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Purpose: The aim of the presented study was to compare the audiological benefit achieved in cochlear implant (CI) patients who, in principle, could still have been treated with an active middle ear implant (AMEI) with a group of AMEI users., Methods: Results of 20 CI patients with a pure-tone average (PTA) of 70 dB HL prior to surgery were compared with a group of 12 subjects treated with a Vibrant Soundbridge (VSB). Pre-surgical comparison included PTA for air conduction and bone conduction, maximum speech recognition score for monosyllabic words (WRSmax), and aided monosyllabic word recognition at 65 dB SPL. One year after surgery, aided monosyllabic speech recognition score at 65 dB SPL was compared., Results: Mean PTA for air conduction in the VSB group was significantly lower than in the CI group (4.8 dB, Z =  - 2.011, p < 0.05). Mean PTA for bone conduction in the VSB group was also significantly lower than in the CI group (23.4 dB, Z =  - 4.673, p < 0.001). WRSmax in the VSB group was significantly better than in the CI group (40.7%, Z =  - 3.705, p < 0.001). One year after treatment, there was no significant difference in aided speech perception in quiet between both subject groups., Conclusion: Comparison of the two methods showed equivalent results for both treatments in subjects with a borderline indication. Not only pure-tone audiometry results but, particularly, speech perception scores pre-surgery should be taken into account in preoperative counseling., (© 2024. The Author(s).)

Background: Although good speech perception in quiet is achievable with cochlear implants (CIs), speech perception in noise is severely impaired compared to normal hearing (NH). In the case of a bimodal CI fitting with a hearing aid (HA) in the opposite ear, the amount of residual acoustic hearing influences speech perception in noise., Objective: The aim of this work was to investigate speech perception in noise in a group of bimodal CI users and compare the results to age-matched HA users and people without subjective hearing loss, as well as with a young NH group., Materials and Methods: Study participants comprised 19 bimodal CI users, 39 HA users, and 40 subjectively NH subjects in the age group 60-90 years and 14 young NH subjects. Speech reception thresholds (SRTs) in noise were adaptively measured using the Oldenburg Sentence Test for the two spatial test conditions S0N0 (speech and noise from the front) and multisource-noise field (MSNF; speech from the front, four spatially distributed noise sources) in continuous noise of the Oldenburg Sentence Test (Ol-noise) and amplitude-modulated Fastl noise (Fastl-noise)., Results: With increasing hearing loss, the median SRT worsened significantly in all conditions. In test condition S0N0, the SRT of the CI group was 5.6 dB worse in Ol-noise than in the young NH group (mean age 26.4 years) and 22.5 dB worse in Fastl-noise; in MSNF, the differences were 6.6 dB (Ol-noise) and 17.3 dB (Fastl-noise), respectively. In the young NH group, median SRT in condition S0N0 improved by 11 dB due to gap listening; in the older NH group, SRTs improved by only 3.1 dB. In the HA and bimodal CI groups there was no gap listening effect and SRTs in Fastl-noise were even worse than in Ol-noise., Conclusion: With increasing hearing loss, speech perception in modulated noise is even more impaired than in continuous noise., (© 2023. The Author(s).)

Purpose: This study investigated whether an interaural delay, e.g. caused by the processing latency of a hearing device, can affect sensitivity to interaural level differences (ILDs) in normal hearing subjects or cochlear implant (CI) users with contralateral normal hearing (SSD-CI)., Methods: Sensitivity to ILD was measured in 10 SSD-CI subjects and in 24 normal hearing subjects. The stimulus was a noise burst presented via headphones and via a direct cable connection (CI). ILD sensitivity was measured for different interaural delays in the range induced by hearing devices. ILD sensitivity was correlated with results obtained in a sound localization task using seven loudspeakers in the frontal horizontal plane., Results: In the normal hearing subjects the sensitivity to interaural level differences deteriorated significantly with increasing interaural delays. In the CI group, no significant effect of interaural delays on ILD sensitivity was found. The NH subjects were significantly more sensitive to ILDs. The mean localization error in the CI group was 10.8° higher than in the normal hearing group. No correlation between sound localization ability and ILD sensitivity was found., Conclusion: Interaural delays influence the perception of ILDs. For normal hearing subjects a significant decrement in sensitivity to ILD was measured. The effect could not be confirmed in the tested SSD-CI group, probably due to a small subject group with large variations. The temporal matching of the two sides may be beneficial for ILD processing and thus sound localization for CI patients. However, further studies are needed for verification., (© 2023. The Author(s).)

