I receive questions often about what is good speech perception so I think it is time to bring this up again in this blog. I wrote an article in 2011 with colleagues from the Beth Israel/NYEE Hearing and Learning Center and Cochlear implant Center where I had been the director.
We had done a survey of audiologists, speech-language pathologists, listening and spoken language specialists and teachers of the deaf. We asked what was good speech perception for children with hearing loss. The answers were very varied. Some actually thought that a score of 40% was good.
IT IS NOT GOOD TO HAVE A SPEECH PERCEPTION SCORE OF 40%.
Why? Because if you can only understand 40% of what is happening around you, you will have a very, very difficult time learning–even in a quiet place. Learning in a classroom will be almost impossible.
So what is good speech perception?
Things are very different now for children with hearing loss than what was available even 20 years ago. Newborn hearing screening identifies babies at birth. They are fit with technology in the first few weeks or months.
If babies do not do well with hearing aids, cochlear implants are available. So our expectations for children with hearing loss should be the same as our expectations for children with typical hearing.
- Excellent speech perception is 90-100%
- Good speech perception is 80-89%
- Fair speech perception is 70-79%
- Poor speech perception is less than 70%
Why does it matter that we label speech perception scores accurately?
If we do not call it what it is than no one knows what to do. If a child has a speech perception score of 74% and I do not say that speech perception is fair, no one working with the child knows that they have work to do.
If I say that speech perception is good or excellent than everyone says, “yeah, great, we can work on something else now.” If I am honest and say that it is “fair” than parents, teachers, therapists, all know that they have work to do.
Selecting the correct test
That said, it is really important that the appropriate speech perception test be used. Tests have to be at the appropriate language level so that we can accurately measure speech perception – this is a long topic for which I have written entire book chapters – not easy to do in a blog.
For example, if we test a 3rd grader with a kindergarten word list we will get a good score but will not know how she will be hearing in school. If we test a preschooler with a kindergarten test we are going to be using a more difficult test than is appropriate.
My test recommendations are below:
I’ve heard that testing using single words rather than phrases or sentences is more-accurate. Is there a minimum age at which that is even possible?
Very good thinking. Most “normal” hearers will think 40 – 50% is wonderful, but you have shown that is really disastrous. They are horribly biased as they have no real experience of the trauma of a daily hearing loss. I think a more realistic range should be 80 — 100%. Now 80% or better still leaves a lot of territory unheard and misunderstood. All too often key words will be missed with the usual bad results. Our improving modern technology is affording us unparalleled hearing ability than was corrected in the past, even with the best hearing aids of the day, Yes, there is a lot of work to do, so let’s aim for 95% speech perception — it is within our reach. I am my own best example — when I was discovered at age 5, the doctors held out no hope whatever. No hope at all, just warehouse him now for his own good. My parents knew progress was inevitable, and fought hard. I’m a “corner card”, if you pros remember that term. I continued the fight with better and better instruments all the way up to cochlear implants. Of course, I was a college graduate 35 years before the implants. Contemporary predictors are no measure of future unknown and unimagined amazing advances. Old Mr. Hopeless beat the late 1940s odds by far.
Speech perception is so important for children with hearing loss. If a teacher believes that 40% is okay they need to be re-educated or replaced. This is a teacher who slurs words, talks to the blackboard, sucks on candy, speaks rapidly, and never ask class “Did you understand this last statement?”. It may have been misunderstood due to an unknown topic.