zaud000070 10.3205/zaud000070 urn:nbn:de:0183-zaud0000704 Short Report Berechnung des prozentualen Hörverlusts aus Sprachaudiogrammen in Deutsch, Französisch und Italienisch Kompis Kompis Martin M Prof. Dr. Dr.

ENT-Department, Inselspital, Rosenbühlgasse 10, University of Bern, 3010 Bern, SwitzerlandUniversitäts-HNO-Klinik, Inselspital, University of Bern, Switzerland

martin.kompis@insel.ch author Candreia Candreia Claudia C

Klinik für HNO-Heilkunde, Luzerner Kantonsspital, Lucerne, Switzerland

author Cao Van Cao Van Hélène H

Service d’ORL et de Chirurgie Cervico-faciale, University Hospital of Geneva, Switzerland

author Veraguth Veraguth Dorothe D

ORL-Klinik, University Hospital of Zurich, Switzerland

author Maire Maire Raphaël R

Service d’ORL et Chirurgie cervico-faciale, CHUV, Lausanne, Switzerland

author German Medical Science GMS Publishing House

Düsseldorf

610 speech audiometry Freiburg monosyllabic words languages Sprachaudiometrie Freiburger Einsilbertest Sprachen 20250822 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). 2628-9083 7 GMS Zeitschrift für Audiologie - Audiological Acoustics GMS Z Audiol (Audiol Acoust) 07 Die Sprachaudiometrie in Ruhe wird in Abhängigkeit von der Mutt</PlainText></TextGroup>erspr<TextGroup><PlainText>a</PlainText></TextGroup>che der Patienten in der Schweiz in deutscher, franz&#246;sischer oder italienischer Sprache durchgef&#252;hrt. F&#252;r versicherungstechnische Fragen kann aus dem Sprachaudiogramm ein prozentualer H&#246;rverlust aus dem Wortverstehen bei 3 vorgegebenen Pegeln berechnet werden. F&#252;r die drei Sprachen werden unterschiedliche Pegel verwendet. Ziel dieser Studie war es zu &#252;berpr&#252;fen, ob die heute benutzten Pegel in den drei Sprachen zu vergleichbaren Resultaten f&#252;hren.</Pgraph><Pgraph>Die Reintonaudiogramme und die Sprachaudiogrammen von 73 Patienten mit deutschen Sprachtests, 50 Patienten mit franz&#246;sischen Sprachtests und 121 Patienten mit italienischen Sprachtests wurden analysiert. Der prozentuale H&#246;rverlust aus dem Sprachaudiogramm wurde jeweils mit dem prozentualen H&#246;rverlust aus dem Reintonaudiogramm gem&#228;&#223; der international gebr&#228;uchlichen CPT-AMA Tabelle verglichen.</Pgraph><Pgraph>Es zeigte sich, dass der deutsche und der italienische Sprachtest gut miteinander &#252;bereinstimmen, der franz&#246;sische Sprachtest hingegen um knapp 10 dB lauter angeboten werden m&#252;sste, um vergleichbare Werte zu ergeben. </Pgraph></Abstract> <Abstract language="en" linked="yes"><Pgraph>In Switzerland, speech audiometry in quiet is conducted in German, French, or Italian, depending on the patient&#8217;s native language. For insurance purposes, a percentage hearing loss is calculated from the speech audiogram based on word recognition scores at three predefined intensity levels, which differ between the three languages. This study aimed to evaluate whether the current intensity levels yield comparable results across all three languages.</Pgraph><Pgraph>We analyzed pure-tone and speech audiograms from 73 patients tested in German, 50 in French, and 121 in Italian. The percentage hearing loss derived from the speech audiogram was compared to that obtained from the pure-tone audiogram, using the internationally used CPT-AMA table.</Pgraph><Pgraph>Our findings indicate that the German and the Italian language tests produce comparable results, whereas the French test requires presentation at nearly 10 dB higher intensity levels to achieve comparable results.</Pgraph></Abstract> <TextBlock name="1 Introduction" linked="yes"> <MainHeadline>1 Introduction</MainHeadline><Pgraph>In order to measure speech comprehension in quiet, in Switzerland, speech tests in German, French, and Italian are used <TextLink reference="1"></TextLink>. The test language should correspond to the language best understood by the patient.