RETHINKING UNAIDED WORD RECOGNITIONSCORE MINIMUMS TO INCREASE NUMBER OF

IMPLANT CANDIDATES

Anna McCraney, AuD

Disclosures

Ototronix Glasscock Hearing Center

Cochlear Implant Adoption

CI Candidates

CI Recipients No CI

?

Triggers to CI Eval Recommendation

Patient dissatisfied with HAs

PTA What level?

PB max What level?

Mild

Moderate

Profound

Hybrid CI

CI

Severe

Mod-Severe

Normal

Severe

Audiometry Based Screening

86% of patients with monosyllabic word recognition scores at or below 32% (or 44% for patients with private insurance) would meet candidacy requirements for cochlear implantation1

Patients with a monosyllabic word recognition test score of ≤40% and/or pure‐tone thresholds (250, 500, 1,000 Hz) of ≥75 dB have a high likelihood of meeting candidacy criteria. 1

PB max [%] < 4FPTA [dB] – 82

i.e. PB max = 50%, referral recommended when 4FPTA = 58 dBHL or higher

1. Gubbels, S, Gartrell, B, Ploch, J, Hanson, K. Can routine office‐based audiometry predict cochlear implant evaluation results? Laryngoscope 2017

2. Hoppe, U, Hast, A, Hocke, T. Audiometry‐Based Screening Procedure for Cochlear Implant Candidacy. OtolNeurotol 2015

Path to Implantation

Accepted treatment tenant Patients with WR > 50% receive sufficient aided

benefit

Primary CI trigger Unaided WR ≤ 50‐60%

Aided WRS vs. Speech Recognition

* McRackan T, Ahlstrom J, Clinkscales W, Myer T, Dubno J. Clinical Implications of Word Recognition Differences in Earphone and Aided Conditions. Otol Neurotol 2016.

SD (SRT + 40)

Aided WRS vs. Speech Recognition

* McRackan T, Ahlstrom J, Clinkscales W, Myer T, Dubno J. Clinical Implications of Word Recognition Differences in Earphone and Aided Conditions. Otol Neurotol 2016.

SD (SRT + 40)

Aided WRS vs. Speech Recognition

* McRackan T, Ahlstrom J, Clinkscales W, Myer T, Dubno J. Clinical Implications of Word Recognition Differences in Earphone and Aided Conditions. Otol Neurotol 2016.

• Patients with similar PB max can have wide differences in aided speech recognition

• PB max cannot be used to reliably predict hearing aid outcomes

• Testing with HAs must be performed to determine actual patient benefit.

SD (SRT + 40)

* McRackan T, Ahlstrom J, Clinkscales W, Myer T, Dubno J. Clinical Implications of Word Recognition Differences in Earphone and Aided Conditions. Otol Neurotol 2016.

SD (SRT + 40)

Aided Benefit vs. Cochlear Potential

Some patients with PB max >50% may qualify for CI or HCI

Aided AzBio vs. Unaided CNC

* McRackan T, et al. Earphone and Aided Word Recognition Differences in Cochlear Implant Candidates. Otol Neurotol 2018.

Aided AzBio vs. Unaided CNC

* McRackan T, et al. Earphone and Aided Word Recognition Differences in Cochlear Implant Candidates. Otol Neurotol 2018.

CI Candidates

50

50

Aided CNC vs. Unaided CNC

* McRackan T, et al. Earphone and Aided Word Recognition Differences in Cochlear Implant Candidates. Otol Neurotol 2018.

50

HCI or CI Candidates

185 Total Ears81 CI Candidates

* Hoppe, U, Hast, A, Hocke, T. Audiometry‐Based Screening Procedure for Cochlear Implant Candidacy. OtolNeurotol 36:1001‐1005, 2015

CI Candidacy

* Hoppe, U, Hast, A, Hocke, T. Audiometry‐Based Screening Procedure for Cochlear Implant Candidacy. OtolNeurotol 36:1001‐1005, 2015

CI Candidacy185 Total Ears

81 CI Candidates

* Hoppe, U, Hast, A, Hocke, T. Audiometry‐Based Screening Procedure for Cochlear Implant Candidacy. OtolNeurotol 36:1001‐1005, 2015

Audiology’s Walking Wounded185 Total Ears

81 CI Candidates

57

30% of CI candidates had PB max ≥50%

24

CI Eval Patients139 patients

278 ears

* Silverstein Institute

CI Eval Patients

* Silverstein Institute

CI Candidacy

HCI or CI Candidacy

139 patients 278 ears

Unveiling Candidates

More potential implant candidates exist, disguised as patients with “aidable” loss Could increase identified candidates by not

limiting aided testing to only those with PB max < 50‐60%

CI Candidates with PB max >60%

* Chang, J, et al. Comparison of MAXUM and Hearing Aid Performance to Word Recognition Performance Obtained under Earphones. Otol Neurotol

AVERAGE CNCMAXUM: 67%Hearing Aid: 15%Improvement: 42%

HCI Candidates with PB max >60%AVERAGE WRS

MAXUM: 82%Hearing Aid: 44%Improvement: 38%

* Hunter, et al; Laryngoscope, The Ototronix Maxum MEI for Severe HF SNHL, 2016

Conclusion

Aided benefit cannot be reliably predicted from PB max so it MUST be measured Early and regular aided testing has the

potential to significantly increase the number of identified potential candidates Expand our armamentarium to include CIs,

HCIs and MEIs for patients with PB max >50%

It all starts with testing…

“If we don’t ask the question, we won’t get the answer.”

James Jerger, PhD

amccraney@ototronix.com