It is unknown how electrode array position in the cochlea influences long-term hearing preservation for cochlear implant (CI) recipients with preserved low-frequency hearing after surgery. The aim of this study was to evaluate the influence of electrode insertion depth relative to regions of post-operative acoustic hearing and hearing preservation ≥ 1 year after CI activation. A retrospective review of adult CI recipients of a straight electrode array from 2017 to 2022 with functional acoustic hearing preservation (≤ 80 dB HL at 250 Hz) at device activation was performed. Proximity was quantified as the angular insertion depth (AID) of the most apical contact relative to the region of preserved functional acoustic hearing. Positive values indicate placement within the functional acoustic region; negative values indicate placement basal to the functional acoustic region. Low-frequency pure tone average (LFPTA) was queried from the preoperative, device activation, and annual post-activation visits. Stepwise regression analyzed whether proximity, AID, age, biological sex, and pre-operative LFPTA were significant predictors for change in unaided hearing thresholds. One hundred and six CI recipients met inclusion criteria. AID ranged from 330° to 717° (mean 513°, SD 79°). Proximity values ranged from -183° to 442° (mean 35°, SD 110°). None of the reviewed independent variables, including proximity, significantly predicted unaided hearing threshold shifts at the 1-year or the ≥ 3-year visits (p ≥ 0.128). Deeper insertion depths and electrode array placement within the functional acoustic hearing region did not predispose CI recipients to delayed loss of residual hearing.

To examine the effects of scala tympani (ST) volume, cochlear duct length (CDL), and angular insertion depth (AID) on low-frequency hearing preservation for cochlear implant (CI) recipients of lateral wall electrode arrays. A retrospective review identified 45 adult CI recipients of 24-, 28-, or 31.5-mm lateral wall electrode arrays with preoperative unaided hearing thresholds ≤45 decibel hearing level (dB HL) at 250 Hz. All patients underwent preoperative and postoperative computed tomography to evaluate cochlear morphology and electrode array position. A linear mixed effects model evaluated effects of ST volume, CDL, AID, preoperative low-frequency pure-tone average (LFPTA; 125, 250, and 500 Hz), age at surgery, and biological sex on the postoperative change in LFPTA at activation and 6 months post-activation. There were significant main effects of ST volume (p = 0.044), age (p = 0.028), and biological sex (p = 0.003), indicating better low-frequency hearing preservation for CI recipients with larger ST volumes, younger age at surgery, and female biological sex. Although CDL positively correlated with ST volume (r = 0.74, p < 0.001), there was no significant main effect of CDL (p = 0.367). A broad range in AID of the most apical electrode contact was observed (301.4°-681.8°); however, there was no significant main effect of AID on low-frequency hearing preservation (p = 0.700). During the initial 6 months following implantation, intrinsic factors such as cochlear morphology may have a greater impact on low-frequency hearing preservation than apical positioning of a flexible lateral wall electrode array when using soft surgical techniques. 3 Laryngoscope, 2024.

The purpose of this study was to determine if traditional audiologic measures (e.g., pure-tone average, speech recognition) and audibility-based measures predict risk for spoken language delay in children who are hard of hearing (CHH) who use hearing aids (HAs). Audibility-based measures included the Speech Intelligibility Index (SII), HA use, and auditory dosage, a measure of auditory access that weighs each child's unaided and aided audibility by the average hours of HA use per day. The authors also sought to estimate values of these measures at which CHH would be at greater risk for delayed outcomes compared with a group of children with typical hearing (CTH) matched for age and socioeconomic status, potentially signaling a need to make changes to a child's hearing technology or intervention plan. The authors compared spoken language outcomes of 182 CHH and 78 CTH and evaluated relationships between language and audiologic measures (e.g., aided SII) in CHH using generalized additive models. They used these models to identify values associated with falling below CTH (by > 1.5 SDs from the mean) on language assessments, putting CHH at risk for language delay. Risk for language delay was associated with aided speech recognition in noise performance (<59% phonemes correct, 95% confidence interval [55%, 62%]), aided Speech Intelligibility Index (SII < 0.61, 95% confidence internal [.53,.68]), and auditory dosage (dosage < 6.0, 95% confidence internal [5.3, 6.7]) in CHH. The level of speech recognition in quiet, unaided pure-tone average, and unaided SII that placed children at risk for language delay could not be determined due to imprecise estimates with broad confidence intervals. Results support using aided SII, aided speech recognition in noise measures, and auditory dosage as tools to facilitate clinical decision-making, such as deciding whether changes to a child's hearing technology are warranted. Values identified in this article can complement other metrics (e.g., unaided hearing thresholds, aided speech recognition testing, language assessment) when considering changes to intervention, such as adding language supports, making HA adjustments, or referring for cochlear implant candidacy evaluation.

