an influence of HA setting on sentence-final word recognition and recall, with the directional microphones leading to ∼6% better performance than the single-channel noise reduction. For the N-back measurements, there was substantial test-retest variability and no influence of HA setting. No interactions with reading span were found. CONCLUSION: HA noise suppression may affect the recognition and recall of speech at positive SNRs, irrespective of individual reading span. Future work should improve the reliability of the auditory working memory measurements.

Diagnosing and Screening in a Minority Language: A Validation Study.

PURPOSE: The Turkish Digit Triplet Test for hearing self-screening purposes and the Turkish Matrix Test (TURMatrix) for follow-up hearing diagnostics offer an automated closed-set response format where patients respond by choosing from response alternatives. Their applicability for testing Turkish-speaking patients in their native language by German audiologists with different Turkish language skills was investigated. METHOD: Tests were composed of spoken numbers (Turkish Digit Triplet Test) or sentences (TURMatrix). For 49 participants differing in hearing ability, speech reception thresholds (SRTs) in noise and quiet were obtained, for the TURMatrix with either the open- or closed-set response format, by audiologists with and without Turkish language skills, respectively. RESULTS: SRTs of both tests correlate closely with each other as well as with hearing ability, but not as closely as individual SRTs in quiet with hearing ability. SRTs in noise of listeners with normal hearing were about 0.7 dB lower for the closed-set than for the open-set response format. CONCLUSIONS: The 2 tests yield comparable results and are applicable to professionals without suitable language skills. For the closed-set response format of the TURMatrix, literacy is crucial and supplemental (visual) cues improve performance. Speech audiometry in noise should assess suprathreshold processing deficits independently from language proficiency in the majority language.

Relation Between Listening Effort and Speech Intelligibility in Noise.

PURPOSE: Subjective ratings of listening effort might be applicable to estimate hearing difficulties at positive signal-to-noise ratios (SNRs) at which speech intelligibility scores are near 100%. Hence, ratings of listening effort were compared with speech intelligibility scores at different SNRs, and the benefit of hearing aids was evaluated. METHOD: Two groups of listeners, 1 with normal hearing and 1 with hearing impairment, performed adaptive speech intelligibility and adaptive listening effort tests (Adaptive Categorical Listening Effort Scaling; Krueger, Schulte, Brand, & Holube, 2017) with sentences of the Oldenburg Sentence Test (Wagener, Brand, & Kollmeier, 1999a, 1999b; Wagener, Kühnel, & Kollmeier, 1999) in 4 different maskers. Model functions were fitted to the data to estimate the speech reception threshold and listening effort ratings for extreme effort and no effort. RESULTS: Listeners with hearing impairment showed higher rated listening effort compared with listeners with normal hearing. For listeners with hearing impairment, the rating extreme effort, which corresponds to negative SNRs, was more correlated to the speech reception threshold than the rating no effort, which corresponds to positive SNRs. A benefit of hearing aids on speech intelligibility was only verifiable at negative SNRs, whereas the effect on listening effort showed high individual differences mainly at positive SNRs. CONCLUSION: The adaptive procedure for rating subjective listening effort yields information beyond using speech intelligibility to estimate hearing difficulties and to evaluate hearing aids.

Speech reception with different bilateral directional processing schemes: Influence of binaural hearing, audiometric asymmetry, and acoustic scenario.

