Long-Term Outcome of Cochlear Implantation in Children With Congenital, Perilingual, and Postlingual Single-Sided Deafness.

OBJECTIVES: We investigated the long-term outcomes of children with single-sided deafness (SSD) after cochlear implant (CI) surgery, during and after rehabilitation, and compared the results of children with congenital, perilingual, and postlingual SSD. We evaluated the impact of SSD at age at onset and duration of deafness on their performance. DESIGN: Thirty-six children with SSD treated with CI participated in the study: 20 had congenital, seven perilingual (defined: >0 to 4 years), and nine had postlingual deafness (defined as >4 years of age). Their outcome with CI were measured on both subjective and objective scales: duration of device use, speech intelligibility in noise and in quiet, bilateral hearing and localization ability, quality of life and hearing, presence and loudness of tinnitus, and hearing ability of the better hearing ear. RESULTS: After a mean follow-up time of 4.75 years, 32 of the 36 children used their CI on a regular basis. The remaining four children were nonusers. These children had congenital SSD and were older than three years at the time of CI surgery. Overall, for congenital/perilingual and postlingual SSD, speech intelligibility in noise and the Speech, Spatial and Qualities of Hearing Scale (SSQ) speech subscore were significantly improved, as were their subjective and objective localization ability and hearing-related quality of life. Children with postlingual SSD benefited from the CI with regard to speech intelligibility, SSQ speech/spatial/total score, and localization error, and children with congenital SSD showed better results with a short duration of deafness of less than 3 years compared with those with a longer deafness period. CONCLUSIONS: Cochlear implantation is a successful treatment for children with congenital/perilingual or postlingual SSD. Results largely differed with respect to the onset and duration of deafness, and better outcomes were achieved by children with postlingual SSD and with a short duration of deafness. Our data also confirmed that children with congenital SSD should be implanted with a CI within three years of age.

Auditory capacity of the better-hearing ear in asymmetric hearing loss.

PURPOSE: Our aim was to investigate the course of the hearing capacity of the better-hearing ear in single-sided deafness (SSD) and asymmetric hearing loss (AHL) over time, in a multicenter study. METHODS: We included 2086 pure-tone audiograms from 323 patients with SSD and AHL from four hospitals and 156 private practice otorhinolaryngologists. We collected: age, gender, etiology, duration of deafness, treatment with CI, number and monosyllabic speech recognition, numerical rating scale (NRS) of tinnitus intensity, and the tinnitus questionnaire according to Goebel and Hiller. We compared the pure tone audiogram of the better-hearing ear in patients with SSD with age- and gender-controlled hearing thresholds from ISO 7029:2017. RESULTS: First, individuals with SSD showed a significantly higher hearing threshold from 0.125 to 8 kHz in the better-hearing ear compared to the ISO 7029:2017. The duration of deafness of the poorer-hearing ear showed no relationship with the hearing threshold of the better-hearing ear. The hearing threshold was significantly higher in typically bilaterally presenting etiologies (chronic otitis media, otosclerosis, and congenital hearing loss), except for Menière's disease. Second, subjects that developed AHL did so in 5.19 ± 5.91 years and showed significant reduction in monosyllabic word and number recognition. CONCLUSIONS: Individuals with SSD show significantly poorer hearing in the better-hearing ear than individuals with NH from the ISO 7029:2017. In clinical practice, we should, therefore, inform our SSD patients that their disease is accompanied by a reduced hearing capacity on the contralateral side, especially in certain etiologies.

Prediction of postoperative speech comprehension with the transcutaneous partially implantable bone conduction hearing system Osia®.

