CC BY-NC-ND 4.0 · Semin Hear 2024; 45(01): 055-082
DOI: 10.1055/s-0043-1770155
Review Article

Speech-in-Noise Testing: An Introduction for Audiologists

Curtis J. Billings
1   Department of Communication Sciences and Disorders, Idaho State University, Pocatello, Idaho
2   VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
Tessa M. Olsen
1   Department of Communication Sciences and Disorders, Idaho State University, Pocatello, Idaho
Lauren Charney
2   VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
Brandon M. Madsen
2   VA RR&D National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon
3   Hearing Systems Section, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
Corrie E. Holmes
1   Department of Communication Sciences and Disorders, Idaho State University, Pocatello, Idaho
› Author Affiliations
Funding/Acknowledgments This work was supported by the United States (U.S.) National Institutes of Health (NIDCD-R03DC10914) and by the U.S. Department of Veterans Affairs (RR&D-5I01RX003702). The contents do not represent the views of the U.S. Department of Veterans Affairs or the U.S. government. The authors would also like to acknowledge the contributions of Nashrah Maamor, Tina Penman, and Paul Pendergraft.


Speech-in-noise testing has been proposed as a useful part of the audiometric test battery dating back to the earliest years of the field of audiology. Many speech-in-noise tests have been developed and used to varying degrees. However, multiple barriers have prevented speech-in-noise testing from being used widely in the clinic. The purpose of this article is to provide a resource to audiologists and other hearing health professionals who want to know (1) what tests are available for use, (2) the rationale behind specific tests, and (3) important considerations when selecting one or more tests to use clinically. In addition, data are presented for four speech-in-noise tests with the purpose of comparing outcomes as a function of age and hearing status. The four tests (QuickSIN, Words in Noise [WIN], Listening in Spatialized Noise–Sentences [LiSN-S], and Coordinate Response Measure [CRM]) were completed by 30 individuals from three groups: 10 young adults with normal hearing, 10 older adults with normal hearing, and 10 older adults with hearing loss. The results suggest that, despite significant differences in performance between groups, group overlap was present such that some individuals from one group performed similar to some individuals of other groups; therefore, individual performance was more important than associated group. When selecting an appropriate speech-in-noise test to use clinically, audiologists should carefully consider the purpose of their testing and the type of information they desire as an outcome. A quick-resource table and appendix is provided to aid audiologists and other health professionals in their selection of an appropriate speech-in-noise test.

Publication History

Article published online:
11 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • American Academy of Audiology (AAA). (2010). American academy of audiology clinical practice guidelines: diagnosis, treatment and management of children and adults with central auditory processing disorder. Accessed May 31, 2023 at:
  • American Speech-Language-Hearing Association (ASHA). (2019). Audiology survey report: clinical focus patterns, 2014–2018. Accessed April 2, 2022 at:
  • American Speech-Language-Hearing Association (ASHA). (2005a). (Central) Auditory Processing Disorders. Accessed April 2, 2022 at:
