HEARING MATTERS 52 The Hearing Journal October 2018 T he Hearing in Noise Test (HINT) was devel- oped at the House Ear Institute to measure speech recognition in quiet and in background noise to assess individual binaural directional hearing, which is critical in the understanding of speech in noise as well as in detecting and identifying sounds within an environment. These processing abilities are im- portant to ensuring the safety of people with hearing- critical and potentially life-threating jobs such as those in law enforcement (police), fire protection, aviation, and armed services. The HINT has been successfully used for over a decade to determine the qualification of job applicants for these positions and predict when their hearing ability may diminish communication perfor- mance. People who use hearing aids and apply for hearing- critical jobs are at a communication disadvantage as changes in the cochlea and auditory system affect both spectral and temporal processing, which in turn affect their ability to hear in background noise. Restoring audibil- ity with hearing aids is only part of the equation as age-related changes or decreases in spatial processing can occur, espe- cially with increased levels of hearing loss. For these reasons, most hearing aid users fail the HINT. In this case study, the patient passed the aided HINT, but this may be because of several factors related to the patient’s individual profile, in addition to having properly fitted and pre- scribed amplification. Clinicians should be aware of the fac- tors that contribute to a patient’s communication success or failure as well as his or her potential to pass the aided HINT and perform well with hearing aids. Some individuals who pass the aided HINT may be given hearing-critical roles with some or no restrictions depending on the job requirements. If the Extended Speech Intelligibility Index (ESII) is applied across a job description, in addition to the Speech Intelligibility Index (SII) measures, other factors such as noise characteristics, distance, and vocal effort become part of the equation. Being able to see the job responsibilities as chang- ing real-world events by measures within the soundscape allows for a more objective view of communication. For example, traffic officers at roadsides can be exposed to noise levels typically between 70 to 105 dBA, with passing trucks producing very loud low-frequency sounds that are considerably different from those encountered by corrections officers in controlled spaces like prison housing and dining areas (typically 65 to 80 dBA; Board of State and Community Corrections, 2013). Passing the aided HINT does not guarantee that restric- tions would not be encountered. An evaluation using the ESII would show that certain situations in both officers’ job de- scriptions could have less than a 50 percent chance of com- munication, even for those who are otologically normal. Recent research by Soli, et al., suggests that “ESII modeling of non- stationary real-world noise environments may prove an objec- tive means of characterizing their impact on the likelihood of effective speech communication” (Ear Hear. 2018 May/ Jun;39(3):436). This sets the standard for those in need of effective communication in critical-hearing jobs as well as the implementation of administrative controls. Combining this methodology with the HINT will help those seeking critical- hearing jobs and their prospective employers have a better understanding of the qualifications of the job and placement. CONDUCTING THE HINT HINT is an adaptive threshold test in which the subject is tasked with identifying and repeating short simple sentences (HINT 6.3 Manual). Scores are based on the reception thresholds for sentences (RTS), which is a 50 percent recog- nition score. Unlike the QuickSIN, testing under headphones Passing the Aided Hearing in Noise Test for Hearing-Critical Jobs By Dennis Colucci, AuD, MA Dr. Colucci is a clinical and forensic audiologist in pri- vate practice in Laguna Hills, CA. iStock/avid_creative