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Purpose: The U.S. Food and Drug Administration indications for cochlear implantation in children is currently 9 months of age and older for children with bilateral profound sensorineural hearing loss (SNHL). Studies have shown that earlier activation of a cochlear implant (CI) can lead to better spoken language outcomes. As auditory skills are a precursor to the development of spoken language, this study was developed to investigate the influence of age at CI activation on auditory skill acquisition in young children. A secondary aim was to describe the auditory skills of children implanted prior to 9 months of age as compared to children with older ages of activation. Method: Functional Listening Index (FLI) scores obtained during routine clinical visits were reviewed for 78 pediatric CI recipients with congenital bilateral profound hearing loss who were activated before 2 years of age. A linear mixed-effects model assessed the effect of age at CI activation on cumulative FLI scores over time. Results: There was a significant interaction between age at activation and chronological age at the time of evaluation, indicating that children with earlier access to sound achieved a greater number of auditory skills than those with later CI activations when measured at the same chronological age. Children activated before the age of 9 months approximated scores expected of children with typical hearing, whereas children activated between 9 and 24 months of age did not. Conclusions: Younger age at CI activation is associated with increased auditory skills over time. Children who undergo cochlear implantation and CI activation before 9 months achieve more auditory skills by 4 years of age than children who are activated at later ages. These data suggest that reducing the approved age at cochlear implantation for children with congenital bilateral profound SNHL may support optimal auditory skill acquisition.

Objective(s): FDA‐approved indications for cochlear implantation include patients with severe‐to‐profound unilateral hearing loss (UHL) or asymmetric hearing loss (AHL); however, these indications are not covered for Medicare beneficiaries. We assessed the outcomes of cochlear implant (CI) use for older adults with UHL or AHL. Methods: Eighteen older adults (≥65 years of age at surgery) with UHL/AHL participated in a prospective, longitudinal investigation evaluating outcomes of CI use. Speech recognition for the affected ear was evaluated with consonant‐nucleus‐consonant (CNC) words. Spatial hearing was assessed with measures of sound source localization and sentence recognition in noise. The target sentence was presented from the front and the masker was either co‐located with the target (SoNo), presented toward the affected ear (SoNci) or contralateral ear (SoNcontra). Perceived benefit was assessed with the Speech, Spatial, and Qualities of Hearing scale (SSQ) and the Tinnitus Handicap Inventory (THI). Results: Participants experienced significant improvements with CI use for CNC words (mean [SD]; preop: 8% [10%], 1 yr: 51% [22%], 5 yr: 50% [19%]), masked sentence recognition (SoNcontra preop: 5% [6%], 1 yr: 22% [15%], 5 yr: 41% [14%]), and localization (preop: 76° [18°], 1 yr: 40° [11°], 5 yr: 41° [14°]), and reported significant improvements in hearing abilities (SSQ Spatial Hearing preop: 3 [1], 1 yr: 6 [2], 5 yr: 6 [2]) and tinnitus severity (THI preop: 16 [18], 1 yr: 4 [14], 5 yr: 6 [12]). Conclusion: Older adults with UHL/AHL experience significant improvements in speech recognition, spatial hearing, and subjective perceptions (e.g., hearing abilities and tinnitus severity) with a CI as compared to pre‐operative abilities. Level of Evidence: 4 Laryngoscope, 135:352–360, 2025 [ABSTRACT FROM AUTHOR]

