The beneficial effect of transparent surgical masks on the communication of adults with hearing loss within clinical settings.

Purpose: The study examined the benefits of transparent versus non-transparent surgical masks on the speech intelligibility in quiet of adult cochlear implant (CI) users, in conjunction with patient preferences and the acoustic effects of the different masks on the speech signal.Methods: Speech tracking test (STT) scores and acoustical characteristics were measured in quiet for live speech in three different conditions, without mask, with a non-transparent surgical mask and with a transparent surgical mask. Patients were asked about their experience with the face masks. The study sample consists of 30 patients using a cochlear implant.Results: We found a significant difference in speech perception among all conditions, with the speech tracking scores revealing a significant advantage when switching from the non-transparent surgical mask to the transparent one. The transparent surgical mask, although it does not transmit high frequencies effectively, seems to have minimal effect on speech comprehension in practice when lip movements are visible. This substantial benefit is further emphasized in the questionnaire, where 82% of the patients express a preference for the transparent surgical mask.Conclusion: The study highlights significant benefits for patients in speech intelligibility in quiet with the use of medically safe transparent facemasks. Transitioning from standard surgical masks to transparent masks demonstrates highly significant effectiveness and patient satisfaction for patients with hearing loss. This research strongly advocates for the implementation of transparent masks in broader hospital and perioperative settings.

In scenarios mandating mask usage, it's advisable for caregivers to opt for transparent surgical masks. Specifically within perioperative settings, where patients might not be able to utilise their hearing aids or cochlear implants, it becomes imperative for all caregivers to consistently wear transparent surgical masks to prevent communication impediments.When utilising a transparent surgical mask, caregivers must recognise that sound may be altered and maintaining a clear view of the face and lips is crucial for effective communication.

Patient and clinician experiences with the multidisciplinary single-day cochlear implant selection (MSCS) protocol.

PURPOSE: This study assessed the MSCS (Multidisciplinary Single-day Cochlear Implant Selection) protocol with a primary focus on sustaining or enhancing patient satisfaction throughout the cochlear implant selection process. MATERIALS AND METHODS: Following the implementation of the new selection protocol, where all selection appointments take place on the same day, we surveyed 37 individuals who underwent the process. Twenty adhered to the standard procedure, while 17 followed the MSCS protocol. We also gathered feedback from seven out of eight involved healthcare providers. This method enabled us to evaluate the protocol's effectiveness in maintaining patient satisfaction and ensuring staff contentment with care delivery within a condensed timeframe. RESULTS: Patient responses showed slight variations in average scores without statistical significant differences, indicating comparable satisfaction between the MSCS pathway and the standard protocol. The majority of patients preferred the MSCS protocol, with none of the MSCS participants opting for appointments spread over multiple days. Healthcare practitioners of the CI center also displayed similar or increased satisfaction levels with the MSCS protocol. CONCLUSION: The adoption of the MSCS in daily clinical care has led to a decrease in patient appointment times without sacrificing patient satisfaction. Additionally, the majority of individuals actively choose the MSCS protocol. Among those who have directly experienced it, there is unanimous preference for the consolidated appointments over spreading them across multiple days. Professionals within the CI team express equal satisfaction with both the new and old protocols, indicating that the reduction in patient time does not diminish overall satisfaction.

Communicating Emotion: Vocal Expression of Linguistic and Emotional Prosody in Children With Mild to Profound Hearing Loss Compared With That of Normal Hearing Peers.

