LM304 - Streamlining Clinical Decision Making During Pre- and Post-Operative Cochlear Implant Assessment Using the New Minimum Speech Test Battery, Version 3

Abstract:
The Minimum Speech Test Battery, Version 3 (MSTB-3) was recently updated and provides clinicians with a more streamlined test battery for pre-operative determination of candidacy and post-operative assessment of cochlear implant performance. This session will describe these updates and how they have been applied in our clinics. Cases studies will be used to demonstrate utilization of the MSTB-3 in pre- operative determination of candidacy in traditional cases and in cases of single-sided deafness (SSD) and asymmetric hearing loss. Case presentations will also be used to demonstrate use of the MSTB-3 to evaluate post-operative performance.

Summary:
Cochlear Implant (CI) candidacy has evolved significantly over the past several decades, resulting in an increase in the number of patients who can benefit from this technology. This has complicated clinical decision-making and has made it necessary to streamline the candidacy determination process. The first version of the MSTB was introduced in 1996 and was updated in 2011 to include more complex test materials. Since 2011, several changes have taken place with CI candidacy, including FDA approval of electroacoustic devices and approval for patients with SSD and asymmetric hearing loss (AHL). The Institute for Cochlear Implant Training (ICIT) organized a team of experts to update the MSTB, which resulted in the MSTB-3. The revised battery includes streamlined testing for evaluating candidacy and post-operative performance, clearly defined protocols, evidence-based recommendations, and supplemental information regarding patient questionnaires and cognitive screening tools.

This revised battery recommends aided speech recognition testing be preceded by unaided audiometric testing and verification of hearing aids to ensure that candidacy decisions are based on the patient’s “best aided” condition, which the MSTB-3 defines as “testing using a hearing aid that has been optimized for hearing loss in the ear to be implanted.” The MSTB-3 is aligned with recent FDA approvals for SSD and AHL as it recommends clinicians base candidacy decisions on the ear to be treated and places less emphasis on speech-recognition scores obtained when patients are tested in a bilateral aided condition. It also includes a recommendation to evaluate the Everyday Listening Condition, which involves testing in the optimized hearing configuration that the patient uses regularly (i.e., bilateral hearing aids, unilateral hearing aid, CROS, etc). Key components of the MSTB-3 include unaided audiometric testing, aided speech recognition assessment using CNC Monosyllabic words for each ear, AzBio sentences in the “best aided” condition for the ear to be implanted, testing in the Everyday Listening Condition, and use of questionnaires to supplement candidacy decisions.

The MSTB-3 also includes a protocol for patients with SSD, which involves presentation of sentences using more difficult signal-to-noise ratios. Although indications for SSD are typically based on CNC scores, the MSTB-3 recommends sentence testing with spatially separated noise as such information may provide additional support for candidacy determination.

The presentation will include case studies to demonstrate utilization of the MSTB-3 in pre-operative determination of candidacy and post-operative performance.

Brief Summary of Clinical Takeaways:
The clinical takeaway for this session is that clinicians will be able to apply the updated MSTB-3 guidelines to their clinical practice using streamlined, evidence-based recommendations to assist with determination of CI candidacy.