1. Readability
Formula HH FRY FORCAST FRE FOG
Flesch-
Kincaid Total
QuickSIN 3 1 1 1 2 1 9
HINT 2 2 2 2 1 2 11
LISN 1 3 3 3 3 3 16
Readability
Formula HH FRY FORCAST FRE FOG
Flesch-
Kincaid
HH
FRY
FORCAST
FRE
FOG
Flesch-Kincaid
Readability of the QuickSIN, HINT and LISN was determined using each formula.
Statistical analyses examined:
 Correlation between formulae (Table 1)
 Overall ranking of difficulty among the speech in noise tests (Table 2)
 Intra-test variance using four of the readability formulas (Table 3)
 Overall comparisons by speech in noise test and by formula (Table 4)
1. Hearing Aid Instruction Guide 2. Readability Analysis of a Speech in Noise Test
• Patients with hearing loss wear hearing aids less often than they should due, in part, to the
fact that they do not know how to use them
• Information given at the hearing aid fitting appointment is largely forgotten soon after
• One solution may be to distribute the instruction guide provided by the hearing aid company
 These contain an abundance of information that is unnecessary for a patients’ specific
hearing aid and situation
 Have a literacy level that does not match that of of the intended audience
•End result is often even more confusion from the patient’s perspective
Create a Hearing Aid Instruction Guide (HAIG) containing basic hearing aid handling skills
that is written at the correct literacy level and personalized according to the patient’s hearing
aid type.
• Using Microsoft Access, a template was created for a HAIG, allowing the audiologist to
enter the patient’s name, audiologist, fit date, hearing aid, and program settings
• Becomes populated with pictures of the selected hearing aid and the appropriate
corresponding information with the push of a button
• HAIG contains clear, simple photos of the most commonly used hearing aids in the area
• Speech in noise testing assesses word recognition in the presence of background
noise, yielding a signal to noise ratio (SNR) threshold
• Examples:
 QuickSIN: A 4-talker babble background noise that steadily decreases in
SNR
 HINT: Consists of simpler sentences and a broadband masker noise that
adaptively changes in SNR
 LISN: Four conditions that vary in talker voice and location
• Each test consists of multiple stimulus lists
• Equivalency among lists is imperative, so that any measured variance can be
attributed to the condition that is being tested, and not a confounding variable
• Studies have demonstrated intra-test variability on the QuickSIN and HINT,
however the effect that sentence readability has on outcome has not been examined
• How do you accurately measure a single sentence’s readability?
• Is there a correlation between the outcome of a QuickSIN list and its readability?
(Only the QuickSIN has outcome data for all of its lists)
• Are the various readability formulae correlated with one another?
• How do the Speech in Noise tests compare to one another in terms of readability?
Improving Rehabilitation Procedures for Patients with Hearing Loss
Lily Vitali, Gabrielle Saunders
National Center for Rehabilitative Auditory Research, Portland VA Medical Center
Problem
Approach
Methods
HAIG
Background
Questions
Example Sentences:
QuickSIN: A white silk jacket goes with any shoes.
HINT: (A/the) boy fell from (a/the) window.
LISN: The police heard the report.
• Writing the guide at the correct literacy level was also considered
• The majority of words commonly used in health related instructional brochures are at a
higher literacy level than that of the average patient’s reading level, often leading to improper
self-treatment and inability to follow proper instructions
• HAIG has a Flesch-Kincaid Reading Grade Level of about 4, depending on personalization
for the patient
• Below are some examples of words changed in order to lower the overall literacy level
Remove Take out Perspire Sweat Instruction Sheet Guide
Future Implications
• The HAIG:
 Novel, personalized, and step-by-step instruction guide
 Could cut down on audiologists’ time spent counseling on hearing aid use
 Provides a reference for patients and could promote hearing aid use
• Template created in Microsoft Access facilitates the production of a customized guide that
could be effortlessly integrated into a hearing aid fitting
• HAIG project is part of a larger study that will compare print, DVD and oral hearing aid use
instructions to evaluate if there may be a better hearing aid orientation method than what is
currently used
Results
Table 1: Formulae correlations
Table 4: Overall comparisons by speech in noise test and by readability formula.
Table 2: Speech in noise test ranking
Acknowledgements
This work was supported by Dr. Gabrielle Saunders, the National Center for Rehabilitative Auditory Research at the VA Medical Center and Saturday Academy. Melissa
Frederick, ShienPei Silverman, Michael Moody and Emily Thielman and everyone else at the NCRAR also offered help and support throughout the project.
The Homan Hewitt (HH) is the only formula that measures the readability of a
single sentence.
Formula: 1.76 + (0.15 x WNUM) + (0.69 x WUNF) – (0.51 x WLON)
• WNUM=Avg. # of words per sentence clause, WUNF= # of unfamiliar* words,
WLON= # of words with greater than 6 letters
*An unfamiliar word is any word less than 80% familiar to 4th graders according
to the Living Word Vocabulary by Edgar Dale and Joseph O’Rouke.
Homan Hewitt Readability Formula
Commonly Used Readability Formulae
Almost all readability formulae take vocabulary and syntax into account but use
different formulae. Five of the most common formulae were used in this
analysis, all requiring a sample size of at least 100 words.
3=Most difficult, 1=Least difficult
FORCAST
FOG
HH
FRY
Flesch-Kincaid
Speech in Noise Test
MeanReadability
HINT
LISN
QuickSIN
FORCAST FOG HH FRY Flesch-Kincaid
Readability Formula
MeanReadability
Phonak User Guide
HINT LISN QuickSIN
Error Bars: ± 1 SD
Table 3: Intra-test variance using four of the
readability formulas.
FORCAST
Frequency(%)
HINT
HINT HINT
HINT
LISN
LISNLISN
LISN
QuickSIN
QuickSINQuickSIN
QuickSIN
Frequency(%)
Frequency(%)
Frequency(%)
FOG
Flesch-Kincaid FRE
Discussion
• No readability formula proves to be the gold standard, especially for a single sentence
• HH ranked the readability of the tests in the opposite order of the other formulas
• Average outcome and average readability are not correlated for the Quick SIN test
• Huge variance between formula measurements; the FORCAST produces the highest
mean readability on average
• The LISN test had the highest overall mean readability while the HINT test had the most
variability between lists
• Audiologists should be aware of list variances when administering speech in noise tests;
perhaps the cheap QuickSIN lists are more consistent than the expensive HINT ones
Significantly Correlated at the .01 Level Significantly Correlated at the .05 Level
Formula Variables
FRY* # of syllables and # of sentences
FORCAST* # of monosyllabic words
FRE (Flesch Reading Ease) Avg. sentence length and avg. # of syllables per word
Flesch-Kincaid Calculated in MS Word, converts FRE value to a grade level
FOG (Gunning’s Fog Index) Avg. sentence length and % of words with 3 or more syllables
Methods
*Modified for use with a single sentence
Grade % Familiarity Word Definition Grade % Familiarity Word Definition