  • American Speech-Language-Hearing Association (ASHA). (2005b). Billing and Coding for Audiology Services, N.D. Accessed April 2, 2022 at:
  • American Speech-Language Hearing Association (ASHA). (2005c). Medicare CPT Coding Rules for Audiology Services. Accessed August 29, 2022 at:
  • Audiology Practice Standards Organization. (2021). Hearing Aid Fitting Standard for Adult and Geriatric Patients. Accessed April 2, 2022 at:
  • Auditec of St. Louis; (1971). Four-Talker Babble. St. Louis, MO: , 63143–2105
  • Auditory Potential(2022). Distributor of AzBio sentence lists. Accessed April 2, 2022 at
  • Bench J, Kowal A, Bamford J. (1979). The BKB (Bamford-Kowal-Bench) sentence lists for partially-hearing children. Br J Audiol 13 (03) 108-112
  • Bilger RC, Nuetzel JM, Rabinowitz WM, Rzeczkowski C. (1984). Standardization of a test of speech perception in noise. J Speech Hear Res 27 (01) 32-48
  • Billings CJ, Bennett KO, Molis MR, Leek MR. (2011). Cortical encoding of signals in noise: effects of stimulus type and recording paradigm. Ear Hear 32 (01) 53-60
  • Billings CJ, Madsen BM. (2018). A perspective on brain-behavior relationships and effects of age and hearing using speech-in-noise stimuli. Hear Res 369: 90-102
  • Billings CJ, Penman TM, Ellis EM, Baltzell LS, McMillan GP. (2016). Phoneme and Word Scoring in Speech-in-Noise Audiometry. Am J Audiol 25 (01) 75-83
  • Bolia RS, Nelson WT, Ericson MA, Simpson BD. (2000). A speech corpus for multitalker communications research. J Acoust Soc Am 107 (02) 1065-1066
  • Brown DK, Cameron S, Martin JS, Watson C, Dillon H. (2010). The North American Listening in Spatialized Noise-Sentences test (NA LiSN-S): normative data and test-retest reliability studies for adolescents and young adults. J Am Acad Audiol 21 (10) 629-641
  • Brungart DS. (2001a). Evaluation of speech intelligibility with the coordinate response measure. J Acoust Soc Am 109 (5, Pt 1): 2276-2279
  • Brungart DS. (2001b). Informational and energetic masking effects in the perception of two simultaneous talkers. J Acoust Soc Am 109 (03) 1101-1109
  • Brungart DS, Simpson BD, Ericson MA, Scott KR. (2001). Informational and energetic masking effects in the perception of multiple simultaneous talkers. J Acoust Soc Am 110 (5, Pt 1): 2527-2538
  • Brungart DS, Walden B, Cord M. et al. (2017). Development and validation of the Speech Reception in Noise (SPRINT) Test. Hear Res 349: 90-97
  • Byrne JET, Kerr AG. (1987). Deafness with normal pure tone audiometry. In: Kerr AG, Groves J, Booth JB. eds. Scott Brown's Otolaryngology. Great Britain, UK: Butterworth and Co.; 383-384
  • Cameron S, Brown D, Keith R, Martin J, Watson C, Dillon H. (2009). Development of the North American Listening in Spatialized Noise-Sentences test (NA LiSN-S): sentence equivalence, normative data, and test-retest reliability studies. J Am Acad Audiol 20 (02) 128-146
  • Cameron S, Dillon H. (2007). Development of the listening in spatialized noise-sentences test (LISN-S). Ear Hear 28 (02) 196-211
  • Cameron S, Glyde H, Dillon H. (2012). Efficacy of the LiSN & Learn auditory training software: randomized blinded controlled study. Audiology Res 2 (01) e15
  • Cameron S, Glyde H, Dillon H. (2011). Listening in Spatialized Noise-Sentences Test (LiSN-S): normative and retest reliability data for adolescents and adults up to 60 years of age. J Am Acad Audiol 22 (10) 697-709
  • Carhart R. (1946). Tests for selection of hearing aids. Laryngoscope 56 (12) 780-794
  • Carhart R. (1951). Basic principles of speech audiometry. Acta Otolaryngol 40 (1-2): 62-71
