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substrate reduction therapy (see there)
Spondee Speech Recognition Threshold
Synonym/acronym: SRT, speech reception threshold, speech recognition threshold.
To evaluate for hearing loss related to speech discrepancies.
Area of applicationEars.
This noninvasive speech audiometric procedure measures the degree of hearing loss for speech. The speech recognition threshold is the lowest hearing level at which speech can barely be recognized or understood. In this test, a number of spondaic words are presented to the patient at different intensities. Spondaic words, or spondees, are words containing two syllables that are equally accented or emphasized when they are spoken to the patient. The SRT is defined as the lowest hearing level at which the patient correctly repeats 50% of a list of spondaic words. Examples are airplane, hot dog, outside, ice cream, and baseball.
This procedure is contraindicated for
- Determine appropriate gain during hearing aid selection
- Determine the extent of hearing loss related to speech recognition, as evidenced by the faintest level at which spondee words are correctly repeated
- Differentiate a real hearing loss from pseudohypoacusis
- Verify pure tone results
- Normal spondee threshold of about 6 to 10 dB (decibels) of the normal pure tone threshold with 50% of the words presented being correctly repeated at the appropriate intensity (see monograph titled “Audiometry, Hearing Loss”)
- Normal speech recognition with 90% to 100% of the words presented being correctly repeated at an appropriate intensity
Abnormal findings related to
- Conductive hearing loss
- Impacted cerumen
- Obstruction of external ear canal (related to presence of a foreign body)
- Otitis externa (related to infection in ear canal)
- Otitis media (related to poor eustachian tube function or infection)
- Otitis media serus (related to fluid in middle ear due to allergies or a cold)
- High-frequency hearing loss (normal hearing range is 20 Hz to 20,000 Hz; high-frequency range begins at 4,000 Hz)
- Presbycusis (related to gradual hearing loss experienced in advancing age, which occurs in the high-frequency range)
- Noise induced (related to exposure over long periods of time)
- Sensorineural hearing loss (acoustic nerve impairment)
- Congenital damage or malformations of the inner ear
- Ménière’s disease
- Ototoxic drugs (aminoglycosides, e.g., gentamicin or tobramycin; salicylates, e.g., aspirin)
- Presbycusis (related to gradual hearing loss experienced in advancing age)
- Serious infections (meningitis, measles, mumps, other viral infections, syphilis)
- Trauma to the inner ear (related to exposure to noise in excess of 90 dB or as a result of physical trauma)
- Tumor (e.g., acoustic neuroma, cerebellopontine angle tumor, meningioma)
- Vascular disorders
Factors that may impair the results of the examination
- Inability of the patient to cooperate or remain still during the procedure because of age or mental status may interfere with the test results.
- Unfamiliarity with the language in which the words are presented or with the words themselves will alter the results.
- Improper placement of the earphones and inconsistency in frequency of word presentation will affect results.
Nursing Implications and Procedure
- Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
- Patient Teaching: Inform the patient this procedure can assist in measuring hearing loss related to speech.
- Obtain a history of the patient’s complaints, including a list of known allergens.
- Obtain a history of the patient’s known or suspected hearing loss, including type and cause; ear conditions with treatment regimens; ear surgery; and other tests and procedures to assess and diagnose hearing deficit.
- Obtain a history of the patient’s symptoms and results of previously performed laboratory tests and diagnostic and surgical procedures.
- Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values).
- Review the procedure with the patient. Ensure that the patient understands words and sounds in the language to be used for the test. Inform the patient that a series of words that change from loud to soft tones will be presented using earphones and that he or she will be asked to repeat the word. Explain that each ear is tested separately. Address concerns about pain and explain that no discomfort will be experienced during the test. Inform the patient that a health-care provider (HCP) performs the test, in a quiet, soundproof room, and that the evaluation takes 5 to 10 min.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Note that there are no food, fluid, or medication restrictions unless by medical direction.
- Potential complications: N/A
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient.
- Instruct the patient to cooperate fully and to follow directions. Ask the patient to remain still during the procedure because movement produces unreliable results.
- Seat the patient on a chair in a soundproof booth. Place the earphones on the patient’s head and secure them over the ears. The audiometer is set at 20 dB above the known pure tone threshold obtained from audiometry. The test represents hearing levels at speech frequencies of 500, 1,000, and 2,000 Hz.
- The spondee words are presented to the ear with the best auditory response using a speech audiometer. The intensity is decreased and then increased to the softest sound at which the patient is able to hear the words and respond correctly to 50% of them. The procedure is then repeated for the other ear.
- Inform the patient that a report of the results will be made available to the requesting HCP, who will discuss the results with the patient.
- Recognize anxiety related to test results, and be supportive of activity related to impaired hearing and perceived loss of independence. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services. Provide contact information, if desired, for the American Speech-Language-Hearing Association (www.asha.org).
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Related tests include antimicrobial drugs, analgesic and antipyretic drugs, audiometry hearing loss, culture bacterial (ear), and Gram stain.
- Refer to the Auditory System table at the end of the book for related tests by body system.