To assess long-term binaural hearing abilities for cochlear implant (CI) users with unilateral hearing loss (UHL) or asymmetric hearing loss (AHL). 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. 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). 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. 3 Laryngoscope, 133:1480-1485, 2023.

Efficacy of cartilage conduction hearing aids in children

Cartilage conduction hearing aids (CC-HAs) are novel hearing aids using the third hearing pathway of cartilage conduction. We assessed the efficacy of CC-HAs in adult hearing-loss patients who had various anatomical conditions of their ear canal(s) and determined who are good candidates for CC-HAs. Patients (n = 37) were categorised into three groups of participants based on ear canal anatomy: (1) canal stenosis; (2) abnormal canal; (3) normal canal. After a 1-month free trial of normal usage, CC-HA-aided and unaided hearing thresholds (43 fitted ears) were determined using standard audiograms, after which participants could choose to purchase the device or not. Group and subgroup purchase rates were calculated along with the purchase reason (or not). Subgroup binary analysis of purchase rates was done according to hearing loss severity (< 70dB and ≥ 70dB) of unaided average air conduction (AC) hearing thresholds. CC-HA provided hearing improvements in all frequencies within each group. Overall, 60.47% of participants purchased a CC-HA after the trial. Over 70% participants with canal stenosis purchased CC-HAs, regardless of their AC hearing thresholds (severe vs. mild), and significantly more mild-loss participants in the abnormal canal group purchased their trial CC-HA compared to severe-loss participants (85.71% vs. 20%). Adult patients with ear canal stenosis or closure are the best candidates for CC-HAs, regardless of their hearing thresholds. Patients with more severe hearing loss accompanied by ear canal anomalies and patients with normal canal anatomy may not be good candidates.

PurposeThe goal of this work was to evaluate the low-frequency hearing preservation of long electrode array cochlear implant (CI) recipients.MethodTwenty-five participants presented with an unaided hearing threshold of ≤ 80 dB HL at 125 Hz pre-operatively in the ear to be implanted. Participants were implanted with a long (31.5-mm) electrode array. The unaided hearing threshold at 125 Hz was compared between the preoperative and postoperative intervals (i.e., initial CI activation, and 1, 3, 6, 9, and 12 months after activation).ResultsEight participants maintained an unaided hearing threshold of ≤ 80 dB HL at 125 Hz postoperatively. The majority (n = 5) demonstrated aidable low-frequency hearing at initial activation, whereas 3 other participants experienced an improvement in unaided low-frequency hearing thresholds at subsequent intervals.ConclusionsCI recipients can retain residual hearing sensitivity with fully inserted long electrode arrays, and low-frequency hearing thresholds may improve during the postoperative period. Therefore, unaided hearing thresholds obtained within the initial weeks after surgery may not reflect later hearing sensitivity. Routine measurement of postoperative unaided hearing thresholds—even for patients who did not demonstrate aidable hearing thresholds initially after cochlear implantation—will identify CI recipients who may benefit from electric–acoustic stimulation.Supplemental Materialhttps://doi.org/10.23641/asha.11356637

