Play Audiometry with Speech-like Stimuli

Traditionally, Play Audiometry has been seen as a test to establish hearing thresholds and is typically performed with warble tones or pure tones. In this video, Michael East discusses a range of alternative stimuli which can be used to perform Play Audiometry and explores how these stimuli provide value to pediatric hearing assessments and reassessments.

You can read the full transcript below.

Introduction to play audiometry and speech testing

Play audiometry can be used to perform speech testing in both aided and unaided conditions. And this is a useful addition to our overall testing strategy. The unaided condition can provide a very useful cross check to our wider hearing assessment. And the aided condition provides us with much more detailed information about what different sounds that patient’s hearing aid can provide for them.

LING sounds in speech testing

The LING sounds are one of the most popular options for speech testing, and these provide a range of different sounds designed to represent the full frequency spectrum of speech sounds. We also have access to the newer ManU-IRU stimuli which have been validated for use with hearing aids.

Basic LING sound detection

The LING sounds can be used in a variety of different ways. The most basic form of this is as a simple detection task where the patient will continue to perform play audiometry, but instead of warble tones, we might use the LING sounds instead.

LING detection tests can be performed at a variety of different levels. At supra threshold, it can provide us with an indication of the child's access to a range of different speech sounds at a natural conversational level. We could also choose to use these LING sounds at close-to-threshold levels, which can provide us with an even better insight into their understanding of quieter speech sounds.

Advanced LING sound identification and discrimination

To take the LING sounds a step further, we can make this a much more advanced test by introducing an identification or discrimination task.

In this case, the child is instructed to listen out for the sound and then correctly identify the corresponding picture or toy which corresponds to the sound that they have heard. For these tests, it is much more advanced as first, we need to ensure that the patient can perceive the sound. And second, that they can correctly identify and understand the sound that they are hearing.

Here we can see an example where the child is using the LING sound mat game. They have their pointing finger ready and point at the image on the mat that matches the sound that they heard. If the child performs repeatedly incorrectly on this, it can be an indicator that hearing aid settings may require some adjustments.

Game-based approaches for LING sounds

Another game variety that we can use for the LING sounds is with different toys which correspond to each of the LING sounds, such as some blocks. Here we can see an example of a child using these LING blocks in a clinical situation.

For younger children or children who find the full LING test slightly more challenging, we can bring this back a little bit and present just smaller numbers of blocks. For example, just using the /ss/ and /sh/ sounds to see if they can differentiate between the two.

Here we can see the blocks and mat being used together as a matching game. However, it's important that this is not used when all six LING sounds are being presented as the options are eliminated as testing goes on, leaving the final block as the only option available and therefore no longer an open set task.

And finally, these blocks can also be used as a more traditional play audiometry toy. For example, we could build a tower or even throw them into a bucket when we hear any type of stimulus.

Important testing guidelines

When you are performing any type of LING sound testing, it's very important that you first familiarize your patient with the different sounds and matching toys or images that you'll be using. If a child is unable to reliably associate the sound with the image or toy, then that can make the rest of our LING testing much less reliable and potentially invalid.

When performing this familiarization exercise, this should be performed at a comfortable supra threshold level to ensure that the patient is able to accurately hear what is required of them. And this can help to ensure that the child's understanding has been thoroughly assessed before we start the test, which will drastically improve the quality and reliability of the testing that we perform.