OBJECTIVES: Emotional prosody is known to play an important role in social communication. Research has shown that children with cochlear implants (CCIs) may face challenges in their ability to express prosody, as their expressions may have less distinct acoustic contrasts and therefore may be judged less accurately. The prosody of children with milder degrees of hearing loss, wearing hearing aids, has sparsely been investigated. More understanding of the prosodic expression by children with hearing loss, hearing aid users in particular, could create more awareness among healthcare professionals and parents on limitations in social communication, which awareness may lead to more targeted rehabilitation. This study aimed to compare the prosodic expression potential of children wearing hearing aids (CHA) with that of CCIs and children with normal hearing (CNH). DESIGN: In this prospective experimental study, utterances of pediatric hearing aid users, cochlear implant users, and CNH containing emotional expressions (happy, sad, and angry) were recorded during a reading task. Of the utterances, three acoustic properties were calculated: fundamental frequency (F0), variance in fundamental frequency (SD of F0), and intensity. Acoustic properties of the utterances were compared within subjects and between groups. RESULTS: A total of 75 children were included (CHA: 26, CCI: 23, and CNH: 26). Participants were between 7 and 13 years of age. The 15 CCI with congenital hearing loss had received the cochlear implant at median age of 8 months. The acoustic patterns of emotions uttered by CHA were similar to those of CCI and CNH. Only in CCI, we found no difference in F0 variation between happiness and anger, although an intensity difference was present. In addition, CCI and CHA produced poorer happy-sad contrasts than did CNH. CONCLUSIONS: The findings of this study suggest that on a fundamental, acoustic level, both CHA and CCI have a prosodic expression potential that is almost on par with normal hearing peers. However, there were some minor limitations observed in the prosodic expression of these children, it is important to determine whether these differences are perceptible to listeners and could affect social communication. This study sets the groundwork for more research that will help us fully understand the implications of these findings and how they may affect the communication abilities of these children. With a clearer understanding of these factors, we can develop effective ways to help improve their communication skills.

Pilot study of a multidisciplinary single-day cochlear implant selection protocol.

PURPOSE: This study aimed to explore and introduce the potential of a MSCS (Multidisciplinary Single-day Cochlear Implant Selection) protocol. The primary objectives of this pilot were to reduce the duration between referral and surgery, minimize hospital visits and decrease the time healthcare professionals dedicate to the cochlear implant (CI) selection process. MATERIALS AND METHODS: We established a pilot program at the CI center of the Erasmus MC, a tertiary referral center in the Netherlands, with the goal of improving and shorten the selection process. We evaluated our pilot, including 15 CI candidates, and conducted a retrospective analysis for time and cost savings. RESULTS: The results showed that the pilot of the MSCS protocol significantly reduced the length of the CI selection phase (84 days vs 1; standard intake vs MSCS protocol) and the number of hospital visits (6 vs 2 visits; standard vs MSCS protocol), resulting in less travel time and lower costs for the CI candidates. The total time of professionals spend on patients was also reduced with 27 %. CONCLUSION: This study highlights the potential benefits of the MSCS protocol in terms of reducing the burden on patients and healthcare providers and improving the efficiency of the CI selection process.

A systematic review on the impact of auditory functioning and language proficiency on psychosocial difficulties in children and adolescents with hearing loss.

OBJECTIVE: Approximately 20% to 40% of children with hearing loss encounter psychosocial difficulties. This prevalence may be outdated, given the advancements in hearing technology and rehabilitation efforts to enhance the psychosocial well-being of these children. A systematic review of up-to-date literature can help to identify factors that may contribute to the children's psychosocial well-being. DESIGN/STUDY SAMPLE: A systematic review was conducted. Original articles were identified through systematic searches in Embase, Medline, PsychINFO, and Web of Science Core Collection. The quality of the papers was assessed using the Newcastle-Ottawa Quality Assessment Scale and custom Reviewers' Criteria. RESULTS: A search was performed on 20 October 2022. A total of 1561 articles were identified, and 36 were included for review. Critical appraisal led to 24 good to fair quality articles, and 12 poor quality articles. CONCLUSION: Children with hearing loss have a twofold risk of experiencing psychosocial difficulties compared to normal hearing peers. Estimates for functioning in social interactions, like speech perception (in noise) or language proficiency, have proven to be more adequate predictors for psychosocial difficulties than the degree of hearing loss. Our findings can be useful for identifying children at risk for difficulties and offering them earlier and more elaborate psychological interventions.

First results of the Strengths and Difficulties Questionnaire, applied as a screening tool for psychosocial difficulties in pediatric audiology.

