Task-Specific Rapid Auditory Perceptual Learning in Adult Cochlear Implant Recipients: What Could It Mean for Speech Recognition.

OBJECTIVES: Speech recognition in cochlear implant (CI) recipients is quite variable, particularly in challenging listening conditions. Demographic, audiological, and cognitive factors explain some, but not all, of this variance. The literature suggests that rapid auditory perceptual learning explains unique variance in speech recognition in listeners with normal hearing and those with hearing loss. The present study focuses on the early adaptation phase of task-specific rapid auditory perceptual learning. It investigates whether adult CI recipients exhibit this learning and, if so, whether it accounts for portions of the variance in their recognition of fast speech and speech in noise. DESIGN: Thirty-six adult CI recipients (ages = 35 to 77, M = 55) completed a battery of general speech recognition tests (sentences in speech-shaped noise, four-talker babble noise, and natural-fast speech), cognitive measures (vocabulary, working memory, attention, and verbal processing speed), and a rapid auditory perceptual learning task with time-compressed speech. Accuracy in the general speech recognition tasks was modeled with a series of generalized mixed models that accounted for demographic, audiological, and cognitive factors before accounting for the contribution of task-specific rapid auditory perceptual learning of time-compressed speech. RESULTS: Most CI recipients exhibited early task-specific rapid auditory perceptual learning of time-compressed speech within the course of the first 20 sentences. This early task-specific rapid auditory perceptual learning had unique contribution to the recognition of natural-fast speech in quiet and speech in noise, although the contribution to natural-fast speech may reflect the rapid learning that occurred in this task. When accounting for demographic and cognitive characteristics, an increase of 1 SD in the early task-specific rapid auditory perceptual learning rate was associated with ~52% increase in the odds of correctly recognizing natural-fast speech in quiet, and ~19% to 28% in the odds of correctly recognizing the different types of speech in noise. Age, vocabulary, attention, and verbal processing speed also had unique contributions to general speech recognition. However, their contribution varied between the different general speech recognition tests. CONCLUSIONS: Consistent with previous findings in other populations, in CI recipients, early task-specific rapid auditory perceptual, learning also accounts for some of the individual differences in the recognition of speech in noise and natural-fast speech in quiet. Thus, across populations, the early rapid adaptation phase of task-specific rapid auditory perceptual learning might serve as a skill that supports speech recognition in various adverse conditions. In CI users, the ability to rapidly adapt to ongoing acoustical challenges may be one of the factors associated with good CI outcomes. Overall, CI recipients with higher cognitive resources and faster rapid learning rates had better speech recognition.

[FOCUSING AND UPDATING INDICATIONS FOR VENTILATING TUBES INSERTION IN PEDIATRIC COCHLEAR IMPLANT CANDIDATES WHO SUFFER FROM OTITIS MEDIA].

BACKGROUND: After cochlear implantation (CI) there is concern regarding the potential risks of spread of middle ear infection along the electrode array into the cochlea and central nervous system and regarding late sequela of otitis media (OM): eardrum perforation, atelectasis and cholesteatoma. The age for implantation in children overlaps the peak age incidence of acute OM (AOM) and secretory OM (SOM) and delay of implantation reduces the potential benefit from the intervention. Therefore, control of OM by inserting ventilating tubes (VT) is widely performed in pediatric CI candidates who also suffer from otitis media. OBJECTIVES: To refine indications for VT insertion in candidates for cochlear implantation who also suffer from OM. METHODS: Of 200 children referred for CI and implanted one after another, 126 were classified as OM-prone, 98 due to AOM and 28 due to SOM. The rate of development of late sequela of middle ear disease was compared between the two subgroups of OM-proneness. RESULTS: A total of 15 children (7.5%) developed late sequela of middle ear disease; all belonged to the SOM group; 3.5% developed eardrum perforation; 3.5% atelectasis and 0.5% cholesteatoma. CONCLUSIONS: Pre-CI VT insertion in children with SOM who underwent CI did not prevent development of late sequela of middle ear disease; VT insertion with the object of preventing late sequela of middle ear disease in CI candidates who suffer from SOM only is not required; in otitis-prone children a long term oto-microscopic follow-up is needed in order to identify late sequela of middle ear disease.

