Assessment methods for determining small changes in hearing performance over time

Abstract

Although the behavioral pure-tone threshold audiogram is considered the gold standard for quantifying hearing loss, assessment of speech understanding, especially in noise, is more relevant to quality of life but is only partly related to the audiogram. Metrics of speech understanding in noise are therefore an attractive target for assessing hearing over time. However, speech-in-noise assessments have more potential sources of variability than pure-tone threshold measures, making it a challenge to obtain results reliable enough to detect small changes in performance. This review examines the benefits and limitations of speech-understanding metrics and their application to longitudinal hearing assessment, and identifies potential sources of variability, including learning effects, differences in item difficulty, and between- and within-individual variations in effort and motivation. We conclude by recommending the integration of non-speech auditory tests, which provide information about aspects of auditory health that have reduced variability and fewer central influences than speech tests, in parallel with the traditional audiogram and speech-based assessments.

Measurement of Spectro-Temporal Processing by Cochlear Implant Users: Effects of Stimulus Level and Validation of an Online Implementation.

“…Efforts to enhance the performance of CI's in noisy environments have become a focal point of extensive research, spanning various approaches such as pre-processing noise removal paradigms, alternative stimulation methods, and the individualised customisation of specific programming parameters (Carlyon & Goehring, 2021). Acutely assessing these changes to CI settings poses a number of challenges including variability in test methodology and outcomes within a recipient (Brungart et al, 2022;Ma et al, 2023), and the need for adaptation to new settings to achieve optimal performance in speech tests (Davis et al, 2005). For example, Schvartz-Leyzac et al (2017) demonstrated bias towards a recipient's routine clinical program influenced by long-term acclimatization, and while providing a period of acclimatization prior to experimental assessment is an option, it risks subjecting the participant to potentially inferior settings they may struggle to tolerate long enough to reliably assess any potential improvement.…”