PURPOSE: Despite major improvements in rehabilitation possibilities, children with sensorineural hearing loss are at risk for psychosocial difficulties. These difficulties can impact their educational and career achievements and may be two to three times more common in children with hearing loss compared to those with normal hearing. Early identification of psychosocial difficulties can be facilitated using the Strengths and Difficulties Questionnaire (SDQ) and may improve outcomes and quality of life. We implemented the SDQ into the clinical follow-up of children with hearing loss in a tertiary referral hospital. With this, prevalence and severity of difficulties in specific psychosocial domains and several predictors were investigated. METHODS: A retrospective, cross-sectional investigation was performed of the following factors in association with the SDQ results: type of hearing device, type and degree of hearing loss, speech perception in quiet and in noise, and type of schooling. RESULTS: Between June 2020 and January 2022, parents of 312 children (age 4-18) completed the SDQ. An additional 113 child-reports were completed. The response rate of the parents was 69%. Problems with peer relationships and prosocial behavior were the most affected areas with clinically elevated scores in 22% of the children. Psychosocial difficulties were distributed similarly across types of hearing device, nature and degrees of hearing loss, and educational settings. Better speech perception in quiet was significantly associated with fewer parent-reported conduct problems. CONCLUSION: The results of the present study suggest that children with hearing loss may be at risk of experiencing challenges with social interactions and attachment in social contexts. Using the SDQ in clinical follow-up may improve the chances for early psychological assessment and intervention. In addition, the study found that children's mental health may be impacted by their communication abilities.

Risk Factors For Hearing Decline From Childhood To Early Adolescence.

OBJECTIVE: To identify risk factors of hearing decline between 9 and 13 years of age. The risk factors examined included sociodemographic, health, and lifestyle-related factors. METHODS: This study was embedded within a population-based prospective cohort study from fetal life onwards in the Netherlands. Pure-tone audiometry and tympanometry were performed at the age of 9 and 13 years. The hearing decline was defined as an increase in low-frequency or high-frequency pure-tone average of at least 5 dB in one of both ears. Multivariable logistic regression was performed to examine the association of possible risk factors with hearing decline. The study was conducted from April 2012 to October 2015, and from April 2016 to September 2019. RESULTS: Of the 3,508 participants included, 7.8% demonstrated a hearing decline in the low frequencies, and 11.3% in the high frequencies. Participants who reported alcohol consumption were more likely to have a hearing decline in the low frequencies (OR 1.5, 95% CI 1.1; 2.0). Moreover, a lower educational level was associated with an increased odds of having a hearing decline in the high frequencies (OR 1.4, 95% CI 1.0; 1.8). Age, sex, household income, personal music player use, and body mass index were not associated with hearing decline. CONCLUSION: Educational level and risky behavior were significantly associated with hearing decline from childhood to early adolescence. The findings of the present study can help in the design of public health interventions to prevent hearing loss at a young age. LEVEL OF EVIDENCE: 2 (prospective cohort study) Laryngoscope, 133:389-395, 2023.

The association of sociodemographic factors and risk behavior with unsafe use of personal listening devices in adolescents.

Many young people are potentially at risk of noise-induced hearing loss due to unsafe use of personal listening devices. The aim of this cross-sectional study was to examine the association of sociodemographic factors and risk behavior with unsafe use of personal listening devices in adolescents to identify a target group for prevention. A smartphone application was developed to objectively measure music listening habits among 314 adolescents with a mean age of 13 years and 7 months (SD ±5 months). Listening habits were characterized as safe or unsafe based on the weekly noise dose. Data on sociodemographic factors and traditional health risk behaviors were obtained by questionnaires. Within the study group, 10.5% of the participants exceeded the 50%, and 4.8% the 100% recommended weekly noise dose. Adolescents with a lower socioeconomic status were more likely to engage in unsafe listening habits as compared to adolescents with a higher socioeconomic status. Additionally, risk behavior was associated with higher odds of having unsafe listening habits as compared to no risk behavior. Age, sex and educational levels were not significantly associated with unsafe listening habits. The findings of the present study indicate that interventions to promote safe listening habits should target adolescents with a lower socioeconomic status and higher risk behavior. Future research is needed to investigate how these adolescents can be motivated to adopt safe listening habits.