Purpose: Bilateral cochlear implantation is an effective treatment for patients with bilateral profound hearing loss. In contrast to children, adults mostly choose a sequential surgery. This study addresses whether simultaneous bilateral CI is associated with higher rates of complications compared to sequential implantation., Methods: 169 bilateral CI surgeries were analyzed retrospectively. 34 of the patients were implanted simultaneously (group 1), whereas 135 patients were implanted sequentially (group 2). The duration of surgery, the incidence of minor and major complications and the duration of hospitalization of both groups were compared., Results: In group 1, the total operating room time was significantly shorter. The incidences of minor and major surgical complications showed no statistically significant differences. A fatal non-surgical complication in group 1 was particularly extensively reappraised without evidence of a causal relationship to the chosen mode of care. The duration of hospitalization was 0.7 days longer than in unilateral implantation but 2.8 days shorter than the combined two hospital stays in group 2., Conclusion: In the synopsis of all considered complications and complication-relevant factors, equivalence of simultaneous and sequential cochlear implantation in adults in terms of safety was found. However, potential side effects related to longer surgical time in simultaneous surgery must be considered individually. Careful patient selection with special consideration to existing comorbidities and preoperative anesthesiologic evaluation is essential., (© 2023. The Author(s).)

Purpose: The cochlear implant (CI) is a standard treatment for patients with severe to profound hearing loss. In recent years, early device activation of the sound processor after 2-3 days following surgery has been established. The aim of this study is to evaluate the residual hearing of CI patients with substantial preoperative low-frequency hearing after early device activation over a period of 12 months., Methods: Results were compared between an early fitted group (EF) with device activation to less than 15 days after CI surgery and a control group (CG) with device activation after 3-6 weeks. In total, 57 patients were divided into EF group (n = 32), and CG (n = 25). Low-frequency residual hearing and speech recognition in quiet and in noise were compared over an observation period of 12 months., Results: No significant difference (p > 0.05) in the residual low-frequency hearing PTA low between EF and CG was found, neither preoperatively (EF 33.2 dB HL/CG 35.0 dB HL), nor postoperatively (EF 46.8 dB HL/CG 46.2 dB HL). In both groups, postoperative residual hearing decreased compared to preoperative and remained stable within the first year after CI surgery. Furthermore, both groups showed no significant differences (p > 0.05) in speech recognition in quiet and in noise within the first year., Conclusion: Early device activation is feasible in CI patients with preoperative low-frequency residual hearing, without an additional effect on postoperative hearing preservation., (© 2023. The Author(s).)

Background: Although good speech perception in quiet is achievable with cochlear implants (CIs), speech perception in noise is severely impaired compared to normal hearing (NH). In the case of a bimodal CI fitting with a hearing aid (HA) in the opposite ear, the amount of residual acoustic hearing influences speech perception in noise., Objective: The aim of this work was to investigate speech perception in noise in a group of bimodal CI users and compare the results to age-matched HA users and people without subjective hearing loss, as well as with a young NH group., Materials and Methods: Study participants comprised 19 bimodal CI users, 39 HA users, and 40 subjectively NH subjects in the age group 60-90 years and 14 young NH subjects. Speech reception thresholds (SRTs) in noise were adaptively measured using the Oldenburg Sentence Test for the two spatial test conditions S0N0 (speech and noise from the front) and multisource-noise field (MSNF; speech from the front, four spatially distributed noise sources) in continuous noise of the Oldenburg Sentence Test (Ol-noise) and amplitude-modulated Fastl noise (Fastl-noise)., Results: With increasing hearing loss, the median SRT worsened significantly in all conditions. In test condition S0N0, the SRT of the CI group was 5.6 dB worse in Ol-noise than in the young NH group (mean age 26.4 years) and 22.5 dB worse in Fastl-noise; in MSNF, the differences were 6.6 dB (Ol-noise) and 17.3 dB (Fastl-noise), respectively. In the young NH group, median SRT in condition S0N0 improved by 11 dB due to gap listening; in the older NH group, SRTs improved by only 3.1 dB. In the HA and bimodal CI groups there was no gap listening effect and SRTs in Fastl-noise were even worse than in Ol-noise., Conclusion: With increasing hearing loss, speech perception in modulated noise is even more impaired than in continuous noise., (© 2023. The Author(s).)

Purpose: Even in older patients, hearing rehabilitation with a cochlear implant has become an established method for deafened or severely hearing-impaired patients. In addition to the hearing improvement, numerous other effects of CI treatment can be observed in clinical routine. In the literature, there is multiple evidence for a rapid and significant improvement in quality of life with CI treatment. The aim of this study was to evaluate the long-term effects of hearing rehabilitation using CI on the quality of life in older patients (≥ 65 years)., Methods: This prospective cross-sectional study examined 84 patients between the age of 65 and 101 years who received unilateral CI treatment for the first time between one and 10 years ago. The World Health Organization Quality-of-Life Scale-Old (WHOQL-OLD) was used to determine the quality of life. The study cohort was divided into three groups to compare the quality of life over time: group I (1-3 years after CI treatment), group II (4-6 years after CI treatment), and group III (7-10 years after CI treatment). In addition, the data from this study were compared with the results of our previous study (Issing et al. 2020) in which we focused on the first 6 months after CI treatment., Results: In all three groups, there was a significant improvement in monosyllabic discrimination within 1 year after CI fitting (p > 0.001). No significant differences were found between the three groups. There were no significant differences between the three groups in the WHOQOL-OLD total score (p = 0.487) or any of the other six facets. Moreover, no significant differences were found compared to the study group of our previous study 6 months after CI treatment., Conclusion: This study demonstrates the long-term stability of the improved quality of life following unilateral CI treatment in patients aged 65 years or older., (© 2022. The Author(s).)

