What to Expect from a Hearing Test – Speech Tests and Speech in Noise Tests

Redlands hearing test clinic

Speech Tests and Speech in Noise Tests

When explaining what is involved in a comprehensive hearing test, we can’t overlook the all-important ‘speech tests’.

  1. A simple ‘Speech Test’ performed in quiet, testing each ear separately.
  2. A ‘Speech in Noise Test’ testing both ears together in the presence of background noise.

At a Glance

  1. The brain and the ear work in sequence to hear and make sense of sounds.
  2. Hearing occurs when the signal, sent by the ear and auditory nerve, arrives in the brain and is decoded.
  3. Speech requires significant brain effort to isolate from other sounds and to interpret.
  4. Whereas a ‘beep’ test checks each ears sensitivity to a simple sound at different pitches, ‘Speech Tests’ test the brains’ ability to decode and interpret a complex signal (words).

What to Expect in a Speech Test

What is regularly described as a speech test is clinically known as an ‘AB Words’ test and takes around 5 minutes to administer. It should always be performed in a sound-treated room or booth. It measures your ability to distinguish speech sounds at different volume levels, in quiet.

The audiologist will play a list of words through one side of the headphones at a time and ask you to repeat each word as it is presented. The list is made up of 10 single-syllable words, running consonant-vowel-consonant, for example, the word ‘bed’.

The audiologist will be considering:

  • Can you accurately distinguish the word presented?
  • Are your speech test results consistent with your beep test results?
  • Does your ability to hear the different sounds change as we increase or decrease the volume?
  • Do your results get better or worse at very high volumes?
  • Do different ears produce different results?

When discussing the results you may experience a few ‘aha’ moments. Hearing loss takes chunks out of words. What is said, and what the sufferer hears, can be two very different things. For example; did the speaker say ‘money for the cheeseboard’ or ‘honey the tea is poured’?

What to Expect During Speech in Noise Test

Whilst the AB Words Speech Test described above measures a patient’s ability to discern different speech sounds in a perfectly quiet environment, the ‘Speech in Noise Test’ is designed to measure the brains’ ability to filter and interpret speech from background noise. The very nature of the test makes it more challenging.

The Speech in Noise test is typically performed after the AB Word test, whilst the patient is still wearing the headphones in the sound-treated room or booth. The test comprises of 6 recorded sentences, spoken by a woman, with background speech-babble playing. The test is presented to both ears at the same time. You will be asked to repeat each sentence after it is presented to you. Each sentence contains 5 critical words. Each critical word, when repeated correctly, scores 1 point (i.e. repeat all 5 words correctly, you score 5/5).

The difficult part is, that with each sentence played, the background speech babble gets louder until by the last sentence it is of equal volume to the female speaker. It’s a bit like trying to hear the conversation at an increasingly rowdy public bar! As opposed to what you might expect, the lower the score the better your brain is at processing speech in noise and the less difficulty you will have hearing in challenging environments. The higher your score, the poorer your processing ability and the harder it is for you to converse in very noisy places.

Red Flags and Warning Signs

It is important to note that your score on the beep test is not a measure of your brains’ ability to discriminate speech in noise, nor is it an indicator of how well you will perform on the Speech in Noise test. The beep test is a simple measure of how sensitive your hearing is to a simple sound at a specific pitch.

If you are one of the many people who find it particularly difficult to hear in noisy environments and a Speech in Noise test was not performed as part of your assessment, then one questions come to mind: Why not?


Speech tests take time and are therefore not performed by all hearing clinics as a matter of routine.

They do however give the clinician valuable insight into your hearing, cognition, and working memory capacity. They also validate what you may have reported in your case history. Speech tests provide essential information that can help the clinician decide on your appropriate referral pathway. If hearing rehabilitation with hearing aids is indicated, this test will help to determine what features and technology will help you to hear better. Greater sophistication in hearing aid features may be required for clearer speech in noise, so this consideration can influence the cost.

Finally, these two tests enable the clinicians to provide appropriate counselling on realistic hearing expectations and the various communication tactics you can use to hear better in different listening situations.

With the speech tests complete, you and your clinician are ready to put all the pieces together. A simple common-sense summary is next, bringing you into the clinicians thinking and building on your earlier conversation about goals.

It’s time to discuss the results and agree upon a plan for hearing rehabilitation.