Purpose: Cochlear implant (CI) recipients who listen with a hearing aid (HA) in the contralateral ear, known as bimodal listeners, demonstrate individual variability in speech recognition in noise. This variability may be due in part to differences in the processing delays of the CI and HA devices. This study investigated the influence of matching the processing delays of CI and HA devices on masked speech recognition for bimodal listeners. Method: Twelve postlingually deafened adult CI recipients completed a task of masked speech recognition in two listening conditions: (a) independent default CI and HA processing delays (mismatched) and (b) with their HA-specific delay applied to the CI processing delay (matched). Speech recognition was evaluated with AzBio sentences presented in a 10-talker masker at a 0 dB SNR. The target was presented from the front loudspeaker at 0° azimuth, and the masker was co-located with the target, presented 90° toward the CI ear, or presented 90° toward the HA ear. Results: There was a significant main effect for target-to-masker configuration, with better performance when the masker was spatially separated from the target. Better masked speech recognition was observed in the matched condition as compared to the mismatched condition. Conclusion: Bimodal listeners may experience better masked speech recognition when the processing delay of the CI is individualized to match the processing delay of the contralateral HA. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the ability to discriminate yes/no questions from statements in three groups of children: bilateral cochlear implant (CI) users, nontraditional CI users with aidable hearing preoperatively in the ear to be implanted, and controls with normal hearing. Half of the nontraditional CI users had sufficient postoperative acoustic hearing in the implanted ear to use electric–acoustic stimulation, and half used a CI alone. Method: Participants heard recorded sentences that were produced either as yes/no questions or as statements by three male and three female talkers. Three raters scored each participant response as either a question or a statement. Bilateral CI users (n = 40, 4–12 years old) and normal-hearing controls (n = 10, 4– 12 years old) were tested binaurally in the free field. Nontraditional CI recipients (n = 22, 6–17 years old) were tested with direct audio input to the study ear. Results: For the bilateral CI users, performance was predicted by age but not by 125-Hz acoustic thresholds; just under half (n = 17) of the participants in this group had measurable 125-Hz thresholds in their better ear. For nontraditional CI recipients, better performance was predicted by lower 125-Hz acoustic thresholds in the test ear, and there was no association with participant age. Performance approached that of the normal-hearing controls for some participants in each group. Conclusions: Results suggest that a 125-Hz acoustic hearing supports discrimination of yes/no questions and statements in pediatric CI users. Bilateral CI users with little or no acoustic hearing at 125 Hz develop the ability to perform this task, but that ability emerges later than for children with better acoustic hearing. These results underscore the importance of preserving acoustic hearing for pediatric CI users when possible. [ABSTRACT FROM AUTHOR]

Objective: Comparison of acute speech recognition for cochlear implant (CI) alone and electric‐acoustic stimulation (EAS) users listening with default maps or place‐based maps using either a spiral ganglion (SG) or a new Synchrotron Radiation‐Artificial Intelligence (SR‐AI) frequency‐to‐place function. Methods: Thirteen adult CI‐alone or EAS users completed a task of speech recognition at initial device activation with maps that differed in the electric filter frequency assignments. The three map conditions were: (1) maps with the default filter settings (default map), (2) place‐based maps with filters aligned to cochlear SG tonotopicity using the SG function (SG place‐based map), and (3) place‐based maps with filters aligned to cochlear Organ of Corti (OC) tonotopicity using the SR‐AI function (SR‐AI place‐based map). Speech recognition was evaluated using a vowel recognition task. Performance was scored as the percent correct for formant 1 recognition due to the rationale that the maps would deviate the most in the estimated cochlear place frequency for low frequencies. Results: On average, participants had better performance with the OC SR‐AI place‐based map as compared to the SG place‐based map and the default map. A larger performance benefit was observed for EAS users than for CI‐alone users. Conclusion: These pilot data suggest that EAS and CI‐alone users may experience better performance with a patient‐centered mapping approach that accounts for the variability in cochlear morphology (OC SR‐AI frequency‐to‐place function) in the individualization of the electric filter frequencies (place‐based mapping procedure). Level of Evidence: 3 Laryngoscope, 133:3540–3547, 2023 [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

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 (SRMci) or the contralateral ear (SRMcontra) 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 SRMcontra. 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 [ABSTRACT FROM AUTHOR]

Purpose: Cochlear implant (CI) recipients with hearing preservation experience significant improvements in speech recognition with electric-acoustic stimulation (EAS) as compared to with a CI alone, although outcomes across EAS users vary. The individual differences in performance may be due in part to default mapping procedures, which result in electric frequency-to-place mismatches for the majority of EAS users. This study assessed the influence of electric mismatches on the early speech recognition for EAS users. Method: Twenty-one participants were randomized at EAS activation to listen exclusively with a default or place-based map. For both groups, the unaided thresholds determined the acoustic cutoff frequency (i.e., > 65 dB HL). For default maps, the electric filter frequencies were assigned to avoid spectral gaps in frequency information but created varying magnitudes of mismatches. For place-based maps, the electric filter frequencies were assigned to avoid frequency-to-place mismatches. Recognition of consonant-nucleus-consonant words and vowels was assessed at activation and 1, 3, and 6 months postactivation. Results: For participants with default maps, electric mismatch at 1500 Hz ranged from 2 to -12.0 semitones (Mdn = -5 semitones). Poorer performance was observed for those with larger magnitudes of electric mismatch. This effect was observed through 6 months of EAS listening experience. Conclusions: The present sample of EAS users experienced better initial performance when electric mismatches were small or eliminated. These data suggest the utility of methods that reduce electric mismatches, such as place-based mapping procedures. Investigation is ongoing to determine whether these differences persist with long-term EAS use. Supplemental Material: https://doi.org/10.23641/asha.22096523 [ABSTRACT FROM AUTHOR]

