Evaluating Hearing Loss for Individuals with Cochlear Implants (2021) / Chapter Skim
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To be used in SSA's program, HINT testing must be performed on a person with properly functioning cochlear implants set at normal settings, with no visual testing cues, in a 1
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. Instead, it requires a "word recognition score of 40 percent or less in the better ear determined using a standardized list of phonetically balanced monosyllabic words." STATEMENT OF TASK SSA has requested that a consensus committee of the National Academies of Sciences, Engineering, and Medicine identify and recommend generalized testing procedures and criteria for evaluating the level of functional hearing ability needed to make a disability determination in adults and children after cochlear implantation.
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3. Among the hearing tests described in task 2, identify those with characteristics most similar to the HINT, determine which tests, performed in the sound field, either binaurally or monaurally, in either quiet or noise, produce measurements most closely analo gous to the word recognition score of the HINT (given HINT testing parameters of properly functioning cochlear implants set at normal settings, with no visual testing cues, in a quiet sound field, at 60 dB HL)
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That number is based on a 9 percent annual growth rate from 2012. In early clinical trials, to qualify for cochlear implants, adults were required to score 0 percent on open-set measures of sentence recognition, and children were required to demonstrate bilateral profound sensorineural hearing loss, as the outcomes with cochlear implants were unknown.
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For young children who are deaf or severely hard-of-hearing, using a cochlear implant exposes them to sounds during an optimal period for developing auditory speech and language skills. There is a growing body of literature demonstrating that children who receive cochlear implants before 12 months of age significantly outperform children who are implanted between 12 and 18 months on measures of language development, speech perception, and vocabulary as well as speech intelligibility (i.e., how well others are able to understand one's speech)
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CHARACTERISTICS OF SELECTED SENTENCE AND WORD TESTS Chapter 4 provides an overview of characteristics of selected speech tests that are commonly used to evaluate hearing loss in adults and children with cochlear implants, in addition to the HINT. Table S-2 briefly summarizes those tests and their reliability or other salient characteristics.
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Currently, adult patients without a cochlear implant meet the criteria in the Listings if they demonstrate an average air conduction hearing threshold of 90 dB or greater in the better ear and an average bone conduction hearing threshold of 60 dB or greater in the better ear (2.10A) , or if they demonstrate a word recognition score of 40 percent correct or
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Bamford-Kowal- 2005 Children Reliability of the BKB-SIN is related Bench Speech in and cochlear to the number of test items, age, and Noise (BKB-SIN) implant cochlear implant use.
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Test Pediatric Arizona 2014 Children The AzBio test lists produce equivalent Biomedical scores. Confidence intervals are (AzBio)
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As indicated previously, cochlear implants were not yet approved by FDA for use in patients with SSD or AHL when the current SSA guidelines were developed. Prior to approval of cochlear implants for SSD and AHL, indications for cochlear implants, like indications for disability, were based on the "best" hearing situation.
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Monosyllabic word recognition is also currently the standard for pediatric cochlear implant candidacy, and the field is moving toward use of a monosyllabic word recognition criterion for determining adult candidacy in the United States. Additionally, for more than two decades monosyllabic word recognition has been used to characterize post-operative outcomes for both adult and pediatric cochlear implant recipients.
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. The Statement of Task requests that the committee "identify and recommend generalized testing procedures and criteria for evaluating the level of functional hearing ability needed to make a disability determination in adults and children after cochlear implantation." Thus, based on standard clinical practice and the committee's professional judgment: The committee recommends using the following presentation level and standardized test setup: • 60 decibel sound pressure level using hearing technology recom mended for the individual that is functioning properly and adjusted to the individual's normal settings.
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Given that cochlear implants are currently the final step on the hearing health care continuum, the committee believes that should an individual with a cochlear implant continue to meet the criteria for cochlear implantation after they have been implanted with their device, they clearly have demonstrated that the cochlear implant has not provided significant benefit. As such, the cochlear implant recipient most likely has a disability related to hearing loss.
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Furthermore, the use of monosyllabic words is consistent with current clinical speech audiometry practice and is readily accessible. While it was not within the committee's scope of work, the committee notes as a consideration that additional information from self-report or parent-report questionnaires may be useful in better characterizing an individual's real-world communicative functioning.
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