The Color Speech Range Audiogram

Dennis Hampton, PhD, is an audiologist and editor of Hearing HealthCare News®, a customized patient newsletter, and Audiology HealthCare News®, a customized physician newsletter. Correspondence can be addressed to HR at [email protected] or to Dr Hampton at .

A useful modification to one of our best and most practical demonstration tools

One of the most important services dispensing professionals provide their patients is the counseling for understanding the nature of their hearing loss.

Audiologists and dispensing professionals take many different approaches to counseling, but every approach usually includes specific information about the audiologic test results. Most clinicians believe that the better an individual understands his or her own hearing loss pattern, the better he or she can understand and accept the difficulties caused by that hearing loss. For example, a patient with a high frequency hearing loss can more readily understand why a man’s voice is easier to understand than a woman’s voice when it is clearly explained that the patient’s hearing for low frequency sounds is in the normal range, while hearing for high frequency sounds is in the range of a moderate hearing loss.

The classic tried-and-true tool used to illustrate the result of audiometric testing is, of course, the puretone audiogram. With thresholds plotted on the graph according to frequency (on the x-axis) and intensity (y-axis), the results are illustrated clearly. These results can then be discussed with the patient.

In an effort to make the results more meaningful, many clinicians have included information about the acoustic world on the audiogram. For example, the “speech banana” has been overlaid on the audiogram so the patient can see how hearing loss interacts with speech sounds. Using the example of someone with a high frequency hearing loss again, the patient would see that most of the energy in the unvoiced phonemes /p/ and /t/, as in “pin” and “tin,” is found in the area softer than his hearing thresholds. This helps the patient understand why he may hear these words, but be unable to recognize the difference between “pin” and “tin.”

We attempted to make it easier for patients to understand the nature of their hearing loss by adding color-keyed information to a puretone audiogram. We also included information about the speech signal based on the audibility (or articulation) index first described by Pavlovic in 1988 (Figure 1).¹

FIGURE 1. Hearing thresholds in the green area suggest the individual should have little or no hearing difficulties. Thresholds in the yellow area suggest occasional hearing difficulties, while someone with hearing thresholds in the red area will have hearing difficulties in most settings.

Rather than discuss the category of the hearing loss (eg, mild, moderate, severe), the colors are used to suggest when hearing sensitivity should cause no hearing difficulties, occasional difficulties, and frequent difficulties. Puretone thresholds in the green range suggest the individual should have little or no hearing difficulties. Thresholds in the yellow area suggest occasional hearing difficulties (difficulties that may seem inconsistent to the patient). Someone with hearing in the red area will have hearing difficulties in most settings.

Several versions of the color speech range audiogram were field tested, resulting in the version shown in Figure 1. Subsequently, this version has been used in a number of clinical settings throughout the United States with favorable results. Dispensing professionals report that their patients have found it easier to understand the audiometric results, particularly how the nature of their own hearing loss is related to their hearing difficulties. It also appears to help family members visualize their spouse’s (or child’s) hearing. Finally, in something of an unforeseen consequence, when puretone thresholds are displayed in the yellow or red area, it seems to make it more difficult for the patient to deny hearing loss since the color seems to “prove” it.

Reference

1. Pavlovic C. Articulation index predictions of speech intelligibility in hearing aid selection. ASHA. 1988;30(6/7):63-65.