Objectives: Access to cochlear implantation may be negatively influenced by extended travel time to a cochlear implant (CI) center or lower socioeconomic status (SES) for the individual. There is a critical need to understand the influence of these variables on patient appointment attendance for candidacy evaluations, and CI recipients' adherence to post‐activation follow‐up recommendations that support optimal outcomes. Methods: A retrospective chart review of adult patients referred to a CI center in North Carolina for initial cochlear implantation candidacy evaluation between April 2017 and July 2019 was conducted. Demographic and audiologic data were collected for each patient. Travel time was determined using geocoding. SES was proxied using ZCTA‐level Social Deprivation Index (SDI) information. Independent samples t tests compared variables between those who did and did not attend the candidacy evaluation. Pearson correlations assessed the association of these variables and the duration of time between initial CI activation and return for first follow‐up visit. Results: Three hundred and ninety patients met the inclusion criteria. There was a statistically significant difference between SDI of those who attended their candidacy evaluation versus those who did not. Age at referral or travel time did not show statistical significance between these two groups. There was no significant correlation with age at referral, travel time, or SDI with the duration of time (days) between initial activation and the 1‐month follow‐up. Conclusions: Our findings suggest that SES may influence a patient's ability to attend a cochlear implantation candidacy evaluation appointment and may further impact the decision to pursue cochlear implantation. Level of evidence: 4 – Case Series. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To assess whether early, significant improvements in sound source localization observed in cochlear implant (CI) recipients with normal hearing (NH) in the contralateral ear are maintained after 5 years of CI use. Study Design: Prospective, repeated measures study. Methods: Participants were recruited from a sample of CI + NH listeners (n = 20) who received their device as part of a prospective clinical trial investigating outcomes of CI use for adult cases of single-sided deafness. Sound source localization was assessed annually after the clinical trial endpoint (1-year post-activation). Listeners were asked to indicate the perceived sound source for a broadband noise burst presented randomly at varied intensity levels from one of 11 speakers along a 180( arc. Performance was quantified as root-mean-squared (RMS) error. Results: Linear mixed models showed superior post-activation performance was maintained with long-term CI use as compared to preoperative abilities (P < .001). Unexpectedly, a significant improvement (P = .009) in sound source localization was observed over the long-term post-activation period (1–5 years). To better understand these long-term findings, the response patterns for the 11 participants who were evaluated at the 1- and 5-year visits were reviewed. This subgroup demonstrated a significant improvement in RMS error (P = .020) and variable error (P = .031), indicating more consistent responses at the 5-year visit. Conclusion: Adult CI + NH listeners experience significant improvements in sound source localization within the initial weeks of listening experience, with additional improvements observed after long-term device use. The present sample demonstrated significant improvements between the 1-year and 5-year visits, with greater accuracy and consistency noted in their response patterns. [ABSTRACT FROM AUTHOR]

Introduction: Cochlear implant (CI) recipients with normal hearing (NH) in the contralateral ear experience a significant improvement in sound source localization when listening with the CI in combination with their NH-ear (CI + NH) as compared to with the NH-ear alone. The improvement in localization is primarily due to sensitivity to interaural level differences (ILDs). Sensitivity to interaural timing differences (ITDs) may be limited by auditory aging, frequency-to-place mismatches, the signal coding strategy, and duration of CI use. The present report assessed the sensitivity of ILD and ITD cues in CI + NH listeners who were recipients of long electrode arrays that provide minimal frequency-to-place mismatches and were mapped with a coding strategy that presents fine structure cues on apical channels. Methods: Sensitivity to ILDs and ITDs for localization was assessed using broadband noise (BBN), as well as high-pass (HP) and low-pass (LP) filtered noise for adult CI + NH listeners. Stimuli were 200-ms noise bursts presented from 11 speakers spaced evenly over an 180° arc. Performance was quantified in root-mean-squared error and response patterns were analyzed to evaluate the consistency, accuracy, and side bias of the responses. Fifteen listeners completed the task at the 2-year post-activation visit; seven listeners repeated the task at a later annual visit. Results: Performance at the 2-year visit was best with the BBN and HP stimuli and poorer with the LP stimulus. Responses to the BBN and HP stimuli were significantly correlated, consistent with the idea that CI + NH listeners primarily use ILD cues for localization. For the LP stimulus, some listeners responded consistently and accurately and with limited side bias, which may indicate sensitivity to ITD cues. Two of the 7 listeners who repeated the task at a later annual visit experienced a significant improvement in performance with the LP stimulus, which may indicate that sensitivity to ITD cues may improve with long-term CI use. Conclusions: CI recipients with a NH-ear primarily use ILD cues for sound source localization, though some may use ITD cues as well. Sensitivity to ITD cues may improve with long-term CI listening experience. [ABSTRACT FROM AUTHOR]