  • Carlson ML, Sladen DP, Gurgel RK, Tombers NM, Lohse CM, Driscoll CL. (2018). Survey of the American Neurotology Society on Cochlear Implantation: Part 1, candidacy assessment and expanding indications. Otol Neurotol 39 (01) e12-e19
  • Chermak GD, Iliadou V, Bamiou D, Musiek FE. (2018). Letter to the editor: response to Vermiglio, 2018. Perspectives of the ASHA Special Interest Groups, SIG6, 3 (02) 77-82
  • Cherry EC. Some experiments on the recognition of speech, with one and with two ears. J Acoust Soc Am 25 (05) 975
  • Clark JG, Huff C, Earl B. (2017). Clinical practice report card – Are we meeting best practice standards for adult hearing rehabilitation?. Audiol Today 29 (06) 15-25
  • Cord MT, Walden BE, Atack RM. (1992). Speech Recognition in Noise Test (SPRINT) for H-3 Profile. Walter Reed Army Medical Center;
  • Cox RM, Alexander GC, Gilmore C. (1978). Development of the Connected Speech Test (CST). Ear Hear 8 (5, Suppl): 119S-126S
  • Cox RM, Alexander GC, Gilmore C, Pusakulich KM. (1988). Use of the Connected Speech Test (CST) with hearing-impaired listeners. Ear Hear 9 (04) 198-207
  • Davidson A, Marrone N, Wong B, Musiek F. (2021). Predicting hearing aid satisfaction in adults: a systematic review of speech-in-noise tests and other behavioral measures. Ear Hear 42 (06) 1485-1498
  • Davis H, Hudgins CV, Marquis RJ. et al. (1946). The selection of hearing aids. Laryngoscope 56 (03) 85-115
  • Durlach NI, Mason CR, Kidd Jr G, Arbogast TL, Colburn HS, Shinn-Cunningham BG. (2003). Note on informational masking. J Acoust Soc Am 113 (06) 2984-2987
  • Etymotic Research; (2005). Bamford-Kowal-Bench Speech-in-Noise Test (Version 1.03) [Audio CD and Test Manual]. Elk Grove Village, IL:
  • Etymotic Research; (2006). QuickSIN™ Speech-in-Noise Test (Version 1.3) [Audio CD and Test Manual]. Elk Grove Village, IL:
  • Gifford RH, Shallop JK, Peterson AM. (2008). Speech recognition materials and ceiling effects: considerations for cochlear implant programs. Audiol Neurotol 13 (03) 193-205
  • Hardy WG. (1950). Hearing aids; procedures for testing and selection. Postgrad Med 7 (01) 11-17
  • Hearing Aid Research Lab (HARL). (n.d.). Connected Speech Test (CST) [Website]. Accessed June 10, 2022 at:
  • Hinchcliffe R. (1992). King-Kopetzky syndrome: an auditory stress disorder. J Audiol Med 1: 89-98
  • Hodgson M, Rempel R, Kennedy S. (1999). Measurement and prediction of typical speech and background-noise levels in university classrooms during lectures. J Acoust Soc Am 105: 226-233
  • Holder JT, Levin LM, Gifford RH. (2018). Speech recognition in noise for adults with normal hearing: Age-normative performance for AzBio, BKB-SIN, and QuickSIN. Otol Neurotol 39 (10) e972
  • Institute of Electrical and Electronic Engineers. (1969). IEEE Recommended Practice for Speech Quality Measures. New York: IEEE;
  • Interacoustics (n.d.). Acceptable Noise Level (ANL) test [Website]. Accessed January 20, 2022 at:
  • Jakien KM, Kampel SD, Stansell MM, Gallun FJ. (2017). Validating a rapid, automated test of spatial release from masking. Am J Audiol 26 (04) 507-518
  • Jayaram M, Baguley DM, Moffat DA. (1992). Speech in noise: a practical test procedure. J Laryngol Otol 106 (02) 105-110
  • Kalikow DN, Stevens KN, Elliott LL. (1977). Development of a test of speech intelligibility in noise using sentence materials with controlled word predictability. J Acoust Soc Am 61 (05) 1337-1351
  • Kidd G, Mason CR, Richards VM. et al. (2008). Informational masking. In: Yost WA, Popper AR, Fay RR. (eds.). Auditory Perception of Sound Sources. New York: Springer; 143-189
