Introduction: The aim of this study was to examine how bimodal stimulation affects quality of life (QOL) during the postoperative period following cochlear implantation (CI). These data could potentially provide evidence to encourage more bimodal candidates to continue hearing aid (HA) use after CI. Methods: In this prospective study, patients completed preoperative and 1-, 3-, and 6-month post-activation QOL surveys on listening effort, speech perception, sound quality/localization, and hearing handicap. Fifteen HA users who were candidates for contralateral CI completed the study (mean age 65.6 years). Results: Patients used both devices at a median rate of 97%, 97%, and 98% of the time at 1, 3, and 6 months, respectively. On average, patients’ hearing handicap scores decreased by 16% at 1 month, 36% at 3 months, and 30% at 6 months. Patients’ listening effort scores decreased by a mean of 10.8% at 1 month, 12.6% at 3 months, and 18.7% at 6 months. Localization significantly improved by 24.3% at 1 month and remained steady. There was no significant improvement in sound quality scores. Conclusion: Bimodal listeners should expect QOL to improve, and listening effort and localization are generally optimized using CI and HA compared to CI alone. Some scores improved at earlier time points than others, suggesting bimodal auditory skills may develop at different rates.

This study investigated how using both a cochlear implant (CI) and a hearing aid (HA) in the other ear, known as bimodal stimulation, affects patient’s hearing-related quality of life after receiving a CI. We hoped our work could potentially encourage greater HA use among bimodal candidates. Researchers prospectively followed 15 individuals, with an average age of 65.6 years, and asked them to fill out surveys before their CI surgery, and then again 1, 3, and 6 months after they started using both devices. Patients used both the CI and HA around 97–98% time. Their ability to locate where sounds were coming from significantly improved by 1 month postop, although sound quality did not meaningfully change. Patients’ hearing handicap score substantially decreased by 3 months postop, meaning they had improved hearing-related quality of life. Their listening effort scores also significantly decreased by 6 months, and at that time point, patient survey responses demonstrated a subjective preference for using both devices rather than either device alone. Overall, using both a CI and a HA together generally improves hearing-related quality of life, listening effort, and sound localization early in the postoperative period. Our study suggests that patients should be encouraged to use their CI and HA for at least 6 months postoperatively because over time they may see additional benefits and improved satisfaction using both devices compared to their CI alone.

Unilateral cochlear implantation (CI) with contralateral hearing aid (HA) use, also known as bimodal hearing or stimulation, has become the standard of care in recent years for individuals with residual hearing in the nonimplanted ear. Specifically, current guidelines recommend a HA in the nonimplanted ear for CI users for hearing thresholds below 90 dB HL [1]. An extensive number of studies have demonstrated the advantages of bimodal hearing based on improved audiometric outcomes including speech perception scores [2‒9].

Despite this evidence, the number of bimodal users is lower than expected [10] – 36–51% of bimodal candidates use their CI alone after implantation [11, 12]. In part, this may be explained by inadequate clinical guidelines for bimodal hearing candidacy and heterogeneous patient outcomes. However, a better understanding of the effects of continued contralateral HA use on quality of life may encourage greater use among bimodal candidates. A limited number of studies have focused on the “real-world” benefits of bimodal hearing, which found improved hearing-related and overall quality of life as well as stronger environmental sound recognition [2, 8, 10]. Positive effects on quality of life have been shown in assessing bimodal users between 2 and 5 years after CI [8, 13]. There is a need to examine the prospective effect of bimodal stimulation on listening effort, speech perception, sound quality, sound localization, and quality of life during the more immediate postoperative period when patients may be most likely to discontinue HA use [12, 14].

Therefore, the aim of this study was to describe the effect of bimodal hearing on users’ quality of life during the postoperative period (1, 3, and 6 months post-activation) and compare it to preoperative scores. It was hypothesized that quality of life and hearing-related disability would improve over time in patients who continued to use their HA after CI, which may encourage greater postop HA use in bimodal candidates.