Purpose: Cochlear implant (CI) recipients with normal or near normal hearing (NH) in the contralateral ear, referred to as single-sided deafness (SSD), experience significantly better speech recognition in noise with their CI than without it, although reported outcomes vary. One possible explanation for differences in outcomes across studies could be differences in the spatial configurations used to assess performance. This study compared speech recognition for different spatial configurations of the target and masker, with test materials used clinically. Method: Sixteen CI users with SSD completed tasks of masked speech recognition presented in five spatial configurations. The target speech was presented from the front speaker (0° azimuth). The masker was located either 90° or 45° toward the CI-ear or NH-ear or colocated with the target. Materials were the AzBio sentences in a 10-talker masker and the Bamford-Kowal-Bench Speech-in-Noise test (BKB-SIN; four-talker masker). Spatial release from masking (SRM) was computed as the benefit associated with spatial separation relative to the colocated condition. Results: Performance was significantly better when the masker was separated toward the CI-ear as compared to colocated. No benefit was observed for spatial separations toward the NH-ear. The magnitude of SRM for spatial separations toward the CI-ear was similar for 45° and 90° when tested with the AzBio sentences, but a larger benefit was observed for 90° as compared to 45° for the BKB-SIN. Conclusions: Masked speech recognition in CI users with SSD varies as a function of the spatial configuration of the target and masker. Results supported an expansion of the clinical test battery at the study site to assess binaural hearing abilities for CI candidates and recipients with SSD. The revised test battery presents the target from the front speaker and the masker colocated with the target, 90° toward the CI-ear, or 90° toward the NH-ear. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the influence of talker protective face coverings on sentence recognition in noise for cochlear implant users. Method: The AzBio sentences were recorded in three conditions: (a) without any face covering (uncovered), (b) with an N95 mask, or (c) with an N95 mask plus face shield. Target sentences were presented at 60 dB SPL, and the 10-talker masker was presented at 50 dB SPL (10 dB signal-to-noise ratio. Speech recognition for these auditory stimuli was compared across conditions for 21 adult subjects with at least 6 months of cochlear implant (CI) use. Results: Significant deterioration in sentence recognition was observed for the N95 plus face shield (Mdn = 27% [IQR: 14%-35%]) compared with the N95 (Mdn = 72% [IQR: 55%-78%]) condition and for the N95 compared to uncovered (Mdn = 86% [IQR: 68%-91%]) condition. Conclusions: Talker protective face coverings have a significant influence on speech recognition in noise for CI users. More research is needed to understand the influence of visual cues with protective face coverings that include a plastic component allowing visualization of the talker's face. [ABSTRACT FROM AUTHOR]

Objectives: The objectives were to characterize the effects of wearing face coverings on: 1) acoustic speech cues, and 2) speech recognition of patients with hearing loss who listen with a cochlear implant. Methods: A prospective cohort study was performed in a tertiary referral center between July and September 2020. A female talker recorded sentences in three conditions: no face covering, N95 mask, and N95 mask plus a face shield. Spectral differences were analyzed between speech produced in each condition. The speech recognition in each condition for twenty‐three adult patients with at least 6 months of cochlear implant use was assessed. Results: Spectral analysis demonstrated preferential attenuation of high‐frequency speech information with the N95 mask plus face shield condition compared to the other conditions. Speech recognition did not differ significantly between the uncovered (median 90% [IQR 89%–94%]) and N95 mask conditions (91% [IQR 86%–94%]; P =.253); however, speech recognition was significantly worse in the N95 mask plus face shield condition (64% [IQR 48%–75%]) compared to the uncovered (P <.001) or N95 mask (P <.001) conditions. Conclusions: The type and combination of protective face coverings used have differential effects on attenuation of speech information, influencing speech recognition of patients with hearing loss. In the face of the COVID‐19 pandemic, there is a need to protect patients and clinicians from spread of disease while maximizing patient speech recognition. The disruptive effect of wearing a face shield in conjunction with a mask may prompt clinicians to consider alternative eye protection, such as goggles, in appropriate clinical situations. Level of Evidence: 3 Laryngoscope, 131:E2038–E2043, 2021 [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]