[COCHLEAR IMPLANTATION IN ELDERLY INDIVIDUALS: INSIGHTS BASED ON A RETROSPECTIVE EVALUATION].

INTRODUCTION: In old age, the typical decline in temporal processing, auditory memory, speed of information processing, and ability to filter out irrelevant competing auditory input lead to deterioration in speech perception. This thereby broadens the target population for cochlear implantation among elderly individuals with severe-to-profound hearing loss. These features also raise concern regarding cochlear implant (CI) fitting and outcomes. AIM: To establish expectations from CI in older individuals. METHODS: This is a retrospective case review of 20 individuals with severe or severe-to-profound hearing loss, aged 60 or older (mean, 66.6 ± 5.25; range, 60-81 at the time of CI. Evaluation included speech-perception tests and the Glasgow Benefit Inventory (GBI) for testing quality of life. RESULTS: Between pre- and post-implantation, mean group values improved from 18.6% to 55.5%, from 37.2% to 84.5%, and from 11.2% to 60.5%, respectively, on the above speech-perception tests. No major postoperative complications were observed. The device was used consistently by all but one patient. GBI revealed improvement on all subscales. CONCLUSIONS: After implantation speech perception improved, there were no major post-CI complications, and post-implantation vertigo was less significant than expected in this age group. These results diminish concerns regarding CI in elderly individuals.

Fundamental frequency information for speech recognition via bimodal stimulation: cochlear implant in one ear and hearing aid in the other.

OBJECTIVE: The aim of this study was to examine the role of fundamental frequency (F0) information in improving speech perception of individuals with a cochlear implant (CI) who use a contralateral hearing aid (HA). The authors hypothesized that in bilateral-bimodal (CI/HA) users the perception of natural prosody speech would be superior to the perception of speech with monotonic flattened F0 contour, whereas in unilateral CI users the perception of both speech signals would be similar. They also hypothesized that in the CI/HA listening condition the speech perception scores would improve as a function of the magnitude of the difference between the F0 characteristics of the target speech signal and the F0 characteristics of the competitors, whereas in the CI-alone condition such a pattern would not be recognized, or at least not as clearly. DESIGN: Two tests were administered to 29 experienced CI/HA adult users who, regardless of their residual hearing or speech perception abilities, had chosen to continue using an HA in the nonimplanted ear for at least 75% of their waking hours. In the first test, the difference between the perception of speech characterized by natural prosody and speech characterized by monotonic flattened F0 contour was assessed in the presence of babble noise produced by three competing male talkers. In the second test the perception of semantically unpredictable sentences was evaluated in the presence of a competing reversed speech sentence spoken by different single talkers with different F0 characteristics. Each test was carried out under two listening conditions: CI alone and CI/HA. RESULTS: Under both listening conditions, the perception of speech characterized by natural prosody was significantly better than the perception of speech in which monotonic F0 contour was flattened. Differences between the scores for natural prosody and for monotonic flattened F0 speech contour were significantly greater, however, in the CI/HA condition than with CI alone. In the second test, the overall scores for perception of semantically unpredictable sentences in the presence of all competitors were higher in the CI/HA condition in the presence of all competitors. In both listening conditions, scores increased significantly with increasing difference between the F0 characteristics of the target speech signal and the F0 characteristics of the competitor. CONCLUSIONS: The higher scores obtained in the CI/HA condition than with CI alone in both of the task-specific tests suggested that the use of a contralateral HA provides improved low-frequency information, resulting in better performance by the CI/HA users.

Everyday hearing functioning in unilateral versus bilateral hearing aid users.

PURPOSE: The purpose of the present study was to assess hearing functioning in everyday listening situations of bilateral and unilateral hearing aid (HA) users. METHOD: 80 Arabic-speaking HA users: 46 bilateral and 34 unilateral HA users with various degrees of HL. Participants completed the Speech, Spatial, and Qualities (SSQ) self-report questionnaire. RESULTS: In general, bilateral users performed better than unilateral users on the speech and spatial scales. For participants with symmetrical unaided HL, the bilateral group significantly surpassed the unilateral group on all three scales. For participants with asymmetrical unaided HL, no significant intergroup differences emerged. Regarding degree of HL, the moderate HL group outperformed the severe, and profound HL groups. No differences emerged between the severe and profound groups. Finally, more severe HL correlated with poorer SSQ performance. Similarly, better speech discrimination scores correlated with better SSQ performance. CONCLUSION: Results support the need for subjective questionnaires when assessing HA benefits.