Objectives: The aim of this study was to compare the impact of reverberation on sound localization accuracy and speech perception in noise between subjects with single-sided deafness using a cochlear implant (SSD-CI) and a normal-hearing control group., Methods: Nine SSD-CI subjects and 21 normal-hearing subjects participated in the study. In Experiment 1, the sound localization accuracy was measured with and without reverberation. In Experiment 2, speech reception thresholds were determined with four asymmetrically arranged noise sources in free-field and in reverberation. For the realization of reverberation, a room simulation system comprising of 128 loudspeakers was used., Results: No significant impact of reverberation was found on the sound localization accuracy of the SSD-CI subjects (free-field: 12.6°, reverberation: 11.9°), whereas the normal-hearing subjects performed significantly worse in reverberation (free-field: 1.8°, reverberation: 3.3°).Both subject groups experienced significantly deteriorated speech reception thresholds due to reverberation (pSSD-CI = 0.008, pNH < 0.001). Mean speech reception thresholds in the SSD-CI subjects were -9.7 dB SNR (free-field) and -4.2 dB SNR (reverberation) and a median individual decrease of 5.7 dB SNR in reverberation. Mean speech reception thresholds in the normal-hearing group were -14.0 dB SNR (free-field) and -10.3 dB SNR (reverberation)., Conclusion: A strong deterioration of sound localization accuracy due to reverberation did not occur. However, although partial restoration of binaural hearing is assumed in SSD-CI users, the impact of reverberation on speech perception in noise is much stronger compared to normal-hearing., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2021, Otology & Neurotology, Inc.)

Background: Tinnitus is a common symptom of severe hearing loss or deafness especially in older people. Hearing rehabilitation for these patients is usually only possible with a cochlear implant (CI). In recent years, an increasing number of old and very old patients have been treated with a CI. The aim of this study was to examine the influence of hearing rehabilitation with a CI on the tinnitus of older people., Materials and Methods: In this prospective study 34 patients between the age of 65 and 86 were included, who were unilaterally treated with a CI for the first time. 16 patients (47.1 %) had tinnitus preoperatively. At three time points (preoperative, on initial fitting and six months postoperatively), tinnitus severity was assessed in addition to speech discrimination in patients with tinnitus using the mini-tinnitus questionnaire (Mini-TF12)., Results: Six month postoperatively we found a highly significant improvement of speech discrimination (preoperatively 11.5 ± 17.4, six-month visit 54.4 ± 28.1 %, p = 0.001) that was accompanied by a highly significant reduction in tinnitus severity according to Mini-TF12 scores (preoperatively 6.9 ± 6.5, six-month visit 4.3 ± 3.3, p = 0.001)., Conclusions: Hearing rehabilitation by means of CI leads to a highly significant reduction of tinnitus severity of pre-operatively existing tinnitus in the elderly., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Clinical speech perception tests with simple presentation conditions often overestimate the impact of signal preprocessing on speech perception in complex listening environments. A new procedure was developed to assess speech perception in interleaved acoustic environments of different complexity that allows investigation of the impact of an automatic scene classification (ASC) algorithm on speech perception. The procedure was applied in cohorts of normal hearing (NH) controls and uni- and bilateral cochlear implant (CI) users. Speech reception thresholds (SRTs) were measured by means of a matrix sentence test in five acoustic environments that included different noise conditions (amplitude modulated and continuous), two spatial configurations, and reverberation. The acoustic environments were encapsulated in a randomized, mixed order single experimental run. Acoustic room simulation was played back with a loudspeaker auralization setup with 128 loudspeakers. 18 NH, 16 unilateral, and 16 bilateral CI users participated. SRTs were evaluated for each individual acoustic environment and as mean-SRT. Mean-SRTs improved by 2.4 dB signal-to-noise ratio for unilateral and 1.3 dB signal-to-noise ratio for bilateral CI users with activated ASC. Without ASC, the mean-SRT of bilateral CI users was 3.7 dB better than the SRT of unilateral CI users. The mean-SRT indicated significant differences, with NH group performing best and unilateral CI users performing worse with a difference of up to 13 dB compared to NH. The proposed speech test procedure successfully demonstrated that speech perception and benefit with ASC depend on the acoustic environment.

