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Supplemental Digital Content is available in the text., Objectives: To understand the varying levels of daily cochlear implant (CI) use in children, previous studies have investigated factors that may be of influence. The objective of this study was to investigate the degree with which new child-related and environment-related characteristics were associated with consistent CI use. Design: The design of this study was retrospective. Data were reviewed of 81 children (51% females, mean age 6.4 years with a range of 1.3 to 17.7 years) who received a CI between 2012 and 2019. Developmental status, quantified burden of comorbidity, hearing experience, and hearing environment were investigated for correlation with consistency in daily CI use. The CIs datalog was used to objectively record the wearing times. Associations were examined using univariate correlation analyses and a linear regression analysis. Results: On average, the CI was worn 8.6 hr per day and 59% of the children wore it more than 8 hr daily. The latter children’s hearing performance was significantly higher than that of the others. Consistency in CI use correlated significantly with the child-related characteristics chronological age, nonverbal intelligence quotient (IQ), American Society of Anesthesiologists physical status class, pre CI acoustic experience, CI experience, and one of the environment related characteristics “parental communication mode.” In a multivariate linear regression model, consistency in CI use was significantly dependent on nonverbal IQ and parental communication mode. These together accounted for 47% of the variation in daily CI use. Conclusions: The findings indicate that children with lower nonverbal IQ scores and low exposure to oral communication by their parents are at risk of inconsistent CI use.

OBJECTIVES: To investigate the possible advantage of the use of a dedicated bimodal hearing aid fitting formula, the Adaptive Phonak Digital Bimodal (APDB), compared with a frequently used standard hearing aid fitting formula, the NAL-NL2. We evaluated the effects of bimodal hearing aid fitting on provided hearing aid gain and on bimodal auditory functioning in a group of experienced bimodal cochlear implant (CI) users. A second aim of our study was to determine the effect of broadband loudness balancing on the prescribed gain of those two fitting formulas. DESIGN: This prospective study used a crossover design in which two fitting methods were compared varying in basic prescription formula (NAL-NL2 or APDB fitting formula). The study consisted of a three-visit crossover design with 3 weeks between sessions. Nineteen postlingually deafened experienced bimodal CI users participated in this study. Auditory functioning was evaluated by a speech in quiet test, a speech in noise test, and a questionnaire on auditory performance. RESULTS: Significant differences between the two fitting formulas were found for frequencies of 2000 Hz and above. For these frequencies, less gain was provided by the APDB fitting formula compared with NAL-NL2. For the APDB fitting formula, a higher compression ratio for frequencies of 1000 Hz and above was found compared with the NAL-NL2 fitting formula. Loudness balancing did not result in large deviations from the prescribed gain by the initial fitting formula. Bimodal benefit was found for speech perception in quiet and for speech perception in noise. No differences in auditory performance were found between the two fitting formulas for any of the auditory performance tests. CONCLUSIONS: The results of this study show that CI users with residual hearing at the contralateral ear can benefit from bimodal stimulation, regardless of the fitting method that was applied. Although significant differences between the output and compression ratio of the NAL-NL2 and the APDB fitting formula existed, no differences in bimodal auditory performance were observed. Therefore, NAL-NL2 or the APDB fitting prescription both seem suited for bimodal fitting purposes. Additional loudness balancing has a marginal effect on the provided hearing aid output.

Objectives: With current cochlear implants (CIs), CI recipients achieve good speech perception in quiet surroundings. However, in acoustically complex, real-life environments, speech comprehension remains difficult and sound quality often remains poor. It is, therefore, a challenge to program CIs for such environments in a clinic. The CI manufacturer Cochlear Ltd. recently introduced a remote control that enables CI recipients to alter the upper stimulation levels of their user programs themselves. In this concept, called remote assistant fitting (RAF), bass and treble controls can be adjusted by applying a tilt to emphasize either the low- or high-frequency C-levels, respectively. This concept of selfprogramming may be able to overcome limitations associated with finetuning the CI sound processor in a clinic. The aim of this study was to investigate to what extent CI recipients already accustomed to their clinically fitted program would adjust the settings in daily life if able to do so. Additionally, we studied the effects of these changes on auditory functioning in terms of speech intelligibility (in quiet and in noise), noise tolerance, and subjectively perceived speech perception and sound quality. Design: Twenty-two experienced adult CI recipients (implant use >12 months) participated in this prospective clinical study, which used a within-subject repeated measures design. All participants had phoneme scores of ≥70% at 65 dB SPL in quiet conditions, and all used a Cochlear Nucleus CP810 sound processor. Auditory performance was tested by a speech-in-quiet test, a speech-in-noise test, an acceptable noise level test, and a questionnaire about perceived auditory functioning, that is, a speech and sound quality (SSQ-C) questionnaire. The first session consisted of a baseline test in which the participants used their own CI program and were instructed on how to use RAF. After the first session, participants used RAF for 3 weeks at home. After these 3 weeks, the participants returned to the clinic for auditory functioning tests with their self-adjusted programs and completed the SSQ-C. Results: Fifteen participants (68%) adjusted their C-level frequency profile by more than 5 clinical levels for at least one electrode. Seven participants preferred a higher contribution of the high frequencies relative to the low frequencies, while five participants preferred more lowfrequency stimulation. One-third of the participants adjusted the high and low frequencies equally, while some participants mainly used the overall volume to change their settings. Several parts of the SSQ-C questionnaire scores showed an improvement in perceived auditory functioning after the subjects used RAF. No significant change was found on the auditory functioning tests for speech-in-quiet, speech-in-noise, or acceptable noise level. Conclusions: In conclusion, the majority of experienced CI users made modest changes in the settings of their programs in various ways and were able to do so with the RAF. After altering the programs, the participants experienced an improvement in speech perception in quiet environments and improved perceived sound quality without compromising auditory performance. Therefore, it can be concluded that self-adjustment of CI settings is a useful and clinically applicable tool that may help CI recipients to improve perceived sound quality in their daily lives.