BACKGROUND: The active transcutaneous, partially implantable osseointegrated bone conduction system Cochlear™ Osia® (Cochlear, Sydney, Australia) has been approved for use in German-speaking countries since April 2021. The Osia is indicated for patients either having conductive (CHL) or mixed hearing loss (MHL) with an average bone conduction (BC) hearing loss of 55 dB HL or less, or having single-sided deafness (SSD). OBJECTIVES: The aim of this retrospective study was to investigate the prediction of postoperative speech recognition with Osia® and to evaluate the speech recognition of patients with MHL and in particular an aided dynamic range of less than 30 dB with Osia®. MATERIALS AND METHODS: Between 2017 and 2022, 29 adult patients were fitted with the Osia®, 10 patients (11 ears) with CHL and 19 patients (25 ears) with MHL. MHL was subdivided into two groups: MHL­I with four-frequency pure-tone average in BC (BC-4PTA) ≥ 20 dB HL and < 40 dB HL (n = 15 patients; 20 ears) vs. MHL-II with BC-4PTA ≥ 40 dB HL (n = 4 patients; 5 ears). All patients tested a bone conduction hearing device on a softband preoperatively. Speech intelligibility in quiet was assessed preoperatively using the Freiburg monosyllabic test in unaided condition, with the trial BCHD preoperatively and with Osia® postoperatively with Osia®. The maximum word recognition score (mWRS) unaided and the word recognition score (WRS) with the test system at 65 dB SPL were correlated with the postoperative WRS with Osia® at 65 dB SPL. RESULTS: Preoperative prediction of postoperative outcome with Osia® was better using the mWRS than by the WRS at 65 dB SPL with the test device on the softband. Postoperative WRS was most predictive for patients with CHL and less predictable for patients with mixed hearing loss with BC-4PTA ≥ 40 dB HL. For the test device on a softband, the achievable outcome tended to a minimum, with the mWRS tending to predict the realistically achievable outcome. CONCLUSION: Osia® can be used for the treatment of CHL and MHL within the indication limits. The average preoperative bone conduction hearing threshold also provides an approximate estimate of the postoperative WRS with Osia®, for which the most accurate prediction is obtained using the preoperative mWRS. Prediction accuracy decreases from a BC-4PTA of ≥ 40 dB HL.

[Prediction of speech understanding with the transcutaneous partially implantable bone conduction hearing system Osia®. German Version]. / Vorhersage des postoperativen Sprachverstehens mit dem transkutanen teilimplantierbaren Knochenleitungshörsystem Osia®.

BACKGROUND: The active transcutaneous, partially implantable osseointegrated bone conduction system Cochlear™ Osia® (Cochlear, Sydney, Australia) has been approved for use in German-speaking countries since April 2021. The Osia is indicated for patients with conductive (CHL) or mixed hearing loss (MHL) with an average bone conduction (BC) hearing loss of 55 dB or less, or with single-sided deafness (SSD). OBJECTIVES: The aim of this retrospective study was to investigate the prediction of postoperative speech recognition with Osia and to evaluate the speech recognition of patients with MHL and an aided dynamic range of less than 30 dB with Osia. MATERIALS AND METHODS: Between 2017 and 2022, 29 adult patients were fitted with the Osia, 10 patients (11 ears) with CHL and 19 patients (21 ears) with MHL. MHL was subdivided into two groups: MHL­I with four-frequency pure-tone average in BC (BC-4PTA) ≥ 20 dB HL and < 40 dB HL (n = 15 patients; 20 ears) vs. MHL-II with BC-4PTA ≥ 40 dB HL (n = 4 patients; 5 ears). All patients tested a bone conduction hearing device on a softband preoperatively. Speech intelligibility in quiet was assessed preoperatively using the Freiburg monosyllabic test unaided and with the test system and postoperatively with Osia. The maximum monosyllabic score (mEV) unaided and the monosyllabic score with the test system at 65 dB SPL were correlated with the postoperative monosyllabic score with Osia at 65 dB SPL. RESULTS: Preoperative prediction of postoperative outcome with Osia was better using the mEV than the EV at 65 dB SPL with the test device on the softband. Postoperative EV was most predictive for patients with CHL and least predictive for patients with mixed hearing loss with 4PTA BC ≥ 40 dB HL. For the test device at softband, results tended to show the minimum achievable outcome and the mEV tended to predict the realistically achievable outcome. CONCLUSION: Osia can be used for the treatment of CHL and MHL within the indication limits. The average preoperative bone conduction hearing threshold also provides an approximate estimate of the postoperative EV with Osia, for which the most accurate prediction is obtained using the preoperative mEV. Prediction accuracy decreases from a BC-4PTA of ≥ 40 dB.

Binaural Integration of Spectrally Degraded Speech in Adult Cochlear Implant Recipients with Single-Sided Deafness.

