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Psychoacoustical and audiometric prediction of auditory disability for different frequency responses at listener-adjusted presentation levels.

Audiometric prediction of word identification scores has typically used one fixed presentation level for all subjects in the sample, with presentation in quiet and a wide range of hearing impairment among the listeners; under such conditions it is hardly surprising that moderate to good predictions are found. To see if prediction is possible under clinically relevant conditions, that is, on a homogeneous clinical sample of new hearing-aid candidates and to listener-adjusted levels, as would obtain in use of a hearing aid. In addition to audiometric variables, we employed a clinical approximation to the psychoacoustic tuning curve. We tested speech identification (FAAF) performance both with a 'rising'(+9 dB/octave) and with a 'flat' frequency response. Prediction of performance in the 'flat' condition was only good when a full set of audiometric frequencies entered the multiple-regression formula, each with its own weighting. Audiometric prediction for the 'rising' frequency response was particularly poor. Thus, the fairly good predictability from thresholds found traditionally for word identification scores or other disability measures appears to be a special case, depending partly on the wide range of hearing levels employed. Within our clinical sample the predictive power of formulae based on the mean of all thresholds or of mid-frequency thresholds alone (as used in compensation schemes) or on a priori combinations of thresholds (such as slopes) was generally poor. However, a three-parameter model taking account separately of low (0.25 kHz) and high-frequency (greater than 2.0 kHz) thresholds was effective. This and other audiometric descriptions were valuably supplemented by a psychoacoustic measure of frequency resolution at 2 kHz. In particular, such supplementation here allowed a satisfactory level of prediction to be achieved for speech heard with a +9 dB/octave frequency response, which the audiogram alone did not. The limitations of the prediction paradigm are discussed and several conceptual and statistical problems not previously emphasised in the audiological literature are illustrated in relation to the data.