Prior research has shown that, among normal hearing college students, Hispanic-identifying participants experience higher levels of environmental noise and lower signal to noise ratios as compared with White non-Hispanic participants. The primary objective of this study was to examine whether these differences extend to cochlear implant (CI) users by using CI datalogging to quantify characteristics of the listeners' auditory environments. The authors further examined whether differences in auditory environments between groups persisted after controlling for demographic and socioeconomic factors. The primary socioeconomic variable of interest was population density, as it strongly correlates with other socioeconomic factors (e.g., education and income) and is more likely to directly influence auditory environments. A retrospective chart review of CI patients at a tertiary medical center in New York City identified 80 adults (38 Hispanic, 42 White non-Hispanic) for further review. Demographic variables were compiled, and home addresses were used to obtain population-based socioeconomic data via the U.S. Census. Datalogging information extracted from the CI speech processor included hours of total use and time spent in different auditory environments, classified by the CI software into sound levels (in dBA) and sound scenes ("noise," "quiet," "speech in noise," "speech in quiet," "music," and "other"). Despite similar levels of device usage, there was a statistically significant group difference in the percentage of time spent in each scene: Hispanic-identifying participants spent more time in "speech in noise," "music," and "noise"; White non-Hispanics spent more time in "quiet" and "other." The Hispanic participants lived in census tracts with higher population density, which correlated with higher sound levels (>70 dBA) in the environment. Group differences in auditory environments remained statistically significant after controlling for age, CI experience, and population density (median daily level difference ~2.4 dB). Even after accounting for demographic and socioeconomic factors, the two groups showed distinct auditory environments, indicating a possible cultural contribution to these differences. Audiologists counseling CI patients regarding auditory environments should be conscious of their patients' cultural background and may consider the impact of listening preferences when advising on which environments to seek out or avoid.

Accurate identification of the specific inner ear malformations can assist the otologist in anticipating surgical challenges and potentially optimizing postoperative hearing outcomes. In this study, we explored the feasibility of applying similar cochlear morphology principles, that is, ones based on easily quantifiable measurements of the basal turn, to differentiate normal lateral wall geometry from malformed variants. We retrospectively collected 60 patients who underwent cochlear implantation in our center between 2005 and 2023 in the presence of a preoperatively recognized inner ear malformation. Of the 120 analyzed cochleae, 111 were eligible for segmentation, which included 8 cochlear hypoplasia type II, 15 cochlear hypoplasia type III, 2 cochlear hypoplasia type V, 38 Incomplete partition type I, 44 Incomplete partition type II, and 4 incomplete partition type III. A control cohort of 141 normal cochleae was selected. Using manual segmentation of the cochlea on preoperative cone beam computed tomography scans, three-dimensional lateral wall spirals were obtained. The spirals were then used to compute simple anatomical measures of the basal turn, namely the cochlear diameter A and width B, the basal turn length computed based on A and B using the elliptic circular approximation approach, the ratio B/A and the B ratio, and cochlear height (H). Initially, two-sided Mann-Whitney-Wilcoxon tests were conducted to derive statistical differences in the aforementioned geometrical parameters between normal and malformed anatomies. Second, logistic regression analyses were performed to define whether the derived geometrical parameters may be used to predict if a specific cochlear morphology is normal or malformed, and to subsequently investigate if such a model may even be capable of distinguishing between different malformation types. Four geometrical basal‑turn parameters easily assessable in clinical imaging, namely the basal turn length along the lateral wall, cochlear height (H), B/A ratio, and B‑ratio, provide enough information to reliably distinguish normal cochleae from malformed variants. The binary logistic model achieved 94% overall accuracy with precision and recall ≥0.92 across classes, with cochlear height H emerging as the dominant predictor. In our models, H and Bb/B were the strongest discriminants for normal versus malformed anatomies and for incomplete partitions versus cochlear hypoplasia, respectively. Moving beyond binary discrimination, the three‑class model (normal versus IP versus CH) retained 90% accuracy. In summary, the models reliably recognize normal versus malformed, incomplete partition versus cochlear hypoplasia, and CHIII among individual subtypes due to reduced height. They are less reliable for IPI versus IPII differentiation, where basal‑turn measures alone appear insufficient, and IPIII, CHII, CHIV, where very small sample sizes depress recall. Simple, basal‑turn measurements of the lateral wall were demonstrated to provide a fast, interpretable, and accurate means to detect cochlear malformations on clinical imaging and to differentiate IP from CH. The approach reliably flags abnormal cases, offers actionable preoperative information for patient‑tailored implantation, and identifies domains where additional features or larger cohorts are needed (IPI versus IPII; rare subtypes). Such a model could lay the groundwork for future automated recognition of cochlear malformations during preoperative planning.