INTRODUCTION: Our purpose was to investigate binaural integration for spectrally degraded speech in normal-hearing (NH) subjects, single-sided deafness (SSD) cochlear implant (CI) recipients, and bilateral deaf bilateral CI recipients. METHODS: We tested ten adult subjects in each group with a modified version of the binaural fusion test according to Matzker. Speech recognition was assessed for monotic listening with the better-hearing ear or CI, monotic listening with the poorer-hearing ear or CI, and dichotic listening. We employed two presentation modes: (1) low pass (LP)-filtered speech to the better ear or CI and high pass (HP)-filtered speech to the poorer ear or CI, and (2) LP-filtered speech to the poorer ear or CI and HP-filtered speech to the better ear or CI. Five magnitudes of LP and HP filtering, i.e., spectral degradation, for each presentation mode were applied yielding two spectrally overlapping and three nonoverlapping presentation conditions. Sentences from the Oldenburg Children's sentence test were applied to assess speech recognition. RESULTS: NH subjects, SSD CI recipients, and bilateral CI recipients were able to understand spectrally degraded speech under both monotic and dichotic listening conditions for both the presentation modes. Speech performance decreased with the increasing loss of spectral information in all the three subject groups. In the NH subjects, speech recognition scores significantly improved for dichotic compared with each monotic listening type under two spectrally nonoverlapping conditions. The SSD CI subjects showed a significant improvement in speech scores for dichotic listening compared with monotic listening with the NH ear under one nonoverlapping condition, i.e., a dichotic benefit in speech recognition with CI. We saw a dichotic benefit in the bilateral CI recipients who achieved significantly better speech scores for dichotic compared with monotic listening with the better CI in three nonoverlapping conditions. CONCLUSIONS: All the three groups (NH subjects, SSD CI recipients, and BiCI recipients) showed binaural integration for the side-separated presentation of spectrally degraded speech. Use of strictly side-separated dichotic stimulus presentation avoided the possible occurrence of physical effects such as the head shadow effect and therefore, confirmed the binaural benefit attributable to central binaural processing.

Neural activity of the auditory cortex predicts speech recognition of patients with asymmetric hearing loss after cochlear implantation.

Patients with asymmetric hearing loss show an asymmetry of glucose metabolism of the primary auditory cortex (PAC). We investigated whether this asymmetry could serve as an objective predictor for speech recognition with CI. Nine patients underwent 18FDG PET prior to CI surgery. Average normalized 18FDG uptake of 25% of voxels with highest uptake was calculated for the PAC employing a probabilistic atlas and cerebellar cortex as reference. Differences in glucose metabolism of the PAC were assessed by an asymmetry index (AI-PAC). We tested the correlation between outcome of CI surgery (6 months post implantation), AI-PAC and clinical predictors. Pre-operative AI-PAC showed a positive correlation with speech recognition with CI (significant for sentences and numbers; trend for monosyllabic words). With a pre-operative AI-PAC ≥ 4.2%, patients reached good CI outcome in sentence recognition of 59-90% and number recognition of 90-100% and less favorable CI outcome in monosyllabic word recognition of 25-45%. Age at symptom onset was significantly associated with all measures of speech recognition, while deafness duration was only associated with sentence recognition. AI-PAC allows for a reliable and quantitative pre-operative prediction of early improvement in speech recognition after CI. 18FDG PET may be a valuable addition to the objective pre-operative assessment of CI candidates. Further studies in larger cohorts and with longer follow-up times are needed.

Bone-anchored hearing system, contralateral routing of signals hearing aid or cochlear implant: what is best in single-sided deafness?

PURPOSE: The aim of the study was to compare long-term results after 1 year in patients with single-sided deafness (SSD) who were fitted with different hearing aids. The participants tested contralateral routing of signals (CROS) hearing aids and bone-anchored hearing systems (BAHS). They were also informed about the possibility of a cochlear implant (CI) and chose one of the three devices. We also investigated which factors influenced the choice of device. METHODS: Prospective study with 89 SSD participants who were divided into three groups by choosing BAHS, CROS, or CI. All participants received test batteries with both objective hearing tests (speech perception in noise and sound localisation) and subjective questionnaires. RESULTS: 16 participants opted for BAHS-, 13 for CROS- and 30 for CI-treatment. The greater the subjective impairment caused by SSD, the more likely patients were to opt for surgical treatment (BAHS or CI). The best results in terms of speech perception in noise (especially when sound reaches the deaf ear and noise the hearing ear), sound localization, and subjective results were achieved with CI. CONCLUSION: The best results regarding the therapy of SSD are achieved with a CI, followed by BAHS. This was evident both in objective tests and in the subjective questionnaires. Nevertheless, an individual decision is required in each case as to which SSD therapy option is best for the patient. Above all, the patient's subjective impairment and expectations should be included in the decision-making process.

Long-term data of the new transcutaneous partially implantable bone conduction hearing system Osia®.

