QuickSIN: An Introduction

Difficulty with hearing in background noise is a common complaint among people with hearing loss. The measurement of signal-to-noise ratio loss (SNR loss) is important because a person’s ability to understand speech in noise cannot be reliably predicted from the pure tone audiogram alone.

Several tests are available to predict their hearing-in-noise ability. They include language-dependent tests such as QuickSIN and the Hearing in Noise Test (HINT), and the language-independent Audible Contrast Threshold (ACT™) test.

This article will focus on the QuickSIN test.

Table of contents

• What is the QuickSIN test?
• What is SNR loss?
• Clinical benefits of performing the QuickSIN test
• Required equipment
• Testing considerations
• Performing the test and scoring
• QuickSIN results

What is the QuickSIN test?

The QuickSIN test provides a quick estimate of SNR loss. A list of six sentences with five key words per sentence is presented in four-talker babble noise. The patient is required to repeat these sentences to the tester. The tester then scores how many of the keywords the patient correctly identifies.

The sentences are presented at pre-recorded SNR levels which decrease in 5-dB steps from 25 dB SNR (very easy) to 0 dB SNR (extremely difficult), encompassing a wide range of listening environments from very complex to very simple.

What is SNR loss?

SNR loss can be considered as the patient’s hearing performance in noise compared to a normal-hearing person’s performance in noise. SNR loss is defined as the dB increase in SNR required by a hearing-impaired person to understand speech in noise, compared to someone with normal hearing.

A normal-hearing person requires about +2 dB SNR (speech louder than the background noise by 2 dB) to identify 50% of key words in sentences on the QuickSIN test.

The dB value of SNR loss is derived from the SNR-50 (SNR for 50% correct) score. A hearing-impaired person who requires speech to be 8 dB higher than the noise to achieve a 50% correct score would have a 6 dB SNR loss (8 dB – 2 dB = 6 dB) (see Figure 1, adapted from Killion, 2002).

Different tests will give different SNR-50 values for the same patient. It has been found that changing from a female to male talker and using easier sentences decreases the normal SNR-50 by 5 dB from +2 to –3 dB, even though the babble noise is identical in both tests. Similarly, when continuous speech-spectrum noise is used, the reported SNR will differ by about 7 dB between computed RMS calibration and traditional frequent peak VU-meter readings (Ludvigsen & Killion, 1997).

QuickSIN is a standardized test of SNR performance under specific conditions. Its scores are reported in SNR loss because it is substantially independent of calibration and test material. Calibration and/or test material differences that affect the SNR-50 values equally for normal and hearing-impaired subjects will cancel out in the SNR loss calculation.

Clinical benefits of performing the QuickSIN test

The QuickSIN test is beneficial because it provides a quick estimate of SNR loss (ability to hear in noise), which can be useful information when counseling patients regarding realistic expectations and selecting advanced hearing aid settings, such as directional microphones.

However, a report by Parmar & Rajasingam (2023) looking at the use of speech-in-noise tests in the UK indicates that these tests have certain challenges, two of which apply to the QuickSIN test:

• These tests are language dependent, requiring validated speech materials to be created for every language (QuickSIN is English only).
• It is not clear how we can use the results of these tests to alter the settings in the hearing aid.

Therefore, you may want to consider the ACT™ test – which addresses these challenges – as an alternative, depending on your clinical needs.

Read more: Audible Contrast Threshold (ACT™) Test: A Complete Guide

Required equipment

To perform the QuickSIN test, you can use either headphones, insert phones, or a free field speaker. And you also need an audiometer with the capability of performing QuickSIN (Table 1).

Table 1: Audiometers from Interacoustics that can perform QuickSIN.

When presenting the QuickSIN test via loudspeaker, present it through one loudspeaker only, with the subject seated facing the loudspeaker (zero degrees azimuth). When using insert phones or headphones, you may present the test either monaurally or binaurally.

Note: Normative data were collected using binaural presentation.

Testing considerations

Before performing the test, we’ll consider:

• Presentation level
• Test instructions
• Aided QuickSIN
• QuickSIN word lists

Presentation level

For patients where the four frequency pure tone average is less than 45 dB HL, set the dial to 70 dB HL. For pure tone averages of 50 dB HL or greater, set the attenuator dial to a level that the patient perceives as “loud, but OK.”

The sound should be perceived as loud, but not uncomfortably loud. You can either use the practice lists to determine the correct presentation level or use the levels measured during speech in quiet testing.

Test instructions

See the example below:

“Imagine that you are at a party. There will be a woman talking and several other talkers in the background. The woman’s voice is easy to hear at first, because her voice is louder than the others. Repeat each sentence the woman says. The background talkers will gradually become louder, making it difficult to understand the woman’s voice, but please guess and repeat as much of each sentence as possible.”

Note: When testing via loudspeaker, the talkback microphone should be close to the patient’s mouth so that responses are clearly audible to the tester.

Aided QuickSIN

It is also possible to do an aided QuickSIN. In the audiometer software, select free field as the transducer and then select the aided icon. This will add an extra column to the QuickSIN scoring table allowing you to compare unaided and aided results.