Exploring one aspect of family-centered practice: Readability of written documents to support parental understanding and decision-making regarding cochlear implants.

Objective The objective of this cross-sectional study was to compare the auditory memory scores obtained using the verbal and picture-pointing response modes in children with cochlear implants and implant-age matched typically developing children. Method The short-term auditory memory test consisting of word sequences ranging from two-word sequences to five-word sequences was developed and administered to 53 children using unilateral cochlear implants and 53 typically developing children matched in terms of implant age and gender. The implant age of the children ranged from 2 years 8 months to 7 years 9 months, and the mean age of implantation was 3 years 5 months. Each participant was tested twice, once using a verbal response task and once using a picture-pointing response task in two different sessions. Results The total auditory memory scores were significantly higher (P < 0.05) for the picture-pointing task as compared to the verbal recall task, especially when the memory task placed a high auditory demand and cognitive load on the children. The total auditory memory scores obtained using both the response tasks were lower in children using cochlear implants as compared to implant-age matched typically developing children (P < 0.05). Conclusion The present findings indicate that the type of response task affects the performance on the short-term auditory memory test in children using cochlear implants and typically developing children, with the picture-pointing response task yielding better scores than the verbal response.

Cochlear implantation (CI) following vestibular schwannoma (VS) resection, traditionally controversial, is increasingly accepted due to advances in surgical techniques. Current evidence is limited to small, short-term studies. This report presents the largest consecutive single-center cohort and offers long-term audiological outcomes. This retrospective study analyzed 73 consecutive patients who underwent VS resection with either simultaneous (97%) or delayed (3%) CI at the Gruppo Otologico between 1985 and 2025, among more than 4000 patients who underwent VS removal during the same period. Sixty-three patients (86%) had sporadic VS, and 10 (14%) had neurofibromatosis type 2 (NF2). Tumor removal was performed using the enlarged translabyrinthine approach (ETLA). Outcomes were assessed through pure-tone average (PTA), speech discrimination scores (SDS), and open-set speech recognition. After a median 35-month follow-up, 48 patients (66%) were active CI users; 20 (27%) were nonusers or nonresponders. Five patients were "removed/non activated" (never activated due to postoperative complications or device malfunction or later explanted despite initial benefit) and were therefore not included in postoperative audiological outcome tables. Due to complications requiring explantation. Among users, the median postoperative PTA was 45.0dB HL (IQR: 40.0-61.3), and the median SDS was 60.0% (IQR: 20.0-70.0). Open-set performance demonstrated high-to-median scores across word, sentence, and comprehension tests. Performance group analysis revealed that 52% of patients achieved intermediate-to-high outcomes, including 75% of NF2 patients. Performing CI immediately after VS resection is feasible and offers long-term functional benefits for most patients, including carefully selected NF2 cases. Although results can vary, more than half of the patients attain meaningful speech perception. This extensive, long-term, single-center experience strongly supports the feasibility of CI in this context, emphasizing the importance of surgical technique, nerve preservation, and precise patient selection.

Temporal evolution of impedance after motorized versus manual cochlear implantation.

Producing words during the semantic fluency task (e.g., "name all the animals you can in a minute") involves not only activating the relevant semantic representations but also being able to flexibly utilize phonological information to facilitate retrieval. However, the mechanisms by which individuals effectively use phonology as a latent cue during memory search remain understudied. In this study, we used a computational approach to examine the use of different lexical sources during memory search in two categorical domains (Animals and Foods) within the semantic fluency task. We captured the relative saliency of semantic and acoustic information by creating blended lexical representations obtained from two language models trained on text (word2vec) and speech (speech2vec). To examine process-level mechanisms, we implemented computational models based on optimal foraging principles to characterize transitions within and across clusters of related items. These models were evaluated within a sample of normal hearing children and a naturally occurring control group with limited early auditory and language experience-prelingually deaf children with cochlear implants. Overall, in domains where semantics and phonology were more highly correlated (i.e., Foods), greater use of phonology in within-cluster transitions was associated with better fluency performance for children with normal hearing. In contrast, though children with cochlear implants amplified acoustic structural information in these domains, they were less able to flexibly leverage phonological information to retrieve more items within clusters. Together, this work highlights how early linguistic experience shapes the ability to use semantic and phonological cues to navigate lexical space in a controlled, adaptive manner. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

