Consensus report suggests updating hearing loss testing after… : The Hearing Journal


The Social Security Administration (SSA) should use a monosyllabic word recognition test to assess the hearing ability of people with cochlear implants (CIs), recommends a special committee convened by the National Academies of Science, Engineering, and Science. medicine in a recent report, Assessment of hearing loss in people with cochlear implants( The report was requested by the SSA as the agency seeks to generalize its listing criteria for determining disability related to hearing loss.

Currently, the SSA uses the Hearing in Noise Test (HINT) to measure grief recognition for people with HF, as part of a screening process for eligibility for disability benefits. However, the committee found that the HINT had limitations that should prompt changes to the testing procedure.

According to the report, the HINT is limited by its “ceiling effects,” referring to the consistently high scores people with IC now get on the test, primarily due to advances in IC technology and the fact that the he exam is often administered in a calm environment. environment. The report also pointed out that HINT is no longer commercially available and has become difficult for clinics to obtain.


To update the SSA’s hearing assessment of post-implantation hearing, the committee recommended a monosyllabic word recognition test, as opposed to sentence recognition measured by the HINT. The SSA already uses word tests to assess hearing in people who do not have cochlear implants.

The recommended post-implantation test should have the following characteristics:

  • It must be conducted with a complete standardized and phonetically or phonemically balanced word list;
  • 60 dB SPL using individually recommended hearing technology that is working properly and adjusted to the individual’s normal settings. In case of unilateral deafness or asymmetrical hearing loss, the non-implanted ear should not be occluded for the test;
  • The level should be calibrated for the presentation of the sound field;
  • Test materials should be registered to ensure standardized administration;
  • The tests must take place quietly in a soundproof booth; and
  • The listener should be seated one meter from the speaker at 0 degree azimuth.

A cut-off score of 40% or less on a monosyllabic word would be used. This is the same threshold that the SSA currently uses for word recognition scores of people with hearing loss but without CI.

“Because this is an accepted criterion for determining the disability status of people with hearing loss, the committee felt it was reasonable to use the same criteria for all people with hearing loss, regardless of their technology. hearing,” said René H. Gifford, PhD, CCC-A, committee member and director of the cochlear implant program at the Vanderbilt Bill Wilkerson Center, as well as associate director of Implantable Hearing Technologies.

Standardized assessments of monosyllabic words, she noted, are readily available and commonly used in diagnostic audiology clinics.

“Additionally, the fields of audiology and otology are moving towards determining candidacy for CI based on monosyllabic word recognition performance,” Gifford said. The audience log. “In fact, two of the three IC manufacturers have completed FDA-regulated clinical trials investigating a revised indication for the application of adult ICs, including individuals achieving up to 40% recognition. aided by words.”

“Thus, there was not only precedent for the existing SSA criterion for determining hearing-related disability and the wide availability and familiarity of monosyllabic word tests, but there is also supporting evidence that this level of speech recognition performance is consistent with a severe communication difficulty rendered. an auditor an CI candidate.

“In summary, the committee agreed that if an individual continued to meet the criteria for a CI after cochlear implantation – achieving less than 40% for aided recognition of monosyllabic words – this would certainly be consistent with disability related to ‘hearing.”


It should be noted that the report recommended not plugging the non-implanted ear when testing for asymmetric hearing loss. This differs from the typical procedure for determining the candidacy of an implant, which obstructs the better ear.

“These recommendations are not relevant to determining candidacy for cochlear implantation,” Gifford clarified.

“All committee members expressed full support for ear-specific testing for the determination of IC candidacy, but our charge was exclusively disability-focused. With respect to disability, the SSA has always considered how an individual can function in day-to-day living conditions. IC recipients with single-sided hearing loss use both their IC and their better auditory ear for daily communication and are assessed in this listening configuration.


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