Assessment of cochlear implant hearing outcomes using ecological momentary assessment in both controlled and real-world settings

Abstract

Laboratory tests of speech understanding demonstrate high effectiveness of cochlear implants (CIs) for individuals with severe-to-profound hearing loss. However, understanding real-world benefits remains challenging. Retrospective questionnaires may be unreliable due to recall bias and limited acoustic information. To address this, we used an Ecological Momentary Assessment (EMA) smartphone app to collect subjective feedback and acoustic data from CI recipients in lab and real-world settings. We characterised challenging acoustic environments for CI users and the influence of internal factors on self-ratings of environmental noisiness, device benefit, and speech understanding. Twenty adults underwent cognitive tests, questionnaires, EMA, and the NAL Dynamic Conversation Test in the lab. Acoustic scenes were reproduced in an anechoic chamber to assess comprehension, familiarise participants with EMA, and establish benchmarks for real-world EMA data. Over four weeks, participants recorded experiences using the EMA app. Analysis of real-world EMA data revealed perceived noisiness was influenced by spectro-temporal properties and sound level. Self-reported communication factors were associated with environmental sound level and predictive of self-reported CI device benefit. Communication factors were also correlated with CI experience and cognitive performance. EMA offers valuable insights into CI recipients' real-world experiences, aiding customization and efficacy evaluation.