Exploring the use of speech in audiology: A mixed methods study

This thesis aims to advance the understanding of how speech testing is, and can be, used for hearing device users within the audiological test battery. To address this, I engaged with clinicians and patients to understand the current role that speech testing plays in audiological testing in the UK, and developed a new listening test, which combined speech testing with localisation judgments in a dual task design. Normal hearing listeners and hearing aid users were tested, and a series of technical measurements were made to understand how advanced hearing aid settings might determine task performance. A questionnaire was completed by public and private sector hearing healthcare professionals in the UK to explore the use of speech testing. Overall, results revealed this assessment tool was underutilised by UK clinicians, but there was a significantly greater use in the private sector. Through a focus group and semi structured interviews with hearing aid users I identified a mismatch between their common listening difficulties and the assessment tools used in audiology and highlighted a lack of deaf awareness in UK adult audiology. The Spatial Speech in Noise Test (SSiN) is a dual task paradigm to simultaneously assess relative localisation and word identification performance. Testing on normal hearing listeners to investigate the impact of the dual task design found the SSiN to increase cognitive load and therefore better reflect challenging listening situations. A comparison of relative localisation and word identification performance showed that hearing aid users benefitted less from spatially separating speech and noise in the SSiN than normal hearing listeners. To investigate how the SSiN could be used to assess advanced hearing aid features, a subset of hearing aid users were fitted with the same hearing aid type and completed the SSiN once with adaptive directionality and once with omnidirectionality. The SSiN results differed between conditions but a larger sample size is needed to confirm these effects. Hearing aid technical measurements were used to quantify how hearing aid output changed in response to the SSiN paradigm