Background: The cochlear implant (CI) is a standard procedure for the treatment of patients with severe to profound hearing loss. In the past, a standard healing period of 3-6 weeks occurred after CI surgery before the sound processor was initially activated. Advancements of surgical techniques and instruments allow an earlier initial activation of the processor within 14 days after surgery., Objective: Evaluation of the early CI device activation after CI surgery within 14 days, comparison to the first activation after 4-6 weeks, and assessment of the feasibility and safety of the early fitting over a 12 month observation period were the objectives of this study., Method: In a prospective study, 127 patients scheduled for CI surgery were divided into early fitting group (EF, n = 67) and control group (CG, n = 60). Individual questionnaires were used to evaluate medical and technical outcomes of the EF. Medical side effects, speech recognition, and follow-up effort were compared with the CG within the first year after CI surgery., Results: The early fitting was feasible in 97% of the EF patients. In the EF, the processor was activated 25 days earlier than in the CG. No major complications were observed in either group. At the follow-up appointments, side effects such as pain and balance problems occurred with comparable frequency in both groups. At initial fitting, the EF showed a significantly higher incidence of medical minor complications (p < 0.05). When developing speech recognition within the first year of CI use, no difference was observed. Furthermore, the follow-up effort within the first year after CI surgery was comparable in both groups., Conclusions: Early fitting of the sound processor is a feasible and safe procedure with comparable follow-up effort. Although more early minor complications were observed in the EF, there were no long-term wound healing problems caused by the early fitting. Regular inspection of the magnet strength is recommended as part of the CI follow-up since postoperative wound swelling must be expected. The early fitting procedure enabled a clear reduction in the waiting time between CI surgery and initial sound processor activation., (© 2021 S. Karger AG, Basel.)

Objective: To determine the effects of cochlear implant (CI) hearing rehabilitation on quality of life in older patients (≥65 yr)., Study Design: Prospective observational study., Setting: Department of Oto-Rhino-Laryngology, Medical University Frankfurt/Main., Patients: Patients aged between 65 and 86 years who received unilateral CI therapy for the first time., Intervention: Unilateral cochlear implantation., Main Outcome Measures: In addition to audiological parameters, the World Health Organization Quality-of-Life Scale - old (WHOQL-OLD) was used to assess quality of life prior to surgery, at the time of first fitting of the audio processor (approx. 1 mo after surgery) and 6 months afterward. Dementia and depression were excluded using dementia detection test (DemTect) and geriatric depression scale., Results: Speech recognition improved significantly during the study period. Furthermore, the total WHOQL-OLD score showed a significant improvement of quality of life comparing the preoperative and the 6 months data (60.0 ± 15.7 to 66.8 ± 12.2 points) (p = 0.001). Only 6 months after surgery, comparable quality of life values were achieved compared to the corresponding population average of the same age group (67.96 ± 14.74 points). No statistically significant difference remained between the study group and the age-adjusted population average (p = 0.37)., Conclusion: To achieve auditory rehabilitation, CI treatment in older patients can be strongly recommended, not only hearing rehabilitation, but also to improve quality of life.

Purpose: Hearing performance data was collected from a large heterogeneous group of subjects implanted with the Cochlear™ Nucleus® CI532 with Slim Modiolar Electrode, for the purposes of postmarket clinical follow-up. Data was analysed for factors which may predict postoperative speech recognition scores., Methods: Data was collected retrospectively from five German clinics for 159 subjects from March 2017 to August 2018. Hearing thresholds and recognition scores for monosyllabic words in quiet and sentences in noise were measured preoperatively and at 3 and 6 months postoperatively., Results: There was a mean gain of 44% points (95% CI 39-49%) at 6 months in monosyllable scores in quiet for implanted ears. Preoperative hearing thresholds in implant ears increased systematically with decreasing age; however, younger subjects had better baseline monosyllable scores with hearing aids compared with older subjects. Baseline performance alone explained 14% of the variation in postoperative scores. Residual hearing was preserved on average to within 22 dB at 250 Hz and 30 dB at 500 Hz of preoperative levels., Conclusions: In a large and varied cohort of routinely treated hearing-impaired adults, speech recognition with the CI532 for German monosyllabic words in quiet at 6 months was equivalent to performance reported at one year or more in other published studies. Although younger subjects had poorer preoperative pure-tone thresholds, they had better preoperative word recognition scores compared with older subjects, and also had higher post implant scores. Further research is required to identify if this phenomenon is just applicable to German health system assessment and referral practices.

