Clinical Implications of Word Recognition Differences in Earphone and Aided Conditions

Abstract

Objective To compare word recognition scores for adults with hearing loss measured using earphones and in the sound field without and with hearing aids (HA) Study design Independent review of pre-surgical audiological data from an active middle ear implant (MEI) FDA clinical trial Setting Multicenter prospective FDA clinical trial Patients Ninety-four adult HA users Interventions/Main outcomes measured Pre-operative earphone, unaided and aided pure tone thresholds, word recognition scores, and speech intelligibility index. Results We performed an independent review of pre-surgical audiological data from a MEI FDA trial and compared unaided and aided word recognition scores with participants’ HAs fit according to the NAL-R algorithm. For 52 participants (55.3%), differences in scores between earphone and aided conditions were >10%; for 33 participants (35.1%), earphone scores were higher by 10% or more than aided scores. These participants had significantly higher pure tone thresholds at 250 Hz, 500 Hz, and 1000 Hz), higher pure tone averages, higher speech recognition thresholds, (and higher earphone speech levels (p=0.002). No significant correlation was observed between word recognition scores measured with earphones and with hearing aids (r=.14; p=0.16), whereas a moderately high positive correlation was observed between unaided and aided word recognition (r=0.68; p<0.001). Conclusion Results of the these analyses do not support the common clinical practice of using word recognition scores measured with earphones to predict aided word recognition or hearing aid benefit. Rather, these results provide evidence supporting the measurement of aided word recognition in patients who are considering hearing aids.

Evaluating speech perception of the MAXUM middle ear implant versus speech perception under inserts

“…This is the first study to report the comparisons between word recognition scores with the MAXUM MEI and WR inserts . Whereas hearing aids have wide and varying outcomes in word recognition scores compared to WR inserts , the MAXUM MEI showed consistent outcomes with a significant, very strong correlation to WR inserts .…”

“…Although PB max is the patient's cochlear potential to understand speech and should be considered as the individual's potential upper limit of hearing aid performance, it is not always an achievable goal . However, there is poor correlation between aided word recognition scores (WRS) and word recognition under inserts (WR inserts ) . In one study, fewer than 40% of patients achieved aided WRS within 10% of their PB max with properly fit hearing aids, and the average across all patients was 20% below PB max, with some as much as 70% below .…”

“…Variations from patient to patient as large as 60% were observed. These findings led to the conclusion that clinicians need to validate hearing aid performance by testing aided WRS rather than just using WR inserts and real‐ear measurement (REM) verification to predict hearing aid benefit …”

“…Although previous studies have reported outcomes comparing aided WRS to PB max or WR inserts , there have not been any studies comparing the word recognition scores of MAXUM or any other MEI to PB max or WR inserts . This is the first study to characterize outcomes of the word recognition scores obtained with the MAXUM to WR inserts .…”

Factors associated with benefit of active middle ear implants compared to conventional hearing aids

“…The standard audiologic test battery includes patients' pure‐tone thresholds and word recognition scores measured at high speech levels in quiet under earphones. Unfortunately, these results provide little predictive value of HA benefit for individual patients . Results of McRackan et al from a multicenter U.S. Food and Drug Administration (FDA) clinical trial demonstrate the value to clinical decision making of unaided and aided word recognition scores as predictors of communication abilities with HAs, rather than word recognition measured under earphones.…”