Initial speech levels may be presented at slightly above SRT and then progressively increased until MCL is achieved. Subsequently, present a speech level above initial MCL, and reduce it until another MCL is obtained. This level provides the maximum level at which word-recognition tests can be administered. UCL also can indicate maximum tolerable amplification. Another reason to establish UCL is to determine dynamic speech range.
Dynamic range represents the limits of useful hearing in each ear.
For many patients with SNHL, this range can be extremely limited because of recruitment. Instruct patients to indicate when presented speech is uncomfortably loud. Instructions are critical, since patients must allow speech above MCL before indicating discomfort. Before testing, ensure that the child understands what the card represents. Once the child has been taught to point to the correct picture card, choose 4-6 cards and present them to the child.