PURPOSE: The new active transcutaneous partially implantable osseointegrated system Cochlear™ Osia® System is indicated in case of conductive or mixed hearing loss (CHL/MHL) with a maximum average bone conduction hearing loss of 55 dB, or in single-sided deafness (SSD). The implant directly stimulates the bone via a piezoelectric transducer and is directed by an external sound processor. We conducted a monocentric retrospective longitudinal within-subject clinical study at our tertiary academic referral center. The aim was to investigate long-term data (2017-2021) on audiological outcomes and hearing-related quality of life for the Osia system. METHODS: Between 2017 and 2020, 22 adults (18: CHL/MHL; 3: SSD) were implanted with the Osia100 implant; seven received bilateral implants. As of 10/2020, the sound processor was upgraded to Osia 2. RESULTS: Mean Osia system use by 04/2021 was 30.9 ± 8.6 months (range 17-40 months). Unaided bone conduction thresholds were unchanged postoperatively. One patient had to be explanted because of prolonged wound infection. Aided hearing thresholds were significantly lower compared to the unaided thresholds preoperatively, along with a marked increase in speech recognition in quiet. Speech processor upgrade resulted in a stable benefit. Patients with CHL/MHL and SSD showed a similar improvement in self-rated hearing performance revealed by SSQ, APHAB, and HUI questionnaires. CONCLUSION: The Osia system is a safe, effective and sustainable option for treatment of conductive and mixed hearing loss or single-sided deafness.

[Establishing an ORL virtual outpatient Dept. during the COVID-19 pandemic]. / Erstellung einer virtuellen HNO-Ambulanz in der Lehre während der COVID-19-Pandemie.

INTRODUCTION: The COVID-19 pandemic changed medical education: teaching has been mostly converted to online mode. Our aim is to offer a complete high-quality curriculum despite the fact of worldwide cutbacks in education. METHODS: The department of otorhinolaryngology introduced case-based learning (CBL). CBL is a learning and teaching approach that prepares students for clinical practice through the use of authentic clinical cases and places them in the role of decision maker. CBL combines theory and practice to prepare students as good as possible without intern shadowing. The students were asked to evaluate CBL as a digital format and as a teaching tool for future clinical work and preparation for the ORL exam. RESULTS: The majority of students (>90%) rated the CBL as a successful digital format. Most students also strongly agreed or agreed that CBL is a good preparation for their future clinical work (>90%) and the ORL exam (>80%). 100% of students CBL confirmed, that they learned something new. CONCLUSION: Following successful introduction of CBL we will implement a new teaching format. The "ORL virtual outpatient Dept." will include information from virtual, anonymized case studies. We choose diagnosis included in the "ORL virtual outpatient Dept." according to the most common ORL disorders encountered by primary care physicians. The "ORL virtual outpatient Dept." can only bridge the absence of practical training, and, in the future, serve as an additional preparation.

PET/CT background noise and its effect on speech recognition.

Positron emission tomography (PET) has been successfully used to investigate central nervous processes, including the central auditory pathway. Unlike early water-cooled PET-scanners, novel PET/CT scanners employ air cooling and include a CT system, both of which result in higher background noise levels. In the present study, we describe the background noise generated by two state-of-the-art air-cooled PET/CT scanners. We measured speech recognition in background noise: recorded PET noise and a speech-shaped noise applied in clinical routine to subjects with normal hearing. Background noise produced by air-cooled PET/CT is considerable: 75.1 dB SPL (64.5 dB(A)) for the Philips Gemini TF64 and 76.9 dB SPL (68.4 dB(A)) for the Philips Vereos PET/CT (Philips Healthcare, The Netherlands). Subjects with normal hearing exhibited better speech recognition in recorded PET background noise compared with clinically applied speech-shaped noise. Speech recognition in both background noises correlated significantly. Background noise generated by PET/CT scanners should be considered when PET is used for the investigation of the central auditory pathway. Speech in PET noise is better than in speech-shaped noise because of the minor masking effect of the background noise of the PET/CT.

Collateral damage of the COVID-19 pandemic: an alarming decline in critical procedures in otorhinolaryngology in a German university hospital.

PURPOSE: The COVID-19 pandemic has a major impact on the diagnosis and treatment of ENT patients. The aim of this study was to analyze the influence of the pandemic on the number of otolaryngological procedures, particularly for critical diagnoses with potential negative effects due to prolonged symptom duration. METHODS: We evaluated 10,716 surgical procedures between January 1, 2018 and May 31, 2020, focusing on the 16-week period around March 16, 2020, which includes 1080 observations. We further analyzed subsets of critical procedures. RESULTS: We found a decline in critical procedures by 43% although no critical procedures were postponed by the hospital. Meanwhile, the share of critical procedures increased up to 90% caused by the cancellation of elective surgery. Especially worrisome was that diagnostic procedures for suspected malignancies decreased by 41% during the pandemic. CONCLUSION: The decline in critical procedures in otorhinolaryngology as collateral damage of the COVID-19 pandemic is considerable and therefore alarming.

