Background: Since the 1940s, measures of pure-tone sensitivity and speech recognition in quiet have been vital components of the audiologic evaluation. Although early investigators urged that speech recognition in noise also should be a component of the audiologic evaluation, only recently has this suggestion started to become a reality. This report focuses on the Words-in-Noise (WIN) Test, which evaluates word recognition in multitalker babble at seven signal-to-noise ratios and uses the 50% correct point (in dB SNR) calculated with the Spearman-Kärber equation as the primary metric. The WIN was developed and validated in a series of 12 laboratory studies. The current study examined the effectiveness of the WIN materials for measuring the word-recognition performance of patients in a typical clinical setting. Purpose: To examine the relations among three audiometric measures including pure-tone thresholds, word-recognition performances in quiet, and word-recognition performances in multitalker babble for veterans seeking remediation for their hearing loss. Research Design: Retrospective, descriptive. Study Sample: The participants were 3430 veterans who for the most part were evaluated consecutively in the Audiology Clinic at the VA Medical Center, Mountain Home, Tennessee. The mean age was 62.3 yr (SD = 12.8 yr). Data Collection and Analysis: The data were collected in the course of a 60 min routine audiologic evaluation. A history, otoscopy, and aural-acoustic immittance measures also were included in the clinic protocol but were not evaluated in this report. Results: Overall, the 1000-8000 Hz thresholds were significantly lower (better) in the right ear (RE) than in the left ear (LE). There was a direct relation between age and the pure-tone thresholds, with greater change across age in the high frequencies than in the low frequencies. Notched audiograms at 4000 Hz were observed in at least one ear in 41% of the participants with more unilateral than bilateral notches. Normal pure-tone thresholds (≤20 dB HL) were obtained from 6% of the participants. Maximum performance on the Northwestern University Auditory Test No. 6 (NU-6) in quiet was ≥90% correct by 50% of the participants, with an additional 20% performing at ≥80% correct; the RE performed 1-3% better than the LE. Of the 3291 who completed the WIN on both ears, only 7% exhibited normal performance (50% correct point of ≤6 dB SNR). Overall, WIN performance was significantly better in the RE (mean = 13.3 dB SNR) than in the LE (mean = 13.8 dB SNR). Recognition performance on both the NU-6 and the WIN decreased as a function of both pure-tone hearing loss and age. There was a stronger relation between the high-frequency pure-tone average (1000, 2000, and 4000 Hz) and the WIN than between the pure-tone average (500, 1000, and 2000 Hz) and the WIN. Conclusions: The results on the WIN from both the previous laboratory studies and the current clinical study indicate that the WIN is an appropriate clinic instrument to assess word-recognition performance in background noise. Recognition performance on a speech-in-quiet task does not predict performance on a speech-in-noise task, as the two tasks reflect different domains of auditory function. Experience with the WIN indicates that word-in-noise tasks should be considered the "stress test" for auditory function.

Background: In certain masking paradigms, the masker can have two components, energetic and informational. Energetic masking is the traditional peripheral masking, whereas informational masking involves confusions (uncertainty) between the signal and masker that originate more centrally in the auditory system. Sperry et al (1997) used Northwestern University Auditory Test No. 6 (NU-6) words in multitalker babble to study the differential effects of energetic and informational masking using babble played temporally forward (FB) and backward (BB). The FB and BB are the same except BB is void of the contextual and semantic content cues that are available in FB. It is these informational cues that are thought to fuel informational masking. Sperry et al found 15% better recognition performance (∼3 dB) on BB than on FB, which can be interpreted as the presence of informational masking in the FB condition and not in the BB condition (Dirks and Bower, 1969). The Words-in-Noise Test (WIN) (Wilson, 2003; Wilson and McArdle, 2007) uses NU-6 words as the signal and multitalker babble as the masker, which is a combination of stimuli that potentially could produce informational masking. The WIN presents 5 or 10 words at each of seven signal-to-noise ratios (S/N, SNR) from 24 to 0 dB in 4 dB decrements with the 50% correct point being the metric of interest. The same recordings of the NU-6 words and multitalker babble used by Sperry et al are used in the WIN. Purpose: To determine whether informational masking was involved with the WIN. Research Design: Descriptive, quasi-experimental designs were conducted in three experiments using FB and BB in various paradigms in which FB and BB varied from 4.3 sec concatenated segments to essentially continuous. Study Sample: Eighty young adults with normal hearing and 64 older adults with sensorineural hearing losses participated in a series of three experiments. Data Collection and Analysis: Experiment 1 compared performance on the normal WIN (FB) with performance on the WIN in which the babble segment with each word was reversed temporally (BB). Experiment 2 examined the effects of continuous FB and BB segments on WIN performance. Experiment 3 replicated the Sperry et al (1997) experiment at 4 and 0 dB S/N using NU-6 words in the FB and BB conditions. Results: Experiment 1-with the WIN paradigm, recognition performances on FB and BB were the same for listeners with normal hearing and listeners with hearing loss, except at the 0 dB S/N with the listeners with normal hearing at which performance was significantly better on BB than FB. Experiment 2-recognition performances on FB and BB were the same at all SNRs for listeners with normal hearing using a slightly modified WIN paradigm. Experiment 3-there was no difference in performances on the FB and BB conditions with either of the two SNRs. Conclusions: Informational masking was not involved in the WIN paradigm. The Sperry et al results were not replicated, which is thought to be related to the way in which the Sperry et al BB condition was produced.