Disease-specificity in correlations between speech audiometry, hearing-related quality of life, and varying calculation methods for pure tone average in middle ear diseases

PURPOSE: This study examined whether different methods for calculating pure tone average (PTA) yield clinically relevant differences in correlations with speech audiometry and hearing-related quality of life (QoL) in conductive and mixed hearing loss. Additionally, we investigated whether these associations vary among distinct middle ear pathologies: otosclerosis, acute otitis media (AOM) and chronic otitis media (COM). METHODS: In an ambispective cohort study at a tertiary referral center, 220 ears were analyzed. 194 ears were collected retrospectively. 26 patients were recruited prospectively. Inclusion criteria were adult age, confirmed diagnosis, near-normal bone conduction and conductive hearing loss without prior middle ear surgery. Pure-tone and Freiburg speech audiometry were analyzed along with the SSQ12 questionnaire in prospective patients. Multiple air conduction (AC) and air-bone gap (ABG) - PTA configurations were compared using linear regression and ANCOVA. RESULTS: up to 0.77). No clinically relevant differences were found between 4-frequency-PTAs using 3 kHz vs. 4 kHz. However, disease-specific patterns emerged: otosclerosis patients showed consistently poorer word recognition than AOM or COM patients at comparable PTA levels. QoL outcomes correlated significantly with AC-based PTAs but not with ABG-based PTAs or speech results. CONCLUSIONS: PTA calculation methods yield comparable correlations with speech understanding; inclusion of 3 or 4 kHz does not alter results meaningfully. Disease-specific discrepancies underscore the need for nuanced interpretation of PTA-speech relationships and support integrating both PTA and QoL measures in patient assessment. The study was conducted under clinical trial registration number DRKS00037758.