Since its introduction, cochlear implantation has seen an uptake and development which could not have been anticipated. Not only have the technical possibilities seen significant change but also the range of indication. Examples include the care of very young or very old patients, bilateral implantation or the use of residual hearing for combined electric-acoustic stimulation (EAS). This development is very dynamic, offering tremendous opportunities for hearing rehabilitation of affected patients. At the same time, however, it places considerable demands on service providers to ensure the care provided is striving to be of optimal quality. In recent years, an intensive discussion has taken place with the aim of defining quality parameters to serve as the cornerstones of cochlear implant (CI) treatment. These were initially based on the description of a defined course of a cochlear implantation and thus on the partial aspects of process, structure and result quality for quality assurance. Practical implementation of these considerations then resulted among other things in the "White Paper CI Care" and the concept of a "National CI Registry" of the DGHNOKHC. In addition to a content-oriented discussion within the professional society of the DGNHNOKHC, other parties like health insurers as payers are also beginning to show interest in influencing the process of CI care (e. g. QuInCI initiative by Techniker Krankenkasse). The legislator is also preparing measures that will directly affect CI care ("Implant Registry Act"). This article will present the current state of knowledge in quality assurance of CI care and define Germany's position compared to other countries., Competing Interests: Der Autor erhält Forschungsunterstützung bzw. Vortragstätigkeit für die Firmen: MED EL Elektromedizinische Geräte Deutschland GmbH; Cochlear Deutschland GmbH + Co. KG; Advance Bionics GmbH, (Eigentümer und Copyright ©Georg Thieme Verlag KG 2019.)

Objectives: The controlled clinical test environment is very different from real-life listening situations, where the presence of additional speakers and variations in background noise signals can affect listening performances. The primary objective of this study is to reduce the gap between clinical results and real-life performances that are reported for many hearing implant users. Methods: Similar to Part I of this study, hearing performance and sound perception are evaluated using the following tests: (i) the Roving Level Test, (ii) the Just Understanding Speech Test, (iii) the Performance Perceptual Test, (iv) the Visual Analogue Scale to evaluate the perceived listening effort required for a range of background noise levels, and (v) the Hearing Implant Sound Quality questionnaire. All subjects recruited for this study used MED-EL hearing implant systems. Results: Results show that, similar to normal hearing listeners, hearing implant users tend to accurately estimate their hearing abilities, and both listening effort and speech recognition thresholds tend to increase with increasing noise. Discussion: The proposed test battery for evaluating speech understanding and listening effort were suitable for use in this study as all of the implant users were able to complete the tests. This test battery can be used to provide audiologists with further information relating to real-life listening performances. Conclusion: Evaluating the self-estimated and verified performance measurements of hearing implant users in real-life listening situations are essential for providing information regarding the discrepancies observed between the objective and subjective reports of hearing difficulties.

The aim of this study was to assess the ability of elderly test subjects without self-reported hearing loss to perceive, hear and comprehend speech in quiet and noise. Furthermore, the effects of age and cognitive performance on hearing were also investigated.The study included 40 subjects aged over 60 years (average age: 69.3 ± 7.1 years). The subjects were screened for dementia (DemTect test) to test for any signs of cognitive deficiencies. Average hearing loss (PTA&#95;4) and average high-frequency hearing loss (PTA&#95;HT) were determined. Speech perception in quiet was tested by means of the Freiburg monosyllabic speech test and in noise by means of the Oldenburg sentence test with two different types of noise (temporally continuous and amplitude modulated). While the results of the DemTect test were age-appropriate for 65 % of the subjects, the remaining 35 % showed signs of mild cognitive impairments. The parameters of cognitive performance decreased significantly with age. The hearing loss (PTA&#95;4 and PTA&#95;HT) of the subjects correlated significantly with both age and DemTect score. Speech perception in both quiet and noise decreased significantly with age as well as within the parameters to assess cognitive performance.Seniors should undergo routine hearing screenings in order to detect hearing disorders as soon as possible so that hearing aids can be prescribed at an early stage. This would also allow, patients to get accustomed to their hearing aids early on and to achieve better hearing, thereby improving their quality of life., Competing Interests: Diese Studie wurde unterstützt von der Cochlear Deutschland GmbH und Co. KG, Hannover., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Combined electric-acoustic stimulation (EAS) is a well-accepted therapeutic treatment for cochlear implant (CI) users with residual hearing in the low frequencies but severe to profound hearing loss in the high frequencies. The recently introduced SONNETeas audio processor offers different microphone directionality (MD) settings and wind noise reduction (WNR) as front-end processing. The aim of this study was to compare speech perception in quiet and noise between two EAS audio processors DUET 2 and SONNETeas, to assess the impact of MD and WNR on speech perception in EAS users in the absence of wind. Furthermore, subjective rating of hearing performance was registered., Method: Speech perception and subjective rating with SONNETeas or DUET 2 audio processor were assessed in 10 experienced EAS users. Speech perception was measured in quiet and in a diffuse noise setup (MSNF). The SONNETeas processor was tested with three MD settings omnidirectional/natural/adaptive and with different intensities of WNR. Subjective rating of auditory benefit and sound quality was rated using two questionnaires., Results: There was no significant difference between DUET 2 and SONNETeas processor using the omnidirectional microphone in quiet and in noise. There was a significant improvement in SRT with MD settings natural (2.2 dB) and adaptive (3.6 dB). No detrimental effect of the WNR algorithm on speech perception was found in the absence of wind. Sound quality was rated as "moderate" for both audio processors., Conclusions: The different MD settings of the SONNETeas can provide EAS users with better speech perception compared to an omnidirectional microphone. Concerning speech perception in quiet and quality of life, the performance of the DUET 2 and SONNETeas audio processors was comparable., Competing Interests: This work was funded by MED-EL Elektromedizinische Geraete GmbH Innsbruck, Austria. The study protocol was designed in collaboration with MED-EL corporation. All testing was conducted at University Frankfurt by employees and all data were analyzed by the authors. The funders had no role in data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objective: The aim of this study was to investigate the impact of microphone configuration and noise reduction algorithm on speech perception of cochlear implant (CI) users in a moving noise setup., Method: Eleven CI users provided with Advanced Bionics implant systems participated in this study. All tests were conducted with three different microphone settings: (a) omnidirectional behind the ear (BTE), (b) inside the pinna (ITP), and (c) adaptive directional microphone (adaptive beamformer, ABF). Speech reception thresholds (SRTs) were measured using the Oldenburg sentence test in a moving noise source condition. Furthermore, the effect of a noise reduction algorithm on speech perception was measured in a condition with an additional static noise source., Results: The ABF setting significantly improved SRT by 5.7 dB compared with the BTE microphone, and by 4.7 dB compared with the ITP microphone in the moving noise condition. In the presence of an additional static noise source, there was a significant improvement in SRT of 0.9 dB with the use of NR in addition to ABF., Conclusion: Adaptive beamforming can significantly improve speech perception in moving noise. Depending on the noise condition, the combination of ABF with NR can provide additional benefit.

