Beyond the audiogram: tone decay as audiological marker for disproportional loss of speech intelligibility

OBJECTIVES: A considerable portion of hearing-impaired patients show disproportional loss in speech intelligibility with respect to their pure tone audiogram. This study investigated the relationship between tone decay (TD) and unaided or aided word recognition scores (WRS).

Audiologists should consider adding tone decay testing to their battery for patients whose speech intelligibility is disproportionately poor relative to their pure-tone audiogram, as it may reveal retrocochlear or neural contributions not captured by threshold alone.

If tone decay reliably predicts disproportionate speech intelligibility loss, it could improve the diagnostic precision of audiological evaluations and guide more targeted rehabilitation strategies.

1. 01Tone decay testing may identify hearing-impaired patients whose speech understanding is worse than their audiogram predicts.
2. 02The study positions tone decay as a marker for retrocochlear or auditory neural processing difficulties.
3. 03Pure-tone audiograms alone can miss clinically significant speech comprehension deficits.
4. 04Findings suggest tone decay could complement audiogram-based diagnostics in complex cases.
5. 05Further validation is needed across diverse hearing loss populations.

PMID

42077071

DOI

10.1080/14992027.2026.2661713.

Journal

International Journal of Audiology

Publication type

research_article

Evidence level

4

Population

Hearing-impaired patients with disproportionate speech intelligibility loss

Intervention

Tone decay testing as an audiological diagnostic marker

Comparator

Pure-tone audiogram findings