</Pgraph><Pgraph>From the measurements, a percentage hearing loss, the so-called &#8220;social index&#8221;, can be calculated as follows: 100&#37; minus the averaged speech intelligibility at three specified levels spaced 15 dB apart. Due to differences between the language tests, the three levels have been defined separately for each of the three languages, as shown in Table 1 <ImgLink imgNo="1" imgType="table" />. </Pgraph><Pgraph>The percentage hearing loss is relevant as it determines whether or not an insurance will cover the cost of hearing aids <TextLink reference="1"></TextLink>. It is therefore important that the measurements are comparable in all three languages.</Pgraph><Pgraph>Our aim was to assess the comparability of the above levels and to suggest improvements, if necessary.</Pgraph></TextBlock> <TextBlock name="2 Materials and methods" linked="yes"> <MainHeadline>2 Materials and methods</MainHeadline><SubHeadline>2.1 Data used and ethics</SubHeadline><Pgraph>Data from three different clinics in three different languages were available for the analysis. These included data from 50 patients at the Geneva University Hospital (French), 121 patients at the Lucerne Cantonal Hospital (Italian), and 73 patients at the Inselspital (German). Their mean age was 54.6 years (range 18&#8211;97), 83 were female, 161 male.</Pgraph><Pgraph>All patients gave their written consent for the use of their data for scientific purposes in anonymized form on a form approved by the local ethics committee.</Pgraph><Pgraph>For all patients, the hearing loss according to CPT-AMA <TextLink reference="2"></TextLink> as well as speech understanding at the 3 levels required for calculating the social index according to <TextGroup><PlainText>Table 1 </PlainText></TextGroup><ImgLink imgNo="1" imgType="table" /><TextGroup><PlainText> were available for both ears separately.</PlainText></TextGroup></Pgraph><Pgraph>The three study groups differ in their size and average hearing loss, which may limit the generalization of the results, as discussed later in section 4.</Pgraph><Pgraph>We hypothesize that one potential reason for the higher average hearing loss observed in the Italian-speaking study group may be the limited availability of specialized tertiary centers in the Italian-speaking part of Switzerland. As a result, individuals from this region must travel to the German- or French-speaking parts of the country to access such care, which may lead them to postpone visits, possibly more so, if they perceive their own hearing loss as mild.</Pgraph><SubHeadline>2.2 Analysis of the current situation</SubHeadline><Pgraph>All three speech tests are calibrated uniformly across Switzerland. Calibration is based on the maximum peak level of each test word, measured using the &#8216;impulse&#8217; time constant and averaged over the test lists <TextLink reference="3"></TextLink>. Each center is required to undergo annual verification and certification of these levels by the Swiss Federal Institute of Metrology.</Pgraph><Pgraph>To analyse the current situation regarding the three language tests, hearing loss according to the social index was plotted against the hearing loss according to the CPT-AMA table, and the linear correlation between the two was calculated for each language separately. This allows the language-independent hearing loss according to the CPT-AMA to serve as a comparison.</Pgraph><SubHeadline>2.3 Extrapolation</SubHeadline><Pgraph>In order to be able to propose new presentation levels that might make the social index more comparable across languages, additional calculations were performed. Ideally, measurements at other levels would be available for this purpose. Since this was not the case, a different approach was chosen. Assuming that only relatively minor shifts in the presentation levels would be necessary, the hypothetical measurement data were estimated from the actual available data, as shown in Figure 1 <ImgLink imgNo="1" imgType="figure" />.</Pgraph><Pgraph>If the required hypothetical measurements were between two existing measured values, they were linearly i<TextGroup><PlainText>n</PlainText></TextGroup>terpo<TextGroup><PlainText>lat</PlainText></TextGroup>ed. If they were outside the measurement range (in the example in Figure 1 <ImgLink imgNo="1" imgType="figure" />, the point on the far right), they were extrapolated. Extrapolated values were limited to the range between 0 and 100&#37;.</Pgraph><Pgraph>The tests in German served as a base and the presentation levels in the other two languages were adjusted.