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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]

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]

Objectives: Bimodal cochlear implant (CI) users vary in speech recognition outcomes. This variability may be influenced partly by the CI and contralateral hearing aid (HA) programming procedures, which can result in mismatches in latency and frequency. We assessed the performance of bimodal listeners when latency mismatches were corrected and analyzed how frequency mismatches influenced outcomes., Methods: Twelve adults with at least 1 year of bimodal use were evaluated in latency mismatched versus matched conditions. Masked sentence recognition was assessed in a 10-talker masker for three spatial configurations: target from the front and the masker either co-located, 90° toward the CI-ear, or 90° toward the HA-ear. Frequency mismatch for the most apical electrode (E1) was determined from postoperative imaging and the filter frequency assignment of their familiar CI map., Results: Participants had significantly better performance when latency mismatches were small or matched between the devices, with an approximately 10% improvement in the configuration with the masker toward the HA-ear. Significantly, poorer performance was observed with larger magnitudes of frequency mismatch, with a 2% drop in performance for every one semitone deviation increase in mismatch. The interaction between latency and frequency mismatch was nonsignificant, suggesting that the benefit of latency matching was approximately additive across the range of frequency mismatches., Conclusions: Detrimental effects of interaural mismatches in latency and frequency were observed, even after long-term device use. These preliminary results suggest that bimodal CI users might benefit from individualized fitting procedures that match latency across devices and minimize frequency mismatch for the CI., Level of Evidence: 3 Laryngoscope, 2025., (© 2025 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: This study was designed to (1) compare preactivation and postactivation performance with a cochlear implant for children with functional preoperative low-frequency hearing, (2) compare outcomes of electric-acoustic stimulation (EAS) versus electric-only stimulation (ES) for children with versus without hearing preservation to understand the benefits of low-frequency acoustic cues, and (3) to investigate the relationship between postoperative acoustic hearing thresholds and performance., Design: This was a prospective, 12-month between-subjects trial including 24 pediatric cochlear implant recipients with preoperative low-frequency functional hearing. Participant ages ranged from 5 to 17 years old. They were recruited at their device activation and fit with EAS or ES based on their postoperative thresholds. Group outcomes were compared for single-word recognition, masked sentence recognition, perceived hearing abilities, speech production, receptive language, expressive language, and prosodic identification., Results: Children experienced improvements in word recognition, subjective hearing, speech production, and expressive language with EAS or ES as compared with their preoperative abilities. Children using EAS performed better on a prosodic identification task and had higher subjective hearing scores postactivation as compared with children using ES. There was a significant relationship between postoperative thresholds at 125 Hz and prosodic identification., Conclusions: The results of this study support cochlear implantation for children with normal-to-moderate low-frequency hearing thresholds and severe-to-profound high-frequency hearing loss. They also highlight the benefits of postoperative hearing preservation for language development., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2025 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)