Speech Perception Gap Is Predictive of an Active Middle Ear Implant Advantage

Abstract

Objective: Evaluate whether the difference between word recognition score (WRS) obtained unaided under earphone and with a hearing aid (HA), the speech perception gap (SPgap), is predictive of performance with a totally implantable active middle ear implant (AMEI). Study Design: Retrospective review of systematically collected data. Setting: Private otologic practice. Patients: One hundred thirty six ears (133 patients) with sensorineural hearing loss implanted with an AMEI. Subjects were 73.5% men, with mean age = 61.3 years. Intervention: Previous AMEI. Main Outcome Measures: WRS with earphone at phonetically balanced maximum (PB-MAX), and with HA and AMEI at 50 dB HL. Differences between earphone, HA and AMEI word recognition, grouped as positive or negative speech perception gap (+SPgap/–SPgap) between two devices. Results: A +SPgap (WRS poorer with device than earphone) occurred in 86.0% of patients with HA and 42.3% with the AMEI. Mean SPgap = 24.7% with HA and 3.0% with AMEI (p ≤ 0.001). With a HA +SPgap, AMEI performance was better than HA by an average difference of 23.2% WRS, with AMEI more than HA in 82.9% of subjects. With HA –SPgap, the mean difference was 1.1% correct and AMEI more than HA in 47.4% of subjects (p ≤ 0.001 and p ≤ 0.002, for mean difference and percent of subjects, respectively). The larger the +SPgap (earphone-HA), the greater the advantage of AMEI over HA (r = 0.62, p ≤ 0.001). Conclusion: A speech perception gap between earphone PB-MAX and aided word recognition score suggests a patient may have better speech perception with an AMEI than with his/her hearing aid. This information is useful for counseling patients who are not performing well or are unsatisfied with their hearing aid.

New Considerations for a Totally Implantable Active Middle Ear Implant

“…In the Shohet et al (9) retrospective study, 86% of the 133 subjects demonstrated a SPgap pre-operatively with their appropriately fit CHA, reinforcing that CHA users often do not reach their cochlear potential. The average SPgap of CHA users pre-operatively in this study was 24.7% compared to 3.0% once they received their AMEI.…”

“…A second vertical reference line at 18 shows the Earphone-HA speech perception gap at and beyond which >85% of subjects perform better with the AMEI than with their HA. From Shohet et al ( 9 ).…”

Ergebnisse und Lebensqualität nach Implantation aktiver Mittelohrimplantate

“…For patients with only SNHL, the value of preoperative air conduction threshold and the maximum recognition score of monosyllables via earphones must be analyzed. One positive predictor for better speech understanding with an active middle ear implant in cases of SNHL compared to conventional hearing aids turned out to be the speech perception gap with a conventional hearing system at a basic speech level (50 dB or 65 dB SPL) and the maximum speech understanding measured via earphones [63,121,122]. The maximum word recognition score in the speech audiogram should nearly be achieved at 65 dB with a conventional hearing system.…”

“…Als positiver Prädiktor für ein besseres Sprachverstehen mit einem aktiven Mittelohrimplantat bei SNHL gegenüber der konventionellen Hörsystemversorgung wurde die Diskrepanz des Sprachverstehens (engl. Speech Perception Gap) mit einem konventionellen Hörsystem bei einem festen Sprachschallpegel (50 dB oder 65 dB SPL) und dem über Kopfhörer gemessenem maximalen Sprachverstehen herausgestellt [63,121,122]. Das maximal erreichte Sprachverstehen im Sprachaudiogramm sollte mit einem konventionellen Hörsystem bereits bei 65 dB annähernd erreicht werden.…”