Distortion Product Otoacoustic Emissions in Screening for Early Stages of High-frequency Hearing Loss in Adolescents.

Objective: Adolescents may be at risk of noise-induced hearing loss due to recreational sound. The aim of this study was to examine the role of distortion product otoacoustic emissions (DPOAEs) in screening for early stages of high-frequency loss such as can be observed in noise-induced hearing loss. Setting and design: This cross-sectional study was embedded within Generation R, an ongoing prospective birth cohort study in Rotterdam, The Netherlands. Data were collected from April 2016 to September 2019. Methods: A total of 3456 adolescents with a mean age of 13 years and 8 months old (standard deviation ± 5 months) were included. Pure-tone thresholds were measured in a sound-treated booth. DPOAEs were recorded using an ILO V6 analyzer with primary levels of 65/55 dB SPL and frequency ratio f2/f1 of 1.22. Subjects had normal middle ear function at the time of assessment, based on tympanometry results. Results: Measurements in 6065 ears showed that DPOAE levels tend to decrease with increasing pure-tone thresholds. However, the intersubject variability of DPOAE levels in ears with the same threshold was large. DPOAE levels could reasonably identify early stages of high-frequency hearing loss. Conclusion: The findings of present study indicate that DPOAE measurements can potentially be used for adolescents hearing screening in the high frequencies. Future research is needed to optimize test performance.

A retrospective analysis of hearing after cholesteatoma surgery: the bony obliteration tympanoplasty versus canal wall up and canal wall down without mastoid obliteration.

OBJECTIVE: To evaluate and compare the hearing outcome after the bony obliteration tympanoplasty (BOT), canal wall up (CWU) without mastoid obliteration and canal wall down (CWD) without mastoid obliteration in a large patient cohort. As the aeration of the middle ear is associated with hearing outcome, we hypothesized that the post-operative hearing after the BOT may be better compared to CWU and CWD without obliteration. METHODS: This is a retrospective cohort study on all adult patients who underwent the BOT, CWU without obliteration or CWD without obliteration for primary or revision cholesteatoma between January 2003 and March 2019 with audiological follow-up at our institution. Pre-operative, short-term post-operative and long-term post-operative hearing tests were analyzed and potential factors influencing post-operative hearing were assessed. RESULTS: 626 ears were included. We found no significant differences between the short-term and long-term post-operative audiometry. The pre-operative air-bone gap (ABG) was the factor with the largest effect size on change in air-bone gap (ABG) between pre- and post-operative. When stratifying for this factor along with the type of ossicular chain reconstruction to account for differences at baseline, no significant differences in post-operative ABG were found between BOT and non-obliteration CWU and CWD. CONCLUSION: In this large retrospective cohort study, we found no significant differences in post-operative ABG between the BOT and the non-obliteration CWU and CWD. A solid comparison of hearing between groups remains very challenging as hearing outcome seems to be dependent on many different factors. Hearing outcome seems to be no additional argument to choose for BOT over non-obliteration surgery.

The impact of face masks on the communication of adults with hearing loss during COVID-19 in a clinical setting.

OBJECTIVE: The aim of the study was to investigate the effect of surgical masks and face shields on speech intelligibility of adults with moderate to severe hearing loss. DESIGN: This study measured speech tracking scores in quiet for life speech in three different conditions: without a mask, with a surgical mask and with a face shield. Acoustic effects of the masks and face shields on the speech signal were also investigated. Study sample: The study sample consists of 42 patients with moderate to severe hearing loss, 23 cochlear implant users and 19 hearing aid users. RESULTS: A significant average difference in speech perception scores was found for the use of a surgical mask compared to the listening situation "without mask". The worse the speech understanding in quiet, the larger the impact of the surgical mask. For the worse performers even the face shield had a negative impact on speech perception. The sound distortion for the face shield compared to the surgical mask was greater. CONCLUSION: This study shows that even for speech perception in quiet, surgical face masks, and face shields to a lesser extent, have a negative effect for patients with moderate to severe hearing loss.

Objective Measurement of Listening Device Use and Its Relation to Hearing Acuity.