Objectives: To report on electrode array measurements for the Nucleus ® CI532 Slim Modiolar Electrode device including: ECAP thresholds, electrode impedances, and psychophysical comfort levels, as well as speech perception results pre- and post-operatively and standardized evaluations of quality of life., Methods: Forty-four subjects were implanted with the CI532. Electrically evoked compound action potential (ECAP) thresholds and impedances were measured using automatic Neural Response Telemetry intra-operatively, at activation and at six months post implant. Pre- and post-operative measures of words in quiet and sentences in noise were made in multiple languages. Quality of life was assessed using The Speech Spatial Qualities questionnaire (SSQ) and Glasgow Benefit Inventory (GBI)., Results: Intra-operative ECAP thresholds were recorded successfully from 90% of electrodes tested. ECAP thresholds varied across the array and a post-hoc Dunn's test showed that median thresholds for electrodes E1-E13 were significantly greater than those for E17-E22 (all P < 0.001). Impedances increased significantly between surgery and activation. Speech recognition scores for words in quiet and sentences in noise showed a significant improvement for the group at six months, when using the cochlear implant, compared with pre-operative performance (P < 0.001). There was a significant increase compared to pre-operative ratings for all sections of the SSQ at six months post activation (P < 0.001). The GBI gave scores significantly above zero for the 'general' subscale and total score., Conclusion: Objective ECAP and impedance measures for this new electrode array were as expected and similar to results reported for other array types. Speech perception and quality of life improved significantly following implantation. (Registered as NCT02392403 on ClinicalTrials.gov PRS).

Objective: Evaluation of a shortened delay time between surgical placement of the cochlear implant (CI) device and processor activation to less than 8 days (early CI fitting). Assessment of benefits and limits of early fitting in terms of medical, technical, audiological, and subjective outcome., Study Design: Prospective., Setting: Tertiary referral center., Patients: Forty-one patients scheduled for cochlear implant surgery divided into early fit (EF, n = 21) and control group (CG, n = 19)., Main Outcome Measures: Questionnaires were used to evaluate technical, medical, and subjective outcomes associated with early fitting. Additional, electrode impedance and speech recognition scores were measured. These data, collected preoperative, at first activation and after 3 months were compared with the CG with standard fitting., Results: The medical and audiological status of the EF subjects allowed early fitting in nearly all patients (20/21). Evidence of pain, delayed wound healing, or other compromises was equal in both study groups. Speech recognition scores show comparable development over time for EF and CG. Average electrode impedance was significantly higher in the CG at first activation., Conclusions: Early fitting of the sound processor is feasible and did not compromise wound healing or generates additional pain. During the first month following surgery, reduction of wound swelling can be expected. Hence, regular inspection of magnet strength is recommended at follow-ups. Over all, early activation of their CI device was highly appreciated by nearly all patients.

