[hearing health assessment] the wonderful use of Lin’s six tones

This article is written by Duan Jirong

Today’s high technology makes many people think that an evaluation device should be invented that can meet almost all the needs of audio evaluation. However, in the process of continuous efforts to develop and research the most powerful evaluation tool, it is easy to miss some simple and practical evaluation procedures which have been proved by experiments. Lin’s six tone test is one of them.

I. The Origin of Lin’s six notes

The concept of six tone test proposed by Daniel Ling is based on the selection of common speech to represent the speech spectrum between 250-8000 Hz. This spectrum range is the same as that of traditional audiometry. The difference is that Ling uses a separate phoneme to represent low, medium and high frequency sounds. Lin’s six tone phonemes include / M /, / U /, / A /, / I /, / SH /, and / S /. There are many specific methods to evaluate the auditory function. Before understanding the specific methods, it is necessary to briefly review the auditory skills.

There are four levels related to sound in auditory skills: perception, discrimination, recognition and understanding.

1. Perception is the most basic auditory skill. To judge the existence or non existence of sound, the simplest way to describe perception is tone test, so that the subjects can respond when they hear the sound. The forms of response can be varied – the response of infants may be to turn their head to the direction of sound transmission, and the response of preschool children may be a game behavior (for example, to hear the sound Just throw a piece of wood into the bucket), and adults are likely to raise their hands or answer “yes” after hearing the sound;

2. Discrimination is the ability to distinguish whether two sounds are the same. The test objective is to investigate the minimum difference between the two sounds that the listener can hear. To distinguish the two sounds, the listener must first be able to detect them, so it is higher than the detection level;

3. Confirmation ability refers to the ability to mark or indicate the sound heard. It requires the listener to be able to detect, identify and uniquely identify (repeat) it. It is a higher ability than detection and identification;

4. Understanding is the most complex auditory skill, because it requires the listener to be able to detect, identify, confirm and understand the meaning of voice or speech. Understanding is the highest of the four levels, which connects auditory perception with speech cognition. Lin’s six notes can effectively test detection, discrimination and confirmation skills, but it can’t test understanding skills.

II. Advantages of Lin’s six notes

It has many advantages, one of which is that it can be used by anyone, including audiologists, speech pathologists, teachers, matchmakers and parents. Lin’s six notes can truly reflect the actual situation of speech and listening. It can be used with hearing aids, cochlear implants or without sound amplification. As a test method without high technology, it can easily and quickly evaluate the basic communication ability of adults and children.

3. The application of Lin’s six tones

Lin’s six tones cover the low to high frequencies in the speech spectrum, which are / M /, / U /, / A /, / I /, / SH /, and / S /. Lin’s six tones help to test children’s hearing and check whether they can hear all the necessary frequency spectrum for learning a language. Audiologists can prepare some cards of Lin’s six tones, make each tone during training, and observe whether children hear it or not. “Little children” may raise their heads when they hear the sound. The older children can be taught to put down the objects that were originally held in their ears to show that they heard the sound. In the end, children can learn to imitate your actions.

Here’s a point to remember to make sure that children don’t see you when you make a sound – a way to make sure that children hear you, not lip reading. During this test, the tester will sit next to or behind the child.

Now, you can start testing right away. In addition, try to change the distance with children, such as 0.5m, 1M, 2M and 3M.

Consult your child’s audiologist immediately if any of the following occurs:

• children no longer respond to sounds they could hear before;

• children’s pronunciation of a sound is different from before;

• children no longer respond to sounds heard at different distances.

Although it may take a lot of time and energy for children to learn to make these sounds, parents must insist on encouraging children to imitate them.

The ability of discrimination can also be evaluated by Ling’s six tone test. The tester can listen to two test sounds for the hearing impaired, and then ask them to identify whether the two sounds are the same. When the subject’s hearing skill is still in the primary stage, two very different sounds should be used, such as / A / and / S /. If the subject has certain discrimination skills, two relatively similar sounds can be used, such as / SH / and / S /. In addition, if the patient wears a hearing aid with frequency shift on, the two tones can be used to test the effect of the patient on the high frequency, so as to achieve the effect of both hearing and discrimination.

Lin’s six tone test has another use, which is related to signal-to-noise ratio. Lin’s six tone test uses a normal volume of conversation sound, and the appropriate listening distance is about 1 to 1.5 meters. Then, keep the sound intensity, and gradually increase the distance between the speaker and the listener. Compared with the background noise intensity, the main sound signal will gradually weaken, which helps to enhance the long-distance hearing skills.

Ling’s six tone test can also be used for the early diagnosis of some middle ear diseases. For example, a 4-year-old boy with moderate to severe sensorineural hearing loss has been wearing a hearing aid for about 2 years. At the beginning of speech ability training, the audiologist checked his hearing aid and tested his functional hearing skills with Ling’s six tones. As a result, the boy was able to repeat all six sounds in the first test confirmation. One day the teacher found that he could not repeat some of the sounds, and immediately realized what was wrong. After confirming that his hearing aid was still working normally, the teacher suggested that his parents take him to the hospital for further examination. Sure enough, the otolaryngologist found that his middle ear was infected. Similar observation methods can be used to determine and solve the problems of new ear models, new hearing aids, reprogrammed hearing aids, waste batteries and cochlear implants.

Sum up

Many clinicians are familiar with Lin’s six tone test. The technology involved in Lin’s six tone test is very simple, easy to learn and master, and has a wide range of clinical applications. But this kind of test is often only used for simple detection purposes. In fact, Lin’s six tones can not only provide fast and convenient verification of auditory ability, realize the continuity and preparation of additional auditory skill development training, provide reference for setting auditory training objectives, but also provide warning signals in time for hearing, hearing loss and problems in auditory amplification system.