Contribution of a contralateral hearing aid to perception of consonant voicing, intonation, and emotional state in adult cochlear implantees.

Binaural hearing in cochlear implant (CI) users can be achieved either by bilateral implantation or bimodally with a contralateral hearing aid (HA). Binaural-bimodal hearing has the advantage of complementing the high-frequency electric information from the CI by low-frequency acoustic information from the HA. We examined the contribution of a contralateral HA in 25 adult implantees to their perception of fundamental frequency-cued speech characteristics (initial consonant voicing, intonation, and emotions). Testing with CI alone, HA alone, and bimodal hearing showed that all three characteristics were best perceived under the bimodal condition. Significant differences were recorded between bimodal and HA conditions in the initial voicing test, between bimodal and CI conditions in the intonation test, and between both bimodal and CI conditions and between bimodal and HA conditions in the emotion-in-speech test. These findings confirmed that such binaural-bimodal hearing enhances perception of these speech characteristics and suggest that implantees with residual hearing in the contralateral ear may benefit from a HA in that ear.

Hearing Outcomes with Percutaneous and Transcutaneous BAHA® Technology in Conductive and Mixed Hearing Loss.

OBJECTIVES: To evaluate outcomes of BAHA Connect® and BAHA Attract® implantations, and to examine the prognostic utility of a preimplantation Softband®-attached processor trial. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Patients who underwent Connect® (19 ears) and Attract® (25 ears) implantation between 2007 and 2017. INTERVENTION: BAHA® implantation. MAIN OUTCOME MEASURES: Unaided air conduction (AC), bone conduction (BC), and speech reception thresholds (SRTs), as well as free field (FF) aided with Softband®-attached processor and with implant-attached processor thresholds. RESULTS: Serviceable implant-attached processor PTA0.5,1,2 kHz (≤35 dB HL) was achieved in 89 and 88% of the Connect® and the Attract® ears, respectively, while at 4 kHz this was achieved in 68 and 32% of the Connect® and the Attract® ears, respectively (p  =  0.032). Significantly more Connect® ears showed alignment between FF aided with implant-attached processors thresholds and BC thresholds. The alignment between the Softband®-attached processors thresholds and implant-attached processors thresholds was similar in the two groups. Both groups exhibited similar positive improvement in the quality of life questionnaires. CONCLUSIONS: Accessibility to sound with the implant-attached processor is well predicted by the pre-implantation Softband® trial, both in the BAHA Connect® and in the BAHA Attract® ears. Hearing rehabilitation targets at 0.5, 1, and 2 kHz are met by most Connect® and Attract® ears, while at 4 kHz the outcome with Attract® is poorer. This information should be presented to the patient during consultation prior to a decision as to the type of BAHA® device to be implanted.

[Bilateral sequential cochlear implantation in children].

INTRODUCTION: Unilateral cochlear implantation (CI) has become the standard of care for patients with severe and profound hearing loss. Most unilateral CI users achieve excellent speech understanding abilities in quiet conditions, but face extreme difficulty in noisy environment, a difficulty which can be minimized with bilateral hearing. AIM OF STUDY: To assess the added benefit from a sequential bilateral cochlear implantation in children, several years after the first CI. MATERIAL AND METHODS: Seven children who underwent sequential CI between 2006 and 2008 were included in the study. Mean age at first CI was 4.1 +/- 3.8 years. Mean age at second CI was 11.3 +/- 2.3 years. The mean interval between implantations was 7.3 +/- 2.8 years. Mean duration of experience with both implants was 11.91 +/- 12.2 months. Performance with the first implant and with the two implants was compared using speech perception tests. RESULTS: All children had significant added benefit from the second implantation. Mean word recognition score with both implants was 71% as compared to 44% with the first CI (P=0.018). Mean sentences recognition score in quiet conditions with both implants was 78% as compared to 60% with the first CI (P=0.028) and mean sentences recognition in noise with both implants was 58% as compared to 26% with the first CI (P=0.028). CONCLUSIONS: Benefit from contralateral implantation was demonstrated in the present study despite the long interval between the first and second implantation and the relatively late age at contralateral implantation. This finding raises the possibility that the window of opportunity for beneficial sequential contralateral implantation is longer than hypothesized so far.