Hearing aid (HA) users can differ markedly in their benefit from directional processing (or beamforming) algorithms. The current study therefore investigated candidacy for different bilateral directional processing schemes. Groups of elderly listeners with symmetric (N = 20) or asymmetric (N = 19) hearing thresholds for frequencies below 2 kHz, a large spread in the binaural intelligibility level difference (BILD), and no difference in age, overall degree of hearing loss, or performance on a measure of selective attention took part. Aided speech reception was measured using virtual acoustics together with a simulation of a linked pair of completely occluding behind-the-ear HAs. Five processing schemes and three acoustic scenarios were used. The processing schemes differed in the tradeoff between signal-to-noise ratio (SNR) improvement and binaural cue preservation. The acoustic scenarios consisted of a frontal target talker presented against two speech maskers from ±60° azimuth or spatially diffuse cafeteria noise. For both groups, a significant interaction between BILD, processing scheme, and acoustic scenario was found. This interaction implied that, in situations with lateral speech maskers, HA users with BILDs larger than about 2 dB profited more from preserved low-frequency binaural cues than from greater SNR improvement, whereas for smaller BILDs the opposite was true. Audiometric asymmetry reduced the influence of binaural hearing. In spatially diffuse noise, the maximal SNR improvement was generally beneficial. N0Sπ detection performance at 500 Hz predicted the benefit from low-frequency binaural cues. Together, these findings provide a basis for adapting bilateral directional processing to individual and situational influences. Further research is needed to investigate their generalizability to more realistic HA conditions (e.g., with low-frequency vent-transmitted sound).

Auditory and Non-Auditory Contributions for Unaided Speech Recognition in Noise as a Function of Hearing Aid Use.

Differences in understanding speech in noise among hearing-impaired individuals cannot be explained entirely by hearing thresholds alone, suggesting the contribution of other factors beyond standard auditory ones as derived from the audiogram. This paper reports two analyses addressing individual differences in the explanation of unaided speech-in-noise performance among n = 438 elderly hearing-impaired listeners (mean = 71.1 ± 5.8 years). The main analysis was designed to identify clinically relevant auditory and non-auditory measures for speech-in-noise prediction using auditory (audiogram, categorical loudness scaling) and cognitive tests (verbal-intelligence test, screening test of dementia), as well as questionnaires assessing various self-reported measures (health status, socio-economic status, and subjective hearing problems). Using stepwise linear regression analysis, 62% of the variance in unaided speech-in-noise performance was explained, with measures Pure-tone average (PTA), Age, and Verbal intelligence emerging as the three most important predictors. In the complementary analysis, those individuals with the same hearing loss profile were separated into hearing aid users (HAU) and non-users (NU), and were then compared regarding potential differences in the test measures and in explaining unaided speech-in-noise recognition. The groupwise comparisons revealed significant differences in auditory measures and self-reported subjective hearing problems, while no differences in the cognitive domain were found. Furthermore, groupwise regression analyses revealed that Verbal intelligence had a predictive value in both groups, whereas Age and PTA only emerged significant in the group of hearing aid NU.

Investigating Differences in Preferred Noise Reduction Strength Among Hearing Aid Users.

Even though hearing aid (HA) users can respond very differently to noise reduction (NR) processing, knowledge about possible drivers of this variability (and thus ways of addressing it in HA fittings) is sparse. The current study investigated differences in preferred NR strength among HA users. Participants were groups of experienced users with clear preferences ("NR lovers"; N = 14) or dislikes ("NR haters"; N = 13) for strong NR processing, as determined in two earlier studies. Maximally acceptable background noise levels, detection thresholds for speech distortions caused by NR processing, and self-reported "sound personality" traits were considered as candidate measures for explaining group membership. Participants also adjusted the strength of the (binaural coherence-based) NR algorithm to their preferred level. Consistent with previous findings, NR lovers favored stronger processing than NR haters, although there also was some overlap. While maximally acceptable noise levels and detection thresholds for speech distortions tended to be higher for NR lovers than for NR haters, group differences were only marginally significant. No clear group differences were observed in the self-report data. Taken together, these results indicate that preferred NR strength is an individual trait that is fairly stable across time and that is not easily captured by psychoacoustic, audiological, or self-report measures aimed at indexing susceptibility to background noise and processing artifacts. To achieve more personalized NR processing, an effective approach may be to let HA users determine the optimal setting themselves during the fitting process.

Directional Processing and Noise Reduction in Hearing Aids: Individual and Situational Influences on Preferred Setting.

