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Objectives: Assess the long-term patterns of perceived tinnitus severity and subjective benefit for adult cochlear implant (CI) users with asymmetric or unilateral hearing loss (AHL or UHL)., Methods: Forty adults underwent cochlear implantation as part of a prospective clinical trial assessing the outcomes of CI use in cases of AHL (n = 20) and UHL (n = 20). Subjective measures included the Tinnitus Handicap Inventory (THI), the Speech, Spatial, & Qualities of Hearing Scale (SSQ), and the Abbreviated Profile of Hearing Aid Benefit (APHAB). Responses were obtained preoperatively and at routine intervals out to 5 years post-activation., Results: For subjective benefit, participants with AHL and UHL reported a significant improvement as compared to preoperative abilities, which was maintained with long-term CI use. For perceived tinnitus severity, participants with AHL and UHL reported a significant reduction with CI use as compared to preoperative perceptions. The perceived tinnitus severity significantly differed for the AHL and UHL cohorts over time. This pattern of results is likely influenced by the worse perceived severity levels for the UHL cohort preoperatively and the fluctuating perceived severity levels for some participants in the AHL cohort post-activation., Conclusion: Adults with AHL and UHL report an early, significant reduction in perceived tinnitus severity and improvement in quality of life with CI use that is generally maintained with long-term device use. Questionnaires such as the THI, SSQ, and APHAB may contribute to a more holistic assessment of the benefits of cochlear implantation in this population., Level of Evidence: 2 Laryngoscope, 133:2792-2797, 2023., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To assess long-term binaural hearing abilities for cochlear implant (CI) users with unilateral hearing loss (UHL) or asymmetric hearing loss (AHL)., Methods: A prospective, longitudinal, repeated measures study was completed at a tertiary referral center evaluating adults with UHL or AHL undergoing cochlear implantation. Binaural hearing abilities were assessed with masked speech recognition tasks using AzBio sentences in a 10-talker masker. Performance was evaluated as the ability to benefit from spatial release from masking (SRM). SRM was calculated as the difference in scores when the masker was presented toward the CI-ear (SRM ci ) or the contralateral ear (SRM contra ) relative to the co-located condition (0°). Assessments were completed pre-operatively and at annual intervals out to 5 years post-activation., Results: Twenty UHL and 19 AHL participants were included in the study. Linear Mixed Models showed significant main effects of interval and group for SRM contra . There was a significant interaction between interval and group, with UHL participants reaching asymptotic performance early and AHL participants demonstrating continued growth in binaural abilities to 5 years post-activation. The improvement in SRM showed a significant positive correlation with contralateral unaided hearing thresholds (p = 0.050) as well as age at implantation (p = 0.031)., Conclusions: CI recipients with UHL and AHL showed improved SRM with long-term device use. The time course of improvement varied by cohort, with the UHL cohort reaching asymptotic performance early and the AHL cohort continuing to improve beyond 1 year. Differences between cohorts could be driven by differences in age at implantation as well as contralateral unaided hearing thresholds., Level of Evidence: 3 Laryngoscope, 133:1480-1485, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose of Review: Children and adults with unilateral or asymmetric hearing loss (UHL/AHL) have poorer spatial hearing (e.g. speech understanding in complex maskers and localization) and quality of life compared with peers with normal hearing bilaterally. Patients with UHL/AHL experience limited benefits with contralateral-routing technologies (e.g. bone conduction, CROS hearing aid systems). Cochlear implantation allows for stimulation of the auditory pathway for the poorer hearing ear. The present study reviews the recent literature on outcomes of cochlear implant use for recipients with UHL/AHL., Recent Findings: Recent research corroborates previous investigations of the significant benefits on measures of spatial hearing, tinnitus severity and quality of life for adult cochlear implant recipients. These benefits are also observed in pediatric cochlear implant recipients, with an association of better outcomes with younger ages at implantation for congenital cases and shorter durations of UHL/AHL for acquired cases. In addition, randomized trials demonstrate better outcomes with cochlear implant use versus contralateral-routing technologies., Summary: Cochlear implantation supports better spatial hearing and quality of life in children and adults with UHL/AHL as compared to alternative listening conditions. Current research supports the expansion of candidacy criteria and insurance coverage for cochlear implantation for patients with UHL/AHL to improve their binaural hearing., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: Assess the influence of cochlear implant (CI) use on the perceived listening effort of adult and pediatric subjects with unilateral hearing loss (UHL) or asymmetric hearing loss (AHL)., Study Design: Prospective cohort., Setting: Tertiary referral center., Patients: Adults and children with UHL or AHL., Intervention: Cochlear implantation. Subjects received their CI as part of a clinical trial assessing the effectiveness of cochlear implantation in cases of UHL and AHL., Main Outcome Measures: Responses to the Listening Effort pragmatic subscale on the Speech, Spatial, and Qualities of Hearing Scale (SSQ) or SSQ for Children with Impaired Hearing (SSQ-C) were compared over the study period. Subjects or their parents completed the questionnaires preoperatively and at predetermined postactivation intervals. For the adult subjects, responses were compared to word recognition in quiet and sentence recognition in noise., Results: Forty adult subjects (n = 20 UHL, n = 20 AHL) and 16 pediatric subjects with UHL enrolled and underwent cochlear implantation. Subjects in all three groups reported a significant reduction in perceived listening effort within the initial months of CI use (p < 0.001; η2 ≥ 0.351). The perceived benefit was significantly correlated with speech recognition in noise for the adult subjects with UHL at the 12-month interval (r(20) = .59, p = 0.006)., Conclusions: Adult and pediatric CI recipients with UHL or AHL report a reduction in listening effort with CI use as compared to their preoperative experiences. Use of the SSQ and SSQ-C Listening Effort pragmatic subscale may provide additional information about a CI recipient's experience beyond the abilities measured in the sound booth., (Copyright © 2021, Otology & Neurotology, Inc.)

