Hearing and Balance in Healthy Aging Project: Characterization of Hearing, Balance, and Other Associated Disorders in Three Population Groups Aged 55 and Over.

INTRODUCTION: Active aging emphasizes optimizing health and participation for a better quality of life as people age. This paper explores the significant impact of hearing loss and balance disorders on the elderly. Age-related hearing loss is thought to contribute to communication breakdown and cognitive dysfunctions. The "hearing and balance in healthy aging" project focuses on early detection, mitigation, and advocacy. Objectives include exploring epidemiological traits, evaluating overall well-being impact, proving positive intervention effects, and advocating societal care for the elderly with hearing loss and balance disorders, aiming to reduce their broader impact on cognition, independence, and sociability. METHODS: This study is observational, prospective study. Subjects over 55 years old with a follow-up every year or every 2 years were divided into three groups, according to their hearing and balance: within the normal range (group A), detected and not treated (group B), and detected and treated (group C). At each visit, they underwent a series of tests or questionnaires, evaluating different areas: hearing, balance, cognition, depression, dependence, tinnitus, loneliness, health. RESULTS: A total of 710 patients were included in the study. The distribution of patients was as follows: group A - 210 patients, group B - 302 patients, and group C - 198 patients. Significant differences were found between the three groups related to age, sex, educational level, bilingualism, and work activity. In group C, there was a higher percentage of males, older than in groups A and B, and the percentage of individuals with a university education was lower (28%), as was the rate of bilingualism (23%). In terms of hearing, significant differences were found in the three groups in the mean PTA, speech discrimination in quiet, and the HINT test, with worse results for group C. Only patients in group C presented a perception of hearing impairment, and the handicap caused by hearing impairment worsened from group A to C. Concerning balance, both tests performed (TuGT and DHI) revealed increased difficulty in maintaining autonomous walking from group A to C, which, again, exhibited the worst results, with statistically significant differences across the group. Analysis about cognition revealed significant differences in DSST questionnaires and in TMT scores, where group C had the worst scores. In HUI3 questionnaire scores, the differences between each and every group were statistically significant, with group C showing moderate disability. CONCLUSION: This extensive analysis, encompassing a considerable number of subjects, reveals significant findings that have important implications for the early prevention of hearing loss and its consequent consequences. At the same time, these data represent an initial exploration, which raises the need for in-depth examinations of additional factors and longer follow-up to continue contributing insights and knowledge for a healthy aging.

Evaluation of a Transimpedance Matrix Algorithm to Detect Anomalous Cochlear Implant Electrode Position.

INTRODUCTION: Transimpedance measurements from cochlear implant electrodes have the potential to identify anomalous electrode array placement, such as tip fold-over (TFO) or fold-back, basal electrode kinking, or buckling. Analysing transimpedance may thus replace intraoperative or post-operative radiological imaging to detect any potential misplacements. A transimpedance algorithm was previously developed to detect deviations from a normal electrode position with the aim of intraoperatively detecting TFO. The algorithm had been calibrated on 35 forced, tip folded electrode arrays in six temporal bones to determine the threshold criterion required to achieve a sensitivity of 100%. Our primary objective here was to estimate the specificity of this TFO algorithm in patients, in a prospective study, for a series of electrode arrays shown to be normally inserted by post-operative imaging. METHODS: Intracochlear voltages were intraoperatively recorded for 157 ears, using Cochlear's Custom Sound™ EP 5 electrophysiological software (Cochlear Ltd., Sydney, NSW, Australia), for both Nucleus® CI512 and CI532 electrode arrays. The algorithm analysed the recorded 22 × 22 transimpedance matrix (TIM) and results were displayed as a heatmap intraoperatively, only visible to the technician in the operating theatre. After all clinical data were collected, the algorithm was evaluated on the bench. The algorithm measures the transimpedance gradients and corresponding phase angles (θ) throughout the TIM and calculates the gradient phase range. If this was greater than the predetermined threshold, the algorithm classified the electrode array insertion as having a TFO. RESULTS: Five ears had no intraoperative TIM and four anomalous matrices were identified from heatmaps and removed from the specificity analysis. Using the 148 remaining data sets (n = 103 CI532 and n = 45 CI512), the algorithm had an average specificity of 98.6% (95.80%-99.75%). CONCLUSION: The algorithm was found to be an effective screening tool for the identification of TFOs. Its specificity was within acceptable levels and resulted in a positive predictive value of 76%, with an estimated incidence of fold-over of 4% in perimodiolar arrays. This would mean 3 out of 4 cases flagged as a fold-over would be correctly identified by the algorithm, with the other being a false positive. The measurements were applied easily in theatre allowing it to be used as a routine clinical tool for confirming correct electrode placement.

