J Am Acad Audiol 2020; 31(02): 118-128
DOI: 10.3766/jaaa.18100
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Relationship Between Auditory and Visual Noise Acceptance in Normal-Hearing Listeners

Kathleen F. Faulkner
*   Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, TN
Patrick N. Plyler
*   Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, TN
Mary K. Easterday
*   Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, TN
Teresa M. Slade
*   Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, TN
› Author Affiliations
Further Information

Publication History

07 December 2018

Publication Date:
25 May 2020 (online)



Research has shown that hearing aid acceptance is closely related to how well an individual tolerates background noise, regardless of improved speech understanding in background noise. The acceptable noise level (ANL) test was developed to quantify background noise acceptance. The ANL test measures a listener’s willingness to listen to speech in noise rather than their ability to understand speech in noise, and is clinically valuable as a predictor of hearing aid success.


Noise acceptance is thought to be mediated by central regions of the nervous system, but the underlying mechanism of noise acceptance is not well understood. Higher order central efferent mechanisms may be weaker and/or central afferent mechanisms are more active in listeners with large versus small ANLs. Noise acceptance, therefore, may not be limited to the auditory modality but observable across modalities. We designed a visual-ANL test, as a parallel of the auditory-ANL test, to examine the relations between auditory and visual noise acceptance.

Research Design:

A correlational design.

Study Sample:

Thirty-seven adults between the ages of 21 and 30 years with normal hearing participated in this study.

Data Collection and Analysis:

All participants completed the standard auditory-ANL task, the visual-ANL task developed for this study, reception thresholds for sentences using the hearing in noise test, and visual sentence recognition in noise using the text reception threshold test. Correlational analyses were performed to evaluate the relations between and among the ANL and perception tasks.


Auditory- and Visual-ANLs were correlated; those who accepted more auditory noise were also those who accepted more visual noise. Auditory and visual perceptual measures were also correlated, demonstrating that both measures reflect common processes underlying the ability to recognize speech in noise. Finally, as expected, noise acceptance levels were unrelated to perception in noise across modalities.


The results of this study support our hypothesis that noise acceptance may not be unique to the auditory modality, specifically, that the common variance shared between the two ANL tasks, may reflect a shared general perceptual or cognitive mechanism that is not specific to the auditory or visual domains. These findings also support that noise acceptance and speech recognition reflect different aspects of auditory and visual perception. Future work will relate these ANL measures with central tasks of inhibition and include hearing-impaired individuals to explore the mechanisms underlying noise acceptance.

This work was presented as a research poster at the American Academy of Audiology Annual Conference, Nashville, TN, 2018.


