Examination of the Words-in-Noise Test Signal-to-Noise Ratio Thresholds From the National Institutes of Health Toolbox for Children and Adults

Purpose: The purpose of this study was to establish and evaluate normative values for the Words-in-Noise (WIN) test from the National Institutes of Health (NIH) Toolbox for children and adults. Method: NIH Toolbox conducted a large national standardization study of the WIN test, in both English and Spanish languages, in 2011 to allow for normative comparisons in a nationally representative sample of children and adults, ages 3–85 years. Clinical and university centers at 10 sites around the United States participated. WIN thresholds were available for either ear from 323 English-speaking adults, 18- to 85-year-olds, as well as from 813 English-speaking children 3- to 17-year-olds. Smaller samples of English-speaking adults and children were tested a second time to determine the test–retest reliability of the measurements. Results: The main dependent measure was the signal-to-noise ratio (SNR) in decibels from the WIN test. Age was the primary variable affecting the WIN SNR, with a curvilinear function observed across the age range of 3–85 years, worse (highest) SNRs at the age extremes. WIN SNRs from the NIH Toolbox generally agreed with those from other data sets in the literature. Analyses of covariance controlling for pure-tone hearing loss found that gender and race/ethnicity had significant, but generally small (≤ 1 dB), effects on WIN SNRs, but age had a stronger effect, with SNRs for 70- to 85-year-olds being 2–3 dB worse compared to all younger age groups. The WIN SNRs for English-speaking adults were reliable with test–retest correlations of .83–.90 for each ear. Conclusion: For English-speaking adults, the WIN SNRs from the NIH Toolbox were found to be valid and reliable. Supplemental Material: https://doi.org/10.23641/asha.32774991