OBJECTIVES: To examine whether adolescents exceed recommended noise exposure limits when using personal listening devices (PLDs) and to investigate the relationship between objectively measured PLD use and hearing thresholds. STUDY DESIGN: Cross-sectional study. SETTING: This study was embedded within an ongoing prospective birth cohort study in Rotterdam, the Netherlands. Data were collected from May 2017 to September 2019. METHODS: A smartphone application was developed to measure daily noise exposure from PLDs. Listening habits were monitored among 314 adolescents with a mean age of 13 years 7 months (SD, 5 months), of whom 51.6% were male. Hearing acuity was measured by pure tone audiometry, and tympanometry was performed in both ears. RESULTS: Within the study group, 2.2% adolescents exceeded the recommended daily noise dose (85 dBA as an 8-hour time-weighted average) among all days when the application was active and 9.9% when among only the listening days. No significant correlation was found between the daily noise dose from PLDs and pure tone thresholds. CONCLUSIONS: The majority of adolescents exhibited listening habits that could be considered safe. As noise-induced hearing loss develops slowly over time, it could be that the effects of PLD use on hearing are not evident yet in this young population with a relatively short duration of PLD use.

Revision surgery for chronically discharging mastoid cavities: mastoid obliteration with canal wall reconstruction versus non-obliteration surgery.

PURPOSE: To evaluate the surgical results of revision canal wall down (CWD) surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to mastoid obliteration with canal wall reconstruction. METHODS: This is a retrospective cohort study. All adult patients (≥ 18 years) who underwent revision surgery for chronically draining mastoid cavities between January 2013 and January 2020 were included. Primary outcome measures included the dry ear rate, complications and postoperative hearing. RESULTS: 79 ears were included; 56 ears received revision CWD with mastoid obliteration and posterior canal wall reconstruction and 23 ears received CWD without mastoid obliteration. The dry ear rate at the most recent outpatient clinic visit (median 28.0 months postoperative) was significantly higher in the obliteration group with 96.4% compared to 73.9% for the non-obliteration group (p = .002). There were no differences in audiological outcome and incidence of complications between the two techniques. CONCLUSION: We show that in our study population revision CWD surgery with mastoid obliteration and posterior canal wall reconstruction is superior to revision CWD surgery without mastoid obliteration in the management of chronically discharging mastoid cavities. In the obliteration group, a dry ear was achieved in 96.4% as this was 73.9% in the non-obliteration group. We found no differences in audiological outcome and in incidence of complications between the two techniques.

Treatment Outcome of the Bony Obliteration Tympanoplasty Versus Nonobliterative Techniques in Cholesteatoma Surgery: A Retrospective Analysis.

OBJECTIVE: In cholesteatoma surgery, obliteration of the mastoid and epitympanic space (bony obliteration tympanoplasty, BOT) is an increasingly used technique with low recurrent and residual cholesteatoma rates. While factors as the postoperative hearing level and infection rate are important for the patient as well, these outcome parameters are not frequently reported on in current literature. The objective of this study is to evaluate the recurrent and residual cholesteatoma rates of the BOT technique and nonobliterative canal wall up (CWU) and canal wall down (CWD) mastoidectomy in a large patient cohort. Secondary objectives were to evaluate the infection rate and hearing outcome for all three techniques. DESIGN: Retrospective cohort study. SETTING: Single-center study. PATIENTS: All 337 adult patients (≥18 yrs) who underwent primary or revision cholesteatoma surgery between January 2013 and March 2019 were included. MAIN OUTCOME AND MEASURES: Recurrent cholesteatoma rates, residual cholesteatoma rates, postoperative infections and other complications, hearing outcome. RESULTS: The estimated combined rate of recurrent and residual cholesteatoma at 5 years follow-up was 7.6% in the BOT group, 34.9% in the CWU group, and 17.9% in the CWD group. The postoperative infection rate in the different groups ranged from 4.3% to 4.9%. The median gain in AC threshold level varied from 0.0 dB in the BOT and CWD group to 3.8 dB in the CWU group. CONCLUSIONS: We show that cholesteatoma recurrence rates after the BOT technique in our clinic are significantly lower compared to CWU surgery. There were no differences in infection rate and no clinically relevant differences in postoperative hearing between the BOT, CWU, and CWD technique.