Realistic Environment Audiometric Booth: Development and Clinical Validation.

BACKGROUND: Technological developments to treat hearing loss with different types of hearing aids and auditory implants have improved the auditory perception of patients, particularly in highly complex listening conditions. These devices can be fitted and adapted to enhance speech perception. Audiological tests that assess hearing with and without auditory devices have traditionally taken place in sound-attenuated audiometric booths. Although the insights gained from these tests are extremely useful, they do not accurately reflect everyday listening situations, and accurate information about the potential benefits of the hearing device in real acoustic scenarios cannot be established. Consequently, it is difficult to optimize this technology since fitting cannot be customized. OBJECTIVES: The aim of this study was to validate an audiological testing method using a new development, the Realistic Environment Audiometric Booth (REAB), in clinical practice. MATERIALS: We used specifically designed software to perform audiological tests in an 8 m2 sound-attenuated booth. The REAB was designed to conduct audiological tests in standard testing conditions and in new hearing scenarios that simulate real-life situations since sound can be emitted simultaneously or alternately 360° around the patient, along with 3D images. METHODS: Prospective study in which subjects were tested randomly in the REAB and the conventional booth (CB) in free field. RESULTS: 150 subjects were recruited, mean age 56 ± 20.7 years. Auditory outcomes for pure-tone audiometry showed a high correlation; this was also the case for speech audiometries in quiet and in noise. The outcome of the new scenarios with real-life noise was plotted, including the mean values and their confidence intervals. A decreasing trend was observed in the results obtained by the different groups, according to their hearing levels. CONCLUSIONS: We have developed and validated a new audiological testing method that enables hearing ability to be assessed in listening conditions similar to those found in real life. The REAB complements the tests performed in CBs, thereby aiding the diagnostic process by reproducing acoustic and visual scenarios that conventional tests do not offer.

Comparative study of two different perimodiolar and a straight cochlear implant electrode array: surgical and audiological outcomes.

PURPOSE: To compare the surgical and audiological outcomes with two perimodiolar electrode arrays (Nucleus 512-Contour Advance® y Nucleus 532-Slim Perimodiolar®) and a straight electrode array (Nucleus 422/522). METHODS: Patients were retrospectively selected from our cochlear implant program database. Only patients with a history of bilateral, sensorineural postlingually profound hearing loss who underwent cochlear implant surgery with either a N512, a N532 or a N422 were included. Throughout a year of follow-up, pure tone audiometry (PTA), speech perception, Impedances and T-C Thresholds levels were analyzed. Surgical data were also analyzed. RESULTS: 66 patients were included (19-CI532, 20-CI512 and 27-CI422). The most common type of cochlea access with the N532, N512 and N422 was through an extended round window, a promontorial cochleostomy and a pure round window, respectively. No significant differences were observed after 12 months in Mean PTA and Speech recognition. No significant differences were seen in the levels of hearing preservation at frequencies of 250 and 500. The average values of the impedances were significantly higher in the CI group N532 and N422 than in the N512. The mean values of the T and C levels were significantly lower in the CI groups N532 and N422 compared with the N512. CONCLUSIONS: No significant differences were observed after 12 months in Mean PTA and Speech recognition; however, a faster acquisition of auditory results were observed in the group of patients treated with the CI N532. The type of electrode array influences in the type of cochleostomy.

