MM305 - Using the MSTB-3 to Quantify and Enhance Outcomes with Hearing Aids

Abstract:
Although a vast majority of clinicians include unaided speech recognition in their audiological evaluation, only about 32% of audiologists evaluate word recognition with hearing aids in place. Such testing provides insight into the communication difficulties the patient experiences when using amplification, informs the patient and clinician of the benefits and limitations of optimized amplification for each patient, and guides the clinician in making appropriate rehabilitative recommendations.
We’ll discuss the MSTB3 and how it can be used to provide patient-centric care that incorporates aided word recognition testing along with real-ear measures and patient satisfaction questionnaires.

Summary::
Recommended best practices for programming hearing aids include objective verification to confirm that amplification is meeting prescribed targets that provide maximum audibility, and subjective assessments of outcome via questionnaires to confirm patient benefit and/or satisfaction. However, the primary goal for most hearing aid wearers is improved speech understanding, and while measures of audibility and subjective benefit are important, these measures fail to ascertain whether amplification has truly improved a patient’s speech recognition ability. Although clinicians evaluate unaided speech recognition in their audiological assessment, recent literature suggests that only 32% of audiologists currently perform aided word recognition tests in their practices. Additionally, numerous investigators report that differences often exist between speech intelligibility scores measured as part of a conventional audiogram (PB Max) and aided word recognition scores obtained when patients utilize hearing aids fitted to prescriptive targets - a difference often referred to as the speech perception (SP) gap. Thus, clinicians cannot assume that patients will reach their PB Max when wearing amplification.

There are several advantages to including aided word recognition in a hearing aid practice. First, such testing provides both patient and clinician with insight into the difficulties the patient experiences when trying to understand speech. Such information can guide rehabilitative recommendations, including a recommendation to participate in an aural rehabilitation program, considerations surrounding the use of assistive listening devices, and recommendations to consider an alternative hearing technology, such as a cochlear implant, when acceptable speech recognition scores cannot be obtained with optimized amplification. Such assessments are vital as they inform the patient and the clinician of the benefits and limitations that optimized amplification has for that patient; this helps facilitate the setting of realistic expectations, facilitates an atmosphere of transparency and trust, and fosters patient-centric care.

In this presentation, we will provide data to support the benefits of incorporating aided monosyllabic word assessment into hearing aid practice. We will report on data collected in our clinic on over 600 ears where we utilize a clinical care protocol that includes objective verification using real-ear measures, objective validation of speech intelligibility using individual ear-aided word recognition testing, and subjective validation using self-assessment questionnaires. We’ll review the recently published Minimum Speech Test Battery (MSTB, Version 3), which provides valuable resources that can be used to incorporate aided word recognition testing into hearing aid care. The MSTB-3 website is available to professionals free of charge and includes score sheets, instructions, and .wav files for the CNC Monosyllabic Words test, patient information reported outcome measures/questionnaires, and other items such as recommendations regarding when cognitive screening may be appropriate for use with patients, and recommendations of when to consider referring patients for a cochlear implant evaluation.

Case studies will be presented that demonstrate how aided word testing can supplement information derived from real-ear measures of audibility and patient questionnaires to meet a minimum standard of care for evidence-based validation of hearing aid fittings.