  • Killion MC, Niquette PA, Gudmundsen GI, Revit LJ, Banerjee S. (2004). Development of a quick speech-in-noise test for measuring signal-to-noise ratio loss in normal-hearing and hearing-impaired listeners. J Acoust Soc Am 116 (4, Pt 1): 2395-2405
  • King PF. (1954). Psychogenic deafness. J Laryngol Otol 68 (09) 623-635
  • Kochkin S. (2010). MarkeTrak VIII: consumer satisfaction with hearing aids is slowly increasing. Hear J 63 (01) 19-32
  • Kopetzky SJ. (1948). Deafness, Tinnitus, and Vertigo. New York, NY: Thomas Nelson & Sons;
  • Kuk F, Korhonen P. (2018). Using traking of noise tolerance (TNT) as an outcome measure for hearing aids. Hear Rev 25: 16-23
  • Markides A. (1986). Age at fitting of hearing aids and speech intelligibility. Br J Audiol 20 (02) 165-167
  • Mealings K, Yeend I, Valderrama JT, Valderrama JT. et al. (2020). Discovering the unmet needs of people with difficulties understanding speech in noise and a normal or near-normal audiogram. Am J Audiol 29 (03) 329-355
  • Middelweerd MJ, Festen JM, Plomp R. (1990). Difficulties with speech intelligibility in noise in spite of a normal pure-tone audiogram. Audiology 29 (01) 1-7
  • Miller GA. (1947). The masking of speech. Psychol Bull 44 (02) 105-129
  • Moore TJ. (1981). Voice communications jamming research. AGARD Conference Proceedings. ;311;2(1)–2(6)
  • MSTB. New Minimum Speech Test Battery for Adult Cochlear Implant Users. 2011 ;1:1–15. Accessed July 18, 2022 at:
  • Mueller HG. (2003). Fitting test protocols are “more honored in the breach than the observance”. Hear J 56 (10) 19-26
  • Mueller HG. (2010). Three pre-tests: What they do and why experts say you should use them more. Hear J 63 (04) 8-17
  • Nabelek AK, Tucker FM, Letowski TR. (1991). Toleration of background noises: relationship with patterns of hearing aid use by elderly persons. J Speech Hear Res 34 (03) 679-685
  • Nabelek AK, Freyaldenhoven MC, Tampas JW, Burchfiel SB, Muenchen RA. (2006). Acceptable noise level as a predictor of hearing aid use. J Am Acad Audiol 17 (09) 626-639
  • Narula AA, Mason SM. (1988). Selective dysacusis – a preliminary report. J R Soc Med 81 (06) 338-340
  • Nilsson M, Soli SD, Sullivan JA. (1994). Development of the Hearing in Noise Test for the measurement of speech reception thresholds in quiet and in noise. J Acoust Soc Am 95 (02) 1085-1099
  • Pearsons KS, Bennett RL, Fidell S. (1977). Speech Levels in Various Noise Environments: Environmental Health Effects Research Series. National Technical Information Service, Springfield;
  • Plomp R. (1977). Acoustical aspects of cocktail parties. Acoustica 38: 186-191
  • Plomp R. (1978). Auditory handicap of hearing impairment and the limited benefit of hearing aids. J Acoust Soc Am 63 (02) 533-549
  • Prentiss S, Snapp H, Zwolan T. (2020). Audiology practices in the preoperative evaluation and management of adult cochlear implant candidates. JAMA Otolaryngol Head Neck Surg 146 (02) 136-142
  • Prins N, Kingdom FAA. (2018). Applying the model-comparison approach to test specific research hypotheses in psychophysical research using the Palamedes toolbox. Front Psychol 9: 1250
  • Pryce H, Wainwright D. (2008). Help-seeking for medically unexplained hearing difficulties: a qualitative study. Int J Ther Rehabil 15 (08) 343-349
  • Rappaport JM, Phillips DP, Gulliver JM. (1993). Disturbed speech intelligibility in noise despite a normal audiogram: a defect in temporal resolution?. J Otolaryngol 22 (06) 447-453
  • Rendell RJ, Stephens SDG. (1988). Auditory disability with normal hearing. Br J Audiol 22: 233-234
  • Spahr AJ, Dorman MF, Litvak LM. et al. (2012). Development and validation of the AzBio sentence lists. Ear Hear 33 (01) 112-117