Phoneme recognition in bimodal hearing.

BACKGROUND: Many unilateral cochlear implant (CI) users have residual hearing in the nonimplanted ear, allowing them to use bimodal hearing. Assessing the hearing aid (HA) contribution is important. OBJECTIVE: To examine the contribution of a contralateral HA in unilateral CI users with severe-profound hearing loss (HL) in the non-implanted ear to phonetic features perception.Participants and method: Monosyllabic word test in noise was used to assess the phonetic features perception in 29 adult bimodal users with severe-profound HL and only minimal speech recognition using HA alone in the nonimplanted ear. RESULTS: For all consonants and vowel features, participants scored better in the bimodal condition than in the CI-alone condition. Better low frequencies thresholds in the HA ear correlated with better perception of phonetic features in the bimodal condition. CONCLUSION: CI/HA users with only minimal speech recognition using HA alone in the nonimplanted ear extract low-frequency information provided by the HA ear and combine it with information coming from the implanted ear.Significance: The results of the study provide a reasoning for unilateral CI users to insist on using a contralateral HA as long as contralateral implantation is not performed, and suggest how to monitor the benefit derived from the HA.

Perception of speech by prelingual pre-adolescent and adolescent cochlear implant users.

This study was undertaken to assess the speech perception benefits, 24 months after cochlear implantation (CI), in 20 young people (age at CI, 8-18.5 years) with prelingual profound hearing loss, in addition to the use of a proposed CI candidacy assessment profile. Speech perception was evaluated in terms of word and sentence perception before CI, and at six-monthly intervals for two years after CI. Before undergoing CI, all participants were tested on a pre-implantation assessment profile. Compared to the pre-CI findings, group results over 24 months post-CI demonstrated improved speech perception abilities reaching, on average, 46% for word recognition, 71.3% for sentences in quiet, and 33.6% for sentences in noise. Pre-CI profile scores correlated significantly with all speech perception results obtained 24 months after CI. Thus, despite their relatively late ages at implantation, all participants showed gradually improving performance in speech perception. The results showed a high variability in the outcomes of the participants. The pre-CI profile appeared to be useful in formulating realistic expectations of CI outcome during pre-implantation consultations, suggesting that expectations can and should be managed according to each patient's pre-implantation assessment.

Idiopathic Intracranial Hypertension Presenting as Auditory Neuropathy Hearing Disorder in a Child.

Otologic manifestations are known to occur in patients with idiopathic intracranial hypertension (IIH), but the occurrence of sensorineural hearing loss, especially in pediatric populations, has been addressed in only a few reports. Here, we describe a pediatric patient who presented with IIH and severe bilateral hearing loss. The patient's hearing loss was diagnosed as a form of auditory neuropathy (AN) and resolved after prompt treatment of the increased intracranial pressure. This case points to a possible association between IIH and AN and suggests that IIH may potentially be a reversible cause of AN spectrum disorder. Laryngoscope, 129:E407-E411, 2019.

Cochlear implantation outcome in straightforward cases: can we do more for adults who cannot understand speech using hearing aids alone?

BACKGROUND: Many adults with moderate-profound hearing loss whose speech recognition has deteriorated and are no longer benefitting from hearing aids (HAs) could benefit from cochlear implantation (CI). Of these, only <5% are implanted. In order to inform eligible patients about expected results and ease the route to implantation, better guidelines for candidate selection are needed. OBJECTIVES: To provide reliable guidelines by determining, in a well-characterized group of implantees, the minimal expected post-CI scores for monosyllabic (MS) word recognition. PATIENTS AND METHODS: In total, 20 adults unilateral implantees considered (prior to implantation) straightforward CI candidates were assessed ≥20 months post-CI. Their post-CI CI-aided thresholds and MS word recognition were compared to their pre-CI scores. In addition, SSQ12 scores were evaluated post-CI. RESULTS: Post-CI, thresholds were 40 dB or better in all participants, and 35 dB or better in 95% of them. 90% scored 60% or better on MS words in quiet. In speech noise all scored 15-60% and 50% scored 45-60%. Poorer unaided pre-CI thresholds yielded greater patient satisfaction. CONCLUSIONS: Adults with moderate-profound hearing loss, whose speech recognition has deteriorated, are no longer benefitting from HAs and fulfil defined criteria for straightforward CI, should be referred for formal CI candidacy evaluation.