The aim of this study was to examine the functional hearing results regarding speech perception and auditory sound localization in a high-resolution directional hearing setup following implantation with a new bone conduction device (MED-EL Bonebridge, Innsbruck, Austria). In addition, we assessed the patient acceptance of the Bonebridge system using a questionnaire. The study design is retrospective study. The setting is University Hospital Frankfurt. 18 patients implanted with a Bonebridge device from May 2012 to January 2015 were participated in this study. Speech perception in quiet was tested with the Freiburg monosyllable test at a presentation level of 65 dB SPL. Speech perception in noise was tested post-operatively with the Oldenburg sentence test (OLSA) in best-aided condition. We assessed auditory sound localization with a high-resolution directional hearing setup. To evaluate the acceptance by patients using the Bonebridge in daily life, we used a modified questionnaire. The overall average of functional hearing gain (n = 18) was 29.3 dB (±20.7 dB). Speech perception of monosyllabic words in quiet improved by 20.7% on average, compared with the pre-operative aided condition. Mean speech reception thresholds (SRTs) of the Oldenburg sentence test (OLSA) improved significantly from -3.8 dB SNR (range -5.7 to 5.8 dB SNR) to -5.2 dB SNR (range -6.3 to -0.6 dB SNR) after implantation. Regarding localization abilities, no significant difference was found between the unaided and aided conditions following Bonebridge implantation. A survey of patients' acceptance and handling of the Bonebridge implant in daily life revealed high patient satisfaction. All patients accepted and benefited from the implanted system. No infections or adverse surgical effects occurred. Speech perception significantly improved in quiet and in noise. No significant difference in sound localization was observed. Acceptance of the Bonebridge implant, tested with a modified questionnaire, was high.

Objective: The present study aimed to determine the extent of hearing preservation retrospectively after atraumatic cochlear implant (CI) surgery using a specialized surgical technique and specially designed flexible electrode to minimize cochlear trauma., Study Design: Retrospective study., Setting: Academic tertiary care center., Patients: A consecutive series of 34 patients who had some preoperative residual hearing were included in this study., Intervention: Patients underwent CI surgery with a flexible 28-mm electrode using a round window insertion technique., Main Outcome Measures: All patients had at least 6 months of postoperative follow-up including audiometric testing and speech perception determined using the Freiburg monosyllable word test and the Oldenburger Sentence Test in noise. Audiometric testing served as a proxy for the evaluation of cochlear trauma and hearing preservation., Results: Hearing was preserved to within 20 dB of preoperative low-frequency pure-tone audiometry (PTA) in 40.7% of patients. Hearing was preserved to within 20 dB of preoperative high-frequency PTA in 35.7% of patients. Overall, a deterioration in hearing thresholds was observed between preoperative assessment and first fitting. Speech perception improved significantly over time after surgery., Conclusion: Using appropriate surgical techniques, and electrodes specially designed to minimize cochlear trauma, hearing preservation can be achieved.

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(1) Background: The aim of the present study was to assess the impact of reverberation on speech perception in noise and spatial release from masking (SRM) in bimodal or bilateral cochlear implant (CI) users and CI subjects with low-frequency residual hearing using combined electric–acoustic stimulation (EAS). (2) Methods: In total, 10 bimodal, 14 bilateral CI users and 14 EAS users, and 17 normal hearing (NH) controls, took part in the study. Speech reception thresholds (SRTs) in unmodulated noise were assessed in co-located masker condition (S0N0) with a spatial separation of speech and noise (S0N60) in both free-field and loudspeaker-based room simulation for two different reverberation times. (3) Results: There was a significant detrimental effect of reverberation on SRTs and SRM in all subject groups. A significant difference between the NH group and all the CI/EAS groups was found. There was no significant difference in SRTs between any CI and EAS group. Only NH subjects achieved spatial release from masking in reverberation, whereas no beneficial effect of spatial separation of speech and noise was found in any CI/EAS group. (4) Conclusions: The subject group with electric–acoustic stimulation did not yield a superior outcome in terms of speech perception in noise under reverberation when the noise was presented towards the better hearing ear. [ABSTRACT FROM AUTHOR]

(1) Background: The fitting of cochlear implants (CI) is an established treatment, even in cases with considerable residual hearing but insufficient speech perception. The aim of this study was to evaluate a prediction model for speech in quiet and to provide reference data and a predictive model for postoperative speech perception in noise (SPiN) after CI provision. (2) Methods: CI candidates with substantial residual hearing (either in hearing threshold or in word recognition scores) were included in a retrospective analysis (n = 87). Speech perception scores in quiet 12 months post-surgery were compared with the predicted scores. A generalized linear model was fitted to speech reception thresholds (SRTs) after CI fitting to identify predictive variables for SPiN. (3) Results: About two-thirds of the recipients achieved the expected outcome in quiet or were better than expected. The mean absolute error of the prediction was 13.5 percentage points. Age at implantation was the only predictive factor for SPiN showing a significant correlation (r = 0.354; p = 0.007). (4) Conclusions: Outcome prediction accuracy for speech in quiet was comparable to previous studies. For CI recipients in the included study population, the SPiN outcome could be predicted only based on the factor age. [ABSTRACT FROM AUTHOR]