This was a single-center prospective within-subject control study at a tertiary medical center. Inclusion criteria were patients over 18 years old with no cognitive impairments who were postlingually deaf and used a HA prior to undergoing CI. Patients were recruited from January 2021 to January 2022. Patients were no longer sent postoperative surveys if they discontinued HA use within 6 months after CI. This study was reviewed and approved by the Institutional Review Board of New York University Grossman School of Medicine (ID: i20-01789). Written informed consent was obtained from all subjects.

The primary endpoint was a 46-question survey focused on listening effort, speech perception, sound quality, sound localization, and quality of life. These variables aimed to capture the users’ satisfaction with bimodal stimulation. The survey included questions from a survey by Fitzpatrick et al. and the Speech, Spatial, and Qualities of Hearing Scale (SSQ), in combination with questions designed by the authors [14, 15]. Stacey et al. [16] previously set a precedent for combining survey questions, and this was necessary for our study because there is no validated quality-of-life questionnaire specific to bimodal users that addresses the particular situation of using two different devices. For the list of all survey questions, please refer to online supplementary material 1 (for all online suppl. material, see https://doi.org/10.1159/000539121). The survey was completed prior to implantation to reflect patients’ baseline as well as at 1, 3, and 6 months post-activation. The survey was emailed to all patients and completed online or using a paper copy at clinical appointments. Surveys were inputted into a secure anonymized database by authors J.A.S. and M.M. Demographic data were collected from patients’ charts.

Various scores were calculated to summarize patients’ responses. The Hearing Handicap Questionnaire was used to measure hearing-related quality of life [15]. The handicap score was based on the average of the numerical answers on a scale of 0–100 to the 12 survey questions. A listening effort score was the average of the numerical answers on a scale of 0–100 to survey questions 8–14. These questions asked patients to rate their effort in listening in common situations, such as speech in quiet, speech in noise, and on the telephone. Likewise, a sound quality score was the average of the numerical responses to questions 26–28 (online suppl. material 1). Statistical analyses were conducted using one-way repeated measures analysis of variance (RM ANOVA) tests (either parametric or nonparametric, depending on the distribution of the data), and a p value <0.05 was considered statistically significant. When a main effect was found, post hoc paired t tests with corrections for multiple comparisons were used to further investigate changes in scores between two time points. Pearson’s product correlations were used for comparing survey and speech perception scores. Descriptive statistics were performed to assess all other survey responses that were multiple choice and did not contribute to the listening effort, sound quality, sound localization, and hearing-related handicap score.

Patient Characteristics

Twenty-one patients were enrolled in the study of which 18 underwent CI and 15 completed the study. Of the patients who completed the study, 9 (60%) were men and the average age at implantation was 65.6 years (SD 22.4). The average preoperative CNC word recognition score (WRS) in the contralateral HA ear was 44% (SD: 27.7) (Table 1). Two out of 18 patients stopped using their HA, one immediately postoperatively and the other at 6 months. Other reasons for patient dropout included geographic relocation, sequential contralateral CI, and three individuals wanted more time to consider CI and never underwent the procedure.

Table 1.

