Objective.To compare hearing and speech understanding between a new, nonskin penetrating Baha system (Baha Attract) to the current Baha system using a skin-penetrating abutment.Methods.Hearing and speech understanding were measured in 16 experienced Baha users. The transmission path via the abutment was compared to a simulated Baha Attract transmission path by attaching the implantable magnet to the abutment and then by adding a sample of artificial skin and the external parts of the Baha Attract system. Four different measurements were performed: bone conduction thresholds directly through the sound processor (BC Direct), aided sound field thresholds, aided speech understanding in quiet, and aided speech understanding in noise.Results.The simulated Baha Attract transmission path introduced an attenuation starting from approximately 5 dB at 1000 Hz, increasing to 20–25 dB above 6000 Hz. However, aided sound field threshold shows smaller differences and aided speech understanding in quiet and in noise does not differ significantly between the two transmission paths.Conclusion.The Baha Attract system transmission path introduces predominately high frequency attenuation. This attenuation can be partially compensated by adequate fitting of the speech processor. No significant decrease in speech understanding in either quiet or in noise was found.

Objective: To evaluate a new methodological approach of applying anatomy-based fitting (ABF) in experienced cochlear implant (CI) users. Participants: Three experienced unilateral and bilateral CI users with postlingual hearing loss. Intervention: Postoperative imaging, via a high-volume Dyna computed tomography, and exact electrode measurement positions were integrated into the clinical fitting software following a new procedure, which adapted individual frequency bandwidths within the audio processor. Main Outcome Measures: Speech perception in quiet and noise, clinical mapping, and self-perceived level of auditory benefit were assessed. Results: For each CI user, ABF mapping provided better speech perception in quiet and in noise compared with the original clinical fitting mapping. In addition, ABF mapping was accepted in CI users despite unequal bilateral array insertion depths and lengths; however, acceptance was only established if the point of first electrode contact was less than 230 Hz. Conclusions: ABF mapping increased the acceptance in CI users with longer electrode arrays and in bilateral CI users who were unsatisfied with their device experience. A larger prospective, randomized investigation is currently underway to assess longitudinal outcomes with ABF mapping.

Fitting cochlear implant (CI) users can be challenging. Anatomy-based fitting (ABF) maps may have the potential to lead to better objective and subjective outcomes than conventional clinically based fitting (CBF) methods. ABF maps were created via information derived from exact electrode contact positions, which were determined via post-operative high-resolution flat panel volume computer tomography and clinical fitting software. The outcome measures were speech understanding in quiet and noise and self-perceived sound quality with the CBF map and with the ABF map. Participants were 10 experienced bilateral CI users. The ABF map provided better speech understanding in quiet and noisy environments compared to the CBF map. Additionally, two approaches of reducing the frequency-to-place mismatch revealed that participants are more likely to accept the ABF map if their electrode array is inserted deep enough to stimulate the apical region of their cochlea. This suggests an Angular Insertion Depth of the most apical contact of around 720°–620°. Participants had better speech understanding in quiet and noise with the ABF map. The maps’ self-perceived sound quality was similar. ABF mapping may be an effective tool for compensating the frequency-to-place mismatch in experienced bilateral CI users.

Objective: To evaluate objective and subjective hearing outcomes in experienced cochlear implant users with single sided deafness (SSD CI) who used fitting maps created via anatomy-based fitting (ABF) and clinically-based fitting (CBF). Participants: Twelve SSD CI users with postlingual hearing loss. Intervention: OTOPLAN (Version 3. (MED-EL) was used to determine intracochlear electrode contact positions using post-operative high-resolution flat panel volume computed tomography. From these positions, the corresponding center frequencies and bandwidths were derived for each channel. These were implemented in the clinical fitting software MAESTRO to yield an ABF map individualized to each user. Main Outcome Measures: ABF and CBF maps were compared. Objective speech perception in quiet and in noise, binaural effects, and self-perceived sound quality were evaluated. Results: Significantly higher speech perception in noise scores were observed with the ABF map compared to the CBF map (mean SRT₅₀: -6.49 vs. -4.8 dB SNR for the S₀N_CI configuration and − 3.85 vs. -2.75 dB SNR for the S₀N₀ configuration). Summation and squelch effects were significantly increased with the ABF map (0.86 vs. 0.21 dB SNR for summation and 0.85 vs. -0.09 dB SNR for squelch). No improvement in speech perception in quiet or spatial release from masking were observed with the ABF map. A similar level of self-perceived sound quality was reported for each map. Upon the end of the study, all users opted to keep the ABF map. This preference was independent of the angular insertion depth of the electrode array. Conclusions: Experienced SSD CI users preferred using the ABF map, which gave them significant improvements in binaural hearing and some aspects of speech perception.

Objective: To implement a unified testing framework into clinical routine that can be used by adults with single-sided deafness (SSD) to assess alternative treatment options before cochlear implantation. Study Design: Retrospective data analysis. Setting: Tertiary referral center with a large CI program. Subjects and Methods: Thirty four participants underwent the new implemented testing procedure, including a test trial with contralateral routing of the signal (CROS) hearing aids and bone conduction devices (BCD) on a headband, before deciding whether to proceed with cochlear implantation. A test battery was used to assess speech in noise, binaural effects (head shadow, squelch, summation, spatial release from masking), sound localization, and quality of life. For participants that chose a CI, the same test battery was repeated during the 6 and 12 months follow-up appointments. Results: Of the 34 participants involved in the study, 11 were implanted with a CI and finished their 12 month evaluation. Sixteen participants decided to stop after the CROS/BCD trial. In the CI-recipient group, a significant head shadow effect of 5.1 to 7.1 dB was achieved with the CI. Recipients in this group received only a limited benefit with either CROS or BCD before implantation. In the non-CI-recipient group, a significant difference between the CROS and BCD, in favor for the CROS device, was found calculating the head shadow and squelch effect. Localization abilities with the CI improved significantly in the CI-recipient group, even between the 6- and 12-month follow-up appointments. In the non-CI-recipient group, localization was significantly better with the BCD during the trial period. Higher scores were obtained from the speech and spatial categories of the Speech, Spatial, and Qualities of Hearing (SSQ) questionnaire with the CI. No subjective difference could be determined in the non-CI-recipient group. Conclusion: Implementing the unified testing framework into a clinical routine was challenging but provided helpful insight into the best treatment option for each individual.