CIGAN: rehabilitation-oriented few-shot speech separation for cocktail party problem in Cochlear implant users

Neurocognitive factors contribute to heterogeneity in cochlear implant (CI) success. This study addresses three gaps: (1) whether long, low-redundancy sentences in quiet vs. short, high-redundancy sentences in noise recruit different cognitive involvement; (2) the methodological conflation of processing speed with inhibition-concentration; (3) the scarcity of tone language evidence in understanding the cognitive-speech relationship. Twenty-five postlingually deafened Mandarin CI users completed long-sentence recognition in quiet (Mandarin Chinese Adaptation of AzBio Sentence, CMnBio) and short-sentence recognition in four-talker babble noise (the BKB Sentences in Noise, BKB-SIN). Auditory input quality was assessed using the Spectral-Temporally Modulated Ripple Test (SMRT). The Shape Trail Test, a pencil-and-line task, was used to assess processing speed (STT-A/B), and inhibition-concentration (STT-B). Because STT-B reflects both processing speed and inhibition-concentration, the latter was isolated using STT-B.A (the residual of STT-B on STT-A). Independent contributions to recognition were assessed with hierarchical regression analyses. SMRT, STT-A, and STT-B showed correlations with both sentence outcomes, whereas STT-B.A correlated solely with BKB-SIN. In regression models controlling for SMRT, STT-A explained significant variance in CMnBio (β = -0.507, p = 0.001) and BKB-SIN (β = -0.371, p = 0.012). STT-B.A contributed only to BKB-SIN (β = -0.318, p = 0.014). Information processing speed shows a general association with sentence recognition in both quiet and noise, whereas inhibition-concentration shows a noise-specific association in Mandarin CI users. This study highlights the importance of methodological distinction separating these two cognitive functions and extends cognition-speech links to tonal languages.

As the number of cochlear implant (CI) surgeries increases, greater emphasis should be placed on incremental improvements and on planning for a patient-centered approach. The shape of the basal turn (BT) of the cochlea has recently been evaluated and classified as either elliptical or round. However, the electrode position inside different shapes was not investigated. This study aims to evaluate the impact of different cochlear shapes on the electrode-to-modiolus distance (EMD) among the CI patients. A retrospective study was conducted on patients with normal cochleae who underwent cochlear implantation. Postoperative imaging was reconstructed using dedicated Otological planning software to assess cochlear morphology and electrode positioning. The cochlear shape was quantified using the basal turn width-to-height ratio (B/A ratio), and the EMD distance was measured. The final analysis included 41 ears. The mean EMD was 3.3mm in the basal electrodes, decreasing to 2.8mm in the middle region and reaching 1.9mm at the apical electrodes. The mean basal turn width-to-height ratio (B/A) was 0.8 (range: 0.7 to 0.9). Simple linear regression revealed that cochleae with a round-shaped basal turn (B/A >0.75) had a slightly shorter, but comparable, EMD in the basal region compared with those with an elliptical shape (3.3 vs. 3.5mm). The apical region showed a bigger but nonsignificant distance in round-shaped cochleae (2.0 vs. 1.8mm). In addition, impedance measurements at the 12-month interval showed a significant difference in basal electrode impedance between round and elliptical cochleae. This study reported no statistically significant association between cochlear anatomic parameters and electrode-to-modiolus distance. Lateral wall electrodes demonstrated comparable distances to the modiolus in both elliptical and round-shaped basal turn cochleae, suggesting stable positioning across anatomic variations. Although descriptive trends were observed, these findings should be interpreted as exploratory. Larger prospective studies are needed to further evaluate the influence of cochlear morphology on electrode positioning across different electrode designs.