</Pgraph></TextBlock> <TextBlock name="3 Results" linked="yes"> <MainHeadline>3 Results</MainHeadline><SubHeadline>3.1 Comparison of the data used</SubHeadline><Pgraph>Table 2 <ImgLink imgNo="2" imgType="table" /> shows an overview of the raw data used.</Pgraph><Pgraph>The average hearing loss according to CPT-AMA is roughly comparable for German and French, but is considerably higher for Italian-speaking patients.</Pgraph><Pgraph>Figure 2 <ImgLink imgNo="2" imgType="figure" /> shows the distribution of hearing loss according to CPT-AMA for the three languages separately. It again shows that severe hearing loss is more common in the Italian-speaking population than in the other two groups.</Pgraph><SubHeadline>3.2 Current state</SubHeadline><Pgraph>Figure 2 <ImgLink imgNo="2" imgType="figure" /> shows the relationship between hearing losses according to the CPT-AMA table and the social index when the measurement levels used today are applied.</Pgraph><Pgraph>As expected, the hearing loss according to the social index increases in all languages approximately proportionally to the hearing loss according to the CPT-AMA table. However, the variance is considerable. The linear regression lines are close for German and Italian, but further apart for French. When tested in French, for the same hearing loss in the audiogram, the hearing loss according to the social index is on average about 10&#37; higher. For the Italian language tests, the mean difference is only about 1&#37;.</Pgraph><SubHeadline>3.3 Extrapolation to align the social index in the three languages</SubHeadline><Pgraph>The extrapolation shown in Figure 1 <ImgLink imgNo="1" imgType="figure" /> was used to test the best possible alignment of the three speech tests. <TextGroup><PlainText>Figure 3 </PlainText></TextGroup><ImgLink imgNo="3" imgType="figure" /> shows the best possible alignment of the data when level shifts in steps of 5 dB were allowed. Table 3 <ImgLink imgNo="3" imgType="table" /> summarizes the resulting differences.</Pgraph><Pgraph>It turns out that the apparently more difficult French language test would have to be conducted at significantly higher presentation levels (&#43;10 dB) than today to become comparable with the other two languages.</Pgraph><Pgraph>A step size of 5 dB was chosen, as it is frequently used in practice in speech audiometry. If a smaller step size of 1 dB is allowed, a slightly better agreement can be achieved with a correction of &#43;9 dB (instead of &#43;10 dB) for the French language test and &#8211;1 dB (instead of 0 dB) for the Italian test. However, the improvement is small. The mean difference between the social index and the CPT-AMA is then 0.12&#37; for French and &#43;0.44&#37; for Italian.</Pgraph></TextBlock> <TextBlock name="4 Discussion and conclusions" linked="yes"> <MainHeadline>4 Discussion and conclusions</MainHeadline><SubHeadline>4.1 Limitations</SubHeadline><Pgraph>The study has several limitations. The data were collected at three different centers. If there are systematic differences between the centers, such as slightly different patient instructions, this could result in a systematic error. In addition, the values in the second part of the study were inter- and extrapolated rather than actually measured, which could result in deviations that might not fully reflect reality.</Pgraph><Pgraph>The three study groups differ in their size. In principle, this can lead to different degrees of statistically stability of the derived parameters. In this preliminary study, we decided to use all the data readily available at the time but is clear that further studies are needed for confirmation, also to address the issue of the higher average hearing loss of the Italian speaking group.</Pgraph><Pgraph>We are using the CPT-AMA-table <TextLink reference="2"></TextLink> to calculate percentage hearing loss from the pure tone audiogram thresholds. While this makes sense in the current context (this method is used throughout Switzerland and in many other countries), there are different methods of calculations, such as the four-frequency table by R&#246;ser <TextLink reference="4"></TextLink>, which is widely used in Germany.