Background and Objectives We reviewed the selection processes of contralateral routing of signal (CROS) hearing aids (HAs) and bone-conduction (BC) Has, and compared aided and unaided hearing thresholds. Subjects and Method Twenty-four patients with asymmetrical hearing loss who used BC HAs (n=12) and CROS HAs (n=12) were enrolled. The choice of two different HAs were compared with respect to the degree of hearing loss, the unaided hearing thresholds and functional gains. Results When the hearing thresholds of the better hearing ears were ＞30 dB HL, most (92%, 11 of 12) chose CROS rather than BC HAs, with significant difference (p=0.001). Both CROS and BC HAs groups showed significantly improved functional gains (46.6 dB and 53.4 dB, respectively). Aided air-conduction (AC) thresholds (40.2 dB HL) in the CROS group were similar to the AC thresholds (43.1 dB HL) of better hearing ears. However, the hearing threshold of Aided AC thresholds (35.8 dB HL) in BC HAs group were less than the BC thresholds (17.3 dB HL) of better hearing ears by 19 dB (p＜0.001). Conclusion Both groups showed significantly increased functional gains. CROS HAs were preferred when hearing thresholds in better hearing ears were ＞30 dB HL. The CROS group showed aided thresholds similar to the thresholds of better hearing ears, but the BC HAs group showed poorer aided thresholds than the thresholds of better hearing ears. For patients with asymmetric hearing loss, HAs should be selected based on the degree and types of hearing loss and the maximum output level of the selected device. Key words: Bone conduction ㆍ Contralateral routing of signal ㆍ Deafness ㆍ Hearing aids ㆍ Hearing loss ㆍ Single-sided

Objectives: To optimize patient’s maps in Electric Acoustic Stimulation (EAS) users based on the degree of post-operative aided hearing thresholds.Methods: Twenty-one adult EAS patients participated in this study. Patients were subdivided into three groups, based on their unaided hearing threshold: (1) electric complementary (EC, n = 6) patients with ≤30 dB HL at 125–500 Hz with severe to profound hearing loss at higher frequencies who only use electric stimulation, (2) EAS (n = 8) patients with 30–70 dB HL from 125 to 250 Hz and profound hearing loss in high frequencies who use combined EAS, and (3) Marginal-EAS (M-EAS, n = 7) patients with 70–95 dB HL at frequencies ≤250 Hz who use combined EAS. Sentence perception in noise, melodic contour identification, and subjective preference were measured using Full Overlap, Narrow Overlap, Gap, and Meet maps.Result: Of the 21 patients that participated, 12 subjects were classified as complete hearing preservation and 9 subjects were classified as partial hearing preservation. The highest performing maps in sentence-in-noise perception and melodic contour identification were Gap, Meet, and Full Overlap for the EC, EAS, and the M-EAS groups, respectively. These results are consistently across different test materials and align with subject preference as well.Conclusion: These results suggest that clinical fitting in EAS listening should be individually tailored. EAS performance can be enhanced by optimizing maps between acoustic and electric stimulation based on the degree of aided hearing thresholds.

