ommends the continued use of the current approach to measuring hearing loss.

Question 2: The validity and reliability of the tests currently used by SSA, as well as their criterion values for disability, may not be optimal. Could other tests (including tests that incorporate background noise) or other criterion values perform better?

Committee Response: In general, for adults, the committee recommends the continued use of the current medical listing of impairments to establish disability, with a modified and specific protocol for speech testing. We also recommend that a battery of tests be administered prior to applying the medical listing criteria, in order to improve the reliability and validity of all stages of the SSA disability determination process. For children, the committee is recommending some changes in the speech perception test battery and criteria, as well as the addition of a test of language competence for children over age 3.

Question 3: At present, as stated in the scope of work, “SSA does not give clear guidance about testing with and/or without hearing aids or cochlear implants for those who use such devices.” Should aided testing be recommended, and if so, how should such tests be conducted?

Committee Response: The committee provides several recommendations for testing with cochlear implants and hearing aids.

Question 4: Current procedures attempt to assess only the abilities to detect simple tones and to understand speech. Because identification of nonspeech sounds and sound localization are required in some jobs, should these auditory abilities be tested as part of the SSA disability process?

Committee Response: Since there are no standard clinical tests for sound localization or nonspeech identification, the committee is not recommending such tests.

Question 5: Can research using measures of health-related quality of life help to determine which auditory skills and losses have the greatest impact on the lives of persons with hearing loss?

Committee Response: The committee does not recommend such quality-of-life measures for use in SSA disability determination.

Question 6: Can performance deficits resulting from hearing loss be separated from those resulting from nonauditory (e.g., cognitive, linguistic) factors?

Committee Response: The committee describes some of the influ-



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