Quality of life outcomes for cochlear implantation in the elderly.

OBJECTIVES: To determine whether individuals older than 60 years of age suffering from profound, bilateral, sensorineural hearing loss and unable to use hearing aids can benefit from a cochlear implant in order to improve hearing performance. Additionally, to evaluate how they manage the external components of their implanted system. MATERIALS AND METHODS: The records of 68 cochlear implant users over 60 years of age were reviewed. They had undergone tonal and speech audiometry evaluations of hearing before and after implantation. A subset of 27 elderly patients were asked to respond to a specially designed questionnaire regarding the use of the external components of the implanted system. RESULTS: Patients over 60 years of age benefit from cochlear implants. The earlier the implantation, the better the results tend to be. Certain limitations when using the external components of the implanted system were evident among the elderly. CONCLUSIONS: People >60 years of age suffering from profound, bilateral, sensorineural hearing loss show improved hearing performance following cochlear implantation. Using the implanted system includes some limitations that should be studied and overcome.

Update and validation of the early word perception test in the Spanish language.

INTRODUCTION: It is extremely important to assess speech perception skills in children with hearing loss, since these skills are essential to guide the rehabilitation process. OBJECTIVE: Update and validate the Early Speech Perception test in Spanish in normal-hearing children. METHOD: Different drawings were selected from children's books used daily in the work of teachers and speech therapists. 69 children aged between 3 and 8 years old participated in the study, divided into 6 groups by age (group 1, 3 years of age (n = 13); group 2, 4 years of age (n = 15); group 3, 5 years of age (n = 12); group 4, 6 years of age (n = 8); group 5, 7 years of age (n = 10); group 6, 8 years of age (n = 11)). For each category of the test, the children had to name and point to the corresponding drawing. RESULTS: The difference between age and gender groups was statistically evaluated. For the naming phase, a significant difference was observed between groups 1 and group 5; and between group 1 and group 6. For the pointing phase there was no difference between the groups, and in all groups, there was a score greater than 98%. In relation to gender, there was no difference between the groups. CONCLUSION: The present study demonstrates that the material developed to assess auditory reception in normal-hearing children from 3 to 8 years old is appropriate.

Early Detection of Hearing Loss among the Elderly.

BACKGROUND: Age-related hearing loss (ARHL) is a complex communication disorder that affects the cochlea and central auditory pathway. The goal of this study is to characterize this type of hearing loss and to identify non-invasive, inexpensive, and quick tests to detect ARHL among elderly adults, seeking to preserve quality of life and reduce the burden on healthcare systems. METHODS: An observational, prospective study is conducted with >55-year-old subjects divided into the following groups: normal range (Group A), detected but not treated (Group B), and detected and treated (Group C). During follow-up, Speech Spatial Qualities (SSQ12), and Hearing Handicap Inventory in the Elderly Screening test (HHIE-S) questionnaires were assessed, along with hearing levels (hearing thresholds at 4 kHz were studied in more depth), and a series of tests and questionnaires to assess balance, cognitive level, level of dependence, and depression. RESULTS: A total of 710 patients were included in this study. The duration of hearing loss (11.8 yr. in Group B and 21.0 yr. in Group C) and average time-to-treatment for Group C (14.1 yr.) are both protracted. Both of the used questionnaires show statistically significant differences among the groups, revealing greater handicaps for Group C. Audiometry performed at 4 kHz shows how hearing loss progresses with age, finding differences between men and women. There is a correlation between time-to-treatment in Group C and the cognitive test DSST (-0.26; p = 0.003). CONCLUSIONS: HHIE-S, SSQ12, and 4 kHz audiometry are sensitive and feasible tests to implement in screening programs.