To examine whether interaural angular insertion depth (AID) mismatch affects horizontal sound localization accuracy (SLA) in adolescents with bilateral cochlear implants (BiCI) since early childhood. Cross-sectional study. University hospital. Twenty subjects with mean age of 16.9 years (range: 12.8 to 21.6y) and 14.7 years (9.6 to 19.6y) of BiCI experience. On the basis of three-dimensional modeling of photon-counting detector-computed tomography images of the inner ears, interaural AID mismatch of the most apical electrodes was estimated. SLA was objectively measured using 4 stimuli providing various spatial cues, quantified by an Error Index (EI). The effect of interaural AID mismatch on the EI was studied using linear regression analyses, and by comparing the EI between a matched and a mismatched group stratified on a mismatch criterion of 75 degrees. The median interaural AID absolute difference was 45.5 degrees (range: 4 to 256 degrees). Across sounds, no linear relationship between interaural AID mismatch and EI existed. No effect of group (matched vs. mismatched) on the EI existed. A significant effect of stimulus ( P <0.001) and an interaction between stimulus and group ( P <0.02) was found, with performance differences between stimuli for the mismatched but not the matched group. Individuals who have been listening through BiCI since early childhood show large variability in AID mismatch between the ears. Horizontal SLA seems unrelated to this mismatch. For large mismatches, the spatial cues present in a sound seem to affect localization accuracy.

Cochlear implant (CI) care in Germany is largely standardized through the national CI clinical practice guideline, the CI White Paper, and established certification procedures. Lifelong aftercare is essential for maintaining long-term treatment outcomes. In particular, technical aftercare may, in accordance with current guidelines, be delegated by a cochlear implant providing department (CIVE) to qualified external cooperation partners (QEK). To preserve the CIVE's overall responsibility, a clearly structured framework for collaboration is required. The aim of this manuscript is to present a practical model for the guideline-compliant delegation of technical aftercare services.A structured cooperation model was developed based on practical experience from existing collaborations and with consideration of the CI clinical practice guideline, the CI White Paper, and applicable regulatory requirements. The model was derived from cooperation agreements currently implemented at the authors' institution with various QEKs. It includes delegable and non-delegable services, qualification requirements, communication and documentation processes, escalation criteria, and quality assurance measures.The structured delegation of technical aftercare to qualified external partners represents a practical and guideline-compliant model for quality-assured CI aftercare. Prerequisites are clearly defined delegation limits, binding quality standards, and continuous supervision by the CIVE. Furthermore, the integrated communication and documentation framework may serve as a basis for future cross-sector and telemedical care structures.

Cochlear implants (CIs) restore hearing by electrically stimulating the auditory nerve, yet the millimeter-scale electrode-neuron separation limits spatial selectivity and temporal fidelity. Rather than relocating the electrode array, we propose a biohybrid strategy that preserves the conventional scala tympani insertion and closes this gap biologically by interposing living neural constructs between the array and the modiolus. This approach leverages the Canaliculi Perforantes of Schuknecht (CPS) to deliver spatially confined biochemical, mechanical, and electrical cues from the scala tympani, biasing spiral ganglion neurites toward contacts while respecting surgical practicality. We review CPS microanatomy and transport, auditory neuron/stem cell-regeneration prospects, hydrogel/assembloid niches, surface and material stacks, and conclude with translational benchmarks, constraints, and a near-mid-long-term roadmap.

This study evaluated the indications for cochlear implant (CI) that extend beyond the current criteria of the Health Implementation Communiqué (HIC) of the Turkish Social Security Institution. A retrospective review was performed on 27 patients who underwent CI, even though they did not meet the HIC criteria. All cases were approved by the Scientific Advisory Board on Auditory Implants of the Ministry of Health. Demographic, clinical, and audiological data, including pre- and post-operative pure-tone averages (PTA) and speech discrimination scores (SDS), were analyzed. The cohort included 15 females and 12 males, with a median age of 17 years. Etiologies comprised congenital hearing loss (n=14), idiopathic sudden sensorineural hearing loss (n=3), post-meningitic hearing loss (n=2), Menière's disease (n=1), and other acquired causes. Exclusion from the HIC criteria was mainly due to age restrictions for bilateral CI, audiological thresholds outside defined limits, single-sided deafness, SDS above 30%, or a gap of more than four years between chronological and language age. Audiological outcomes from 22 patients revealed a median PTA with the CI alone of 35 dB hearing level and a median SDS of 58%, with significant improvement compared to baseline (p<0.001). While most patients demonstrated substantial benefit, 14.8% (cases 6, 17, 21, 25) exhibited poor performance (SDS <30%). Case analyses underscored the impact of etiology and duration of auditory deprivation on outcomes. CI beyond conventional reimbursement criteria can provide meaningful functional gains. Individualized, evidence-based, multidisciplinary evaluation supports broader access to hearing rehabilitation and is consistent with global trends in personalized auditory care.