BACKGROUND: A better understanding of individual differences in hearing aid (HA) outcome is a prerequisite for more personalized HA fittings. Currently, knowledge of how different user factors relate to response to directional processing (DIR) and noise reduction (NR) is sparse. PURPOSE: To extend a recent study linking preference for DIR and NR to pure-tone average hearing thresholds (PTA) and cognitive factors by investigating if (1) equivalent links exist for different types of DIR and NR, (2) self-reported noise sensitivity and personality can account for additional variability in preferred DIR and NR settings, and (3) spatial target speech configuration interacts with individual DIR preference. RESEARCH DESIGN: Using a correlational study design, overall preference for different combinations of DIR and NR programmed into a commercial HA was assessed in a complex speech-in-noise situation and related to PTA, cognitive function, and different personality traits. STUDY SAMPLE: Sixty experienced HA users aged 60-82 yr with controlled variation in PTA and working memory capacity took part in this study. All of them had participated in the earlier study, as part of which they were tested on a measure of "executive control" tapping into cognitive functions such as working memory, mental flexibility, and selective attention. DATA COLLECTION AND ANALYSIS: Six HA settings based on unilateral (within-device) or bilateral (across-device) DIR combined with inactive, moderate, or strong single-microphone NR were programmed into a pair of behind-the-ear HAs together with individually prescribed amplification. Overall preference was assessed using a free-field simulation of a busy cafeteria situation with either a single frontal talker or two talkers at ±30° azimuth as the target speech. In addition, two questionnaires targeting noise sensitivity and the "Big Five" personality traits were administered. Data were analyzed using multiple regression analyses and repeated-measures analyses of variance with a focus on potential interactions between the HA settings and user factors. RESULTS: Consistent with the earlier study, preferred HA setting was related to PTA and executive control. However, effects were weaker this time. Noise sensitivity and personality did not interact with HA settings. As expected, spatial target speech configuration influenced preference, with bilateral and unilateral DIR "winning" in the single- and two-talker scenario, respectively. In general, participants with higher PTA tended to more strongly prefer bilateral DIR than participants with lower PTA. CONCLUSIONS: Although the current study lends some support to the view that PTA and cognitive factors affect preferred DIR and NR setting, it also indicates that these effects can vary across noise management technologies. To facilitate more personalized HA fittings, future research should investigate the source of this variability.

Selecting Appropriate Tests to Assess the Benefits of Bilateral Amplification With Hearing Aids.

The aim of this study was to investigate the effect of bilateral hearing aids (HA) in subjects with mild and moderate-to-severe hearing loss. This study was designed as a within-subject feasibility study. Bilateral HA use was assessed using different laboratory tests on speech reception, listening effort, noise tolerance, and localization. All data were evaluated with bilateral and unilateral HA fittings. Forty experienced bilateral HA users were included with hearing impairment ranging from mild to moderate-to-severe. Subjects were stratified into two groups based on the degree of hearing loss. Speech reception in noise, listening effort, and localization tests showed a bilateral benefit for the moderate-to-severely hearing-impaired subjects. A bilateral benefit was also observed for listening effort in the mildly hearing-impaired group. The assessment of listening effort shows promise as a measure of bilateral HA benefit for mild hearing impairment. Localization and speech reception in noise tests provide additional value for larger losses. The next step is to compare experienced unilateral with bilateral HA users.

Do you hear the noise? The German matrix sentence test with a fixed noise level in subjects with normal hearing and hearing impairment.