</Pgraph><Pgraph>Figure 4 <ImgLink imgNo="4" imgType="figure" /> shows a comparison of the percentage hearing loss values for the German speaking group, where this methodical choice may be most relevant. It can be seen, that the two methods lead to similar, but not to identical estimates of the percentage hearing loss from the same data. Generally, the percentage hearing loss is higher when calculated according to the methods of R&#246;ser (mean difference &#43;4.1&#37;, range &#8211;5.8&#37; to &#43;13.7&#37;). Differences tend to be larger around the 20 to 40&#37; hearing loss range. </Pgraph><Pgraph>For an ideal data set, i.e. if all 3 study groups contained subjects with exactly the same pure tone threshold, the choice of the method of calculation would not have any impact at all. Individual data points in Figure 2 <ImgLink imgNo="2" imgType="figure" /> and <TextGroup><PlainText>Figure 3 </PlainText></TextGroup><ImgLink imgNo="3" imgType="figure" /> would shift slightly to the left or to the right, but by the exact same amount for all 3 languages. In a real-world data set such as ours, differences must be expe<TextGroup><PlainText>c</PlainText></TextGroup>ted. However, we would not expect a systematic bias between languages, if the same method of calculation is used for all data points.</Pgraph><SubHeadline>4.2 A tentative explanation for the higher levels in French</SubHeadline><Pgraph>It was not a primary aim of this study to investigate why differences between the test in the different languages occur. There is a number of possible reasons, such as e.g. the selection of words for a given test or how fast or how clearly they are spoken. However, we find hints in the literature and in our study, which suggest another intriguing reason, why higher levels should be used specifically in the French test.</Pgraph><Pgraph>We hypothesize that French as a language might be slightly more difficult to understand even for native speakers than e.g. German for German native speakers. We can find this tendency also in other test for speech understanding, such as the French matrix test, with a speech reception threshold of (&#8211;6.0&#177;0.6) dB <TextLink reference="5"></TextLink>, whereas a similar test in German requires by lower speech reception threshold of (&#8211;7.1&#177;1.1) dB <TextLink reference="6"></TextLink>. Please note however, that this explanation is currently very much hypothetical.</Pgraph><SubHeadline>4.3 Conclusions and recommendations</SubHeadline><Pgraph>Based on the above analysis, the following levels listed in Table 4 <ImgLink imgNo="4" imgType="table" /> should be used for better comparability.</Pgraph><Pgraph>The levels for the German and Italian language tests would remain unchanged, while those for the French language test would be increased by 10 dB, as our study suggests that the French language test has a higher level of difficulty than previously assumed.</Pgraph><Pgraph>We would like to point out that this is not the only possible approach. Alternatively, for example, the minimum percentage hearing loss threshold above which individuals become eligible for insurance benefits could be defined differently depending on the language of the test used.</Pgraph><Pgraph>An increase of 10 dB is a significant step and would have insurance implications. French-speaking patients would be more likely to be denied reimbursement for hearing aids than today. On the other hand, comparability with patients of other languages would be improved, and patients from all three language groups would be treated more similarly than today.</Pgraph><Pgraph>In case of introduction of new levels, the authors recommend re-examining the comparability between languages with actual measurements using the new presentation levels, rather than interpolations.</Pgraph></TextBlock> <TextBlock name="Notes" linked="yes"> <MainHeadline>Notes</MainHeadline><SubHeadline>Conference presentation</SubHeadline><Pgraph>This contribution was presented at the 27<Superscript>th</Superscript> Annual Conference of the German Society of Audiology and published as an abstract <TextLink reference="7"></TextLink>.