Patient preoperative hearing characteristics

Subject #Preop non-implanted WRS unaided, %Preop non-implanted WRS aided, %SDT non-implanted ear, dB HLSRT non-implanted ear, dB HLPreop PTA (air) non-implanted ear, dB HLPreop AzBio in noise (CI, non-implanted, bilateral), %Postop AzBio in noise (CI, non-implanted, bimodal), %
40 62 50 60 67 67, 63, na 21, 40, 46 
14 80 na 93 DNT, DNT, DNT 42, DNT, 63 
10 45 na 68 na 34, DNT, 41 
12 60 75 na 78 18, 91, 84 50, na, na 
na 60 na 93 DNT, DNT, DNT 93, DNT, 88 
28 28 na 65 50 31, 10, 33 41, 11, 47 
36 48 na 70 72 31, 40, 36 na 
32 52 na 70 68 54, 60, 57 63, 48, 63 
58 56 55 na 68 23, 54, 50 75, 56, 48 
10 85 100 110 5, 0, 4 na 
11 88 80 na 35 42 DNT, 91, 94 71, 88, 96 
12 60 68 na 60 58 0, 62, 75 38, CNT, CNT 
13 69 64 na 70 65 26, 43, 48 51, CNT, 58 
14 28 40 na 30 62 23, 20, 36 48, 47, 34 
15 22 20 na 80 87 DNT, 11, 14 69, DNT, 67 
Subject #Preop non-implanted WRS unaided, %Preop non-implanted WRS aided, %SDT non-implanted ear, dB HLSRT non-implanted ear, dB HLPreop PTA (air) non-implanted ear, dB HLPreop AzBio in noise (CI, non-implanted, bilateral), %Postop AzBio in noise (CI, non-implanted, bimodal), %
40 62 50 60 67 67, 63, na 21, 40, 46 
14 80 na 93 DNT, DNT, DNT 42, DNT, 63 
10 45 na 68 na 34, DNT, 41 
12 60 75 na 78 18, 91, 84 50, na, na 
na 60 na 93 DNT, DNT, DNT 93, DNT, 88 
28 28 na 65 50 31, 10, 33 41, 11, 47 
36 48 na 70 72 31, 40, 36 na 
32 52 na 70 68 54, 60, 57 63, 48, 63 
58 56 55 na 68 23, 54, 50 75, 56, 48 
10 85 100 110 5, 0, 4 na 
11 88 80 na 35 42 DNT, 91, 94 71, 88, 96 
12 60 68 na 60 58 0, 62, 75 38, CNT, CNT 
13 69 64 na 70 65 26, 43, 48 51, CNT, 58 
14 28 40 na 30 62 23, 20, 36 48, 47, 34 
15 22 20 na 80 87 DNT, 11, 14 69, DNT, 67 

WRS, word recognition score; SDT, speech detection threshold; SRT, speech reception threshold; PTA, pure tone average; AzBio, AzBio sentence test.

Device Logistics

Thirteen patients (86.7%) used two HAs preop and 13 (86.7%) used their HA for more than 10 h a day. All patients reported planning on using their HA after CI. On a scale of never (0) to always (100), patients reported using both devices at a median score of 97%, 97%, and 98% of awake time at 1, 3, and 6 months, respectively. Similarly, the percent of time patients reported using only one device from never (0) to always (100) decreased across the 6 months, with a median rating of only CI 16% of the time and only HA 4% of the time at 6 months. For HA-only usage, there was a statistically significant decrease between 1 month (median 11.5% of the time) and 6 months (one-way RM ANOVA on ranks: Χ2(2) = 11.40, p = 0.002). One individual required greater than 6 HA adjustments within 3 months post-activation. However, by 6 months post-activation, 46% of patients had no HA adjustments and 46% underwent 1–3 adjustments. Ease of managing the device from complicated (0) to easy (100) did not meaningfully differ across postop surveys ranging from an average of 70–74% from 1 to 6 months (one-way RM ANOVA: (F(14, 2) = 0.66, p = 0.53). Overall, patients felt that wearing their HA with their CI was helpful with a mean score of 72.4% at 1 month and 76.5% at 6 months, a nonstatistically significant difference (p > 0.05). Beyond 3 months postoperatively, subjective hearing in patients’ non-implanted ear remained the same for at least 6 (40%) patients, though a considerable percentage of patients (31% at 3 months, 45% at 6 months) believed their hearing seemed a little or a lot worse compared to preoperatively.

Listening Effort and Speech Perception

Patients’ listening effort scores ranged from 0% (no effort) to 100% (maximal effort). Scores steadily decreased, from a mean of 77.0% preoperatively to 66.2% at 1 month, 64.4% at 3 months, and 58.3% at 6 months. A one-way RM ANOVA demonstrated a statistically significant effect of time points on effort scores (F(14, 3) = 4.22, p = 0.01). Post hoc tests revealed no significant difference between pre- and postoperative scores at the 1-month and 3-month time points (p = 0.12, p = 0.06, respectively) but a significant difference at 6 months postoperatively (p = 0.01), suggesting the reduction in listening effort was not realized immediately (Fig. 1). By 6 months post-activation, 100% of patients agreed conversations require the least effort when using their HA and CI together (rather than one device alone), and 73% agreed they feel less tired using bimodal hearing compared to CI or HA alone.

Fig. 1.

Listening effort scores at preop and 1, 3, and 6 months post-activation. *p < 0.05, **p < 0.01, ***p < 0.001.

Fig. 1.

