The Effect of Real Ear Target Deviations on SSQ and Speech Intelligibility in a Clinical Population.
Simon E Lansbergen, Gertjan Dingemanse, Niek J Versfeld and 2 others
PMID 41553816WHAT IT FOUND
Hearing aids improved both speech scores and patient-reported outcomes.
High-frequency under-amplification was linked to smaller gains in self-reported benefit, but did not predict speech recognition in quiet. Closer matching to targets above 4 kHz may help patients feel the difference, though the effect is modest.
Key findings
01High-frequency deviations from the NAL-NL2 target (RTD2) were significantly associated with reduced improvement in self-reported hearing ability (SSQ scores), though the effect size was small.
02Deviations from the NAL-NL2 target did not predict aided speech intelligibility in quiet; this outcome was instead driven by the interaction between hearing aid use and pure-tone average.
03Fittings generally met the ±5 dB tolerance window at frequencies up to 2 kHz, but high-frequency targets (4 and 8 kHz) were frequently missed due to under-amplification.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was retrospective and single-center, with a population referred to a tertiary center, meaning patients likely had more complex or severe hearing loss than community samples. Hearing aid selection, initial programming, and interim fine-tuning were not standardized or fully documented, introducing uncontrolled variability. REM data reflected 'as-worn' settings rather than optimized REM-guided fits, so the study observes associations rather than testing the efficacy of REM verification. Unaided and aided speech intelligibility were measured at different levels (SRT+10 dB vs. 55 dB SPL), which influenced the observed interaction between treatment and hearing loss severity. No established Minimal Clinically Important Difference (MCID) exists for the SSQ short form, making it difficult to judge whether the small statistical effects are clinically meaningful for individual patients.
Declared interests
The authors declared no potential conflicts of interest and received no financial support for the research.
The easy way to misread this
Do not interpret the lack of association between REM deviations and speech intelligibility in quiet as evidence that high-frequency fitting is irrelevant. The study found that high-frequency under-amplification did reduce patient-reported benefit, and the authors suggest high-frequency audibility may matter more in complex listening situations like noise, which were not tested here.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →