# Characterization of the Intelligibility of
## 1 Introduction
### Speech-in-Noise Screening Test Design  
To account for common situations in which the language is not known (e.g., screening in multilingual settings, screening at a distance), we recently developed a novel, automated speech-in-noise test for hearing screening in multilingual settings. Specifically, we used a set of nonsense VCV stimuli viable for use across listeners of various languages presented in a multiple-choice format using an adaptive three-alternative forced-choice (3 AFC) task [23; 24; 25; 26]. Several ways to communicate the individual responses to stimuli in psychophysical tasks have been used in the literature, e.g., automatization of typed and spoken responses, for example, using automated speech recognition algorithms [27]. However, using automated approaches to record individual responses has limitations, as individuals, particularly the older ones, may have difficulties repeating the stimuli due to higher cognitive load and potential unease and anxiety [28]. In this study, a forced-choice task is adopted for several reasons. First of all, multiple-choice tasks are easy to implement in a user-operated and automated procedure, which could be a simple graphic user interface in which the subject selects the desired response (e.g., [5; 12]). Moreover, the simple interaction required (i.e., clicking on a screen) can help reduce the negative influence of cognitive decline, slowed temporal processing and added memory demands on speech recognition performance in older adults [28]. In this study, a 3 AFC task was used as it is shown to perform better than the popular and widespread two-alternative forced-choice task in terms of threshold estimation stability under different types of adaptive procedures [29].  
The VCV stimuli used in this study could yield optimal screening for a number of reasons. Firstly, decreased VCV recognition may indicate decreased ability to recognize consonants and fast transients, which are among the first clues of the presence of age-related high-frequency hearing loss [11]. Moreover, nonsense syllable recognition tests such as VCV tests present good test-retest reliability and precision under multiple experimental conditions, such as stimulus randomization and uncontrolled background noise [30]. VCVs are also associated with smaller inter-stimulus variability of intelligibility within the set compared to, e.g., CVC words or sentences and may be more easily equalized before the test [26]. Additionally, VCV recognition is largely independent of lexicon and semantics, thus limiting the influence of auditory-cognitive interactions and the involvement of higher-level processing centers in the recognition task [31]. By using VCV stimuli,multiple-choice recognition tasks can be implemented in a simple user-operated automated procedure (e.g., by using a graphical user interface on a touch screen). Last but not least, the intelligibility of VSVs is less influenced by the subjects' education, literacy, and native language compared to words or sentences [32]. This issue is particularly relevant in today's globalized world with multilingual societies, especially in remote screening settings where the languages spoken by participants are not necessarily known. In any case, to date, there is still a lack of validated, automated speech-in-noise screening tests viable for use at a distance in non-native listeners.