Performance outcomes for borderline cochlear implant recipients with substantial preoperative residual hearing.

OBJECTIVE: This study examined whether cochlear implant (CI) recipients with substantial preoperative residual hearing obtained more benefit from a CI than from a hearing aid (HA). STUDY DESIGN: Retrospective records review. SETTING: Tertiary referral center. PATIENTS: Thirty-seven CI recipients (11 children/teens, 26 adults) were identified that met the following inclusion criteria: preimplant sentence recognition scores greater than 50% correct in the implanted ear or greater than 60% in the best-aided/binaural condition (Group 1, n = 18); audiometric thresholds less than 70 dB HL at 2 or more frequencies (i.e., better than a severe-profound hearing loss; Group 2, n = 13 ears in 12 recipients), or those that met both the audiometric and sentence-recognition criteria (Group 3, n = 7). MAIN OUTCOME MEASURE: Postimplant speech-perception scores. RESULTS: Postimplant speech perception was substantially better than the preimplant performance for 12 of 18 recipients in Group 1, 10 of 12 recipients (11/13 ears) in Group 2, and 5 of 7 recipients in Group 3 (total, 73.7%). Five recipients (13.1%) showed no change from preimplant performance levels. Results were inconclusive for 2 recipients (5.3%) because preimplant versus postimplant testing was conducted in different conditions. Three recipients (7.9%) exhibited decreased performance postimplant. CONCLUSION: For most recipients whose hearing was better than that defined by traditional candidacy criteria, performance improved with the CI. These results may help clinicians guide candidates in the decision-making process by providing information on the range of outcomes for recipients with similar preimplant performance levels, identify the need for additional preimplant counseling regarding expectations, and recognize the importance of systematizing preimplant and postimplant testing for longitudinal assessment of performance.

Energy transmittance predicts conductive hearing loss in older children and adults.

The test performance of a wideband acoustic transfer function (ATF) test and 226-Hz tympanometry was assessed in predicting the presence of conductive hearing loss, based on an air-bone gap of 20 dB or more. Two ATF tests were designed using an improved calibration method over a frequency range (0.25-8 kHz): an ambient-pressure test and a tympanometric test using an excess static pressure in the ear canal. Wideband responses were objectively classified using moment analyses of energy transmittance, which was a more appropriate test variable than energy reflectance. Subjects included adults and children of age 10 years and up, with 42 normal-functioning ears and 18 ears with a conductive hearing loss. Predictors were based on the magnitudes of the moment deviations from the 10th to 90th percentiles of the normal group. Comparing tests at a fixed specificity of 0.90, the sensitivities were 0.28 for peak-compensated static acoustic admittance at 226 Hz, 0.72 for ambient-pressure ATF, and 0.94 for pressurized ATF. Pressurized ATF was accurate at predicting conductive hearing loss with an area under the receiver operating characteristic curve of 0.95. Ambient-pressure ATF may have sufficient accuracy to use in some hearing-screening applications, whereas pressurized ATF has additional accuracy that may be appropriate for hearing-diagnostic applications.