The aim of the study was to investigate the link between temporal fine structure (TFS) processing, pitch, and speech perception performance in adult cochlear implant (CI) recipients, including bimodal listeners who may benefit better low-frequency (LF) temporal coding in the contralateral ear. The study participants were 43 adult CI recipients (23 unilateral, 6 bilateral, and 14 bimodal listeners). Two new LF pitch perception tests-harmonic intonation (HI) and disharmonic intonation (DI)-were used to evaluate TFS sensitivity. HI and DI were designed to estimate a difference limen for discrimination of tone changes based on harmonic or inharmonic pitch glides. Speech perception was assessed using the newly developed Italian Sentence Test with Adaptive Randomized Roving level (STARR) test where sentences relevant to everyday contexts were presented at low, medium, and high levels in a fluctuating background noise to estimate a speech reception threshold (SRT). Although TFS and STARR performances in the majority of CI recipients were much poorer than those of hearing people reported in the literature, a considerable intersubject variability was observed. For CI listeners, median just noticeable differences were 27.0 and 147.0 Hz for HI and DI, respectively. HI outcomes were significantly better than those for DI. Median STARR score was 14.8 dB. Better performers with speech reception thresholds less than 20 dB had a median score of 8.6 dB. A significant effect of age was observed for both HI/DI tests, suggesting that TFS sensitivity tended to worsen with increasing age. CI pure-tone thresholds and duration of profound deafness were significantly correlated with STARR performance. Bimodal users showed significantly better TFS and STARR performance for bimodal listening than for their CI-only condition. Median bimodal gains were 33.0 Hz for the HI test and 95.0 Hz for the DI test. DI outcomes in bimodal users revealed a significant correlation with unaided hearing thresholds for octave frequencies lower than 1000 Hz. Median STARR scores were 17.3 versus 8.1 dB for CI only and bimodal listening, respectively. STARR performance was significantly correlated with HI findings for CI listeners and with those of DI for bimodal listeners. LF pitch perception was found to be abnormal in the majority of adult CI recipients, confirming poor TFS processing of CIs. Similarly, the STARR findings reflected a common performance deterioration with the HI/DI tests, suggesting the cause probably being a lack of access to TFS information. Contralateral hearing aid users obtained a remarkable bimodal benefit for all tests. Such results highlighted the importance of TFS cues for challenging speech perception and the relevance to everyday listening conditions. HI/DI and STARR tests show promise for gaining insights into how TFS and speech perception are being limited and may guide the customization of CI program parameters and support the fine tuning of bimodal listening.

This study examined the safety and efficacy of a fully implantable active middle ear (AMEI) system. Outcome measures assessed AMEI performance compared with an optimally fitted conventional hearing aid (CHA). Fifty adults with stable, symmetric moderate-to-severe sensorineural hearing loss were implanted at 9 ambulatory settings. Consonant-Nucleus-Consonant (CNC) words, Bamford-Kowel-Bench Speech in Noise test (BKB-SIN), Abbreviated Profile of Hearing Aid Benefit (APHAB), and unaided hearing thresholds in the implanted ear were compared to baseline measures obtained using a personal CHA. Changes in thresholds were observed from pre- to 12-month postoperative assessments. CNC word scores decreased (within 10%), and the BKB-SIN showed no change from pre- to 12-month postoperative time points. The APHAB revealed improvement. Findings suggest no difference in performance between an appropriately fit CHA and the AMEI at 12 months. This study indicates AMEIs have the potential to help individuals who choose not to use CHAs.

Conclusions: The round window (RW) approach in the use of the Vibrant Soundbridge® (VSB) is a safe and effective treatment of conductive and mixed hearing losses for a period of more than 3 years of device use. Objective: To investigate the long-term safety and efficacy as well as user satisfaction of patients with conductive and mixed hearing losses implanted with the VSB using RW vibroplasty. Methods: Twelve patients with conductive and mixed hearing losses were evaluated after 40 months of daily VSB use. Safety was assessed by evaluating reports of postoperative medical and surgical complications as well as by changes in bone conduction hearing thresholds. Efficacy outcome measures included aided and unaided hearing thresholds, speech recognition in quiet and in noise and subjective benefit questionnaires. Results: The safety results revealed no significant medical complications. One subject experienced sudden hearing loss after 18–24 months of device use, but still continues to wear the device to her satisfaction. With regard to efficacy, there were no significant changes from short- to long-term results in aided word understanding, functional gain or speech recognition threshold, suggesting that the outcomes are stable over time. Subjective questionnaires revealed either the same or better results compared with the short-term data.

