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Otorinolaringologia 2019 June;69(2):69-74

DOI: 10.23736/S0392-6621.18.02195-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Acoustic bimodal stimulation: preoperative predictors of outcome and intra-patient comparison with electrical stimulation

Anna D'ERAMO 1 , Andrea CANALE 2, Federico DAGNA 3, Carla MONTUSCHI 2, Federico CARANZANO 1, Carmine F. GERVASIO 4, Roberto ALBERA 2

1 Section of Otorhinolaryngology, Department of Surgery, University of Turin, Turin, Italy; 2 Section of Otorhinolaryngology, Department of Surgery, Città della Salute e della Scienza, Turin, Italy; 3 Section of Otorhinolaryngology, Department of Surgery, Santa Croce Hospital, Moncalieri, Turin, Italy; 4 Section of Otorhinolaryngology, Department of Surgery, Ospedale degli Infermi, Biella, Italy



BACKGROUND: Acoustic bimodal stimulation is one of the most debated topics in audiology. Wearing a hearing aid contralaterally to the cochlear implant provides an advantage in noisy environments but benefit in silence is still debated. More importantly it is still unclear why some patients seem to benefit from it and others do not, and in later years researchers have been looking for preoperative predictors of bimodal benefit.
METHODS: We selected a sample of 19 bimodal patients and tested their hearing thresholds (in the unaided, hearing aid only, cochlear implant only and bimodal condition), their speech recognition in quiet (with their cochlear implant only and in the bimodal condition) and their speech recognition in noise (in the bimodal condition varying the position of the sound source). We obtained a subjective evaluation of the auditory performance via the SSQ: Speech Spatial and Qualities of Hearing Scale and we also ran a regression analysis in order to identify possible correlation between preoperative data (such as unaided and hearing-aid-only hearing thresholds) and indicators of bimodal benefit.
RESULTS: Results showed that in our sample bimodal stimulation yielded to a better hearing thresholds and better speech recognition in quiet. In speech recognition with competing noise the direction from which the stimulus came from was irrelevant to intelligibility. These results were matched by a subjective perception of bimodal benefit as shown by the SSQ scores. Based on speech recognition in quiet results, we noticed that a group of patients within the sample did not benefit from bimodal stimulation (group 2) and we decided to compare them to those who did (group 1). Group 1 results were similar to those of the sample, showing an improvement with bimodal stimulation in all tested conditions. In group 2 results showed no improvement either in hearing thresholds or SSQ scores, also a trend was noticed towards reliance to cochlear implant in noisy environments. Our correlation analysis failed to identify preoperative predictors of outcome despite recent evidence suggesting a link between bimodal performance and unaided threshold.
CONCLUSIONS: Overall, results in our study show that bimodal stimulation can grant an advantage over electrical stimulation both in terms of PTA and speech recognition in quiet. A subgroup of patients, though, appears not to benefit from it and as of today there is no way to predict preoperatively who they are.


KEY WORDS: Cochlear implants - Hearing aids - Hearing loss

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