Can Audiometric Configuration Predict Which Patients Derive Greater Speech Intelligibility Benefit from Hearing Aid Fitting?

Background: Although hearing aids improve audibility in patients with sensorineural hearing loss (SNHL), improvements in maximal speech intelligibility vary substantially among individuals, and reliable predictors of hearing aid benefit remain lacking. We investigated whether audiometric configuration predicts speech intelligibility benefit following hearing aid fitting in adults with moderate SNHL. Methods: In this retrospective cohort study, 351 adults with newly diagnosed moderate SNHL who were fitted with hearing aids between January 2017 and December 2021 at a tertiary referral center were classified as having down-sloping or flat hearing loss according to the difference between low- and high-frequency hearing thresholds. Speech intelligibility benefit was evaluated using the maximum word recognition score (WRSmax) before hearing aid fitting and at 1 month and 1 year after fitting. Results: Compared with patients with flat hearing loss, those with down-sloping hearing loss demonstrated greater immediate improvement in WRSmax at 1 month (10.43 [10.32] vs. 7.18 [9.44] percentage points, p = 0.004) and greater cumulative improvement at 1 year (11.00 [10.55] vs. 6.79 [11.79] percentage points, p = 0.020). These associations remained significant after adjustment for age and sex (B = 2.506, p = 0.024 and B = 3.792, p = 0.044, respectively). Conclusions: In adults with moderate sensorineural hearing loss, a down-sloping audiometric configuration was associated with greater improvement in speech intelligibility following HA fitting than a flat audiometric configuration.