This study investigated the intelligibility and processing characteristics of Mandarin sentences synthesized based on a large-scale language model (LLM), compared to natural speech, specifically for deaf adults with cochlear implants (CIs). Fifty participants, 25 Mandarin-speaking deaf adults with CIs and 25 Mandarin-speaking adults with normal hearing (NH), were enrolled in the study. Sentence recognition rates and reaction times were measured using sentences from the Mandarin speech perception database presented as six different speech types. These included original natural speech by a single female speaker at slow and normal speaking rates as well as synthetic speech generated by the LLM-based text-to-speech (TTS) model in two different voices (male and female) at two speaking rates (slow and normal). Linear mixed-effect models analyzed how sentence recognition accuracy and reaction time varied with listener group and speech type. Participants with CIs demonstrated significantly lower sentence recognition rates and longer reaction times than NH participants for both natural and synthetic speech. Participants with CIs exhibited greater individual variability than NH listeners in terms of sentence recognition performance and reaction times. Changes in speaking rate significantly impacted the recognition rates of participants with CIs. Crucially, when controlling for speaking rate differences, there was no significant difference in sentence recognition rates or reaction times between natural and LLM-based synthetic speech for participants with CIs. The results suggest that LLM-based synthetic speech could achieve intelligibility levels indistinguishable from natural speech for CI recipients under comparable speaking rate conditions, similar to its performance for NH listeners. This study offers valuable insights for the future application of advanced TTS models in speech perception assessment and auditory rehabilitation for patients with CIs, including the potential development of personalized training materials. https://doi.org/10.23641/asha.32736135.

Timely access to hearing technology is paramount to ensure early auditory access to the sounds needed for listening and learning in children with early hearing loss (HL). Although children typically move to cochlear implants (CIs) after first having tried hearing aids (HAs), there are some cases where the HA trial may create unnecessary additional delays. This clinical focus article presents three categories of patients where implantation appears warranted without an HA trial. This study examines 3 years of retrospective chart data for pediatric CI patients at a tertiary care center who did not complete an HA trial before surgery. We identified 22 cases and examined their diagnostic audiological profiles and preimplant trajectory of care. Our results coalesced around three broad categories where omission of the HA trial appears warranted: cases of late-onset/progressive HL, cases of children lost to follow-up after newborn hearing screening, and cases of auditory neuropathy spectrum disorder where hearing technology was deferred until behavioral testing was possible. Following surgery, we observed wide variability in device use rates, suggesting that some families may struggle with full-time use of CIs despite the streamlined candidacy process. Taken together, our results show that, in appropriate cases, CIs may be considered for children with HL without first completing an HA trial. This has important implications for closing the timing gaps introduced by loss to follow-up in the United States' national Early Hearing Detection and Intervention program.