Is the cochlear implant a successful long-term solution for single-sided deaf and asymmetric hearing-impaired patients?

PURPOSE: We investigated the long-term results of cochlear implant (CI) recipients with asymmetric hearing loss (AHL) or single-sided deafness (SSD). We focused on wearing behavior, audiometric hearing rehabilitation, and subjective benefits of the CI. CI is expected to improve audiological results, subjective hearing perception, and tinnitus burden. METHODS: Speech recognition in background noise and sound localization were assessed preoperatively and after at least six years of CI experience. Validated questionnaires determined the subjective benefit of CI use and the subjective evaluation of tinnitus. RESULTS: Over 80% of the included AHL and SSD CI recipients used their CI between 6 and 10 h daily; four subjects with SSD were non-users. Speech recognition in background noise and sound localization improved significantly compared with the unaided preoperative situation. Additionally, CI improved subjective speech intelligibility and spatial hearing impression while reducing tinnitus burden. CONCLUSION: Subjects with AHL and SSD benefit from CI, subjectively and audiologically. Cochlear implant is a successful long-term treatment for AHL and SSD.

Comparison of Speech Recognition and Localization Ability in Single-sided Deaf Patients Implanted With Different Cochlear Implant Electrode Array Designs.

OBJECTIVE: Choice of electrode array (EA) design and differences in outcome are major concerns both to patients with single-sided deafness (SSD) and to surgeons before cochlear implant (CI) surgery. The present work investigates the effects of EA design on 1) insertion depths, and 2) audiological outcomes of SSD CI recipients. STUDY DESIGN: Retrospective study. SETTING: Tertiary academic center. PATIENTS: Forty patients with acquired SSD matched according to duration of deafness MAIN OUTCOME MEASURES:: Fourteen CI recipients were implanted with a perimodiolar electrode (cochlear perimodiolar [CPM]), 12 with a shorter lateral wall electrode (cochlear lateral wall [CLW]), and 14 with a longer lateral wall electrode array (medEl lateral wall [MLW]). Postoperative rotational tomography was evaluated to determine cochlear size and EA angle of insertion depth (AID). Binaural speech comprehension in noise (in three configuration presentations) and localization ability were assessed 12 months postoperatively with CI. RESULTS: AID was significantly deeper in MLW (mean 527.94 degrees) compared with the CPM (mean 366.35 degrees) and CLW groups (mean 367.01 degrees). No significant difference in AID was seen between the CPM and CLW groups (difference 0.66 degrees). Cochlear sizes revealed no significant differences between any groups. All three groups showed significant improvement in head shadow effect (difference on average CPM: 6.3 dB SPL, CLW 5 dB SPL, and MLW 4.05 dB SPL) and localization ability at 12 months postoperatively (difference on average CPM: 19.72 degrees, CLW: 24 degrees, and MLW: 12.9 degrees). No significant difference in the extent of audiological benefit was observed between any groups. CONCLUSION: No effect on binaural benefit was apparent from the selection of the three EA designs in SSD CI recipients. Further studies focusing on subjective results, sound quality, and music perception depending on EA design in SSD CI recipients are needed.

Long-term results of cochlear implantation in children with congenital single-sided deafness.

PURPOSE: The purpose of this retrospective study was to investigate the outcome and critical age of cochlear implantation in congenital single-sided deafness (SSD). METHODS: 11 children with congenital SSD were implanted with a cochlear implant (CI). Auditory performance was measured through the results of speech discrimination, subjective assessment by the Categories of auditory performance (CAP) score, the Speech, Spatial and Qualities scale questionnaire (SSQ) and the German version of the IOI-HA [Internationales Inventar zur Evaluation von Hörgeräten (IIEH, version for CI)]. RESULTS: Long-term follow-up [median: 3 years and 5 months (3;5 years)] revealed that nine children use their CI (> 8 h/day) and two became nonusers. In children aged below 3;2 years at surgery, there was a substantial long-term increase in speech discrimination and subjective benefit. Children over 4;4 years of age at CI surgery improved partially in audiological/subjective measurements. Among children above 5 years, the SSQ score did not improve despite further slight improvement in speech discrimination long-term. CONCLUSION: Our data suggest a critical age for CI surgery below 3 years in children with congenital SSD for successful hearing rehabilitation. It is mandatory to identify children with SSD as early as bilaterally deaf children.

