The Ling Thing: How to Administer the Ling Six Sound Test



Author: By Sharon McKarns, Au.D.

The Ling Six Sound Test 1,2 has long been used by both pediatric and cochlear implant audiologists to quickly and accurately determine if a child can hear the sounds of speech necessary to develop spoken language. The test, however, does not have to be limited to use with children. I have found that is can be quite useful when working with adults. It is a helpful tool dispensing audiologists can utilize to quickly assess or fine tune hearing aid fittings, ensure equipment is functioning properly, or to demonstrate to patients the need for amplification.

The phonemes or speech sounds used for the Ling Six Sound Test are /m/, /ah/, /u/(oo), /i/(ee), /sh/ and /s/. The individual phonemes were chosen to represent the spectrum of speech sounds from 250 Hz to 8000 Hz. Figure 1 shows these six sounds in relation to the standard audiogram. Figure 2 outlines the formant frequencies of each of the six Ling sounds. Note that all frequencies between 150 Hz to 6000 Hz are represented, which are typically the frequencies amplified by a hearing aid. Given the important nature of these speech sounds with respect to language comprehension, it is not a coincidence these are the same frequencies we test during a diagnostic hearing evaluation.

Figure 1. Relative levels of the Ling 6 Sounds presented using average conversational speech at a distance of six feet (anagram adapted from Pollack, et. al, 1997).


Figure 2. The approximate formant frequencies of the Ling Sounds.

Adapted from http://successforkidswithhearingloss.com4

To administer the Ling Six Sound Test, stand six feet away from the patient and use an average conversational level of speech. Next, say each sound one at a time and have the patient repeat the sound back to you. Be sure to present the phonemes without visual cues. Instruct the patient to close his eyes, or use an acoustic screen. Covering your mouth with your hand could potentially smear the speech sounds.

Randomize the order each time you give the test so the patient doesn’t respond based on memory. It’s important that you remain consistent with your test protocol. Altering the distance between you and the patient, or altering the loudness of your voice will affect outcomes. A little practice is all you will need to be consistent.

The information you gain from this quick assessment will tell you about the functional hearing of a patient. During a hearing aid evaluation, for example, you can present the test in an unaided condition, note the responses and repeat once you put hearing aids on the patient. This is a very powerful way to demonstrate the need for, and subsequent benefit of amplification. This is especially helpful if the spouse is present and observes the difference in patient responses between the unaided and aided condition.

The test is also useful when fine tuning hearing aids: Quickly present the six sounds to determine if the patient is hearing them. If there are sounds that are not detected, increase the gain in the frequency region of the sounds that were missed. Repeat and adjust until the patient has access to all six sounds, if possible.

As a clinician, I have also found the Ling Six Sound Test to be beneficial in programming hearing aids for patients who may benefit from frequency compression technology. Doing a “behavioral fitting” often yielded better discrimination and identification of certain phonemes than relying on software algorithms alone. To accomplish this, instruct the patient to listen to two sounds being presented and respond with “same or different.” /sh/ and /s/ are good examples of this. Again, randomize the order of presentation (/sh/ /sh/, /sh /s/, etc.). With careful attention to patient response and minor fine tuning adjustments, you could end up with better fittings and happier patients.

The Ling Six Sound Test is a quick way to assess the functional hearing of an individual in either the unaided or aided condition. It is not intended to replace the conventional audiological assessment battery, but it does provide helpful information very quickly, and in a manner that patients and their significant others often very easily understand. For these reasons, audiologists are encouraged to add the Ling Six Sound Test to their clinical tool box and to use as needed.    
Dr. Sharon McKarns is a licensed and certified Audiologist with 25 years of experience. She joined Audiology Management Group in 2014 as a business advisor. Sharon has worked in a variety of hearing health care settings including ENT practices, hospitals, private practice, school districts and nonprofit organizations. Her experience as both a clinician and executive director of an organization dedicated to helping children and adults with hearing loss has enhanced her ability to develop and convey clinical, financial, and operational strategy. Sharon’s diverse background in hearing health care, business, and academics contributes to her unique perspective in medical practice development, growth strategies and patient centered care. In her free time, Sharon enjoys spending time with her family, cooking, traveling and exploring the outdoors. She can be contacted at smckarns@audiologymg.com.
References
1 Ling, D. (1976). Speech and the hearing impaired child: Theory and Practice. Washington, DC: Alexander Graham Bell Association for the Deaf.

2 Ling, D. (1989). Foundations of spoken language for the hearing impaired child. Washington DC: Alexander Graham Bell Association for the Deaf.

3 Pollack, D , et al (1997). Educational Audiology for The Limited-Hearing Infant and Preschooler . Springfield : Charles C. Thomas.

4 DF Smiley, P. M. (2004). Using the Six Sound Test Every Day. Retrieved from Audiology Online: audiologyonline.com