Listening effort scores at preop and 1, 3, and 6 months post-activation. *p < 0.05, **p < 0.01, ***p < 0.001.

Close modal

Speech perception in a noisy situation was reported as best in the bimodal condition for 76.9% of patients at 1 and 3 months, and 83.3% at 6 months, compared to using one device alone. Speech perception in quiet listening situations was reported to be best in the bimodal condition for 76.9% of patients at 1 month, 84.6% at 3 months, and 100% at 6 months. For telephone use, the percentage of patients who reported a preference for bimodal listening increased from 38.4% at 1 and 3 months to 58.3% at 6 months; however, at that time, 25% of patients still preferred the HA alone. In general, most patients (71%) agreed speech sounded best using CI and HA at the 1-month time point, and this increased to 77% at 3 months and 82% at 6 months.

Speech perception was measured clinically at 3 months post-activation. Word recognition scores in the CI and bimodal listening conditions significantly increased compared to preimplantation scores by an average of 43.2% (paired t test: t(13) = −5.6, p < 0.0001) and 26.9% (t(10) = −2.9, p = 0.02), respectively. There was no significant change detected for HA word recognition scores (t(8) = 1.7, p = 0.1). For sentence recognition in noise, there was a trend toward improved scores for the CI condition (24.1%, t(8) = 2.19, p = 0.06), but this did not reach statistical significance. There was no statistically significant improvement in the bimodal condition (t(7) = −1.03, p = 0.3). There were less than 10 participants with a score in the HA condition at 3 months, so results could not be reliably compared to preoperative scores. There were no significant correlations detected between the absolute listening effort scores and preoperative clinical word recognition scores for CNC words or AzBio sentences in noise (+10 dB signal-to-noise ratios [SNR]), either in the ear-to-be-implanted, HA ear, or bilateral HA conditions (p > 0.05). There was a trend toward a relation between improvement in listening effort and improvement in word recognition score, for both the CI side (r = 0.55, p = 0.06) and the bimodal condition (r = 0.62, p = 0.07); no other statistically significant correlations were detected (p > 0.5).

Sound Quality and Localization

Average sound quality scores were stable from the preoperative to the one- and 3-month time points (means: 42.3%, 42.6%, and 45.3%), then increased at 6 months to 56.2%. A one-way RM ANOVA did not find a significant effect of time point on the sound quality score (F(14, 3) = 1.34, p = 0.28), suggesting that adding electric listening did not significantly affect perceived sound quality (Fig. 2). Despite the differing acoustic and electric signals, patients appeared to quickly adapt to bimodal listening. At all post-activation time points, a majority of patients agreed that sounds coming from their CI and HA appeared to fuse together. At 1 month, patients rated their HA and CI on similarity of sound quality, with 0% being very similar and 100% being very different, as 79.8%. At 6 months, the average score was similar (73.1%). The extent to which an HA interfered with CI sound quality from not at all (0) to a lot (100) decreased from an average of 18% at 1 month post-activation to 13% at 6 months.

Fig. 2.

Sound quality scores at preop and 1, 3, and 6 months post-activation. *p < 0.05, **p < 0.01, ***p < 0.001.

Fig. 2.

Sound quality scores at preop and 1, 3, and 6 months post-activation. *p < 0.05, **p < 0.01, ***p < 0.001.

Close modal

Sound quality also affects the music listening experience, and at 1 month, 64% of patients stated that music sounded best with CI and HA. This decreased to 45% at 6 months, and at that time, 55% of patients reported no difference between CI and HA, HA alone, or CI alone.

In terms of localization, there was a statistically significant improvement in how patients rated the utility of their devices (two HAs preoperatively, CI + HA postoperatively), as early as 1 month post-activation (Fig. 3). A one-way RM ANOVA showed a significant effect of time period (F(14, 3) = 6.92, p < 0.001). Post hoc t tests with correction for multiple comparisons revealed a significant difference between preoperative and 1-month, 3-month, and 6-month scores (p < 0.02), but no significant difference between any of the postoperative time points (p > 0.5). This suggests that after an initial improvement (24.3% compared to the preoperative time point), scores were stable out to 6 months.

Fig. 3.