  • Alworth LN, Plyler PN, Madix SG. 2007. Effect of personality type on the acceptance of noise. Poster Presented at the American Academy of Audiology Annual Conference Denver, CO:
  • American National Standards Institute (ANSI) 2010. Maximum Ambient Noise Levels for Audiometric Test Rooms. ANSI S3.1-1999. New York, NY: ANSI;
  • Besser J, Zekveld AA, Kramer SE, Rönnberg J, Festen JM. 2012; New measures of masked text recognition in relation to speech-in-noise perception and their associations with age and cognitive abilities. J Speech Lang Hear Res 55 (01) 194-209
  • Bilger RC, Nuetzel JM, Rabinowitz WM, Rzeczkowski C. 1984; Standardization of a test of speech perception in noise. J Speech Hear Res 27 (01) 32-48
  • Brännström KJ, Zunic E, Borovac A, Ibertsson T. 2012; Acceptance of background noise, working memory capacity, and auditory evoked potentials in subjects with normal hearing. J Am Acad Audiol 23 (07) 542-552
  • Brännström KJ, Holm L, Kastberg T, Olsen SØ. 2013; The acceptable noise level: the effect of repeated measurements. Int J Audiol 53 (01) 21-29
  • Brännström KJ, Olsen SØ, Holm L, Kastberg T, Ibertsson T. 2014; The effect of repeated measurements and working memory on the most comfortable level in the ANL test. Int J Audiol 53 (11) 787-795
  • Campbell R. 2008; The processing of audio-visual speech: empirical and neural bases. Philos Trans R Soc Lond B Biol Sci 363 (1493) 1001-1010
  • Franklin C, Johnson LV, White L, Franklin C, Smith-Olinde L. 2013; The relationship between personality type and acceptable noise levels: a Pilot Study. ISRN Otolaryngol 2013: 902532
  • Freyaldenhoven MC, Thelin JW, Plyler PN, Nabelek AK, Burchfield SB. 2005; Effect of stimulant medication on the acceptance of background noise in individuals with attention deficit/hyperactivity disorder. J Am Acad Audiol 16 (09) 677-686
  • Freyaldenhoven MC, Plyler PN, Thelin JW, Burchfield SB. 2006; a Acceptance of noise with monaural and binaural amplification. J Am Acad Audiol 17 (09) 659-666
  • Freyaldenhoven MC, Smiley DF, Muenchen RA, Konrad TN. 2006; b Acceptable noise level: reliability measures and comparison to preference for background sounds. J Am Acad Audiol 17 (09) 640-648
  • George EL, Zekveld AA, Kramer SE, Goverts ST, Festen JM, Houtgast T. 2007; Auditory and nonauditory factors affecting speech reception in noise by older listeners. J Acoust Soc Am 121 (04) 2362-2375
  • Gordon-Hickey S, Adams E, Moore R, Gaal A, Berry K, Brock S. 2012; Intertester reliability of the acceptable noise level. J Am Acad Audiol 23 (07) 534-541
  • Grant KW, Walden BE, Seitz PF. 1998; Auditory-visual speech recognition by hearing-impaired subjects: consonant recognition, sentence recognition, and auditory-visual integration. J Acoust Soc Am 103: 2677-2690
  • Grant KW, Seitz PF. 2000; The use of visible speech cues for improving auditory detection of spoken sentences. J Acoust Soc Am 108 (03) 1197-1208
  • Harkrider AW, Smith SB. 2005; Acceptable noise level, phoneme recognition in noise, and measures of auditory efferent activity. J Am Acad Audiol 16 (08) 530-545
  • Harkrider AW, Tampas JW. 2006; Differences in responses from the cochleae and central nervous systems of females with low versus high acceptable noise levels. J Am Acad Audiol 17 (09) 667-676
  • Humes LE, Christopherson LA, Cokely CG. 1992. Central auditory processing disorders in the elderly: fact or fiction?. In: Katz J, Stecker N, Henderson D. Central Auditory Processing: A Transdisciplinary View. Philadelphia, PA: BC Decker; 141-150
  • Humes LE. 2005; Do “auditory processing” tests measure auditory processing in the elderly?. Ear Hear 26: 109-119
  • Humes LE, Burk MH, Coughlin MP, Busey TA, Strauser LE. 2007; Auditory speech recognition and visual text recognition in younger and older adults: similarities and differences between modalities and the effects of presentation rate. J Speech Lang Hear Res 50 (02) 283-303
  • Humes LE, Kidd GR, Lentz JJ. 2013; Auditory and cognitive factors underlying individual differences in aided speech-understanding among older adults. Front Syst Neurosci 7 (01) 55
  • Koo TK, Li MY. 2016; A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15 (02) 155-163
  • Kramer SE, Zekveld AA, Houtgast T. 2009; Measuring cognitive factors in speech comprehension: the value of using the Text Reception Threshold test as a visual equivalent of the SRT test. Scand J Psychol 50 (05) 507-515
  • Krull V, Humes LE, Kidd GR. 2013; Reconstructing wholes from parts: effects of modality, age, and hearing loss on word recognition. Ear Hear 34 (02) e14-e23
  • Lyxell B, Rönnberg J. 1987; Guessing and speechreading. Br J Audiol 21: 13-20
  • McFarland DJ, Cacace AT. 1995; Modality specificity as a criterion for diagnosing central auditory processing disorders. Am J Audiol 4: 36-48
  • Miller SE, Wathen K, Cash E, Pitts T, Cornell L. 2018; Auditory sensory gating predicts acceptable noise level. Hear Res 359: 76-84
  • Mueller HG, Weber J, Hornsby BW. 2006; The effects of digital noise reduction on the acceptance of background noise. Trends Amp 10: 1-9