Clinical Profile and Results Obtained in Patients Treated by Auditory Brainstem Implants. / Perfil clínico y resultados obtenidos en los pacientes tratados mediante implante auditivo del tronco del encéfalo.

INTRODUCTION: Cochlear implants have been able to treat some types of hearing loss, but those related to cochlear nerve impairment made it necessary to find new ways to manage these deficits; leading to auditory brainstem implants (ABI). AIM: Our objective is to present the clinical profile of patients treated through an ABI and the results obtained from 1997 to 2017. MATERIAL AND METHODS: On the one hand, patients with statoacoustic nerve tumours (VIIIcranial nerve) were selected, and on the other hand, patients withoutVIII tumours with congenital malformations of the inner ear. Before and after the placement of the ABI, hearing was assessed through tonal audiometry, from which the PTA (Pure Tone Average) and the CAP (Categories of Auditory Performance) scale were obtained. RESULTS: A total of 20 patients undergoing ABI surgery were included. Eight were of tumour cause (40%) and 12 non-tumour (60%). In 15 subjects (75%) a suboccipital approach was performed and in 5 (25%) translabyrinthine. The mean of active electrodes before the implantation of Cochlear® (Nucleus ABI24) was 13/21 (61.90%) versus 8.5/12 (70.83%) of the Med-el® (ABI Med-el). An improvement in the mean PTA of 118.49dB was found against 46.55dB at 2years. On the CAP scale, values of1 were obtained in the preimplantation and of 2.57 (1-5) in the 2-year revision. CONCLUSION: The ABI is a safe option, and with good hearing results when the indication is made correctly.

Prelingual Deaf Children Treated With Cochlear Implant: Monitoring Performance With Percentiles.

OBJECTIVES: To develop a percentile ranking system driven by speech recognition data obtained from different groups of patients treated with a cochlear implant to serve as a tool to monitor the progress of these patients. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Diagnosed with a bilateral, profound sensorineural hearing loss treated with a unilateral cochlear implant. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURE: Six different percentiles (p) were classified taking into account the correlation between speech recognition outcome scores and age at implantation, with reference to the onset of hearing loss. RESULTS: Four hundred sixteen prelingual patients were included. These subjects were divided into subgroups depending on age at implantation.Prelingual group, from the fifth year after implantation, p50 centered on the following percentages of correct words in each subgroup: 100, 94.6, 91.4, 91.0, 79.2, and 63.1% in children implanted under 12 months, 1, 2, 3, 4 to 6, 7 to 10 years, respectively. After a 12-year follow-up, a significant negative correlation between age at implantation and speech recognition was observed in both prelinguals (Rhos=-0.578, p<0.001). CONCLUSION: A percentile system was developed to monitor the postimplant progress of prelingual deaf implanted patients, with potential applications in patient follow-up and handling circumstances that may deteriorate results.

Hearing Impairment and Quality of Life in Adults with Asymmetric Hearing Loss: Benefits of Bimodal Stimulation.

OBJECTIVES: Bimodal stimulation for asymmetric hearing loss is an emerging treatment with proven audiometric outcomes. Our objectives are to assess the changes of the hearing impairment and the quality of life of patients treated with this type of stimulation, when compared to a unilateral Cochlear Implant (CI) stimulated condition. MATERIALS AND METHODS: 31 patients with asymmetric hearing loss (Group 1) were recruited for the study. They were divided into three groups, based on their hearing loss in the ear treated with the hearing aid: Group 1A (Pure Tone Audiometry (PTA) between 41 and 70 decibels (dB)); Group 1B, (PTA between 71 and 80 dB) and Group 1C (PTA between 81 and 90 dB). 30 patients had profound, bilateral hearing loss. Then, users of a unilateral cochlear implant were recruited for the control group. Their hearing impairment and quality of life were analyzed with questionnaires Abbreviated Profile of Hearing Aid Benefit (APHAB), Speech, Spatial and Qualities of Hearing Scale (SSQ) and the Health Utilities Index (HUI). They were followed up for at least 2 years. RESULTS: The group with the asymmetric hearing loss obtains a statistically significant clinical improvement in the APHAB under category "with hearing aid" compared to "without hearing aid". The group with the asymmetric hearing loss benefits more across basically all variables compared with the control group in the SSQ. Group 1A obtains the best outcome of the sample in the HUI. CONCLUSION: Bimodal stimulation and better hearing in the ear treated with the hearing aid reduce hearing impairment and improve the quality of life.