Impact of face masks in public spaces during COVID-19 pandemic on daily life communication of cochlear implant users.

OBJECTIVE/HYPOTHESIS: Investigate potential problems in the daily life communication of cochlear implant (CI) patients due to the widespread use of face masks in public places during the COVID-19 pandemic. STUDY DESIGN: Prospective survey study. METHODS: This study used an online questionnaire about the effects of face masks on daily life communication of adult CI users. The questionnaire consists of three parts: (a) A face mask questionnaire, (b) loneliness question (c) three subdomains of the Nijmegen Cochlear Implant Questionnaire to assess quality of life. The questionnaires were send out on October 20, 2020. Four hundred and seven adult CI users were invited to participate in the study. The survey inclusion was closed on November 5, 2020. The study setting was the Rotterdam Cochlear Implant Center, Erasmus MC, a tertiary referral center in The Netherlands. The loneliness question and Nijmegen Cochlear Implant Questionnaire were analyzed for possible differences between the current situation with masks and the situation before, when masks were not commonly used. RESULTS: Two hundred and twenty one adult CI users (54% female, mean age 62 years) participated in the study. The face mask questionnaire showed that face masks cause considerable problems in daily life communication of 80% of the participants. Also, CI users tend to feel more lonely and all used subdomains of the Nijmegen Cochlear Implant Questionnaire worsened due to the use of face masks. CONCLUSION: The widespread use of face masks greatly complicates the daily life communication of CI users and reduces quality of life. LEVEL OF EVIDENCE: 3.

A 4-year follow-up study of hearing acuity in a large population-based cohort of children and adolescents.

OBJECTIVES: To describe the prevalence of hearing loss among 13 year old adolescents, and to examine the change in prevalence between ages 9 and 13 years. METHODS: This study was embedded within Generation R, a population-based prospective cohort study from fetal life onwards in the Netherlands. Pure-tone thresholds were obtained at 0.5 to 8 kHz, and tympanometry was performed. Sensorineural hearing loss (SNHL) was defined as a low-frequency and/or high-frequency pure-tone average of more than 15 dB HL in one of both ears. Audiometric signs suggestive of noise-induced hearing loss (NIHL) included the presence of a notch and/or high-frequency hearing loss. The study was conducted from April 2012 to October 2015, and April 2016 to September 2019. RESULTS: A total of 4572 adolescents with a mean age of 13 years and 7 months (SD, 5 months) were included, of whom 2334 (51.0%) were girls. Within the cohort, 6.4% (95% CI, 5.7%-7.2%) were estimated to have SNHL, and 12.4% (95% CI, 11.5%-13.4%) met the criteria of NIHL. In total, 3675 participants were included in the longitudinal analysis. The prevalence of SNHL decreased from 8.0% to 5.3% between ages 9 and 13 years (P < .001). The prevalence of NIHL increased from 9.8% to 11.7% (P = .004), due to an increase in number of participants with a notch. CONCLUSIONS: The prevalence of SNHL significantly decreased by 2.7% (95% CI, 1.6%-3.9%) between ages 9 and 13 years, probably due to a change in alertness during assessment at the age of 13 years. Other possible explanations include the presence of selection bias or a decline in prevalence of conductive hearing loss. The number of participants with audiometric signs suggestive of NIHL increased by 1.9% (95% CI, 0.5%-3.3%). LEVEL OF EVIDENCE: Level 3.

A smartphone application to objectively monitor music listening habits in adolescents : Personal listening device usage and the accuracy of self-reported listening habits.