In this prospective multicenter study, tinnitus loudness and tinnitus-related distress were investigated in 174 cochlear implant (CI) candidates who underwent CI surgery at a Swiss cochlear implant center. All subjects participated in two session, one preoperatively and one 6 months after device activation. In both sessions, tinnitus loudness was assessed using a visual analogue scale and tinnitus distress using a standardized tinnitus questionnaire. The data were compared with unaided pre- and postoperative pure tone thresholds, and postoperative speech reception scores. 71.8% of the subjects reported tinnitus preoperatively. Six months after CI surgery 20.0% of these reported abolition of their tinnitus, 51.2% a subjective improvement, 21.6% no change and 7.2% a deterioration. Of the 49 (28.2%) subjects with no tinnitus preoperatively, 5 developed tinnitus 6 months after CI. These 5 had poorer speech understanding after CI surgery with their device than the group who remained tinnitus free. We found no correlation between tinnitus improvement, age, duration of tinnitus, or change in unaided hearing thresholds between the two sessions.

The use of bilateral amplification is now common clinical practice for hearing aid users but not for cochlear implant recipients. In the past, most cochlear implant recipients were implanted in one ear and wore only a monaural cochlear implant processor. There has been recent interest in benefits arising from bilateral stimulation that may be present for cochlear implant recipients. One option for bilateral stimulation is the use of a cochlear implant in one ear and a hearing aid in the opposite nonimplanted ear (bimodal hearing). This study evaluated the effect of wearing a cochlear implant in one ear and a digital hearing aid in the opposite ear on speech recognition and localization. A repeated-measures correlational study was completed. Nineteen adult Cochlear Nucleus 24 implant recipients participated in the study. The participants were fit with a Widex Senso Vita 38 hearing aid to achieve maximum audibility and comfort within their dynamic range. Soundfield thresholds, loudness growth, speech recognition, localization, and subjective questionnaires were obtained six-eight weeks after the hearing aid fitting. Testing was completed in three conditions: hearing aid only, cochlear implant only, and cochlear implant and hearing aid (bimodal). All tests were repeated four weeks after the first test session. Repeated-measures analysis of variance was used to analyze the data. Significant effects were further examined using pairwise comparison of means or in the case of continuous moderators, regression analyses. The speech-recognition and localization tasks were unique, in that a speech stimulus presented from a variety of roaming azimuths (140 degree loudspeaker array) was used. Performance in the bimodal condition was significantly better for speech recognition and localization compared to the cochlear implant-only and hearing aid-only conditions. Performance was also different between these conditions when the location (i.e., side of the loudspeaker array that presented the word) was analyzed. In the bimodal condition, the speech-recognition and localization tasks were equal regardless of which side of the loudspeaker array presented the word, while performance was significantly poorer for the monaural conditions (hearing aid only and cochlear implant only) when the words were presented on the side with no stimulation. Binaural loudness summation of 1-3 dB was seen in soundfield thresholds and loudness growth in the bimodal condition. Measures of the audibility of sound with the hearing aid, including unaided thresholds, soundfield thresholds, and the Speech Intelligibility Index, were significant moderators of speech recognition and localization. Based on the questionnaire responses, participants showed a strong preference for bimodal stimulation. These findings suggest that a well-fit digital hearing aid worn in conjunction with a cochlear implant is beneficial to speech recognition and localization. The dynamic test procedures used in this study illustrate the importance of bilateral hearing for locating, identifying, and switching attention between multiple speakers. It is recommended that unilateral cochlear implant recipients, with measurable unaided hearing thresholds, be fit with a hearing aid.