Background/Objectives: Cochlear implant (CI) candidacy has expanded beyond traditional bilateral hearing loss (HL) to include single-sided deafness (SSD) and asymmetric hearing loss (AHL), yet baseline differences in speech recognition and patient-reported outcome measures (PROMs) between these groups—bilateral HL, SSD, and AHL—remain poorly characterized. The objective of this study was to characterize and compare preoperative speech recognition performance and PROMs between traditional bilateral HL and SSD/AHL CI candidates, and to examine associations between preoperative word recognition scores and PROMs across the full cohort. Methods: Sixty-eight adults (mean age 71.6 years, SD 7.4) undergoing preoperative CI evaluation were enrolled (31 bilateral HL, 12 SSD, and 25 AHL). Consonant–Nucleus–Consonant (CNC) word recognition and AzBio sentence recognition were assessed for both the ear-to-be-implanted (CI ear) and the contralateral ear. The following PROMs were evaluated: the Speech, Spatial and Qualities of Hearing Scale (SSQ-12); Cochlear Implant Quality of Life–35 (CIQOL-35); Patient Health Questionnaire-2 (PHQ-2); Tinnitus Handicap Inventory (THI); and the Instrumental Activities of Daily Living (IADL). Group comparisons used Mann–Whitney U tests and t-tests. CNC, SSQ-Mean, and CIQOL-Global associations were assessed using multivariable linear regression analysis. Results: Preoperative CI-ear speech recognition did not differ between the bilateral HL and SSD/AHL groups. SSD/AHL candidates had significantly higher contralateral-ear speech recognition performance, better SSQ-12 scores across all domains, and higher CIQOL-35 Global, Communication, Entertainment, and Environment scores compared to bilateral HL candidates. However, the CIQOL-35 Emotional, Listening Effort, and Social domains, PHQ-2, THI, and IADL did not differ significantly between the bilateral HL and SSD/AHL groups. Across our entire sample of candidates, CI-ear CNC scores were not significantly associated with preoperative SSQ-Mean or CIQOL-Global scores, while contralateral-ear CNC scores showed moderate, significant associations with both measures. Conclusions: Traditional bilateral and SSD/AHL CI candidates exhibit distinct preoperative PROM profiles (namely, the SSQ-12 and CIQOL-35) despite having no significant differences in CI-ear speech recognition. Contralateral-ear CNC scores—but not CI-ear scores—were significantly associated with the SSQ-Mean and CIQOL-Global, suggesting that contralateral-ear CNC scores may offer relevant insight into CI candidates’ functional hearing. These findings support population-specific counseling and highlight the complementary value of PROMs and audiometric data in CI candidacy evaluations.

To compare operative times and audiometric outcomes between robotic-assisted cochlear implantation (CI) and manual insertion. Retrospective study. Tertiary academic center. Patients undergoing CI between October 2022 and October 2024. Robotic-assisted or manual CI. Operative time and audiometric outcomes between techniques. Fifty-one patients (17 robotic-assisted, 34 manual) were included. Demographics were similar between cohorts, although the robotic cohort was older {median [interquartile range (IQR)] 74.4y [56.1 to 83.1] vs. 60.1y [42.3 to 72.5], P=0.025}. Operative time did not differ significantly; robotic-assisted cases showed a median increase of ~20 minutes with substantial interquartile overlap and no statistically significant difference (P=0.171). Preoperatively, the robotic cohort demonstrated higher aided speech perception [consonant-nucleus-consonant word (CNC-w) 22% vs. 0%, P=0.003; (CNC phoneme) CNC-p 45% vs. 15%, P=0.014; AzBio-Quiet 28% vs. 5%, P=0.006] and better low-frequency thresholds (250 to 500 Hz; 60 vs. 72.5 dB HL, P=0.003), whereas unaided speech reception threshold (SRT), word recognition score (WRS), and pure-tone average at 0.5, 1, 2, and 3 kHz (PTA) did not differ. Postoperatively, both cohorts improved, with no significant between-group differences at 3, 6, or 12 months or most recent follow-up for SRT, CNC-w, CNC-p, AzBio-Quiet, or aided PTA. Robotic-assisted CI electrode insertion was associated with a limited, non-statistically significant operative time increase and similar short-term to intermediate-term audiometric outcomes compared with manual insertion.

Antiviral therapy is recommended for infants with moderate-to-severe symptomatic congenital CMV, as randomized controlled trials have demonstrated improved audiologic and neurodevelopmental outcomes when treatment is initiated within the first month of life; for isolated SNHL, evidence remains limited, and treatment decisions should be individualized. Following medical management, children with severe-to-profound SNHL should undergo timely evaluation for hearing rehabilitation, including cochlear implantation when appropriate, as early access to auditory input may optimize speech, language, and communication outcomes. Although progress may be slower in children with neurologic comorbidities, most achieve meaningful improvements in hearing and communication.

The impact of race and ethnicity on cochlear implant outcomes.