A prospective clinical trial evaluated the effectiveness of cochlear implantation in adults with asymmetric hearing loss (AHL). Twenty subjects with mild-to-moderate hearing loss in the better ear and moderate-to-profound hearing loss in the poorer ear underwent cochlear implantation of the poorer hearing ear. Subjects were evaluated preoperatively and at 1, 3, 6, 9, and 12 months post-activation. Preoperative performance was evaluated unaided, with traditional hearing aids (HAs) or with a bone-conduction HA. Post-activation performance was evaluated with the cochlear implant (CI) alone or in combination with a contralateral HA (bimodal). Test measures included subjective benefit, word recognition, and spatial hearing (i.e., localization and masked sentence recognition). Significant subjective benefit was reported as early as the 1-month interval, indicating better performance with the CI compared with the preferred preoperative condition. Aided word recognition with the CI alone was significantly improved at the 1-month interval compared with preoperative performance with an HA and continued to improve through the 12-month interval. Subjects demonstrated early, significant improvements in the bimodal condition on the spatial hearing tasks compared with baseline preoperative performance tested unaided. The magnitude of the benefit was reduced for subjects with AHL when compared with published data on CI users with normal hearing in the contralateral ear; this finding may reflect significant differences in age at implantation and hearing sensitivity across cohorts.

Objective: Translabyrinthine (TL) vestibular schwannoma (VS) resection may be accomplished with preservation of the cochlear nerve, permitting successful, concurrent cochlear implantation. In this single institution, Food and Drug Administration-approved feasibility study, we wished to determine the success and outcomes of concurrent cochlear implantation at the time of TL resection of VS., Study Design: Prospective cohort., Setting: Tertiary referral center., Patients: Patients with small VS less than 1.5 cm in size., Intervention: Concurrent TL VS resection and cochlear implantation., Main Outcome Measure: Sound localization and speech understanding., Results: All cochlear nerves were anatomically preserved. Five out of seven patients had auditory precepts at the time of activation. At 1 month following surgery, AzBio scores (0 dB SNR, with sound front, noise to normal ear) were improved by an average of 10% with implant on, persisting to 6 months out from surgery. Localization 1 month after surgery was markedly improved with root mean square 78 degrees ±13 in the "implant off" condition and 41 ± 9 degrees in the "implant on" condition. Average tinnitus severity was reduced in subjects and speech and spatial hearing was improved on speech, spatial and qualities of hearing scale (SSQ)., Conclusions: These data demonstrate preservation of electrical hearing in TL VS surgery is consistently possible, and although speech outcomes do not achieve the same levels seen with other etiologies of hearing loss, excellent improvement in sound localization, improved speech understanding, and substantial reductions in tinnitus are achieved.