Active middle ear implants. / Implantes activos de oído medio.

Active middle ear implants are surgically implanted prosthesis, which intend to stimulate the ossicular chain or the inner ear fluids through the oval or round windows. These implants may be useful for the treatment of certain patients with sensorineural hearing loss as well as for conductive or mixed hearing loss. This clinical guide attempts to summarize the current knowledge concerning the basic characteristics and indications of the most commonly used middle ear implants, including Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia), and CodacsTM. (Cochlear, Australia).

Guideline on cochlear implants. / Guía clínica sobre implantes cocleares.

INTRODUCTION: In the last decade numerous hospitals have started to work with patients who are candidates for a cochlear implant (CI) and there have been numerous and relevant advances in the treatment of sensorineural hearing loss that extended the indications for cochlear implants. OBJECTIVES: To provide a guideline on cochlear implants to specialists in otorhinolaryngology, other medical specialities, health authorities and society in general. METHODS: The Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), in a coordinated and agreed way, performed a review of the current state of CI based on the existing regulations and in the scientific publications referenced in the bibliography of the document drafted. RESULTS: The clinical guideline on cochlear implants provides information on: a) Definition and description of Cochlear Implant; b) Indications for cochlear implants; c) Organizational requirements for a cochlear implant programme. CONCLUSIONS: A clinical guideline on cochlear implants has been developed by a Committee of Experts of the SEORL-CCC, to help and guide all the health professionals involved in this field of CI in decision-making to treathearing impairment.

Vestibulo-Cochlear Function After Cochlear Implantation in Patients With Meniere's Disease.

OBJECTIVES: To measure the auditory (pure tone audiometry and word recognition scores) and vestibular (video head impulse test and vestibular myogenic potentials) outcomes in patients diagnosed with Meniere's disease (MD) who underwent cochlear implantation. MATERIAL AND METHODS: This prospective study included 23 cochlear implant users with MD and 29 patients diagnosed with far-advanced otosclerosis (the control group). RESULTS: The preoperative mean pure tone average thresholds were 99 and 122.5 dB for the Meniere's and control groups, respectively. Word recognition scores after cochlear implant yielded a median of 80% and 72% for the Meniere's and control groups, respectively. Semicircular canal gain was not observed to vary post implantation (mean variation for lateral, posterior, and anterior plane was 0, 0.03, and 0, respectively). The mean ocular and cervical myogenic potentials asymmetry varied as 9.65% and 18.39%, respectively. CONCLUSIONS: The auditory performance improved in patients with MD similar to the general cochlear implant population. No major dysfunction of otolithic or semicircular canal function was demonstrated after the implantation surgery.

Work activity in patients treated with cochlear implants. / Actividad laboral en pacientes tratados con implantes cocleares.