  • Musacchia G, Arum L, Nicol T, Garstecki D, Kraus N. 2009; Audiovisual deficits in older adults with hearing loss: biological evidence. Ear Hear 30 (05) 505-514
  • Nabelek AK, Tucker FM, Letowski TR. 1991; Toleration of background noises: relationship with patterns of hearing aid use by elderly persons. J Speech Hear Res 34 (03) 679-685
  • Nabelek AK, Tampas JW, Burchfield SB. 2004; Comparison of speech perception in background noise with acceptance of background noise in aided and unaided conditions. J Speech Lang Hear Res 47 (05) 1001-1011
  • Nabelek AK. 2006; Acceptable noise level: a clinical measure for predicting hearing aid outcome. J Am Acad Audiol 17 (09) 624-625
  • Nabelek AK, Freyaldenhoven MC, Tampas JW, Burchfiel SB, Muenchen RA. 2006; Acceptable noise level as a predictor of hearing aid use. J Am Acad Audiol 17 (09) 626-639
  • Nichols AC, Gordon-Hickey S. 2012; The relationship of locus of control, self-control, and acceptable noise levels for young listeners with normal hearing. Int J Audiol 51 (04) 353-359
  • NIDCD 2016 Epidemiology and Statistics Program, based on December 2015 Census Bureau estimates of the noninstitutionalized U.S. population, personal communication; May 2016
  • Nilsson M, Soli SD, Sullivan JA. 1994; Development of the Hearing in Noise Test for the measurement of speech reception thresholds in quiet and in noise. J Acoust Soc Am 95 (02) 1085-1099
  • Pichora-Fuller MK, Kramer SE, Eckert MA, Edwards B, Hornsby BW, Humes LE, Lemke U, Lunner T, Matthen M, Mackersie CL, Naylor G, Phillips NA, Richter M, Rudner M, Sommers MS, Tremblay KL, Wingfield A. 2016; Hearing impairment and cognitive energy: the framework for understanding effortful listening (FUEL). Ear Hear 37 (1, Suppl) 5S-27S
  • Plyler PN, Alworth LN. 2008. ANL with and without visual speech input. Poster Presented at the American Academy of Audiology Annual Conference Charlotte, NC:
  • Plyler PN, Bahng J, von Hapsburg D. 2008; The acceptance of background noise in adult cochlear implant users. J Speech Lang Hear Res 51 (02) 502-515
  • Plyler PN, Alworth LN, Rossini TP, Mapes KE. 2011; Effects of speech signal content and speaker gender on acceptance of noise in listeners with normal hearing. Int J Audiol 50 (04) 243-248
  • Plyler PN, Lang R, Monroe AL, Gaudiano P. 2015; The effects of audiovisual stimulation on the acceptance of background noise. J Am Acad Audiol 26 (05) 451-460
  • Remez RE. 2005. Three puzzles of multimodal speech perception. In: Bailly G, Perrier P, Vatikiotis-Bateson E. Audiovisual Speech. Cambridge, MA: MIT Press; 12-19
  • Rogers DS, Harkrider AW, Burchfield SB, Nabelek AK. 2003; The influence of listener's gender on the acceptance of background noise. J Am Acad Audiol 14 (07) 372-382 , quiz 401.
  • Rönnberg J, Lunner T, Ng EH, Lidestam B, Zekveld AA, Sörqvist P, Lyxell B, Träff U, Yumba W, Classon E, Hällgren M, Larsby B, Signoret C, Pichora-Fuller MK, Rudner M, Danielsson H, Stenfelt S. 2016; Hearing impairment, cognition and speech understanding: exploratory factor analyses of a comprehensive test battery for a group of hearing aid users, the n200 study. Int J Audiol 55 (11) 623-642
  • Shetty HN, Mahadev S, Veeresh D. 2014; The relationship between acceptable noise level and electrophysiologic auditory brainstem and cortical signal to noise ratios. Audiol Res 4 (01) 93
  • Smith KG, Fogerty D. 2015; Integration of partial information within and across modalities: contributions to spoken and written sentence recognition. J Speech Lang Hear Res 58: 1805-1817
  • Smith KG, Fogerty D. 2016; Integration of partial information for spoken and written sentence recognition by older listeners. J Acoust Soc Am 139 (06) EL240
  • Sumby WH, Pollack I. 1954; Visual contribution to speech intelligibility in noise. J Acoust Soc Am 26: 212-215
  • Tye-Murray N, Sommers MS, Spehar B. 2007; Audiovisual integration and lipreading abilities of older adults with normal and impaired hearing. Ear Hear 28 (05) 656-668
  • Watson CS, Qui WW, Chamberlain MM, Li X. 1996; Auditory and visual speech perception: confirmation of a modality independent source of individual differences. J Acoust Soc Am 100: 1153-1162
  • Witten IB, Knudsen EI. 2005; Why seeing is believing: merging auditory and visual worlds. Neuron 48 (03) 489-496
  • Wu Y-H, Stangl E, Pang C, Zhang X. 2014; The effect of audiovisual and binaural listening on the acceptable noise level (ANL): establishing an ANL conceptual model. J Am Acad Audiol 25 (02) 141-153
  • Wu Y-H, Ho H-C, Hsiao S-H, Brummet RB, Chipara O. 2016; Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL). Int J Audiol 55 (05) 285-294
  • Zekveld AA, George ELJ, Kramer SE, Goverts ST, Houtgast T. 2007; The development of the Text Reception Threshold test: a visual analogue of the Speech Reception threshold test. J Speech Lang Hear Res 50: 576-584
  • Zekveld AA, Kramer SE, Vlaming MS, Houtgast T. 2008; Audiovisual perception of speech in noise and masked written text. Ear Hear 29 (01) 99-111
  • Zekveld AA, Pronk M, Danielsson H, Rönnberg J. 2018; Reading behind the lines: the factors affecting the text reception threshold in hearing aid users. J Speech Lang Hear Res 61 (03) 762-775