Localization scores at preop and 1, 3, and 6 months post-activation. *p < 0.05, **p < 0.01, ***p < 0.001.

Fig. 3.

Localization scores at preop and 1, 3, and 6 months post-activation. *p < 0.05, **p < 0.01, ***p < 0.001.

Close modal

When utilizing both devices, a similar proportion of patients reported hearing a sound from in front of them either in the middle of their head (1 month: 46%, 3 months: 42%, 6 months: 30%) or closer to the ear with the implant (1 month: 38%, 3 months: 33%, 6 months: 50%). In the bimodal hearing state, 80% of patients believed a sound was louder in the CI ear at 6 months, compared to 46% at 3 months and 62% at 1 month.

Hearing-Related Quality of Life

On average, patients’ hearing-related handicap score decreased at each time point (i.e., QOL improved), from 73.6% preoperatively to 60.1%, 52.3%, and 46.7% at 1, 3, and 6 months postoperatively, respectively (Fig. 4). This change was statistically significant (one-way RM ANOVA showed a main effect of time point: (F(14, 3) = 6.12, p = 0.002)). Post hoc t tests corrected for multiple comparisons showed no significant difference between preop and 1-month scores (p = 0.11), with a significant decrease in preoperative scores seen from the 3-month time point onwards (p < 0.006).

Fig. 4.

Hearing-related handicap scores at preop and 1, 3, and 6 months post-activation. *p < 0.05, **p < 0.01, ***p < 0.001.

Fig. 4.

Hearing-related handicap scores at preop and 1, 3, and 6 months post-activation. *p < 0.05, **p < 0.01, ***p < 0.001.

Close modal

This study aimed to determine the effect of bimodal hearing on the immediate postoperative listening experience and quality of life. Compared to prior to implantation, patients experienced improved listening effort, sound localization, and hearing-related quality of life when using a contralateral HA with their CI within 6 months postoperatively.

Patient listening effort significantly decreased at 6 months compared to preop while subjective speech perception remained high post-CI. Prior studies have demonstrated contradictory results regarding bimodal stimulation’s effect on listening effort compared to CI alone, which may change based on the speech reception threshold [9, 17]. Noble et al. [17] determined no significant difference in the listening effort component of the SSQ comparing users with unilateral CI to CI with contralateral HA at approximately 2 years post-CI. Devocht et al. [9] measured listening effort at over 1 year post-CI using a validated test involving the Dutch Matrix corpus at different SNR using stationary and fluctuating background noise, which demonstrated further decline in listening effort for bimodal users compared to CI alone at higher SNRs. Our study provides preliminary evidence that on a day-to-day basis, patients report the least fatigue and concentration using bimodal hearing compared to a CI alone as early as 1–6 months post-activation. This is based on patient’s subjective survey responses in which the options were “hearing aid alone,” “cochlear implant alone,” “both devices,” and “no difference.” Notably, this decreased listening effort is supported by the trend toward an association between improvement in listening effort and improvement in word recognition score seen for both the CI side and bimodal condition. The high and stable post-CI subjective and objective speech perception scores align with prior studies [13, 18]. No change in HA ear scores or self-reported HA ear thresholds was seen for most patients, which serves as an important control for these findings. Prior comparison of CI alone to bimodal users found no difference in patient-reported speech perception, and we are limited in our ability to isolate the specific effect of contralateral HA use on speech perception in our patient cohort [8].

There was no significant change in sound quality over the 6 months post-activation. This finding is surprising given prior evidence that patients subjectively prefer the sound quality in the bimodal condition compared to CI or HA alone [8, 19]. However, two of the three questions comprising the sound quality scored were related to the ability to recognize familiar music as well as the clarity and naturalness of music. By 6 months, over half of the patients reported no difference in how music sounded whether listening using CI alone, HA alone, or using both devices. Thus, the relatively constant postop sound quality score might be explained by the unclear benefit that bimodal listening adds to listening to music, which was similarly seen in a previous retrospective SSQ-based study comparing CI to bimodal users [8]. Regardless, patients reported that sounds from their CI and HA fused together quickly with no difference in sound fusion between one and 6 months. In comparison, there was an immediate and significant improvement in self-reported sound localization by 1 month. This emphasizes that the known sound localization benefit from bimodal stimulation [7, 20] seems to occur very early postoperatively and remains stable.

