Speech-In-Noise Testing – Embracing Best Practice Guidelines

The primary complaint of individuals seeking care from a hearing healthcare professional is difficulty understanding speech, especially in background noise. Hearing evaluations typically include pure-tone audiometry, which establishes the softest sounds an individual can hear at each frequency tested (typically 125–8000 Hz), and speech audiometry, which uses recorded or live speech in a quiet setting. Speech in quiet testing allows the clinician to evaluate the softest speech sounds an individual can hear and the accuracy of understanding words at a volume well above thresholds. However, testing speech only in quiet listening conditions does not predict hearing in background noise. Time constraints, reimbursement concerns, and lack of clear guidance on when to administer speech-in-noise (SIN) testing often top the reasons for omitting this from the hearing test battery. However, research and clinical experience suggest that SIN testing is easily implemented and invaluable when guiding the course of hearing loss management. For example, the inclusion of SIN testing can help determine the appropriate size of in-the-ear devices to include directional microphones or counseling patients on realistic expectations for hearing in noisy settings, advising them on remote microphones or other accessories with or without hearing aids. Routine inclusion of SIN testing can also help clarify isolated ear difficulties vs hearing binaurally and serve as a baseline for follow-up aided SIN testing to monitor the benefit of hearing amplification. For these reasons, Cleveland Clinic’s audiology section conducted a quality project from March to June 2022, including SIN testing for all patients who reported difficulty hearing in background noise. Additional data outcomes included the time to complete the additional testing and other measures within the audiology hearing test battery and the total scheduled hearing aid evaluations based on SIN testing.

Based on a sample of 389 patients seen at one Cleveland Clinic audiology facility, 25% (N = 97) received SIN testing based on a history of difficulty hearing in background noise. Of those with SIN testing, 49% (N = 48) received recommendations for a hearing technology evaluation. Interestingly, 2 patients had normal hearing on audiometric testing. Nevertheless, counseling with SIN test results provided an opportunity to assist with their primary complaints of difficulty hearing in background noise with a hearing technology referral.

Percentage of Patients Receiving Speech-In-Noise Testing


Percentage of Patients Referred for Hearing Aid Technology After SIN Testing