The Referral Context
An 81-year-old patient presented with persistent difficulty understanding speech despite full-time use of hearing aids fitted two years prior. The hearing aids she was using had been supplied and fitted elsewhere. This was the patient’s first visit to Pindrop Hearing.
Her reported symptoms included:
- Muffled sound quality
- Poor speech clarity in background noise
- Difficulty following conversation in group settings
- Increased reliance on visual cues
- Reduced telephone comprehension
- Progressive social withdrawal
She had remained compliant with hearing aid use but experienced limited functional benefit.
This presentation raises an important clinical question: whether the deficit reflects progression of cochlear pathology, central processing limitations or remediable optimisation issues.
Diagnostic Findings
Pure tone audiometry confirmed a bilateral moderate-severe sensorineural hearing loss, consistent with presbycusis.
However, functional testing revealed the primary issue.
Speech discrimination testing in noise was performed both unaided and aided with the patient’s existing hearing aids.
Results demonstrated:
- Limited aided improvement in speech discrimination
- Persistent functional speech impairment despite amplification
- Inadequate real-world performance from existing devices
These findings confirmed that amplification had restored audibility but not functional speech understanding.
This distinction is critical, as pure tone thresholds alone do not reflect communicative function.
Intervention and Verification
The patient was fitted with:
- Phonak Infinio Sphere 90 hearing aids
- Custom C-Shell earmoulds to optimise acoustic coupling
- Advanced directional processing designed to improve signal-to-noise performance
Verification was performed using Real Ear Measurements (REM) to ensure precise prescriptive gain matching.
Technology selection and programming were guided specifically by functional speech performance requirements.
Functional Outcome
Repeat aided speech-in-noise testing demonstrated marked improvement in speech discrimination compared to both unaided and previously aided conditions.
This confirmed restoration of functional speech perception.
Subjectively, the patient reported:
“I have my life back now, Christina.”
This outcome reflects objective and clinically meaningful improvement in communicative ability.
Clinical Implications for ENT Practice
This case highlights several important considerations:
Persistent speech difficulty despite hearing aids does not necessarily indicate irreversible auditory limitation.
Suboptimal device selection, programming, or verification may significantly limit functional benefit.
Speech-in-noise testing is essential to differentiate between audibility and functional impairment
Patients may meet amplification targets but remain communicatively impaired.
Appropriate optimisation can deliver substantial improvement even in elderly patients with established sensorineural hearing loss
Functional deficits are often remediable with appropriate intervention.
When to Consider Referral
Referral for comprehensive audiological reassessment should be considered when patients report:
- Persistent difficulty understanding speech despite hearing aid use
- Dissatisfaction with hearing aid benefit
- Difficulty hearing in noise disproportionate to audiometric thresholds
- Progressive communicative impairment despite amplification
Specialist assessment including speech-in-noise testing and verified fitting can identify remediable causes and significantly improve patient outcomes.
Author: Christina Kourie, Clinical Audiologist – Harley Street and Chelsea Clinics, Pindrop Hearing