QuickSIN word lists

The sentences in QuickSIN are based on the IEEE (Institute of Electrical and Electronics Engineers) sentences. These were derived from the Harvard Phonetically Balanced Sentences, developed at Harvard University.

The IEEE formed a subcommittee that was charged with developing practice guidelines for speech quality measurements to help communication engineers assess speech transmission systems.

The 720 IEEE sentences (72 lists of 10 sentences each, with five key words in each sentence) were published as the 1969 document, “IEEE Recommended Practice for Speech Quality Measurements.”

Performing the test and scoring

When the test begins, a sentence with a SNR of +25 dB is played. Ask the patient to repeat the sentence. The hearing care professional scores how many of the five key words are repeated correctly in each sentence. The key words are marked as bold on the score sheets.

Give one point for each key word repeated correctly. Enter the number of correct words identified on the audiometer by pressing the corresponding button (1 to 5). The second sentence will then play at an SNR of 20 dB followed by the other sentences at 15-, 10-, 5-, and 0-dB SNR.

At the end of the test, the total number of correct words for the list will automatically be calculated. The SNR loss is calculated for each list by using the formula:

SNR loss = 25.5 – total correct

Note: For greater accuracy, two or more lists should be averaged.

Where does the number 25.5 come from?

First, it is important to explain where a different number comes from: 27.5. The number 27.5 comes from the Tillman-Olsen (1973) recommended method for obtaining spondee thresholds.

In the Tillman-Olsen method, two spondees are presented at each level, starting at a level where all spondees are repeated correctly and decreasing in 2-dB steps until no responses are obtained for several words.

The starting level plus 1 dB, minus the total number of spondees repeated correctly, is the spondee threshold. The simple arithmetic comes from the use of 2-dB steps and two words per step.

If the audiometer only has 5-dB steps, the corresponding method would use five words per step and take the starting level plus 2.5 dB (half of the step size, just as in the case of 2-dB steps), minus the total number of spondees repeated correctly.

The QuickSIN has five words per step and 5 dB per step. The highest SNR is 25 dB, so we take 25 + 2.5 = 27.5, minus the total number of words repeated correctly. This gives what we call the SNR-50, which is the SNR required for the patient to repeat 50% of the words correctly.

If someone repeats all the words correctly down to 15 dB SNR and then misses everything beyond that point, then they gave 15 correct responses (five key words identified each at 25-, 20-, and 15-dB SNR).

Since they scored 100% correct at 15 dB SNR and 0% correct at 10 dB SNR, their SNR-50 would be about 12.5 dB, halfway between 15 and 10. This is the value given by the formula 27.5 – 15 = 12.5 dB.

It is then required to factor in the SNR-50 for a normal-hearing person. As mentioned earlier in the article, QuickSIN has a +2 dB SNR for normally hearing individuals (speech is required to be +2 dB louder than the noise).

We therefore must subtract 2 dB to derive the formula for a patient's SNR loss on QuickSIN:

SNR loss = 25.5 – total correct

QuickSIN results

You can see an example word list with results in Figure 2, which are then categorized according to Table 2.

Table 2: Degrees of SNR loss. The higher the SNR loss, the more SNR improvement is needed.

The results from the QuickSIN test can then be used to counsel the patient on the likelihood they will have hearing-in-noise challenges.

Those with SNR values greater than 3 dB will be expected to perform worse than individuals in background noise and therefore can benefit from technology to assist them in these situations. One such technology will be directional microphones.

As the SNR loss becomes moderate and severe, then directional microphones alone might not be sufficient and additional signal enhancing technologies might need to be used alongside, such as remote microphone technology and FM systems.

Another application for the test is to counsel the patient on the challenges they will have in background noise, with those with high SNR values experiencing greater challenges in noise. This is useful in setting realistic expectations for the hearing aid fitting.

This test can also be used alongside the acceptable noise level (ANL) test and the scores of both tests can be plotted on a red flag matrix to predict annoyance and intelligibility difficulties with hearing aids (Figure 3).

Conclusion

The QuickSIN test provides a fast method to measure a person’s hearing-in-noise ability. You can perform the test using insert phones, headphones, or in the free field, making it clinically versatile.

However, note that QuickSIN requires the patient to have a solid understanding of the English language. Therefore, for those who do not speak English, a more suitable alternative is the ACT™ test.

References

Killion, M. (2002). New thinking on hearing in noise: A generalized articulation index. Seminars in Hearing, 23(1), 57-76.

Ludvigsen, C., & Killion, M. (1997). Personal communication.

Parmar, B., & Rajasingam, S. (2023). Adult speech testing in the UK. ENT & Audiology News.

Taylor, B., & Bernstein, J. (2011). The red flag matrix: Using the QuickSIN and the ANL tests. Audiology Practices, 3(3).

Tillman, T. W., & Olsen, W. O. (1973). Speech audiometry. In J. Jerger (Ed.), Modern developments in audiology (pp. 37-74). New York: Academic Press.