Perception: hearing

Perception - Speech-in-noise test (hearing)


Constructs: speech-in-noise recognition, self-reported hearing ability in noise, self-reported hearing aid use

Contact: Marieke Pronk

Background (see also Documentation on Perception - Hearing (self-report))
Problems with understanding speech in noisy environments is the most prominent and prevalent hearing complaint in hearing-impaired persons,1,2 and in the case of age-related hearing loss, is often the first occurring complaint.3 This may not be surprising considering that much speech interaction in everyday conditions occurs in the presence of background noise (e.g., music, voices, traffic).

Although pure tone audiometry is still considered the gold standard assessment for hearing loss, the relationship with daily life functioning is generally only fair.4,5 This seems to hold especially for self-reported speech understanding in background noise6 and speech understanding in group conversations.7 Further, pure tone audiometry does not reflect the declining central auditory processing functions that occur with aging.8 Central auditory functions are requires to evaluate pitch, loudness, and duration of acoustical signals, and for speech processing also cover more global cognitive functions such as speed of information processing, attention, and working memory.8, 15, 16  Contrary to pure tone audiometry, tests assessing the ability to recognize speech in noise may tap into these central functions to some extent. Moreover, they hold high validity from the patient perspective. As was mentioned above, difficulty in understanding speech in noise is one of the most frequently‐reported disabilities in hearing‐impaired persons, and is generally viewed as the most limiting disability.1,2

Before publications of the LASA data on speech-in-noise recognition (See ‘Previous use in LASA), speech‐in‐noise recognition was scarcely investigated as an outcome of health-related, cognitive, or environmental factors, or as a determinant of psychosocial health.

Measurement instrument in LASA: Speech-in-noise test (SNT) (LASA193)
The Speech-in-noise test (SNT) that is used in LASA was administered in the medical interview. The test was originally developed as a functional screening self-test that could be performed by telephone.9,10 In this test, speech material is offered at different intensity levels against a constant level of continuous background noise. The speech-reception-threshold in noise, the SRTn, is determined. It is defined as the signal-to-noise ratio (SNR) in decibel (dB) corresponding to 50% intelligibility of the speech material.

Procedure in LASA: Presentation of the speech material was via headphones on both ears. Hearing aids had to be removed. Before the test started, the respondent could indicate whether the interviewer should increase or decrease the volume of the uttered speech material to a pleasant and optimally understandable level. When the test started, different monosyllabic digit triplets (e.g., 5-1-8) were presented in varying signal-to-noise ratios. After each triplet, the subject had to repeat the digits (s)he heard out loud. The interviewer subsequently presses the corresponding numbers on the key board of the telephone (wave E and F) or laptop (wave G). The participants were encouraged to guess when they could not understand the digits clearly.

An automatic up-down adaptive procedure was applied in the test: the signal-to-noise ratio decreased by 2 dB (i.e., becomes more difficult) after a correct (=all three digits) response, and increased by 2 dB (i.e., becomes easier) after an incorrect response. A series of 23 triplets is chosen randomly from the total set of 80 possible triplets. The SRTn is the average signal-to-noise ratio of the last 20 presentations. A ceiling of +8 dB was incorporated into the software on waves E and F (not on G).

Two examples: 1) Respondent A has a score of -5.0 dB SNR. This means that he/she understands 50% of the speech correctly if the mean level of the speech is 5.0 dB lower than the level of the noise. 2) Respondent B has a score of -2.0 dB.  This means that he/she understands 50% of the speech correctly if the mean level of the speech is only 2.0 dB lower than the level of the noise. So, respondent B  has a better hearing than respondent A. So, the lower (the more negative) a person’s score, the better his/her speech-in-noise recognition ability.

The score is provided as a continuous score (variable name: e/f/gmsrttn). Additionally, three categories can be distinguished: poor (<-5.5 dB SNR), insufficient (-5.5 ≤ SRTn≤ -2.8 dB SNR) and good (>-2.8 dB SNR) (variable name: e/f/gmsrttnc). These categories were based on the standard Dutch sentence in noise test (performed while using headphones) by Plomp & Mimpen.11

In a validation study a high correlation of the SNT by telephone with the standard Dutch sentences SNT by Plomp and Mimpen (1979)11 was found (r= 0.87), indicating that the triplet SNT by telephone is a valid test to measure speech-in-noise recognition9. Test-retest reliability was satisfactory in an older sub sample from Nachtegaal et al.12 (Intraclass Correlation Coefficient, two-way random effects model = 0.70, n=152, range 58-82 years).