Hearing loss in old age, which often goes untreated, has far-reaching consequences. Furthermore, reduction of cognitive abilities and dementia can also occur, which also affects quality of life. The aim of this study was to investigate the hearing performance of seniors without hearing complaints with respect to speech perception in noise and the ability to localize sounds. Results were tested for correlations with age and cognitive performance. The study included 40 subjects aged between 60 and 90 years (mean age: 69.3 years) with not self-reported hearing problems. The subjects were screened for dementia. Audiological tests included pure-tone audiometry and speech perception in two types of background noise (continuous and amplitude-modulated noise) which was either co-located or spatially separated (multi-source noise field, MSNF) from the target speech. Sound localization ability was assessed and hearing performance was self-evaluated by a questionnaire. Speech in noise and sound localization was compared with young normal hearing adults. Although considering themselves as hearing normal, 17 subjects had at least a mild hearing loss. There was a significant negative correlation between hearing loss and dementia screening (DemTect) score. Speech perception in noise decreased significantly with age. There were significant negative correlations between speech perception in noise and DemTect score for both spatial configurations. Mean SRTs obtained in the co-located noise condition with amplitude-modulated noise were on average 3.1 dB better than with continuous noise. This gap-listening effect was severely diminished compared to a younger normal hearing subject group. In continuous noise, spatial separation of speech and noise led to better SRTs compared to the co-located masker condition. SRTs in MSNF deteriorated in modulated noise compared to continuous noise by 2.6 dB. Highest impact of age was found for speech perception scores using noise stimuli with temporal modulation in binaural test conditions. Mean localization error was in the range of young adults. Mean amount of front/back confusions was 11.5% higher than for young adults. Speech perception tests in the presence of temporally modulated noise can serve as a screening method for early detection of hearing disorders in older adults. This allows for early prescription of hearing aids. [ABSTRACT FROM AUTHOR]

Background: Due to the coronavirus disease 2019 (COVID-19) pandemic, interventions in the upper airways are considered high-risk procedures for otolaryngologists and their colleagues. The purpose of this study was to evaluate limitations in hearing and communication when using a powered air-purifying respirator (PAPR) system to protect against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission and to assess the benefit of a headset. Methods: Acoustic properties of the PAPR system were measured using a head and torso simulator. Audiological tests (tone audiometry, Freiburg speech test, Oldenburg sentence test (OLSA)) were performed in normal-hearing subjects (n = 10) to assess hearing with PAPR. The audiological test setup also included simulation of conditions in which the target speaker used either a PAPR, a filtering face piece (FFP) 3 respirator, or a surgical face mask. Results: Audiological measurements revealed that sound insulation by the PAPR headtop and noise, generated by the blower-assisted respiratory protection system, resulted in significantly deteriorated hearing thresholds (4.0 ± 7.2 dB hearing level (HL) vs. 49.2 ± 11.0 dB HL, p < 0.001) and speech recognition scores in quiet (100.0 ± 0.0% vs. 2.5 ± 4.2%, p < 0.001; OLSA: 20.8 ± 1.8 dB vs. 61.0 ± 3.3 dB SPL, p < 0.001) when compared to hearing without PAPR. Hearing with PAPR was significantly improved when the subjects were equipped with an in-ear headset (p < 0.001). Sound attenuation by FFP3 respirators and surgical face masks had no clinically relevant impact on speech perception. Conclusions: The PAPR system evaluated here can be considered for high-risk procedures in SARS-CoV-2-positive patients, provided that hearing and communication of the surgical team are optimized by the additional use of a headset. [ABSTRACT FROM AUTHOR]

Objective: The objective of this prospective, single-subject, repeated measures study was to evaluate the audiological benefit and patient satisfaction with an adhesive, pressure-free bone conduction hearing system (ADHEAR; MED-EL, Innsbruck, Austria) in patients who underwent middle ear surgery with transient hearing loss due to auditory canal tamponade. Methods: Eleven adult subjects suffering from transient conductive hearing loss were enrolled in the study and followed up to 3 weeks after middle ear surgery. Bone and air conduction thresholds were measured pre and postoperatively to evaluate eligibility for enrollment. Postoperative unaided and aided sound-field thresholds, as well as speech tests in quiet and noise were compared to confirm hearing improvement with the hearing system. To determine patient satisfaction, the SSQ12 and a system-specific quality of life questionnaire was administered to all subjects. Results: Speech perception for monosyllables in quiet improved by 46%, with statistical significance for the ADHEAR system compared to the unaided condition after one week. The functional hearing gain improved by 19 dB. Speech perception in noise with the device was − 6.7 dB SNR on average, with a statistically significant improvement of 2.7 dB SNR. The results of the questionnaire showed a high level of patient satisfaction and subjective hearing improvement. No serious skin reactions or other severe complications occurred. Conclusion: As long as the auditory canal is blocked due to tamponade, patients benefit from hearing rehabilitation. This adhesive hearing system is a safe and effective device to treat transient conductive hearing loss and may considerably improve treatment for patients even with short-term hearing loss. [ABSTRACT FROM AUTHOR]