Determinants of poor speech discrimination in a primary care otolaryngology population: a retrospective observational study

Background Hearing loss is highly prevalent among adults and is a major contributor to communication difficulties, particularly in older populations. Pure-tone audiometry (PTA) is routinely used to assess hearing sensitivity; however, threshold measurements alone may not fully reflect functional speech understanding. This study aimed to evaluate speech discrimination performance in a primary care otolaryngology population and to identify baseline factors associated with poor speech discrimination. Methods This retrospective observational study included patients who underwent PTA and word recognition score (WRS) testing at a primary care otolaryngology clinic between September 1, 2025, and January 20, 2026. Hearing levels were classified according to the World Health Organization (WHO) grading system based on better ear PTA. Poor speech discrimination was defined as better-ear WRS < 70%. Multivariable logistic regression analysis was performed to identify factors associated with poor speech discrimination. Results A total of 503 patients were included, with a median age of 50 years (interquartile range [IQR], 35–63), and 43.7% were male. Twenty patients were excluded from hearing grade analyses due to invalid audiometric results. Poor speech discrimination was observed in 43 patients (8.9%). In multivariable analysis, higher better ear PTA (odds ratio [OR], 1.12 per 1-dB increase; 95% confidence interval [CI], 1.07–1.17; p < 0.001) and older age (OR, 1.09 per 1-year increase; 95% CI, 1.03–1.15; p = 0.003) were independently associated with poor speech discrimination. Sex, noise exposure, and systemic comorbidities were not significantly associated with speech discrimination outcomes. Conclusions In a primary care otolaryngology population, poor speech discrimination is primarily driven by hearing threshold severity and age rather than by systemic comorbidities. Routine assessment of speech discrimination in addition to PTA may improve identification of patients at risk for functional communication impairment and facilitate earlier intervention.