Patient guide · Audiology
Speech audiometry, tests how well you hear speech, not just tones.
Speech audiometry measures how well you understand speech at different volumes — complementing the pure tone audiogram. Foundation for hearing-aid fitting, cochlear implant candidacy and retrocochlear pathology screening.
Key facts
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Definition
Diagnostic speech-recognition test
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Duration
15–20 minute test
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Complements
Pure tone audiometry
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Threshold
Speech recognition threshold (SRT)
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Score
Word recognition score (WRS)
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Guides
Hearing-aid + implant candidacy
How it’s done
From consultation to a structured plan — what happens, in order.
Speech audiometry runs alongside pure tone testing in a sound-treated booth — painless, quick and non-invasive.
- 01
Audiology consultation
History, symptom review and communication needs assessed by a registered audiologist.
- 02
Otoscopy
Ear canal and tympanic membrane examined to exclude wax or middle-ear pathology.
- 03
Pure tone audiometry (baseline)
Air- and bone-conduction thresholds establish the audiogram foundation.
- 04
Speech recognition threshold
Lowest level at which spondee words are correctly repeated 50% of the time.
- 05
Word recognition score at 40 dB SL
Percentage of monosyllabic words correctly identified above threshold.
- 06
Interpretation vs PTA
Speech scores compared with the audiogram to detect retrocochlear patterns.
- 07
Structured plan
Findings translated into a hearing-aid, implant or onward-referral pathway.
What it shows
What speech audiometry reveals about your hearing.
Beyond the audiogram: the tests speak to clarity, retrocochlear risk and how you’ll do in the real world.
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Speech recognition threshold (SRT)
Anchors the audiogram — cross-checks pure tone thresholds for reliability.
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Word recognition score (WRS)
How clearly speech is understood at a comfortable listening level.
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Retrocochlear pattern (poor WRS vs PTA)
Disproportionately poor word scores flag possible eighth-nerve pathology.
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Rollover phenomenon
A fall in WRS at high intensity — a classic retrocochlear indicator.
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Central auditory processing disorder
Difficulty processing speech despite normal peripheral hearing.
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Non-organic hearing loss
Inconsistency between SRT and pure tone thresholds raises suspicion.
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Hearing-aid candidacy
Guides amplification prescription and realistic outcome counselling.
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Red flag: WRS < 50% + asymmetric SNHL — urgent MRI IAM
Requires urgent imaging of the internal auditory meatus to exclude vestibular schwannoma.
Treatment options
What the results lead to.
The pathway from a speech-audiometry finding to a plan you can act on — audiological, surgical or multi-disciplinary.
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Hearing-aid fitting
Prescription amplification calibrated to your audiogram and speech scores.
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Cochlear implant candidacy
Formal assessment when hearing aids no longer provide useful speech understanding.
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Bone-anchored hearing aid
Option for conductive, mixed or single-sided deafness where aids underperform.
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Assistive listening devices
Remote microphones, loop systems and streaming for challenging environments.
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Auditory training
Structured listening practice to improve speech-in-noise performance.
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ENT / neuro-otology referral
For asymmetric loss, rollover or suspected retrocochlear pathology.
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Structured audiology follow-up
Scheduled reviews to track thresholds, adjust fitting and refine outcomes.
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Multi-disciplinary team review
Combined audiology, ENT and rehabilitation input for complex cases.
Red flags
When speech audiometry is more urgent.
Patterns and presentations that push a speech-audiometry work-up up the priority list, or that need imaging and specialist review.
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WRS < 50% with asymmetric SNHL
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Rollover phenomenon
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Suspected vestibular schwannoma
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Post-acoustic trauma
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Central auditory processing disorder
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Non-organic hearing loss
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Post-COVID hearing change
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Post-radiotherapy hearing loss
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Ototoxic drug exposure
Frequently asked
Everything patients ask about speech audiometry.
Quick answers on what SRT and WRS mean, how the test differs from the audiogram, and when the rollover phenomenon prompts urgent imaging.
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What is speech audiometry?
A diagnostic hearing test that measures how well you understand speech — not just tones. It complements pure tone audiometry and is central to hearing-aid prescription and cochlear implant assessment.
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How is it different from a pure tone audiogram?
The pure tone audiogram measures the quietest tones you can detect at each frequency. Speech audiometry measures whether you can actually understand words — a functional, real-world measure.
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What is the speech recognition threshold (SRT)?
The lowest intensity, in decibels, at which you correctly repeat familiar two-syllable (spondee) words 50% of the time. It cross-checks the pure tone thresholds and anchors the audiogram.
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What is the word recognition score (WRS)?
The percentage of monosyllabic words you correctly repeat when they are presented at a comfortable listening level — usually 40 dB above your SRT. It reflects clarity, not just audibility.
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What is rollover, and why does it matter?
Rollover is a fall in WRS as speech is made louder — the opposite of the expected pattern. It is a classic sign of retrocochlear pathology such as a vestibular schwannoma and typically prompts an urgent MRI of the internal auditory meatus.
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When is an urgent MRI IAM needed?
When WRS is disproportionately poor (often < 50%) relative to the audiogram, or where hearing loss is asymmetric — the pattern raises concern for a vestibular schwannoma and warrants urgent imaging.
Sources
Reviewed against the primary literature.
Next clinical review scheduled 2027-07-30.
Related tests
Looking for a different test?
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Pure tone audiometry
The baseline audiogram — thresholds by frequency.
Learn more -
Speech in noise tests
How well you hear speech when background noise is present.
Learn more -
Private audiology assessment
A full concierge audiology work-up in a London clinic.
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All tests
Browse every test and procedure we arrange.
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In practice, in London
What speech audiometry looks like on the ground in London
With speech audiometry, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Waiting lists on the NHS for speech audiometry vary widely by borough and by how the GP letter reads. Privately in London, we can normally offer a slot inside the same week, sometimes within 48 hours if there’s a cancellation. The difference isn’t clinical quality — the consultants are frequently the same faces you’d see on the NHS — it’s the calendar.
In practice, a private speech audiometry appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For speech audiometry specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
The value of going through a concierge for speech audiometry isn’t access — anyone with an insurer or a credit card can get a private appointment in London. The value is knowing which consultant reads this particular presentation best, which unit turns reports around fastest, and which pathway won’t hit a dead end if the findings point somewhere unexpected.
Nearby in the library