BACKGROUND: Listening to music through personal listening devices (PLDs) has become more prevalent during last decades. The aim of this study was to evaluate music listening habits through PLDs in adolescents with a smartphone application, and to assess the accuracy of self-reported listening habits. METHODS: This study was embedded in the Generation R Study, a population-based prospective birth cohort in Rotterdam, the Netherlands. A smartphone application for Android operating systems was developed to objectively monitor music listening habits for a period of 35 days. A postal questionnaire was used to subjectively assess listening habits. The level of agreement between the objectively measured and self-reported listening habits were evaluated using weighted kappa coefficients. Data were collected from May 2017 to March 2019. RESULTS: A total of 311 adolescents aged 12 to 15 years were included, of whom 237 (76.2%) completed the postal questionnaire. The results of the smartphone application showed that the median listening frequency was 2.1 days a week (IQR 1.0-3.4), the median listening time 21.1 min a day (IQR 9.1-53.7), and the mean listening level 54.5% (SD 18.1%). There was a slight to fair agreement between the objectively measured, and self-reported listening habits according to the weighted kappa coefficients (k = 0.179 to 0.364). CONCLUSIONS: The results of the current study suggest that self-reported measures of listening habits are not always accurate. We consider a smartphone application to monitor listening habits of added value in future research investigating the possible damaging effects of PLDs on hearing acuity.

Comparing Two Hearing Aid Fitting Algorithms for Bimodal Cochlear Implant Users.

OBJECTIVES: To investigate the possible advantage of the use of a dedicated bimodal hearing aid fitting formula, the Adaptive Phonak Digital Bimodal (APDB), compared with a frequently used standard hearing aid fitting formula, the NAL-NL2. We evaluated the effects of bimodal hearing aid fitting on provided hearing aid gain and on bimodal auditory functioning in a group of experienced bimodal cochlear implant (CI) users. A second aim of our study was to determine the effect of broadband loudness balancing on the prescribed gain of those two fitting formulas. DESIGN: This prospective study used a crossover design in which two fitting methods were compared varying in basic prescription formula (NAL-NL2 or APDB fitting formula). The study consisted of a three-visit crossover design with 3 weeks between sessions. Nineteen postlingually deafened experienced bimodal CI users participated in this study. Auditory functioning was evaluated by a speech in quiet test, a speech in noise test, and a questionnaire on auditory performance. RESULTS: Significant differences between the two fitting formulas were found for frequencies of 2000 Hz and above. For these frequencies, less gain was provided by the APDB fitting formula compared with NAL-NL2. For the APDB fitting formula, a higher compression ratio for frequencies of 1000 Hz and above was found compared with the NAL-NL2 fitting formula. Loudness balancing did not result in large deviations from the prescribed gain by the initial fitting formula. Bimodal benefit was found for speech perception in quiet and for speech perception in noise. No differences in auditory performance were found between the two fitting formulas for any of the auditory performance tests. CONCLUSIONS: The results of this study show that CI users with residual hearing at the contralateral ear can benefit from bimodal stimulation, regardless of the fitting method that was applied. Although significant differences between the output and compression ratio of the NAL-NL2 and the APDB fitting formula existed, no differences in bimodal auditory performance were observed. Therefore, NAL-NL2 or the APDB fitting prescription both seem suited for bimodal fitting purposes. Additional loudness balancing has a marginal effect on the provided hearing aid output.

Comparing the Effect of Different Hearing Aid Fitting Methods in Bimodal Cochlear Implant Users.

Purpose The aim of the study was to investigate the effect of 3 hearing aid fitting procedures on provided gain of the hearing aid in bimodal cochlear implant users and their effect on bimodal benefit. Method This prospective study measured hearing aid gain and auditory performance in a cross-over design in which 3 hearing aid fitting methods were compared. Hearing aid fitting methods differed in initial gain prescription rule (NAL-NL2 and Audiogram+) and loudness balancing method (broadband vs. narrowband loudness balancing). Auditory functioning was evaluated by a speech-in-quiet test, a speech-in-noise test, and a sound localization test. Fourteen postlingually deafened adult bimodal cochlear implant users participated in the study. Results No differences in provided gain and in bimodal performance were found for the different hearing aid fittings. For all hearing aid fittings, a bimodal benefit was found for speech in noise and sound localization. Conclusion Our results confirm that cochlear implant users with residual hearing in the contralateral ear substantially benefit from bimodal stimulation. However, on average, no differences were found between different types of fitting methods, varying in prescription rule and loudness balancing method.