The present study was aimed to compare gain and speech intelligibility measured in quiet and in noise between the Signia hearing aid and the Vibrant Soundbridge (VSB), both devices using the same sound processing technology. A prospective longitudinal study was performed. Six patients with a steeply sloping high-frequency hearing loss were selected. The protocol comprised 3 months' hearing aid use, VSB implantation, and 3 months' VSB use. Patient performances were evaluated unaided and aided by audiologic assessments, including free-field thresholds and word recognition tasks in quiet and in noise. Statistical analysis revealed a slight decrease in overall frequencies in pure-tone audiometry after surgery; however, this decrease did not exceed 5 dB and was not different from the changes that occurred in the contralateral nonimplanted ear. The measures of aided and unaided hearing thresholds showed statistically significant larger gains with the VSB than with the hearing aid. In quiet, speech performances were poorer unaided than with either device. Because of ceiling effects, statistically significant higher scores with the VSB than with the hearing aid were only observed at the lowest intensity level. In noise, speech intelligibility was reported to be better with the VSB compared with both unaided and with the hearing aid at 5 signal-to-noise ratios. This prospective study demonstrated that direct-drive stimulation provided by the VSB allows better speech performances than acoustic stimulation for rehabilitation of patients with steeply sloping high-frequency hearing losses.

To predict bimodal benefit before cochlear implantation, we compared the performances of participants with bimodal fitting and with a cochlear implant alone on speech perception tests. Twenty-two children with a cochlear implant in one ear and a hearing aid in the other (bimodal fitting) were included. Several aided and unaided average hearing thresholds and the aided word recognition score of the hearing aid ear were related to the bimodal benefit on a phoneme recognition test in quiet and in noise. Results with bimodal fitting were compared to results with the cochlear implant alone on a phoneme recognition test in quiet and in noise. No relationship was found between any of the hearing thresholds or the aided phoneme recognition score of the hearing aid ear and the bimodal benefit on the phoneme recognition tests. At the group level, the bimodal scores on the phoneme recognition tests in quiet and in noise were significantly better than the scores with the cochlear implant alone. Preoperatively available audiometric parameters are not reliable predictors of bimodal benefit in candidates for cochlear implantation. Children with unilateral implants benefit from bimodal fitting on speech tests. This improvement in performance warrants the recommendation of bimodal fitting even when bimodal benefit cannot be predicted.

The purpose of this article is to present psychophysical data for 40 Nucleus 24 Contour adult patients with 1 mo of device experience and speech perception results for a group of 56 adult patients with 3 mo experience using the Nucleus 24 Contour cochlear implant system. Postoperative hearing thresholds (i.e., under headphones) in the implanted ear were also assessed in a group of 85 patients who had measurable hearing preoperatively. This was of interest because preservation of residual hearing, postoperatively, is consistent with atraumatic insertion of the electrode array. In addition, data will be presented that reflected feedback from 40 surgeons who participated in the trial. Participants in this study were 18 yr of age or older, with bilateral severe to profound sensorineural hearing loss with no congenital component. Preoperatively, they scored < or = 50% open-set sentence recognition (HINT sentences) in the ear to be implanted and < or = 60% in the best-aided condition. The investigation was a repeated-measures single-subject experiment and took place at 46 different North American clinical sites. Preoperative performance was compared with postoperative performance 3 mo after device activation. Clinicians were able to program patients' processors with one, two, or all three speech-processing strategies. Testing took place using the participant's preferred speech-processing strategy (SPEAK, CIS, or ACE). Preoperative unaided hearing thresholds were compared with unaided thresholds in the implanted ear measured 1 mo after device activation. Surgeons were canvassed regarding surgical use and design of the device via a questionnaire after having completed at least one Nucleus 24 Contour surgery. Average T- and C-levels for the Nucleus 24 Contour patients were considerably lower than those using the Nucleus 24 (CI24M). A total of 85 patients had measurable hearing preoperatively at two or more audiometric frequencies in the ear implanted. Of these patients 41 (48%) had measurable hearing at one or more frequencies and 32 (38%) had measurable hearing at two or more frequencies postoperatively. In general, surgeons found the Nucleus 24 Contour easy to insert and were pleased with the design features of the device. The downsized receiver/stimulator (of the Nucleus 24 Contour) required less drilling than the Nucleus 24, reducing surgical time, as well as making the Contour better suited for implantation in those with small skull sizes (e.g., small children and infants). After 3 mo of device use, mean open-set speech perception in quiet and in noise was significantly better than preoperative performance on all test measures. Patients using the ACE strategy had significantly better mean scores for all measures than patients using SPEAK. Only two patients preferred to use the CIS coding strategy. CONCLUSIONS The results presented in this article demonstrated that the design objectives of the Nucleus 24 Contour were met. Namely, results from this study, together with insertion studies, were consistent with perimodiolar placement using an implant design that the majority of surgeons found easy to insert with relatively minimal trauma. Reduced T- and C-levels were observed with Contour patients when compared with patients using the Nucleus 24 with the straight array, consistent with perimodiolar placement. A survey of surgeons participating in the clinical trial indicated easier, or equally easy, insertion of the Contour array, compared with previous Nucleus products as well as other manufacturers' devices, without the use of additional insertion tools or array positioners. Postoperatively, 46% of patients with preoperative residual hearing maintained some level of unaided hearing postoperatively, suggesting atraumatic insertion of the Nucleus 24 Contour electrode array. It is worth noting that all 216 patients implanted during this study had full insertions of their Contour electrode arrays. High levels of open-set speech perception in quiet and in noise were achieved and patients using the ACE strategy had significantly better mean scores for all measures than patients using SPEAK. Only two patients preferred to use the CIS coding strategy.

