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Fie. 7.2. Social Adequacy Index (SAI}. Table to derive SAI from speech I~eption
threshold and discrimination loss. PB words ~ phonetically balanc.,~vords.
-
Katz, Jack, Handbook of CLWICAL AUDIOLOGY Fourth Edition, Williams and Wilkins, 199
CHAPTER I3 : INTEGRATING AUDIOMETRIC RESULTS, page 183.
Speech Audiometry - ~
Speech audiometry was established as a routine part of the audiological battery as a resu7~_of the
development of speech threshold tests {Hudgins et a1., 1947) and word recognition (speech discrimination tests
(Egan, 1948) at the Harvard Psychoacoustic Laboratory. Today the most common clinical methoi~ of det~~ning
speech thresholds and speech recogrtion still involve the use of spondaic woxds and monosyllabic word lists
respectively.
Using the Harvard Psychoacoustic Laboratory Phonetically Balanced ward lists {PAL Pl3 50) retarded by
Rush Hughes, speech discrimination scores helped to confirm the diagnosis of conductive hearing toss (high
scores), mixed loss, and sensory loss (tower scares) (Thurlow et al., 1949). In addition, the SRT and average
discrimination toss from PB 50-word Gsts presented at three levels (33, 48, and 63 dB SL) representing faint,
average, and loud conversational speech were used together to estimate the degree of hearing handicap called the
social adequacy index (SAI) {Davis, 1948}. As clinical use of the CID W-I and W-22 word lists (I-firsh et ai., 1452)
succeeded the Harvard FAL lists, word recognition scares became less diagnostic and the SAI fell into disuse, but
the basic clinical value of speech threshold tests and word recognition has continued.
The use of the SRT to validate the accuracy of puretone thresholds became, in addition, a valuable
differentia( diagnostic indication of pseudohypacusis as Gerhart (1952} reported SRTs being obtained at much
better hearing levels than puretone averages for cases of pseudohypacusis.
As has happened before (amply shown buy the SHHH organization) a profession will become so distracted by
research/statistical disciplines that its responsibility to serve the needs of patients gets forgotten. The real world is
noisy. Discrimination scores (PB°/a) are imprecise, of course, but have real value as ~ measures of
communicative adequacy. The SAI has frequently proven itself in Workmen's Compensation and Disability
determination cases. As the chart above shows, a SAI of less than 33 is tantamount to dea~ess. f~tnote by 7L~,2. b ~2
,om m. o.
M.S. Werner. e P ~ -
File No. `1
Ref. Date Ml~'! ~ ~t1Os}