Patients’ hearing-related handicap score decreased at each survey interval, with a significant decrease (e.g., improved QOL) seen by 3 months post-activation. This complements existing literature that has demonstrated improved quality of life with bimodal stimulation at 12 months compared to preimplantation using the Nijmegen Cochlear Implant Questionnaire (NCIQ) and Health-Utility Index Questionnaire Mark 3 (HUI3) [7].

Based on subjective survey responses, patients had no difficulty managing and wearing both devices, and HA-only use significantly decreased over time. While our objectives did not include determining reasons for discontinuation, our results suggest other reasons may lead to discontinued HA use in potential bimodal users. Previous studies found patients’ reasons for discontinuing a contralateral HA to include no perceived additional benefit from the HA or HA interference with CI [12]. This lack of overall additional benefit is evidenced by another study that demonstrated by 12 months post-CI, QOL per the NCIQ is not significantly different between bimodal listeners and those who use CI alone [2]. Nevertheless, we found patients on average report low levels of HA interference with CI sound quality at 1 month post-activation, which further decreased at 6 months, and most patients found CI and HA to provide additional benefit over CI alone for speech perception in noisy and quiet situations.

Ultimately, HA fitting may play a key role in optimizing the overall benefit of bimodal stimulation [21]. Almost half the patients in this study reported no HA adjustments post-CI, though it is possible that their audiologist recommended adjusting their HA and they did not follow up. Of note, some patients see a separate audiologist for their HA and some switch to having their HA managed by their CI audiologist. The latter is likely more beneficial due to the two devices getting programmed together, which may promote continued HA use. HA retention post-CI also appears to be related to the amount of residual hearing in the contralateral ear [11], and we indeed found the 1 patient in our cohort who stopped using their HA immediately postop had a 0% CNC unaided WRS in the non-implanted ear.

Study limitations include a small sample size, the number of patients lost to follow-up, and the length of follow-up. Additionally, the authors determined a CI-alone control group was not feasible or ethical based on the substantial evidence demonstrating improved outcomes using CI and HA compared to CI alone [22‒29]. Due to the survey’s scope, we lack quantitative data comparing HA use pre- and postoperatively. Further research with a larger sample size is necessary to better understand the causes of discontinued HA use in bimodal candidates to enhance current clinician guidelines and improve patient counseling.

In conclusion, postoperative benefits of bimodal stimulation increased over a 6-month period. Though individual differences exist, our study provides preliminary evidence that sound localization, hearing-related quality of life, and listening effort significantly improve by 1, 3, and 6 months postop, respectively. Clinicians may consider informing patients that those who continue using their HA after implantation should expect their QOL to improve and that listening effort and sound quality are generally optimized using CI and HA compared to CI alone.

This study was reviewed and approved by the Institutional Review Board of New York University Grossman School of Medicine (ID: i20-01789). Written informed consent was obtained from all subjects.

The authors have no conflicts of interest to declare.

This study received no funding.

JS: patient enrollment, data collection and analysis, and writing – original draft. LA: conceptualization, methodology, investigation, data collection and analysis, and writing – review and editing. MM: patient enrollment and data collection. WS: methodology, patient enrollment, and data collection. ES: methodology, data collection, and writing – review and editing. SW: conceptualization, methodology, investigation, writing – review and editing, and supervision.

Additional Information

Presented at meetings: AAO-HNSF 2023 Annual Meeting & OTO Experience, Nashville, TN, USA, on September 30–October 4, 2023.

The data supporting the study’s results are not publicly available as it could compromise the privacy of research participants but are available from the corresponding author [J.A.S.] upon reasonable request.