Hearing progress and fluctuations in bimodal-binaural hearing users (unilateral cochlear implants and contralateral hearing aid).

CONCLUSIONS: Mean scores achieved using a cochlear implant (CI) plus a hearing aid (HA) were consistently higher (statistically non-significant) than those for CI alone. The addition of a contralateral HA partially compensated for the negative hearing fluctuations as well as for the slow initial progress with the CI. OBJECTIVES: To examine hearing progress over the first 3 years after unilateral cochlear implantation in users who had residual hearing in the non-implanted ear at the time of surgery and continued to use a HA in that ear thereafter. PATIENTS AND METHODS: Thirteen patients were followed up for 36 months after continuous concomitant use of a CI and a contralateral HA. To evaluate hearing progress, sentence identification in background noise (presentation level, 55 dB; S/N ratio, +10 dB) was tested for CI alone and for CI with contralateral HA (CI+HA). Subjects were tested after 6, 12, 18, 24, and 36 months of concomitant use of both devices. Mixed regression model was used to evaluate the group's progression of scores and the added value of a contralateral HA over time. RESULTS: When last tested (36 months after CI) the mean group score for CI alone was 72.6% +/- 19.3%, and 12/13 patients scored at least 65% with either CI alone or CI+HA. Mean scores achieved using CI+HA were consistently higher than those for CI alone. Percentage improvement in CI+HA relative to CI alone was highest (19.2%) after 18 months of concomitant usage and then diminished gradually to 7.7% at 36 months. Most patients showed some negative fluctuations in performance with CI alone at some point during the 36 months of post-CI follow-up.

[Cochlear implantation in children with otitis media: third stage of a long-term prospective study].

INTRODUCTION: The age at which cochlear implantation (CI) is performed in children generally corresponds to the age at which the prevalence of otitis media (OM) is highest. The risks of problematic middle ear infection and of potential spread of middle ear infection along the electrode array into the cochlea and the central nervous system are relatively high. Thus, it is necessary to establish a practicable protocol aimed at controlling OM prior to and after CI in young candidates. OBJECTIVE: To assess the risk for otitis media after cochlear implantation in otitis media (OM)-prone and non-OM-prone children who were treated according to a structured protocol designed to control OM prior to implantation. PATIENTS AND METHODS: Of 113 children referred for cochlear implantation during the study period, and were implanted under the age of 7 years, 70 were classified as OM-prone (Group A) and 43 as non-OM-prone (group B). Group A patients were managed according to a structured protocol aimed at pre-implantation control of OM. Postimplantation follow-up ranged from 6 to 75 months (average 35.5 months). RESULTS: In the OM-prone group of children, the mean age at referral and at implantation was significantly lower and the mean interval between referral and implantation significantly higher than in the healthy group. During the first month after implantation 18 children suffered from acute otitis media, the vast majority of them (16) belonged to the OM-prone children (22.8% of this group) and 2 subjects belonged to the non-OM-prone children (4.6% of this group). During the late post-operative period 28 of the OM-prone children (40%) and 4 of the non-OM-prone children (9.3%) developed acute OM in the implanted ear. Eleven (9.7 %) of these cases, (10 belonging to the OM-prone group B (14%), and one belonging to the non-OM-prone group A (2.3%)) proved to be recurrent and therapeutically challenging. Three subjects developed acute mastoiditis without intracranial complications. Each episode of mastoiditis or otitis media was controlled conservatively without any need of surgical drainage of the mastoid. This group of challenging cases did not differ from the OM-prone children who did not prove to be OM-challenging post-CI in regards to age at referral, age at CI and average number of ventilation tube (VT) operations prior to CI. Most pathogen isolations (65%) from OM or from VT drainage developed after CI were typical pathogens for acute otitis media (AOM). However, the percentage of non-typical AOM pathogen isolation increased with time after CI. CONCLUSIONS: Early referral led to early implantation, even in children susceptible to OM. The incidence of OM decreased after implantation in both groups, but was still significantly higher in the OM-prone group. Meanwhile, prior to CI it is not possible to predict the cases that become therapeutically challenging at a later stage.