Descriptive data of the SNT on wave E for variable ‘emsrttn’: speech-reception-threshold (in dB signal to noise ratio)







Std. Deviation
Std. Error of Skewness
Std. Error of Kurtosis


Differences in administration and data collection across waves - systematic shifts in scores
Different administration and data collection modes caused slight but systematic shifts in the SRTns. During the E and the F wave, a telephone was used to perform the test. Portable telephone testing equipment was brought by the LASA interviewer, consisting of a telephone (Ranex RX 2712), a telephone amplifier (Humantechnik TA-2) and headphones (Philips SBC HP550). On the E wave, all the data was sent to a computer on the department of Audiology at the VUmc. On the F measurement, a ‘PTT’ connection was used and the data was collected at the PTT (Dutch general landline provider). During the G wave, a laptop and headphones were brought by the interviewer to perform the measurement. The software of the test was similar to that on E and F.

The systematic shifts in the SRTns that should be considered when one wants to compare the data longitudinally are: -0.86 dB SNR for the F-wave, and -0.49 dB for the G wave (both relative to the SRTnsof wave E). So,if one would like to compare the E, F, and G measurement, one should apply a correction to the scores of the F and G measurements (score on F minus 0.86 db SNR, score on G minus 0.49 dB SNR). These shifts were estimated by determining age‐gender specific averages of the SRTn scores E, F, and G.13 The E averages were regressed on F averages (weighing the data points for the summed sample size). The systematic shift (i.e., the constant in the regression equation) was estimated by setting the regression coefficient on 1. The same procedure was applied to the G shift.

Measurement instruments in LASA - Self-reported hearing ability in noise (LASA194)
In wave E, F, and G, an extra self-reported hearing ability question was administered preceding the Speech-in-noise test, in the Medical interview. It addresses hearing ability in noise. The item originates from the Amsterdam Inventory for Auditory Disability and Handicap (AIADH).14 In wave  H, this question was part of the Senses-section of the Medical Interview (see above under ‘Slight variations of the self-reported hearing ability questions applied across LASA waves/cohorts’).

The variable in SPSS was: e/f/ghearup: Can you understand someone who speaks to you during a birthday party or reception? Answer categories: Almost never (1), Sometimes (2), Often (3), Almost always (4)

Measurement instruments in LASA-Hearing aid use (LASA194)
Information on hearing aid use was asked as part of a set of questions preceding the Speech-in-noise test (see also Documentation ‘Speech-in-noise test) on each of the waves (E, F, G).

The variable in SPSS is: e/f/ghearwa: Do you wear hearing aids? (None, 1, 2)

On G, an additional question was asked as part of this set of questions preceeding the Speech-in-noise test:

The variable in SPSS is: gmhearwh: How many hours per day do you wear your hearing aids on average? (I do not have hearing aids, I do not wear my hearing aids, Less than 1 hour, 1-4 hours, 4-8 hours, The whole day)

Other data on hearing aid use was asked in the Senses section (See documentation on Perception - Hearing (self-report)).

LASAE194 / LASAF194 / LASAG194 (medical interview, in Dutch)

Variable information
LASAE193 / LASAF193 / LASAG193;
LASAE194 / LASAF194 / LASAG194

Availability of information per wave1:










MB * I*

Speech-in-noise test









Self-reported hearing ability in noise







Hearing aid use (as part of speech-in-noise test session)







1 More information is available on:

* 2B=baseline second cohort;
   3B=baseline third cohort;
   MB=migrants: baseline first cohort (Under Construction);
   I=Under Construction

Me=data collected in medical interview

 Please see documentation on Hearing (self-report) for additional available data on hearing aid use.

Previous use in LASA

  • The relationship between self-reported hearing ability and Speech-in-noise test hearing ability was investigated by Smits et al. (2006). Data of the E wave were used.
  • In the same study by Smits et al. (2006), speech-in-noise recognition ability was used to derive age-specific prevalence rates of hearing loss (in addition to rates based on self-report). Hearing aid use prevalence was also determined.
  • Using longitudinal data (wave E & F) Pronk et al. (2011) compared the predictive ability of speech-in-noise recognition ability (wave E) for follow-up psychosocial health (wave F) to that of the subjective hearing measure of LASA (wave E)(see also documentation Hearing (Self-report)). Two double publications of this article were published (Pronk et al. 2012, 2013a, see below).
  • Using longitudinal data (wave E, F, and G) Pronk et al. (2014) investigated change in speech-in-noise recognition as a determinant of change in psychosocial health (social loneliness, emotional loneliness, anxiety, depression).
  • Speech-in-noise recognition ability was used as an outcome (to assess the change in SRTn over time for different baseline ages and genders in a study by Pronk et al. (2013b13). SRTn data of E, F, and G were used. The change in SRTn over time was modeled. Additionally, the demographic, health-related, environmental, and cognitive determinants of the change in SRTn over time were investigated.
  • Publications

