What question did this study set out to answer?

This research aims to determine the relationship between real-ear target deviations and changes in SSQ scores and speech intelligibility in adults.

January 21, 2026Open Access

The Effect of Real Ear Target Deviations on SSQ and Speech Intelligibility in a Clinical Population

Puntos clave

This research aims to determine the relationship between real-ear target deviations and changes in SSQ scores and speech intelligibility in adults.
Analyzed data from 298 adults fitted with new or replacement hearing aids.
Conducted baseline and follow-up measures including unaided/aided speech recognition and SSQ scores.
Used Principal Components Analysis to summarize real-ear-to-target differences into overall gain and high-frequency gain.
Employed mixed-effects models to investigate various factors affecting speech and SSQ scores.
Hearing-aid use improved SSQ scores by an average of 1.4 points and aided speech recognition in quiet.
Real-ear target deviations did not significantly predict SSQ or speech scores.
Higher pure-tone average and steeper audiogram slopes were linked to lower speech scores.
Age and pure-tone average negatively influenced SSQ score improvements.

Resumen

The quality of hearing-aid (HA) fitting is typically evaluated using speech intelligibility tests and/or Real-Ear Measurements (REMs). Although it is assumed that a better fit improves daily outcomes, supporting evidence is inconclusive. This study examined whether deviations from National Acoustic Laboratories Non-Linear (NAL-NL2) real-ear targets (real-ear-to-target difference, RTD) predicted changes in Speech, Spatial, and Qualities of Hearing Scale (SSQ) scores, and whether they related to aided speech recognition in quiet. The effects of hearing loss and patient characteristics were also considered. Data from 298 adults (mean age 65 years) fitted with new or replacement HAs (66%) were analyzed. Baseline measures included unaided speech recognition in quiet and a 17-item SSQ; follow-up measures included aided speech recognition in quiet, RTDs, and the SSQ. Principal Components Analysis summarized RTDs into overall gain (RTD 1 ) and high-frequency gain (RTD 2 ). The effects of treatment, RTD, pure-tone average (PTA), audiogram slope, asymmetry, age, gender, and HA experience on SSQ scores were investigated with mixed-effects models. Hearing-aid use improved both SSQ score (by 1.4 points) and speech in quiet. The RTD 1 predicted neither SSQ nor speech scores. Underamplification above 2 kHz (RTD 2 ) did not influence speech scores significantly, but reduced SSQ improvement. Higher PTA and steeper slopes were associated with lower aided speech scores, while higher PTA and age reduced SSQ improvement. Hearing-aid experience showed modest SSQ-domain effects. About half of SSQ variance reflected between-subject differences. HAs provide substantial benefit, despite moderate NAL-NL2 mismatches. Accurate 4–8 kHz fittings maximize outcomes by the SSQ, supporting REM-guided fitting practices.

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