</Pgraph><SubHeadline>Competing interests</SubHeadline><Pgraph>The authors declare that they have no competing interests.</Pgraph></TextBlock> <References linked="yes"> <Reference refNo="1"> <RefAuthor>Schweizerische Gesellschaft f&#252;r Oto-Rhino-Laryngologie</RefAuthor> <RefAuthor>Hals- und Gesichtschirurgie</RefAuthor> <RefTitle></RefTitle> <RefYear>2018</RefYear> <RefBookTitle>Empfehlungen f&#252;r IV-Experten&#228;rzte zur Verordnung und &#220;berpr&#252;fung der Anpassung von H&#246;rger&#228;ten</RefBookTitle> <RefPage></RefPage> <RefTotal>Schweizerische Gesellschaft f&#252;r Oto-Rhino-Laryngologie, Hals- und Gesichtschirurgie. Empfehlungen f&#252;r IV-Experten&#228;rzte zur Verordnung und &#220;berpr&#252;fung der Anpassung von H&#246;rger&#228;ten. 2018.</RefTotal> </Reference> <Reference refNo="8"> <RefAuthor>Winkler A</RefAuthor> <RefAuthor>Holube I</RefAuthor> <RefTitle>Was wissen wir &#252;ber den Freiburger Sprachtest&#63;</RefTitle> <RefYear>2014</RefYear> <RefJournal>Z Audiol</RefJournal> <RefPage>146-54</RefPage> <RefTotal>Winkler A, Holube I. Was wissen wir &#252;ber den Freiburger Sprachtest&#63; Z Audiol. 2014;53(4):146-54.</RefTotal> </Reference> <Reference refNo="9"> <RefAuthor>Kompis M</RefAuthor> <RefAuthor>Krebs M</RefAuthor> <RefAuthor>H&#228;usler R</RefAuthor> <RefTitle>Uberpr&#252;fung der Bezugskurven der Schweizer Version des Freiburger Zahlen- und Einsilbertests</RefTitle> <RefYear>2006</RefYear> <RefJournal>HNO</RefJournal> <RefPage>445-50</RefPage> <RefTotal>Kompis M, Krebs M, H&#228;usler R. Uberpr&#252;fung der Bezugskurven der Schweizer Version des Freiburger Zahlen- und Einsilbertests &#91;Verification of normative values for the Swiss version of the Freiburg speech intelligibility test&#93;. HNO. 2006 Jun;54(6):445-50. DOI: 10.1007&#47;s00106-005-1337-8</RefTotal> <RefLink>https:&#47;&#47;doi.org&#47;10.1007&#47;s00106-005-1337-8</RefLink> </Reference> <Reference refNo="10"> <RefAuthor>Fournier JE</RefAuthor> <RefTitle>La strat&#233;gie du diagnostic audiom&#233;trique</RefTitle> <RefYear>1964</RefYear> <RefJournal>J Fran d&#8217;ORL</RefJournal> <RefPage>53-61</RefPage> <RefTotal>Fournier JE. La strat&#233;gie du diagnostic audiom&#233;trique. J Fran d&#8217;ORL. 1964;13:53-61.</RefTotal> </Reference> <Reference refNo="11"> <RefAuthor>Kompis M</RefAuthor> <RefTitle>Sprachaudiometrie</RefTitle> <RefYear>2022</RefYear> <RefBookTitle>Audiologie</RefBookTitle> <RefPage>97-126</RefPage> <RefTotal>Kompis M. Audiologie. 5. ed. Bern: Hogrefe; 2022. Sprachaudiometrie. p. 97-126.</RefTotal> </Reference> <Reference refNo="2"> <RefAuthor>American Medical Association</RefAuthor> <RefAuthor> Council on Physical Medicine</RefAuthor> <RefTitle>Tentative standard procedure for evaluating the percentage loss of hearing in medicolegal cases</RefTitle> <RefYear>1947</RefYear> <RefJournal>J Am Med Assoc</RefJournal> <RefPage>396-7</RefPage> <RefTotal>American Medical Association; Council on Physical Medicine. Tentative standard procedure for evaluating the percentage loss of hearing in medicolegal cases. J Am Med Assoc. 1947 Feb 8;133(6):396-7.</RefTotal> </Reference> <Reference refNo="3"> <RefAuthor>Holube I</RefAuthor> <RefAuthor>Steffens T</RefAuthor> <RefAuthor>Winkler A</RefAuthor> <RefTitle>Zur Kalibrierung des Freiburger Einsilbertests</RefTitle> <RefYear>2019</RefYear> <RefJournal>HNO</RefJournal> <RefPage>304-5</RefPage> <RefTotal>Holube I, Steffens T, Winkler A. Zur Kalibrierung des Freiburger Einsilbertests &#91;Calibration of the Freiburg monosyllabic speech test&#93;. HNO. 2019 Apr;67(4):304-5. DOI: 10.1007&#47;s00106-019-0636-4</RefTotal> <RefLink>https:&#47;&#47;doi.org&#47;10.1007&#47;s00106-019-0636-4</RefLink> </Reference> <Reference refNo="4"> <RefAuthor>R&#246;ser D</RefAuthor> <RefTitle>Das Tonaudiogramm als Grundlage f&#252;r die MdE-Skala</RefTitle> <RefYear>1973</RefYear> <RefJournal>Z Laryngol Rhinol Otol</RefJournal> <RefPage>666-73</RefPage> <RefTotal>R&#246;ser D. Das Tonaudiogramm als Grundlage f&#252;r die MdE-Skala &#91;The MdE scale based on the pure tone audiogram&#93;. 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DOI: 10.3109&#47;14992027.2011.633568</RefTotal> <RefLink>https:&#47;&#47;doi.org&#47;10.3109&#47;14992027.2011.633568</RefLink> </Reference> <Reference refNo="6"> <RefAuthor>Wagener KC</RefAuthor> <RefAuthor>Brand T</RefAuthor> <RefAuthor>Kollmeier B</RefAuthor> <RefTitle>Entwicklung und Evaluation eines Satztests f&#252;r die deutsche Sprache Teil III: Evaluation des Oldenburger Satztests</RefTitle> <RefYear>1999</RefYear> <RefJournal>Z Audiol</RefJournal> <RefPage>86-95</RefPage> <RefTotal>Wagener KC, Brand T, Kollmeier B. Entwicklung und Evaluation eines Satztests f&#252;r die deutsche Sprache Teil III: Evaluation des Oldenburger Satztests. Z Audiol. 1999;38(3):86-95.</RefTotal> </Reference> <Reference refNo="7"> <RefAuthor>Kompis M</RefAuthor> <RefAuthor>Candreia C</RefAuthor> <RefAuthor>Cao Van H</RefAuthor> <RefAuthor>Veraguth D</RefAuthor> <RefAuthor>Maire R</RefAuthor> <RefTitle>Berechnung des prozentualen H&#246;rverlusts aus Sprachaudiogrammen in Deutsch, Franz&#246;sisch und Italienisch</RefTitle> <RefYear>2025</RefYear> <RefBookTitle>27. Jahrestagung der Deutschen Gesellschaft f&#252;r Audiologie und Arbeitstagung der Arbeitsgemeinschaft Deutschsprachiger Audiologen, Neurootologen und Otologen. G&#246;ttingen, 19.-21.03.2025</RefBookTitle> <RefPage>Doc031</RefPage> <RefTotal>Kompis M, Candreia C, Cao Van H, Veraguth D, Maire R. Berechnung des prozentualen H&#246;rverlusts aus Sprachaudiogrammen in Deutsch, Franz&#246;sisch und Italienisch. In: Deutsche Gesellschaft f&#252;r Audiologie e. V.; ADANO, editors. 27. Jahrestagung der Deutschen Gesellschaft f&#252;r Audiologie und Arbeitstagung der Arbeitsgemeinschaft Deutschsprachiger Audiologen, Neurootologen und Otologen. G&#246;ttingen, 19.-21.03.2025. D&#252;sseldorf: German Medical Science GMS Publishing House; 2025. Doc031. DOI: 10.3205&#47;25dga031</RefTotal> <RefLink>https:&#47;&#47;doi.org&#47;10.3205&#47;25dga031</RefLink> </Reference> </References> <Media> <Tables> <Table format="png"> <MediaNo>1</MediaNo> <MediaID>1</MediaID> <Caption><Pgraph><Mark1>Table 1: Calculation of the social index in 3 different languages (current version)</Mark1></Pgraph></Caption> </Table> <Table format="png"> <MediaNo>2</MediaNo> <MediaID>2</MediaID> <Caption><Pgraph><Mark1>Table 2: Comparison of mean hearing loss according to CPT-AMA table</Mark1></Pgraph></Caption> </Table> <Table format="png"> <MediaNo>3</MediaNo> <MediaID>3</MediaID> <Caption><Pgraph><Mark1>Table 3: Comparability with optimized choice of speech levels using a step size of 5 dB</Mark1></Pgraph></Caption> </Table> <Table format="png"> <MediaNo>4</MediaNo> <MediaID>4</MediaID> <Caption><Pgraph><Mark1>Table 4: Proposed measurement levels with improved comparability between languages</Mark1></Pgraph></Caption> </Table> <NoOfTables>4</NoOfTables> </Tables> <Figures> <Figure width="323" height="200" format="png"> <MediaNo>1</MediaNo> <MediaID>1</MediaID> <Caption><Pgraph><Mark1>Figure 1: Principle of the interpolation and extrapolation used (black dots: actual measurements; red dots calculated values)</Mark1></Pgraph></Caption> </Figure> <Figure width="405" height="302" format="png"> <MediaNo>2</MediaNo> <MediaID>2</MediaID> <Caption><Pgraph><Mark1>Figure 2: Analysis of the current state. Dots represent data of individual ears, lines represent the linear regressions for each language separately.</Mark1></Pgraph></Caption> </Figure> <Figure width="404" height="301" format="png"> <MediaNo>3</MediaNo> <MediaID>3</MediaID> <Caption><Pgraph><Mark1>Figure 3: Comparability of the social index with optimized choice of speech levels (step size 5 dB)</Mark1></Pgraph></Caption> </Figure> <Figure width="339" height="286" format="png"> <MediaNo>4</MediaNo> <MediaID>4</MediaID> <Caption><Pgraph><Mark1>Figure 4: Comparison of percentage hearing loss values calculated according to CPT-AMA &#91;2&#93; and to R&#246;ser 1973 &#91;4&#93;. Red dots denote individual ears group, the dashed black line identity and the red line a second order polynomial (quadratic) fit to the data.</Mark1></Pgraph></Caption> </Figure> <NoOfPictures>4</NoOfPictures> </Figures> <InlineFigures> <NoOfPictures>0</NoOfPictures> </InlineFigures> <Attachments> <NoOfAttachments>0</NoOfAttachments> </Attachments> </Media> </OrigData> </GmsArticle>