INTRODUCTION: The aim of this study was to determine the impact that the cochlear implant (CI) had in the working life of individuals implanted, using the first version of a questionnaire developed in the cochlear implant program at the University Clinic of Navarre. Its purpose was to demonstrate that the CI significantly affected the working lives of these patients. MATERIAL AND METHODS: This was a retrospection study on a population of 60 patients (mean age, 48 years old) with bilateral profound sensorineural hearing loss treated with CI and to whom a questionnaire on working life satisfaction was given. RESULTS: Of the patients completing the questionnaire, 94.23% were currently satisfied at work. Almost all of them (93.05%) were more motivated to go to work after the implantation. The majority (79.31%) considered themselves more competent after surgery and device activation. Social relations at work were considered to have improved after cochlear implantation by 67.23% of patients. CONCLUSIONS: The CI provided positive support in the professional sphere as well as in social abilities by improving communication skills of implanted patients. The development of tools to assess the degree of job satisfaction of patients treated with a CI is of great interest.

Bimodal Stimulation with Cochlear Implant and Hearing Aid in Cases of Highly Asymmetrical Hearing Loss.

OBJECTIVE: Bimodal stimulation is a possible treatment for asymmetrical hearing loss, wherein 1 ear is stimulated with a cochlear implant and the other is stimulated with a hearing aid. This emerging indication has gained significance over the last few years. However, little research has been conducted regarding the performance in different types of asymmetric Hearing loss. This study seeks to prove the bilateral-binaural advantage in a group of patients treated with bimodal stimulation (cochlear implant and hearing aid), with different degrees of hearing loss in their best ear. MATERIALS AND METHODS: In total, 31 patients were recruited for the study. They were divided into 3 groups on the basis of the ear with the hearing aid: Group A, pure tone average (PTA) between 41 and 70 dB HL; Group B, PTA between 71 and 80 dB HL; and Group C, PTA between 81 and 90 dB HL. The performance in PTA and disyllabic word recognition were analyzed separately in each ear and then bimodally. The minimum follow-up period was 2 years. RESULTS: There were statistically significant differences between bimodal and monaural conditions both in PTA and in disyllabic word recognition. The better the residual hearing in the ear with the hearing aid, the greater were the benefits obtained with bilateralism-binaurality. CONCLUSION: Bimodal stimulation provides better results than any monaural hearing mode, regardless of whether it involves the use of a hearing aid alone or a cochlear implant alone.

Speech perception with the ACE and the SPEAK speech coding strategies for children implanted with the Nucleus cochlear implant.

OBJECTIVE: The aim of this study is to determine whether implanted children using the ACE speech coding strategy demonstrate superior performances compared to implanted children using the SPEAK speech coding strategy over time. METHODS: Cochlear implanted children with prelinguistic sensorineural bilateral deafness of profound degree, using either the ACE or SPEAK coding strategy, were evaluated and compared. Both groups of children used one of the speech coding strategies continuously from the initial programming session and for a period of 2 years post-switch-on. One group comprised children who were retrospectively implanted and had received the SPEAK speech coding strategy (n=32) and the second group consisted of prospectively implanted children who received the ACE speech coding strategy (n=26). Both populations were homogenous as far as age of implantation, degree of hearing loss, anatomy of the cochlea, depth of electrode insertion, and educational and rehabilitative support provided. Children were assessed at 6, 12 and 24 months post switch-on via pure-tone audiometry and for speech perception tests. Children using the ACE speech coding strategy were additionally evaluated using the MAIS and MUSS language scales. RESULTS: Satisfactory benefits in speech perception were demonstrated by both groups of implanted children. No significant difference between the mean pure tone thresholds was observed postoperatively between the groups. Two years post switch-on the group using the ACE speech coding strategy demonstrated superior results for vowel discrimination in comparison to children using the SPEAK coding strategy. No significant difference was observed between the groups for performance on discrimination of syllable patterns (ESP) or for disyllablic word recognition tests. Additionally, the group of ACE users demonstrated maximum performance on MAIS and MUSS scales, 2 years post switch-on. CONCLUSIONS: The results clearly demonstrate significant benefit of cochlear implantation in prelinguistically deafened children for speech perception ability when using either the SPEAK or ACE speech coding strategies. Children using the ACE speech coding strategy demonstrate more rapid progress in improved speech perception ability initially, however 2 years post switch-on, no significant difference in performance on open-set speech recognition tests can be noted irrespective of the strategy in use.