OBJECTIVE: The aim of this study was to determine the relationship between hearing loss and speech reception threshold (SRT) in a fixed noise condition using the German Oldenburg sentence test (OLSA). DESIGN: After training with two easily-audible lists of the OLSA, SRTs were determined monaurally with headphones at a fixed noise level of 65 dB SPL using a standard adaptive procedure, converging to 50% speech intelligibility. STUDY SAMPLE: Data was obtained from 315 ears of 177 subjects with hearing losses ranging from -5 to 90 dB HL pure-tone average (PTA, 0.5, 1, 2, 3 kHz). RESULTS: Two domains were identified with a linear dependence of SRT on PTA. The SRT increased with a slope of 0.094 ± 0.006 dB SNR/dB HL (standard deviation (SD) of residuals = 1.17 dB) for PTAs < 47 dB HL and with a slope of 0.811 ± 0.049 dB SNR/dB HL (SD of residuals = 5.54 dB) for higher PTAs. CONCLUSION: The OLSA can be applied to subjects with a wide range of hearing losses. With 65 dB SPL fixed noise presentation level the SRT is determined by listening in noise for PTAs < ∼47 dB HL, and above it is determined by listening in quiet.

How much does language proficiency by non-native listeners influence speech audiometric tests in noise?

OBJECTIVE: The current study investigates the extent to which the linguistic complexity of three commonly employed speech recognition tests and second language proficiency influence speech recognition thresholds (SRTs) in noise in non-native listeners. DESIGN: SRTs were measured for non-natives and natives using three German speech recognition tests: the digit triplet test (DTT), the Oldenburg sentence test (OLSA), and the Göttingen sentence test (GÖSA). STUDY SAMPLE: Sixty-four non-native and eight native listeners participated. RESULTS: Non-natives can show native-like SRTs in noise only for the linguistically easy speech material (DTT). Furthermore, the limitation of phonemic-acoustical cues in digit triplets affects speech recognition to the same extent in non-natives and natives. For more complex and less familiar speech materials, non-natives, ranging from basic to advanced proficiency in German, require on average 3-dB better signal-to-noise ratio for the OLSA and 6-dB for the GÖSA to obtain 50% speech recognition compared to native listeners. CONCLUSIONS: In clinical audiology, SRT measurements with a closed-set speech test (i.e. DTT for screening or OLSA test for clinical purposes) should be used with non-native listeners rather than open-set speech tests (such as the GÖSA or HINT), especially if a closed-set version in the patient's own native language is available.

The multilingual matrix test: Principles, applications, and comparison across languages: A review.

OBJECTIVE: A review of the development, evaluation, and application of the so-called 'matrix sentence test' for speech intelligibility testing in a multilingual society is provided. The format allows for repeated use with the same patient in her or his native language even if the experimenter does not understand the language. DESIGN: Using a closed-set format, the syntactically fixed, semantically unpredictable sentences (e.g. 'Peter bought eight white ships') provide a vocabulary of 50 words (10 alternatives for each position in the sentence). The principles (i.e. construction, optimization, evaluation, and validation) for 14 different languages are reviewed. Studies of the influence of talker, language, noise, the training effect, open vs. closed conduct of the test, and the subjects' language proficiency are reported and application examples are discussed. RESULTS: The optimization principles result in a steep intelligibility function and a high homogeneity of the speech materials presented and test lists employed, yielding a high efficiency and excellent comparability across languages. The characteristics of speakers generally dominate the differences across languages. CONCLUSION: The matrix test format with the principles outlined here is recommended for producing efficient, reliable, and comparable speech reception thresholds across different languages.

Development of a Dutch matrix sentence test to assess speech intelligibility in noise.

OBJECTIVE: A Dutch matrix sentence test was developed and evaluated. A matrix test is a speech-in-noise test based on a closed speech corpus of sentences derived from words from fixed categories. An example is "Mark gives five large flowers." DESIGN: This report consists of the development of the speech test and a multi-center evaluation. STUDY SAMPLE: Forty-five normal-hearing participants. RESULTS: The developed matrix test has a speech reception threshold in stationary noise of - 8.4 dB with an inter-list standard deviation of 0.2 dB. The slope of the intelligibility function is 10.2 %/dB and this is slightly lower than that of similar tests in other languages (12.6 to 17.1 %/dB). CONCLUSIONS: The matrix test is now also available in Dutch and can be used in both Flanders and the Netherlands.