An infant girl (JD) was assessed as having a mild-to-moderate sensorineural hearing loss in her left ear and a moderate-to-severe sensorineural loss in her right ear, based on results of auditory brain-stem response (ABR) at age 3 months and soundfield testing at 4, 5, and 9 months (Better ear PTA=55 dB HL). JD was fitted with hearing aids binaurally. The one risk factor in her birth history is prenatal polydrug exposure, including cocaine. She had recurrent otitis media, but tympanometry and other evidence weigh against middle ear problems as the cause of her hearing loss. A follow-up ABR at 13 months revealed JD to have normal hearing, a result confirmed by audiometric testing of her unaided hearing thresholds (PTA=10 dB HL). The implication is that, between ages 9 and 13 months, JD’s hearing improved to normal levels, possibly as a result of delayed maturation of the peripheral auditory tracts. Early detection of hearing loss may reveal more children like JD who have sensorineural losses that spontaneously remediate with development. Such cases would highlight the need for repeated testing of unaided thresholds in hearing-impaired infants, especially if aggressive intervention is contemplated. [Work supported by NIH and the Texas Advanced Research Program.]

The relationship between hearing loss and speech intelligibility was investigated in a sample of 121 young deaf children. Significant independent effects were associated with the unaided hearing threshold level (HTL), but not with the aided HTL or with shape. Further analysis of the data suggested the existence of three distinct groups. Most children with losses of 70-89 db developed some intelligible speech and the unaided HTL had additional predictive validity. Between 90 and 104 db, considerable variability occurred, and the aided HTL had additional predictive validity. Above 105 db, few children developed any intelligible speech.

The status of residual hearing in patients who have undergone cochlear implantation was reported at the American Academy of Otolaryngology–Head Neck Surgery meeting in Chicago, Sept 22, 1987, by William F. House, MD, and Cathleen O'Connor, MA, of the Otologic Medical Group in Los Angeles. Unaided hearing thresholds (greater than 100 dB, SL) were identified in 26 adults and eight children out of the 140 adults and 130 children who had received cochlear implants. Twenty patients (14 adults and six children) were available for the study. Twelve of 20 patients demonstrated significant improvement in unaided hearing thresholds, ranging from 6 to 26 dB, with an average of 14 dB. Four of these patients demonstrated progressive hearing loss in the implanted ear. All of these patients had undergone insertion with 14-, 16-, or 18-mm electrodes. Another patient who had undergone the insertion of with 14-, 16-, or 18-mm electrodes. Another patient