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Objectives: To evaluate outcomes of BAHA Connect® and BAHA Attract® implantations, and to examine the prognostic utility of a preimplantation Softband®-attached processor trial., Study Design: Retrospective case review., Setting: Tertiary referral center., Patients: Patients who underwent Connect® (19 ears) and Attract® (25 ears) implantation between 2007 and 2017., Intervention: BAHA® implantation., Main Outcome Measures: Unaided air conduction (AC), bone conduction (BC), and speech reception thresholds (SRTs), as well as free field (FF) aided with Softband®-attached processor and with implant-attached processor thresholds., Results: Serviceable implant-attached processor PTA0.5,1,2 kHz (≤35 dB HL) was achieved in 89 and 88% of the Connect® and the Attract® ears, respectively, while at 4 kHz this was achieved in 68 and 32% of the Connect® and the Attract® ears, respectively (p  =  0.032). Significantly more Connect® ears showed alignment between FF aided with implant-attached processors thresholds and BC thresholds. The alignment between the Softband®-attached processors thresholds and implant-attached processors thresholds was similar in the two groups. Both groups exhibited similar positive improvement in the quality of life questionnaires., Conclusions: Accessibility to sound with the implant-attached processor is well predicted by the pre-implantation Softband® trial, both in the BAHA Connect® and in the BAHA Attract® ears. Hearing rehabilitation targets at 0.5, 1, and 2 kHz are met by most Connect® and Attract® ears, while at 4 kHz the outcome with Attract® is poorer. This information should be presented to the patient during consultation prior to a decision as to the type of BAHA® device to be implanted., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2021, Otology & Neurotology, Inc.)

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

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

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

Conclusions: The range of evaluation tools used in deciding which ear to implant and which to designate for a hearing aid (HA) should be expanded to include additional aspects to those tested by audiometry and basic speech perception. Residual hearing in non-implanted ears remains stable for at least 3 years after unilateral cochlear implantation, but regular refitting and monitoring of the HA function combined with cochlear implant (CI) mapping are mandatory for maximizing benefit from binaural-bimodal hearing., Objectives: To examine whether the clinical decision-making tools currently used to assess hearing are reliable guides when choosing the preferred ear for CI, and to determine the rate of residual hearing deterioration in the non-implanted ear over 36 months post-CI as a guide to recommending subsequent continued use of a contralateral HA as opposed to CI., Patients and Methods: This was a retrospective evaluation of patients' charts. The pre-CI choice of the ear for implantation in a group of 37 binaural-bimodal users was re-evaluated. In a second group of 22 patients, residual hearing deterioration was followed for 36 months post-implantation., Results: In the group of 37 patients, subjective identification of the worse-hearing ear was in agreement with audiometric results in 28 cases, but disagreed with the unaided audiometric results in the other 9. Mean threshold values for the group of 22 patients remained stable over 36 months post-CI, except for the aided threshold at 4.0 kHz, which deteriorated by 10.9 dB (p=0.003).

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

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