1.
Holder
JT
,
Holcomb
MA
,
Snapp
H
,
Labadie
RF
,
Vroegop
J
,
Rocca
C
, et al
.
Guidelines for best practice in the audiological management of adults using bimodal hearing configurations
.
Otol Neurotol Open
.
2022
;
2
(
2
):
e011
.
2.
Nyirjesy
S
,
Rodman
C
,
Tamati
TN
,
Moberly
AC
.
Are there real-world benefits to bimodal listening
.
Otol Neurotol
.
2020
;
41
(
9
):
e1111
e1117
.
3.
Mok
M
,
Grayden
D
,
Dowell
RC
,
Lawrence
D
.
Speech perception for adults who use hearing aids in conjunction with cochlear implants in opposite ears
.
J Speech Lang Hear Res
.
2006
;
49
(
2
):
338
51
.
4.
Holtmann
LC
,
Janosi
A
,
Bagus
H
,
Scholz
T
,
Lang
S
,
Arweiler-Harbeck
D
, et al
.
Aligning hearing aid and cochlear implant improves hearing outcome in bimodal cochlear implant users
.
Otol Neurotol
.
2020
;
41
(
10
):
1350
6
.
5.
Illg
A
,
Bojanowicz
M
,
Lesinski-Schiedat
A
,
Lenarz
T
,
Büchner
A
.
Evaluation of the bimodal benefit in a large cohort of cochlear implant subjects using a contralateral hearing aid
.
Otol Neurotol
.
2014
;
35
(
9
):
e240
4
.
6.
Kelsall
D
,
Lupo
J
,
Biever
A
.
Longitudinal outcomes of cochlear implantation and bimodal hearing in a large group of adults: a multicenter clinical study
.
Am J Otolaryngol
.
2021
;
42
(
1
):
102773
.
7.
van Loon
MC
,
Smits
C
,
Smit
CF
,
Hensen
EF
,
Merkus
P
.
Cochlear implantation in adults with asymmetric hearing loss: benefits of bimodal stimulation
.
Otol Neurotol
.
2017
;
38
(
6
):
e100
6
.
8.
Farinetti
A
,
Roman
S
,
Mancini
J
,
Baumstarck-Barrau
K
,
Meller
R
,
Lavieille
JP
, et al
.
Quality of life in bimodal hearing users (unilateral cochlear implants and contralateral hearing aids)
.
Eur Arch Oto-Rhino-Laryngol
.
2015
;
272
(
11
):
3209
15
.
9.
Devocht
EMJ
,
Janssen
AML
,
Chalupper
J
,
Stokroos
RJ
,
George
ELJ
.
The benefits of bimodal aiding on extended dimensions of speech perception: intelligibility, listening effort, and sound quality
.
Trends Hear
.
2017
;
21
:
2331216517727900
.
10.
Neuman
AC
,
Waltzman
SB
,
Shapiro
WH
,
Neukam
JD
,
Zeman
AM
,
Svirsky
MA
.
Self-reported usage, functional benefit, and audiologic characteristics of cochlear implant patients who use a contralateral hearing aid
.
Trends Hear
.
2017
;
21
:
2331216517699530
.
11.
Devocht
EM
,
George
EL
,
Janssen
AM
,
Stokroos
RJ
.
Bimodal hearing aid retention after unilateral cochlear implantation
.
Audiol Neurootol
.
2015
;
20
(
6
):
383
93
.
12.
Fitzpatrick
EM
,
Leblanc
S
.
Exploring the factors influencing discontinued hearing aid use in patients with unilateral cochlear implants
.
Trends Amplif
.
2010
;
14
(
4
):
199
210
.
13.
Sanhueza
I
,
Manrique-Huarte
R
,
Calavia
D
,
Huarte
A
,
Manrique
M
.
Hearing impairment and quality of life in adults with asymmetric hearing loss: benefits of bimodal stimulation
.
J Int Adv Otol
.
2019
;
15
(
1
):
62
9
.
14.
Fitzpatrick
EM
,
Séguin
C
,
Schramm
D
,
Chenier
J
,
Armstrong
S
.
Users’ experience of a cochlear implant combined with a hearing aid
.
Int J Audiol
.
2009
;
48
(
4
):
172
82
.
15.
Gatehouse
S
,
Noble
W
.
The speech, spatial and qualities of hearing scale (SSQ)
.
Int J Audiol
.
2004
;
43
(
2
):
85
99
.
16.
Stacey
PC
,
Fortnum
HM
,
Barton
GR
,
Summerfield
AQ
.
