What Is a Word Recognition Test? Learn How Accurate Speech Tests Are.

audiologist performing a word recognition test

Trouble understanding conversations is typically one of the first signs that you’re losing your hearing, according to the American Speech-Language-Hearing Association. That’s why speech testing is such a crucial part of every screening test for hearing loss.

Speech testing evaluates your ability to detect speech and understand words and sentences. This guide will tell you the basics of speech testing.

Speech Audiometry

Speech audiometry is one of a battery of tests you will take during a standard hearing exam, but is not a part of online hearing tests. The test time is about 10 to 15 minutes, and it’s usually done right after pure tone audiometry. While pure tone testing determines the type and severity of hearing loss, speech testing evaluates your speech-language abilities.  

The test results are helpful for programming hearing devices.

A hearing aid specialist can use the test results to measure how much gain the hearing aid has to provide to make sounds clear.

An audiologist can also determine if there’s a significant difference between ears by mapping the results on “critical difference tables.”

Why Speech Testing Is Done

Speech testing is primarily used to understand the impact of hearing loss on a person’s speech-language abilities.

The test evaluates a patient’s capacity to understand speech without visual cues or context.

Here are some reasons speech testing is commonly used in hearing exams:

  • It confirms the pure tone audiometry results, read on an audiogram.
  • It gauges the effect of hearing loss on an individual’s communication skills.
  • It monitors the efficacy of assistive devices over time.
  • Speech recognition predicts the likelihood of treatment success.
  • It helps diagnose certain underlying conditions.
  • The test results provide helpful information for hearing aid fitting and programming.

How Is Speech Testing Done

Speech testing is typically performed by a licensed hearing care professional after the audiologist measures hearing thresholds using pure tones.

Environment

The speech testing environment has two soundproof rooms: the equipment and testing rooms.

The ambient noise levels in the testing environment should meet American National Standards Institute (ANSI) specifications.

Audiologists manipulate the audiometers from the equipment room and the patient takes the test in the testing room, which has speakers, headphones, and other transducers.

Equipment

Speech audiometry is performed using a speech audiometer built into the same device used for pure tone testing. Sounds are transmitted via headphones and speakers, and a microphone is used for instructing the patient and live voice testing.

The examiner may also play a set of wave files using an external sound player instead of live voice testing.

The diagnostic audiometers also come with a talk-back and talk-forward microphone for communication between the patient and the tester.

The test material needed for speech testing includes a list of monosyllabic words.

Procedure

Generally, speech testing follows this process:

  • The examiner will instruct the patient to repeat back the words presented.
  • The audiologist will turn the volume to a level the patient can hear.
  • The tester will present a list of 50 single-syllable words and record the patient’s correct and incorrect responses. Each ear may be tested separately.
  • The tester calculates the word recognition score, which is the percentage of words repeated correctly.

Speech Audiometry Subtests

Speech testing consists of subtests that will yield a set of metrics the audiologist uses to evaluate your speech-language abilities.

Speech Recognition Threshold Tests

The speech recognition threshold refers to the minimum sound intensity level at which a person can detect the presence of speech at least 50 percent of the time.

It’s also known as speech awareness or speech detection threshold.

It is widely used to double-check the results of tone testing. Ideally, the speech recognition threshold should closely agree with the average pure tone threshold levels obtained at 500 Hz, 100 Hz, and 2,000 Hz.

Did you know you can also measure the range of frequencies you can hear using a sound frequency test? Read more about it in our guide.

This test only requires the patient to detect the presence of speech. In other words, you don’t need to understand what is being said.

In speech recognition threshold tests you don’t need to understand what is being said, you just need to raise your hand or press a button when you hear a speech signal.

Speech Reception Threshold Tests

The speech reception threshold refers to the lowest volume at which an individual can identify speech at least half of the time.

During the speech reception test, the examiner will present a list of disyllabic words with equal stress placed on each syllable (E.g., football, hotdog, sidewalk). The patient will be instructed to repeat back the words heard.

SRT is also used to validate pure tone thresholds as the reception threshold should be very close to the average of pure tone thresholds obtained at 500 Hz, 1000 Hz, and 2000 Hz.

Word Recognition Testing

Speech discrimination testing checks a person’s ability to understand and repeat single-syllable words.

The tester presents a list of 50 single-syllable words (E.g. cat, dog, pool) at an audible level. The patient will be asked to repeat the words.

After the test, the hearing specialist will calculate the speech discrimination score, which is the percentage of words repeated correctly versus those incorrectly repeated.

A normal score would be between 85 to 100 percent.

An individual with a score below 85 percent will benefit from hearing aids.

Noise Test

Though it’s not common, an audiologist may administer a hearing-in-noise test (HINT) to test word recognition in background noise.

However, this is usually only given for hearing-critical and potentially life-threatening occupations where the ability to communicate clearly is essential, such as aviation, law enforcement, and the armed forces.  

Accuracy of Speech Testing

Speech testing is essential to planning your treatment, but the accuracy of tests can vary with factors such as patient cooperation and test procedure.

Typically the word list used in a speech discrimination test contains 50 monosyllabics. However, some examiners may use a half list to save time. This can affect the accuracy of the score.

For instance, if you correctly repeat 10 out of 20 words, your score would be 50 percent, whereas if you repeat 10 out of 50 words, your score would be 20%.

When administering speech discrimination tests, the tester can use recorded wave files or read the list aloud through a microphone.

Live voice tests are generally less accurate than tests that use recordings because the patient’s ability to understand the tester can vary with the voice quality or dialect used.

Therefore, the use of recorded speech would yield more accurate scores.

Speech audiometry is a subjective hearing test. This means the patient has to cooperate and follow the tester’s instructions to get accurate test results.

If a patient isn’t motivated enough to listen carefully and repeat back words, the score may not reflect the individual’s actual hearing ability.

Conclusion

Speech testing is a valuable part of the audiologist’s toolkit. It includes tests of a person’s ability to detect the presence of speech and repeat back individual words. Speech testing validates the results of tests that use pure tones and provides information that helps hearing professionals effectively treat your condition.

Individuals with mild or moderate hearing loss but relatively high word recognition scores benefit the most from using hearing devices.

Frequently Asked Questions

What is a Good Speech Discrimination Score?

A person with normal hearing should be able to hear 85 to 100 percent of the words that the tester presents.

Do I Need Speech Testing to Purchase Hearing Aids?

According to the American Speech-Language-Hearing Association, you can buy hearing devices online by taking an online screening test. However, these tests are less reliable than a professional audiological exam and cannot tell you the cause of your impairment. If you have difficulty hearing, you should consult an audiologist.