Comparison of speech perception in bimodal cochlear implant patients with respect to the cochlear coverage.

Background: The hearing success of patients with bimodal fitting, utilizing both a cochlear implant (CI) and a hearing aid (HA), varies considerably: While some patients benefit from bimodal CI and HA, others do not.
Objectives: This retrospective study aimed to investigate speech perception in bimodally fitted patients and compare it with the cochlear coverage (CC).
Methods: The CC was calculated with the OTOPLAN software, measuring the cochlear duct length on temporal bone CT scans of 39 patients retrospectively. The patients were categorized into two groups: CC ≤ 65% (CC ⁵⁰⁰ ) and CC > 65% (CC ⁶⁰⁰ ). Monaural speech intelligibility for monosyllables at a sound pressure level (SPL) of 65 dB in a free-field setting was assessed before and after CI at various time points. The two groups, one with preoperative HA and one with postoperative CI, were compared. Additionally, speech intelligibility was correlated with CC in the entire cohort before CI and at the last available follow-up (last observation time, LOT).
Results: Overall, there was no significant difference in speech intelligibility between CC ⁵⁰⁰ and CC ⁶⁰⁰ patients, with both groups demonstrating a consistent improvement after implantation. While CC ⁶⁰⁰ patients tended to exhibit earlier improvement in speech intelligibility, CC ⁵⁰⁰ patients showed a slower initial improvement within the first 3 months but demonstrated a steeper learning curve thereafter. At LOT, the two patient groups converged, with no significant differences in expected speech intelligibility. There was no significant relationship between unimodal/unilateral free-field speech intelligibility and CC. Interestingly, patients with a CC of 70-75% achieved the highest speech intelligibility.
Conclusion: Despite of the lack of a significant correlation between CC and speech perception, patients appeared to reach their maximum in unimodal/unilateral speech perception primarily at a coverage level of 70-75%. Nevertheless, further investigation is warranted, as CC ⁵⁰⁰ was associated with shorter cochlear duct length, and different types of electrodes were used in both groups.
(© 2023. The Author(s).)