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Clinical Implications of Word Recognition Differences in Earphone and Aided Conditions

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 presurgical 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: Preoperative earphone, aided word recognition scores, and speech intelligibility index. Results: We performed an independent review of presurgical audiological data from an 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, 500, 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 = 0.14; 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 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.