Case report: cochlear implant in a child with schizencephaly and cortical dysplasia.

Schizencephaly is a developmental disorder of the cerebral cortex, usually with seizures occurring before the age of 3. We describe pre-implantation considerations and post-implantation outcome in a child with schizencephaly and bilateral profound hearing loss. Cochlear implantation was performed in the right ear when she was 21 months old. At 4 years and 3 months she developed an epileptic pattern on electroencephalogram and had mild attacks of dysesthesia. Now aged 6, she uses the implant successfully and needs no anticonvulsant medication. Language skills, though delayed, are progressing steadily. We consider that the epileptic pattern was unrelated to the electrical stimulation, and conclude that implantation is not contraindicated in children with cortical anomalies.

Binaural-bimodal hearing: concomitant use of a unilateral cochlear implant and a contralateral hearing aid.

CONCLUSION: The benefit obtained with a contralateral hearing aid (HA) in unilateral cochlear implantees improves over time, at least during the first year after implantation. OBJECTIVE: To evaluate binaural-bimodal auditory ability and its early changes over time after unilateral cochlear implantation in patients with residual hearing in the non-implanted ear, in which they use an HA. MATERIAL AND METHODS: Sentence identification in background noise was tested in 12 patients (3 post-lingual adults and 9 pre-lingual adults and older children) under 3 listening conditions: cochlear implant (CI) alone, HA alone and CI+HA. The presentation level was 55 dB HL with a signal-to-noise ratio of +10 dB. Subjects were tested after 1-6 months of concomitant use of both devices and again after a further 7-12 months. RESULTS: At the first testing session, the mean score in background noise was 34.9% with CI alone (range 0-90%) and 41.1% with both devices (range 0-100%). Seven patients could recognize sentences in noise with CI alone, and four of them showed further improvement with added amplification. At the second session, at which all subjects could recognize sentences in noise with the CI alone, seven showed further improvement with added amplification. The mean score was 60.6% with CI alone (range 10-99%) and 75.5% with both devices (range 52-100%).

Cochlear implantation in children with otitis media: second stage of a long-term prospective study.

OBJECTIVE: To present the findings of the second stage of an ongoing prospective study of the outcome of cochlear implantation in otitis media (OM)-prone and non-OM-prone children who were treated according to a structured protocol designed to control OM prior to implantation. PATIENTS AND METHODS: Of 60 children referred for cochlear implantation during the study period, 34 were classified as OM-prone (Group A) and 26 as non-OM-prone (group B). Group A patients were managed according to a structured protocol aimed at pre-implantation control of OM. A ventilating tube (with or without adenoidectomy) was inserted in the affected ear(s) of these children, if necessary more than once. Post-implantation follow-up ranged from 3 to 45 months (average 20 months). RESULTS: In the OM-prone group of children, the mean age at referral and at implantation was significantly lower and the mean interval between referral and implantation significantly higher than in the healthy group. During implantation, 21 children (19 from the OM-prone group A) had thick middle ear mucosa that had to be removed to allow identification of the round window niche. After implantation, 13 of the OM-prone children (38%) and 2 of the non-OM-prone children (7.6%) developed acute OM in the implanted ear. Five of these cases, all belonging to the OM-prone group, proved to be recurrent and therapeutically challenging, and 2 of them also developed acute mastoiditis. There were no other OM-related complications. CONCLUSIONS: Early referral led to early implantation, even in children susceptible to OM. The incidence of OM decreased after implantation, but was still significantly higher in the OM-prone group. On the basis of these results, we recommend the continuous use of a ventilating tube in OM-prone pediatric implantees until they outgrow their susceptibility to OM.

From hearing with a cochlear implant and a contralateral hearing aid (CI/HA) to hearing with two cochlear implants (CI/CI): a within-subject design comparison.

