Hearing in Noise Test (HINT)

What is the HINT test? The Hearing in Noise Test (HINT) measures a person’s ability to hear speech in quiet and in noise. During the test, the patient uses both ears together (binaural hearing) to repeat sentences. Binaural hearing ability is essential for communication in noisy settings and for other aspects of functional hearing, such as sound localization and recognition of environmental sounds. In this test, the patient is required to repeat sentences both in a quiet environment and with competing noise being presented from different directions. Who takes this test? This test is primarily used for three populations. The first group is those patients with normal hearing or a very mild hearing loss who report persistent difficulty understanding conversation amid background noise. This test provides some objective measure of how much difficulty an individual is having compared to persons that have normal hearing in quiet and in noise. The second group is peace officers who have hearing impairment.

Audiology Services ABR and Stacked ABR (Audiology Brainstem Response) Adult Acoustic Immittance ASSR Audiogram Electrocochleography ENG Instructions HINT Otoacoustic Emissions Pediatric Hearing Test Pediatric Acoustic Immittance Posturography

They are required by the California Peace Officer Standards training (POST) guidelines* to have the HINT test because even minor degrees of hearing impairment can make it increasingly difficult for an officer to effectively carry out his/her duties. The third group is our hearing aid users who wish to assess how different types of hearing aids benefit them in noisy situations.

What is involved in taking this test?

The HINT battery consists of four test conditions. For each test, speech is located directly in front of the subject at 0° azimuth, and all sound sources are one meter from the center of the subject’s head. For each of the four conditions, the subject is required to listen to a sentence and repeat it. The four test conditions are: (1) sentences with no competing noise, (2) sentences with competing noise presented directly in front of the patient, (3) noise presented at 90° to the right of the patient, and (4) noise presented at 90° to the left of the patient. In all conditions, the competing noise is presented at a steady loudness of 65dB(A). The loudness of the sentences presented is varied throughout the test, depending on whether the patient repeats it correctly or not.

How is the HINT test scored?

The tester scores each sentence repeated as either correct or incorrect. All words in the sentence must be repeated correctly. At the end of the test, a signal-to-noise ratio (SNR) is generated for each test condition. A signal-to-noise ratio equals how loud the sentences needed to be turned up above the noise floor so that the patient could repeat them correctly 50% of the time. For example, an SNR of 5dB indicates that the sentences had to be presented at 70dB (or 5dB above the 65dB noise floor) in order to be repeated correctly 50% of the time. The higher the SNR, the more difficulty the patient has hearing in noise. The HINT test is scored as a “pass” or “fail” in each condition and the cut-off criteria are based on the scores from a group of more than 50 subjects with normal hearing. These scores were provided bu House Ear Institute who developed the HINT test.

HINT test results show three things:

1. Subject’s signal to noise ratio threshold (e.g. 5dB)
   
2. Subject’s threshold as a percentile in reference to the normal distribution of the data (e.g. 95th %ile)
   
3. Subject’s maximum percent change in intelligibility. This is the predicted maximum difference in intelligibility in reference to the mean normal performance (e.g. the subject’s predicted intelligibility is 23% poorer than normal hearing intelligibility)

Click here for an example of HINT results.

After the HINT test is complete the results are discussed with the patient. The patient will then follow up with the referring physician or the referring law enforcement agency. For referring agencies, a cover letter will be sent with the HINT results to both the patient and the agency within one week.

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