Predictive Accuracy of Softband Simulation for Postoperative Hearing with Bone Conduction Devices

Background: Bone conduction devices (BCDs) are used to rehabilitate conductive hearing loss, mixed hearing loss, and single-sided deafness. Preoperative softband simulation is commonly used to estimate expected postoperative benefit; however, its predictive accuracy is uncertain. Purpose: To determine how accurately preoperative softband simulation predicts postoperative audiological outcomes after BCD implantation. Research Design: This retrospective paired-control study compared preoperative softband performance with postoperative implanted BCD outcomes. Study Sample: This study included 19 patients with conductive hearing loss, mixed hearing loss, or single-sided deafness who underwent both preoperative softband simulation and postoperative audiological testing at a tertiary academic medical center. Intervention: Patients completed preoperative testing using softband-mounted sound processors and postoperative testing using their implanted BCD device. Data Collection and Analysis: Pure-tone average (PTA), consonant-nucleus-consonant (CNC) word recognition, and Quick Speech-in-Noise (QuickSIN) scores were collected preoperatively and postoperatively. Paired t tests or Wilcoxon signed-rank tests evaluated group differences. Predictive accuracy was assessed with Spearman correlation coefficients and intraclass correlation coefficients (ICCs). Results: Softband PTA significantly overestimated postoperative thresholds (mean difference = 5.8 dB HL; p = 0.023), and softband PTA was not significantly correlated with postoperative PTA (ρ = 0.43; p = 0.069). Agreement was poor (ICC = 0.28). Postoperative CNC word recognition scores were significantly higher than preoperative softband scores (mean difference = 7.5 percent; p = 0.034), and a strong correlation was observed between preoperative and postoperative performance (ρ = 0.67; p = 0.003). QuickSIN scores did not differ significantly and did not demonstrate a correlation. Conclusions: Softband simulation underestimates average postoperative improvement in hearing thresholds and speech discrimination after BCD implantation. Among individual predictors, preoperative simulated CNC scores approximate postoperative performance more closely than pure-tone thresholds, whereas PTA predictions show poor agreement. Clinical Relevance Statement: Softband simulation is widely used in counseling, but its predictive accuracy varies. These findings suggest that clinicians should place greater emphasis on speech-based testing rather than pure-tone thresholds when using softband results to guide patient expectations and preoperative decision-making. An improved understanding of softband limitations may enhance counseling and support to enable more accurate preparation for BCD outcomes.