On the relationship between patient-reported outcome measure and precision audiometry

Abstract

Abstract Introduction: Audiometric methods for hearing-impaired patients are constantly evolving as new therapeutic interventions and improved clinical standards are established. This study was aimed at evaluating the relationship between cochlear implant (CI) users' subjective judgement of everyday communication situations and results from various speech-audiometric test procedures. To reconstruct challenging everyday listening situations in the clinic to different degrees, the temporal characteristics of the background noise and the spatial arrangement of the signal sources were varied for speech tests in background noise. Methods: In a prospective study, 20 CI-experienced, postlingually deafened users of the Nucleus CI were included. Speech comprehension was measured in quiet (by Freiburg words) and in noise (by the Oldenburg sentence test) while stationary speech-simulating or temporally fluctuating noise was applied and the noise sources were varied from S0N0 through S0NCI to S0N90,180,270. Subjective feedback from the patients was obtained by using the HISQUI19 questionnaire. Results: Word comprehension at 65 dB in quiet showed a significant positive correlation with the user's subjective assessment of hearing ability using the questionnaire (Pearson's R = 0.59). In stationary background noise for the clinically established hearing situation S0N0, there was a negative correlation (R=–0.38, changing to –0.55 in fluctuating ICRA background noise). This trend of greater correlation of the subjective evaluation of comprehension against fluctuating background noise as compared with stationary background noise was also evident in listening situations with spatially separated signal sources, with speech coming from the front and background noise from the side (S0NCI) and from the rear hemisphere (S0N90, S0N90,180,270). On the other hand, the test–retest accuracy was reduced by a substantial factor in the transition from stationary to fluctuating background noise. Conclusions: By introducing temporal fluctuations in the background noise, the ecological validity can be improved, but at the cost of a parallel decrease in the accuracy of the test procedure. Especially in the context of studies, this knowledge may help to improve the adaptation of the test method to the scientific question in evaluating the relationship between ecological validity and precision audiometry.