Hearing-impaired children in the United Kingdom, I: auditory performance, communication skills, educational achievements, quality of life, and cochlear implantation
.
Ear Hear
.
2006
;
27
(
2
):
161
86
.
17.
Noble
W
,
Tyler
R
,
Dunn
C
,
Bhullar
N
.
Unilateral and bilateral cochlear implants and the implant-plus-hearing-aid profile: comparing self-assessed and measured abilities
.
Int J Audiol
.
2008
;
47
(
8
):
505
14
.
18.
Ching
TY
,
Incerti
P
,
Hill
M
.
Binaural benefits for adults who use hearing aids and cochlear implants in opposite ears
.
Ear Hear
.
2004
;
25
(
1
):
9
21
.
19.
Morera
C
,
Cavalle
L
,
Manrique
M
,
Huarte
A
,
Angel
R
,
Osorio
A
, et al
.
Contralateral hearing aid use in cochlear implanted patients: multicenter study of bimodal benefit
.
Acta Otolaryngol
.
2012
;
132
(
10
):
1084
94
.
20.
Potts
LG
,
Skinner
MW
,
Litovsky
RA
,
Strube
MJ
,
Kuk
F
.
Recognition and localization of speech by adult cochlear implant recipients wearing a digital hearing aid in the nonimplanted ear (bimodal hearing)
.
J Am Acad Audiol
.
2009
;
20
(
6
):
353
73
.
21.
Vroegop
JL
,
Goedegebure
A
,
van der Schroeff
MP
.
How to optimally fit a hearing aid for bimodal cochlear implant users: a systematic review
.
Ear Hear
.
2018
;
39
(
6
):
1039
45
.
22.
Sturm
JJ
,
Kuhlmey
M
,
Alexiades
G
,
Hoffman
R
,
Kim
AH
.
Comparison of speech performance in bimodal versus bilateral cochlear implant users
.
Laryngoscope
.
2021
;
131
(
4
):
E1322
E1327
.
23.
Bruce
I
,
Schaefer
S
,
Kluk
K
,
Nichani
J
,
Odriscoll
M
,
Rajai
A
, et al
.
Children using a unilateral cochlear implant and contralateral hearing aid: bimodal hearing outcomes when one ear is outside the UK (NICE 2009) audiological criteria for cochlear implantation - a single site case-control study
.
BMJ Open
.
2023
;
13
(
6
):
e071168
.
24.
Iwasaki
S
,
Nishio
S
,
Moteki
H
,
Takumi
Y
,
Fukushima
K
,
Kasai
N
, et al
.
Language development in Japanese children who receive cochlear implant and/or hearing aid
.
Int J Pediatr Otorhinolaryngol
.
2012
;
76
(
3
):
433
8
.
25.
Cullington
HE
,
Bele
D
,
Brinton
JC
,
Cooper
S
,
Daft
M
,
Harding
J
, et al
.
United Kingdom national paediatric bilateral project: demographics and results of localization and speech perception testing
.
Cochlear Implants Int
.
2017
;
18
(
1
):
2
22
.
26.
Cullington
HE
,
Bele
D
,
Brinton
JC
,
Cooper
S
,
Daft
M
,
Harding
J
, et al
.
United Kingdom national paediatric bilateral project: results of professional rating scales and parent questionnaires
.
Cochlear Implants Int
.
2017
;
18
(
1
):
23
35
.
27.
Nilakantan
A
,
Raj
P
,
Saini
S
,
Mittal
R
.
Early speech perception test outcome in children with severe sensorineural hearing loss with unilateral cochlear implants alone versus bimodal stimulation
.
Indian J Otolaryngol Head Neck Surg
.
2018
;
70
(
3
):
398
404
.
28.
Ganek
HV
,
Feness
ML
,
Goulding
G
,
Liberman
GM
,
Steel
MM
,
Ruderman
LA
, et al
.
A survey of pediatric cochlear implant recipients as young adults
.
Int J Pediatr Otorhinolaryngol
.
2020
;
132
:
109902
.
29.
Deep
NL
,
Green
JE
,
Chen
S
,
Shapiro
WH
,
McMenomey
SO
,
Thomas Roland
J
Jr
, et al
.
From bimodal hearing to sequential bilateral cochlear implantation in children-A within-subject comparison
.
Otol Neurotol
.
2020
;
41
(
6
):
767
74
.