Binaural Hearing Rehabilitation Improves Speech Perception, Quality of Life, Tinnitus Distress, and Psychological Comorbidities.

OBJECTIVES: To determine and compare the benefit of binaural hearing rehabilitation via cochlear implantation (CI) on speech perception, assessment of auditory abilities, tinnitus distress, health-related quality of life (HRQoL) and psychological comorbidities in patients suffering from asymmetric hearing loss (AHL) as well as bilaterally-deafened and sequentially bilaterally-implanted patients. METHODS: 53 patients were implanted between 2011 and 2016. 24 AHL patients were implanted unilaterally, using a hearing aid on the other side. 29 bilaterally-deafened patients were sequentially implanted bilaterally. Speech perception, subjective hearing quality, HRQoL, tinnitus distress, anxiety, depressiveness, perceived stress level and coping abilities were evaluated before implantation, as well as 6 and 24 months postoperatively. RESULTS: Before CI, AHL and bilaterally-deaf patients showed significant differences regarding assessment of auditory abilities, speech discrimination, tinnitus distress and HRQoL. 24 months after CI both groups significantly improved in those scales. We could not find a significant difference between the groups after 2 years. Tinnitus distress significantly decreased 6 and 24 months postoperatively in both groups. CONCLUSIONS: This study demonstrates the long-term benefit of binaural hearing rehabilitation in AHL and bilaterally-deaf patients not only regarding speech perception but also HRQoL, tinnitus distress and subjective hearing quality. Bilaterally-deafened patients present lower scores preoperatively, but they did not differ from AHL patients 2 years after CI. Up to now, this is the first study evaluating the outcome of CI in AHL patients compared to bilaterally-implanted patients and demonstrating the benefit of binaural hearing rehabilitation in these specific groups.

Application of Digital Remote Wireless Microphone Technology in Single-Sided Deaf Cochlear Implant Recipients.

BACKGROUND: Previous research showed benefits of remote wireless technology in bilaterally moderate- to-severe hearing-impaired participants provided with hearing aid(s), cochlear implant(s) (CIs), or bimodal devices as well as in single-sided deaf (SSD) cochlear implant recipients (with CI from Cochlear™) and normal-hearing (NH) participants. PURPOSE: To evaluate the effect of the digital remote wireless microphone system, Roger™, on speech recognition at different levels of multisource noise in SSD CI recipients using MED-EL CI sound processor OPUS 2. Outcomes were assessed as a function of the listening condition (NH only, NH + CI, NH + CIRog, NHRog + CI, and NHRog + CIRog), Roger™ receiver type (Roger™ Focus for NH; Roger™ Xand Roger™ MyLink for CI) and accessory mixing ratio. STUDY SAMPLE: Eleven adult, SSD participants aided with CI from MED-EL. DATA COLLECTION AND ANALYSIS: Speech recognition in noise was assessed in two no-Roger™ conditions, one Roger™ X condition, and two Roger™ MyLink conditions. For the Roger™ X and no-Roger™ conditions, speech recognition was tested at 60.3 dB(A) with the Oldenburg Sentence Test in classroom noise at levels of 55, 65, and 75 dB(A). For the two Roger™ MyLink conditions, speech recognition at 60.3 dB(A) was measured at a noise level of 75 dB(A). Roger™ X was assessed with an accessory mixing ratio of 1:1 (summation of unattenuated microphone and audio accessory input). For Roger™ MyLink, two accessory mixing ratios were investigated, MT (1:1, summation of unattenuated microphone and telecoil input) and T with maximum attenuation of microphone input. RESULTS: Speech recognition at higher noise levels (65 and 75 dB(A)) improved significantly with Roger™ in both unilateral use conditions (NH + CIRog and NHRog + CI) as well as bilateral use condition (NHRog + CIRog). Both the bilateral application of Roger™ and the unilateral Roger™ application on the NH ear outperformed the Roger™ application on CI alone. There was no statistically significant effect of type of CI Roger™ receiver (Roger™ X or Roger™ MyLink) and the accessory mixing ratio (MT or T) on speech recognition. CONCLUSIONS: Speech recognition for distant speakers in multisource noise improved significantly with the application of Roger™ in SSD CI recipients. Both the unilateral Roger™ application on the NH ear or the CI as well as the bilateral Roger™ application can be recommended.