    • Pronk, M., Deeg, D. J. H., Smits, C., Van Tilburg, T. G., Kuik, D. J., Festen, J.M., & Kramer, S.E. (2011). Prospective effects of hearing status on loneliness and depression in older adults ‐ Identification of subgroups. Int J Audiol, 50, 887‐896. doi:10.3109/14992027.2011.599871.
    • Pronk, M., Kramer, S. E., & Deeg, D. J. H. (2012). Slechter gehoor bij ouderen leidt tot meer eenzaamheid, maar niet voor iedereen. Tijdschr Gerontol Geriatr, 43, 103‐104. [In Dutch. Double publication of Pronk et al. (2011), Int J Audiol, 50, 887‐896]
    • Pronk, M., Deeg, D. J. H., Kramer, S. E. Hearing status in older adults: A significant determinant of depression and loneliness? Results from the Longitudinal Aging Study Amsterdam. (2013a). Am J Audiol, 22, 316-320. [Double publication of Pronk et al. (2011), Int J Audiol, 50, 887‐896]
    • Pronk, M., Deeg, D.J.H., Smits, C., Twisk, J.W.R., Van Tilburg, T.G., Festen, J.M., Kramer, S.E. (2014). Hearing loss in older persons: does the rate of decline affect psychosocial health? Journal of Aging and Health, 26, 5, 703-723.
    • Pronk, M., Deeg, D. J. H., Festen, J. M., Twisk, J. W., Smits, C., Comijs, H. C., & Kramer, S.E. Decline in older persons’ ability to recognize speech in noise ‐ The influence of demographic, health‐related, environmental, and cognitive factors. (2013b) Ear Hear, 34, 722-732.
    • Smits, C., Kramer, S. E., & Houtgast, T. (2006).Speech reception thresholds in noise and selfreported hearing disability in a general adult population. Ear Hear, 27, 538‐549.


    1. Kramer, S. E., Kapteyn, T. S., & Festen, J. M. (1998). The self‐reported handicapping effect of hearing disabilities. Audiology, 37, 302‐312.
    2. Stark, P. & Hickson, L. (2004). Outcomes of hearing aid fitting for older people with hearing impairment and their significant others. Int J Audiol, 43, 390‐398.
    3. Gates, G. A. & Mills, J. H. (2005). Presbycusis. Lancet, 366, 1111‐1120.
    4. Demeester, K., Topsakal, V., Hendrickx, J. J., Fransen, E., Van Laer, L., Van Camp, G., Van de Heyning, P., & Van Wieringen, A. (2012). Hearing disability measured by the speech, spatial, and qualities of hearing scale in clinically normal‐hearing and hearing‐impaired middle‐aged persons, and disability screening by means of a reduced SSQ (the SSQ5). Ear Hear, 33, 615‐616.
    5. Engdahl, B., Tambs, K., & Hoffman, H. J. (2013). Otoacoustic emissions, pure‐tone audiometry, and self‐reported hearing. Int J Audiol, 52, 74‐82.
    6. Kramer, S. E., Kapteyn, T. S., Festen, J. M., &Tobi, H. (1996). The relationships between self‐reported hearing disability and measures of auditory disability. Audiology, 35, 277‐287.
    7. Gatehouse, S. & Noble, W. (2004). The Speech, Spatial and Qualities of Hearing Scale (SSQ). Int J Audiol, 43, 85‐99.
    8. Pichora‐Fuller, M. K. & Souza, P. E. (2003). Effects of aging on auditory processing of speech. Int J Audiol, 42 Suppl 2, 2S11‐2S16.
    9. Smits, C., Kramer, S.E., Houtgast, T. (2004). Development and validation of an automatic speech-in-noise screening test by telephone. Int J Audiol, 43, 15-28.
    10. Smits, C., Houtgast, T. (2005). Results from the Dutch Speech-in-Noise Screening Test by Telephone. Ear Hear, 26, 89-95.
    11. Plomp, R. & Mimpen, A. M. (1979). Improving the reliability of testing the speech reception threshold for sentences. Audiology, 18, 43‐52.
    12. Nachtegaal, J., Smit, J. H., Smits, C., Bezemer, P. D., Van Beek, J. H. M., Festen, J. M., & Kramer, S. E. (2009). The association between hearing status and psychosocial health before the age of 70 years. Results from an internet based National Survey on Hearing. Ear Hear, 30, 302‐312.
    13. Pronk, M., Deeg, D. J. H., Festen, J. M., Twisk, J. W., Smits, C., Comijs, H. C., & Kramer, S.E. Decline in older persons’ ability to recognize speech in noise ‐ The influence of demographic, health‐related, environmental, and cognitive factors. Ear Hear, 34; 722–732.
    14. Kramer, S. E., Kapteyn, T. S., Festen, J. M., & Tobi, H. (1995). Factors in subjective hearing disability. Audiology, 34, 311‐320.
    15. Rönnberg, J., Rudner, M., Foo, C. (2008). Cognition counts: a working memory system for ease of language understanding (ELU). Int J Audiol 47(2): S99-105.
    16. Pichora-Fuller, M.K. & Souza, P.E. (2003). Effects of aging on auditory processing of speech. Int J Audiol, 42 Suppl 2, 2S11-2S16.