LiCoS: A new linguistically controlled sentences test to assess functional hearing performance

Purpose: To overcome the potential tension between clinical and ecological validity in speech audiometric assessment by creating a new set of sentence materials with high linguistic validity for the Dutch-speaking area. Methods: A linguistic "fingerprint" of modern spoken Dutch and Flemish served to generate a set of sentences recorded from 1 male and 1 female talker. The sentences were presented to 30 normal-hearing listeners in stationary speech noise at a signal-to-noise ratio (SNR) of -5 dB sound pressure level (SPL). A list design criterion was used to achieve perceptive homogeneity across the test lists, by scrambling lists of sentences of different syntactic types while controlling for linguistic complexity. The original set of test materials was narrowed down to 360 sentences, and list equivalency was evaluated at the audiological and linguistic levels. A psychometric curve was generated with a resolution of 2 dB based on a second group of 60 young normal-hearing native speakers of Dutch and Flemish. Results: Sentence understanding showed an average repetition accuracy of 63.40% (SD 1.01) across the lists at an SNR of -5 dB SPL. No significant differences were found between the lists at the level of the individual listener. At the linguistic level, the sentence lists showed an equal distribution of phonological, morphological, and syntactic features. Conclusion: LiCoS combines the clinical benefit of acoustic control at the list level with the high ecological validity of linguistically representative test items. The new speech audiometric test is particularly appropriate to assess sentence understanding in individuals who would otherwise exhibit near-ceiling performance when tested with linguistically more simplified test stimuli. In combination with pure tone audiometric assessment, LiCoS provides valuable complementary information with respect to the functional hearing of patients.