Objective: Assess whether differences in speech perception are observed after exclusive listening experience with high-definition continuous interleaved sampling (HDCIS) versus fine structure processing (FSP) coding strategies., Methods: Subjects were randomly assigned at initial activation of the external speech processor to receive the HDCIS or FSP coding strategy. Frequency filter assignments were consistent across subjects. The speech perception test battery included CNC words in quiet, HINT sentences in quiet and steady noise (+10 dB SNR), AzBio sentences in quiet and a 10-talker babble (+10 dB SNR), and BKB-SIN. Assessment intervals included 1, 3, and 6 months post-activation., Results: Data from 22 subjects (11 with HDCIS and 11 with FSP) were assessed over time. Speech perception performance was not significantly different between groups., Discussion: Speech perception performance was not significantly different after 6 months of listening experience with the HDCIS or FSP coding strategy.

Background: Candidacy criteria for cochlear implantation are expanding to include patients with substantial low-to-mid frequency hearing sensitivity. Postoperative hearing preservation has been achieved in cochlear implant recipients, though with variable outcomes. Previous investigations on postoperative hearing preservation outcomes have evaluated intraoperative procedures. There has been limited review as to whether electric stimulation influences hearing preservation., Purpose: The purpose of this analysis was to evaluate whether charge levels associated with electric stimulation influence postoperative hearing preservation within the first year of listening experience., Research Design: Retrospective analysis of unaided residual hearing and charge levels., Study Sample: Twenty-eight cochlear implant recipients with postoperative residual hearing in the operative ear and at least 12 mo of listening experience with electric-acoustic stimulation (EAS)., Data Collection and Analysis: Assessment intervals included initial cochlear implant activation, initial EAS activation, and 3-, 6-, and 12-mo postinitial EAS activation. A masked low-frequency bone-conduction (BC) pure-tone average (PTA) was calculated for all participants at each assessment interval. Charge levels for each electrode were determined using the most comfortable loudness level and pulse width values. Charge levels associated with different regions of the electrode array were compared to the change in the low-frequency BC PTA between two consecutive intervals., Results: Charge levels had little to no association with the postoperative change in low-frequency BC PTA within the first year of listening experience., Conclusions: Electric charge levels do not appear to be reliably related to the subsequent loss of residual low-frequency hearing in the implanted ear within the first year of EAS listening experience., (American Academy of Audiology.)

Background: Cochlear implant (CI) recipients with postoperative hearing preservation may utilize an ipsilateral bimodal listening condition known as electric-acoustic stimulation (EAS). Studies on EAS have reported significant improvements in speech perception abilities over CI-alone listening conditions. Adjustments to the hearing aid (HA) settings to match prescription targets routinely used in the programming of conventional amplification may provide additional gains in speech perception abilities., Purpose: Investigate the difference in users' speech perception scores when listening with the recommended HA settings for EAS patients versus HA settings adjusted to match National Acoustic Laboratories' nonlinear fitting procedure version 1 (NAL-NL1) targets., Research Design: Prospective analysis of the influence of HA settings., Study Sample: Nine EAS recipients with greater than 12 mo of listening experience with the DUET speech processor., Intervention: Subjects were tested in the EAS listening condition with two different HA setting configurations. Speech perception materials included consonant-nucleus-consonant (CNC) words in quiet, AzBio sentences in 10-talker speech babble at a signal-to-noise ratio (SNR) of +10, and the Bamford-Kowal-Bench sentences in noise (BKB-SIN) test., Data Collection and Analysis: The speech perception performance on each test measure was compared between the two HA configurations., Results: Subjects experienced a significant improvement in speech perception abilities with the HA settings adjusted to match NAL-NL1 targets over the recommended HA settings., Conclusions: EAS subjects have been shown to experience improvements in speech perception abilities when listening to ipsilateral combined stimulation. This population's abilities may be underestimated with current HA settings. Tailoring the HA output to the patient's individual hearing loss offers improved outcomes on speech perception measures., (American Academy of Audiology.)