  • Saunders GH, Haggard MP. (1989). The clinical assessment of obscure auditory dysfunction–1. Auditory and psychological factors. Ear Hear 10 (03) 200-208
  • Saunders GH, Cienkowski KM. (2002). A test to measure subjective and objective speech intelligibility. J Am Acad Audiol 13 (01) 38-49
  • Schafer EC, Pogue J, Milrany T. (2012). List equivalency of the AzBio sentence test in noise for listeners with normal-hearing sensitivity or cochlear implants. J Am Acad Audiol 23 (07) 501-509
  • Saunders GH, Forsline A, Fausti SA. (2004). The performance-perceptual test and its relationship to unaided reported handicap. Ear Hear 25 (02) 117-126
  • Saunders GH, Forsline A. (2006). The Performance-Perceptual Test (PPT) and its relationship to aided reported handicap and hearing aid satisfaction. Ear Hear 27 (03) 229-242
  • Sladen DP, Gifford RH, Haynes D. et al. (2017). Evaluation of a revised indication for determining adult cochlear implant candidacy. Laryngoscope 2017; 127 (10) 2368-2374
  • Smeds K, Wolters F, Rung M. (2015). Estimation of signal-to-noise ratios in realistic sound scenarios. J Am Acad Audiol 26 (02) 183-196
  • Stephens SDG. (1976). The input for a damaged cochlea—a brief review. Br J Audiol 10: 97-101
  • Strom KE. (2006). The HR 2006 dispensing survey. Hearing Review 13: 16-39
  • Studebaker GAA. A “rationalized” arcsine transform. J Speech Hear Res 1985; 28 (03) 455-462
  • Taylor B. (2003). Speech-in-noise tests: How and why to include them in your basic test battery. The Hearing Journal 56 (01) 40,42-46
  • Teder H. (1990). Noise and speech levels in noisy environments. Hearing Instruments 41 (04) 32-33
  • U.S. Department of the Air Force. Manual 48–123. Medical Examinations and Standards, December 8, 2020. Accessed May 31, 2023 at:
  • U.S. Department of the Army. Army Regulation 40–501. Standards of Medical Fitness, 4 August 4, 2011. Accessed May 31, 2023 at:
  • U.S. Department of the Navy. NMCPHC TM-6260.51.99–3. Navy Medicine Hearing Conservation Program Technical Manual, July 2020. Accessed May 31, 2023 at:
  • Vermiglio AJ. (2018a). The gold standard and auditory processing disorder. Perspectives of the ASHA Special Interest Groups, SIG6, 3(1):6–17
  • Vermiglio AJ. (2018b). Response to the Letter to the Editor from Chermak. Perspectives of the ASHA Special Interest Groups, SIG6, 3(2):83–90
  • Vermiglio AJ. (2008). The American English hearing in noise test. Int J Audiol 47 (06) 386-387
  • Vermiglio AJ, Leclerc L, Thornton M, Osborne H, Bonilla E, Fang X. (2021). Diagnostic accuracy of the AzBio Speech Recognition in Noise Test. J Speech Lang Hear Res 64 (08) 3303-3316
  • Wilson RH. (2003). Development of a speech-in-multitalker-babble paradigm to assess word-recognition performance. J Am Acad Audiol 14 (09) 453-470
  • Wilson RH. (2004). Adding speech-in-noise testing to your clinical protocol: Why and how. Hear J 57 (02) 10-18
  • Wilson RH, Burks CA. (2005). Use of 35 words for evaluation of hearing loss in signal-to-babble ratio: A clinic protocol. J Rehabil Res Dev 42 (06) 839-852
  • Wilson RH. (2011). Clinical experience with the words-in-noise test on 3430 veterans: comparisons with pure-tone thresholds and word recognition in quiet. J Am Acad Audiol 22 (07) 405-423
  • Wilson RH, McArdle R. (2005). Speech signals used to evaluate functional status of the auditory system. J Rehabil Res Dev 42 (4, Suppl 2): 79-94
  • Wingfield A. (1996). Cognitive factors in auditory performance: context, speed of processing, and constraints of memory. J Am Acad Audiol 7 (03) 175-182