Advantages of cochlear implantation in prelingual deaf children before 2 years of age when compared with later implantation.

OBJECTIVES: To compare the auditory abilities and speech performance of children with a profound prelingual bilateral hearing-impairment when subjected to a cochlear implant (CI) before or after 2 years of age. To analyze the complications that arose during, or as a result of, the implantation process in these groups. DESIGN: Prospective cohort single-subject, repeated-measures study of children with profound bilateral hearing impairment subjected to CI. SETTING: Tertiary referral center with a program of pediatric CI from 1991. PATIENTS: This study analyzed 130 children subjected to multichannel CI for profound prelingual bilateral hearing-impairment in two age groups: 0 to 2 (n = 36) and 2 to 6 years of age (n = 94). INTERVENTIONS: The children were evaluated before, and each year after, the intervention (for up to 5 years) with both closed-set and open-set auditory and speech perception tests. Their speech ability was evaluated according to the Peabody Picture Vocabulary and Reynell general oral expression scales. RESULTS: Auditory and speech perception tests improved significantly in all children after CI, regardless of the follow-up time. The infant's performance was better the earlier the implant was performed. Speech tests showed that the development of children treated before 2 years of age was similar to normal children, and no additional complications were observed when compared with CI in older children. CONCLUSIONS: When performed before 2 years of age, CI offers a quicker and better improvement of performance without augmenting the complications associated with such an intervention.

Evaluation of Neural Response Telemetry (NRT™) with focus on long-term rate adaptation over a wide range of stimulation rates.

Custom Sound EP™ (CSEP) is an advanced flexible software tool dedicated to recording of electrically evoked compound action potentials (ECAPs) in Nucleus® recipients using Neural Response Telemetry™ (NRT™). European multi-centre studies of the Freedom™ cochlear implant system confirmed that CSEP offers tools to effectively record ECAP thresholds, amplitude growth functions, recovery functions, spread of excitation functions, and rate adaptation functions and an automated algorithm (AutoNRT™) to measure threshold profiles. This paper reports on rate adaptation measurements. Rate adaptation of ECAP amplitudes can successfully be measured up to rates of 495 pulses per second (pps) by repeating conventional ECAP measurements and over a wide range of rates up to 8000 pps using the masked response extraction technique. Rate adaptation did not show a predictable relationship with speech perception and coding strategy channel rate preference. The masked response extraction method offers opportunities to study long-term rate adaptation with well-defined and controlled stimulation paradigms.

Contralateral hearing aid use in cochlear implanted patients: multicenter study of bimodal benefit.

CONCLUSION: The use of a hearing aid (HA) in combination with a cochlear implant (CI) significantly improved performance for speech perception in quiet, in noise, and for localization compared with monaural conditions. No significant differences in functional performance were observed following optimization of HA fitting. OBJECTIVES: To evaluate the binaural benefits derived from using a contralateral HA in conjunction with a CI in subjects with significant functional hearing in the nonimplanted ear and the effects of HA fitting optimization. METHODS: Fifteen adult CI users, intra-subject controls, were enrolled in a prospective repeated-measure multicenter study. Evaluation of performance for speech understanding, localization, and subjective impressions was conducted before and following HA fitting optimization for CI alone, HA alone, and CI + HA. RESULTS: For speech testing in quiet, bimodal scores were significantly better than for HA alone and CI alone conditions (p < 0.01). For speech and noise (S0N0) at 0° azimuth the scores were significantly better in the bimodal condition than for CI alone (p = 0.01), indicating binaural summation. When noise was presented to the HA side (S0NHA) bimodal scores were significantly better than for CI alone (p < 0.01 and p < 0.05, respectively), suggesting a significant binaural squelch effect. Sound localization ability was significantly improved in the bimodal condition compared with the CI alone condition (p = 0.002).