OBJECTIVE: To compare within-subject bilateral-binaural and bimodal complementary abilities between bimodal (cochlear implant and hearing aid; CI/HA) and bilateral CI hearing (CI/CI), thereby enabling better-informed counseling of experienced CI/HA users contemplating contralateral implantation. STUDY DESIGN: Comparative within-subject case review. SETTING: Outpatient hearing clinic. PATIENTS: Ten experienced adult CI/HA users with severe-to-profound hearing loss in the HA ear, who converted to CI/CI between 2 and 11 years after initial implantation. INTERVENTION: Task-specific testing of bilateral-binaural hearing (sound lateralization, binaural summation/redundancy/unmasking, head-shadow effect), bimodal complementary benefit (contribution of low-frequency information), and a self-report Speech, Spatial, and Qualities of Hearing (SSQ) questionnaire, all before and 1 year after contralateral cochlear implantation. MAIN OUTCOME MEASURES: Test result differences between CI/HA and CI/CI conditions. RESULTS: CI/CI hearing was better than CI/HA for speech lateralization and for perception of semantically unpredictable sentences in speech noise with speech at 0 degrees and noise at +90 degrees azimuth on the old CI side. CI/HA was better than CI/CI only for differences between perception of natural prosody speech and of speech with flattened fundamental frequency (F0) contour with speech and noise in front (at 0 degrees azimuth). Total scores on the SSQ questionnaire were higher in CI/CI than in CI/HA users. CONCLUSION: Counseling regarding contralateral implantation for CI/HA users with severe-to-profound hearing loss in the HA ear, though generally positive, should consider individual functional needs, and cover expectations about the expected trade-off between gaining improved understanding and speech lateralization in challenging listening conditions and losing some low-frequency cues still available with CI/HA hearing.

Functional status of hearing aids in bilateral-bimodal users.

OBJECTIVE: To assess the functional status of the hearing aid (HA) in bilateral-bimodal users, in whom HA monitoring is often neglected because fitting efforts are focused on the cochlear implant (CI). Also, to define an audiometric pattern of residual hearing that might explain why, despite nonoptimal bimodal fitting, certain cochlear implantees still opt to use a HA. STUDY DESIGN: Retrospective case review. SETTING: Ambulatory care clinic. PARTICIPANTS: Experienced bimodal (CI/HA) adult users (N = 31) who use their HA during most of their waking hours. HA settings were required to meet a selected prescriptive (NAL-NL1) electro-acoustical Verifit Speechmap target at low frequencies using the simulated real-ear mode. INTERVENTION: After initial evaluation, HAs that did not meet the Speechmap target underwent appropriate fitting and reevaluation. MAIN OUTCOME MEASURE(S): Number of patients whose HAs met the defined Speechmap criteria after refitting; residual hearing levels in patients who achieved optimal bimodal fitting and in those who did not. RESULTS: At initial evaluation, the HA in 25 (81%) of the 31 participants was malfunctioning or poorly tuned. After HA replacement or retuning, 19 participants (61%) met the Speechmap targets, and 12 (39%) did not. However, the 2 groups had similar mean levels of unaided and aided residual hearing thresholds at 250 or 500 Hz. CONCLUSION: To maximize the benefit for bilateral-bimodal users, specific guidelines must be established also for fitting of their HAs. The focus should be on achieving the maximum amplification possible at low frequencies.

Natural history of contralateral residual hearing in unilateral cochlear implant users - long-term findings.

CONCLUSION: The long-term stability of low-frequency residual hearing found in a significant number of bilateral-bimodal users (cochlear implant (CI) in one ear and a hearing aid (HA) on the other ear; CI/HA) with severe-to-profound or profound hearing loss in the non-implanted ear justifies bilateral-bimodal fitting efforts in this group. Since low-frequency residual hearing tends to deteriorate in some of these CI/HA users, periodic evaluation, which includes pure-tone thresholds and speech perception tests, is mandatory for determining the point in time at which CI/HA hearing is no longer effective, and the patient should accordingly be considered as a candidate for contralateral cochlear implantation. OBJECTIVE: To determine, in bilateral-bimodal (CI/HA) users with severe-to-profound or profound hearing loss in the non-implanted ear, the rate of residual hearing deterioration in the non-implanted ear after cochlear implantation. METHODS: Pure-tone aided and unaided thresholds in the non-implanted ears of 39 CI/HA users at 0.25-4.0 kHz were recorded prospectively up to 6 years after implantation. RESULTS: Group mean threshold values in the non-implanted ears remained stable over 3, 4, 5 and 6 years post-implantation, except for significant deterioration at 4.0 kHz of both unaided (4.2, 5.2, 9.0 and 8.2 dB, respectively) and aided thresholds (8.1, 4.6, 6.1 and 8.3 dB, respectively).