MM103 - Novel Use of Aided Speech Recognition Testing Outside the Booth for Device Validation

Abstract:
Aided speech measures are commonly used to assess performance in pediatric and cochlear implant patients, while adult hearing aid wearers are often only evaluated using unaided word recognition scores during routine audiometry. Performed in quiet under earphones, the results poorly predict real-world hearing aid performance and satisfaction, particularly in noisy environments. Space and time are often cited as primary barriers. This session reviews our experience utilizing a short, aided speech recognition protocol in non-booth spaces with hearing aid patients and illustrates how it has improved patient counseling, outcomes, and differentiates us from competitors.

Summary:
When fitting hearing aids, both audibility and speech recognition are key to success, yet the primary approach for verifying a hearing aid fitting (real-ear measures), addresses only audibility while patients are usually most interested in improving their understanding of speech. Word recognition scores are traditionally measured under earphones during routine audiometry, but these unaided scores in quiet have poor correlation for performance with hearing aids (McRackan et al, 2018), which may lead patients to form unrealistic expectations for hearing aid performance. Additionally, these measures do not provide any information on their ability to understand speech in background noise which is the primary concern of most patients (LePrell & Clavier, 2017) and better correlates with hearing aid satisfaction (Walden & Walden 2004; Sanders & Forsline 2006; Davidson, et al 2021). In fact, speech recognition in quiet has no relationship with hearing aid satisfaction and continued usage (Humes 2003; Killon & Gudmunsen 2005). Lastly, recognizing when hearing aids are no longer enough is frequently delayed, resulting in a 2% utilization of cochlear implant technology by candidates (Nassiri et al, 2021).

A more pragmatic approach would be for audiologists to routinely complete aided speech recognition testing; however time and space are often cited as limiting factors in addition to unfamiliarity with identifying implant candidates. In order to simplify the process and increase utilization of aided speech testing, we developed and implemented a “boothless” aided speech recognition screening protocol among the hearing aid audiologists in our large, well-established academic medical center program. This protocol serves two purposes: to verify and validate hearing aid fittings in combination with real-ear measures, and to increase accurate and early identification of cochlear implant candidates.

Testing protocols were developed to assess patients' performance in the unaided and aided conditions on QuickSIN measures and CNC words following speech mapping verification measures. This is accomplished in one of two ways; either in the test booth soundfield, calibrated to 60 dBA for QuickSin and CNC Words or in a fitting room outside of the test booth by using a wireless Bluetooth speaker was set approximately 3 feet from the patient and calibrated to 70 dBA for the QuickSin and 60 dBA for CNC words. Using the patient as their own control, measures are completed binaurally for QuickSin in the unaided and aided condition. CNC word testing is completed in each ear individually both unaided and aided with the contralateral ear plugged and muffed.

Initial assessments have validated patient concerns of inadequate hearing aid performance despite appropriate access to speech, verified through speech mapping and empowered the programming audiologist to provide evidence-based recommendations regarding technology. Patients assessed with these protocols have also reported improved satisfaction in the hearing healthcare they have received.

This Mini Module showcases how clinics can enhance patient counseling, differentiate themselves from the competition, set a higher standard of care, and improve patient outcomes by strategically using non-booth spaces for aided speech recognition testing.

Brief Summary of Clinical Takeaways:
The clinical takeaway for this session is that aided speech recognition testing should be included in routine adult hearing aid validation measures as it can improve patient outcomes, reduce counseling time, differentiate from competitors, and improve clinic efficiency.