title: A comparative study on speech in noise understanding with a direct acoustic cochlear implant in subjects with severe to profound mixed hearing loss.
abstract: The aim of this study was to investigate the efficacy of a direct acoustic cochlear implant (DACI) for speech understanding in noise in patients suffering from severe to profound mixed hearing loss (MHL) due to various etiologies compared to the preoperative best-aided condition. The study was performed at five tertiary referral centers in Europe (Belgium, Germany, Poland and Spain). Nineteen adult subjects with severe to profound MHL due to (advanced) otosclerosis, ear canal fibrosis, chronic otitis media, tympanosclerosis or previous cholesteatoma were implanted with a DACI (Codacs™ Investigational Device) combined with a conventional stapes prosthesis. Unaided and aided speech reception scores in quiet and in noise, preoperative and postoperative air and bone conduction thresholds and aided and unaided sound field thresholds were measured prospectively during the study. Subjective benefit analysis was determined through the Abbreviated Profile of Hearing Aid Benefit questionnaire. Quality of life was measured by the Health Utilities Index. All subjects were fitted preoperatively with hearing aids and/or a bone conduction implant on a headband before DACI implantation. This allows direct comparison between different hearing rehabilitation solutions. The mean speech reception threshold in noise improved significantly by 7.9 dB signal-to-noise ratio (SNR) after activation of the DACI compared to the preoperative best-aided condition. For all 19 subjects, a mean postoperative aided speech reception threshold of 2.6 dB SNR (standard deviation: 8.3 dB) was measured. On average, no significant shift in the bone conduction thresholds was noted 4-5 months after implantation. A mean sound field threshold improvement of 46 and 16 dB was measured compared to the preoperative unaided and best-aided condition, respectively. Speech perception tests in quiet showed a mean improvement of the word recognition scores by 65 and 48% at 65 dB SPL compared to the preoperative unaided and best-aided condition, respectively. In summary, DACI provides an effective improvement of the speech perception in noise compared to the best-aided condition in subjects suffering from severe to profound MHL.
authors.affiliation: Clinic for Laryngology, Rhinology and Otology, Hannover Medical School, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lenarz
authors.forename: Nicolas
authors.initials: N
authors.lastname: Verhaert
authors.forename: Christian
authors.initials: C
authors.lastname: Desloovere
authors.forename: Jolien
authors.initials: J
authors.lastname: Desmet
authors.forename: Christiane
authors.initials: C
authors.lastname: D'hondt
authors.forename: Juan Carlos Falcón
authors.initials: JC
authors.lastname: González
authors.forename: Eugen
authors.initials: E
authors.lastname: Kludt
authors.forename: Angel Ramos
authors.initials: AR
authors.lastname: Macías
authors.forename: Henryk
authors.initials: H
authors.lastname: Skarżyński
authors.forename: Paul
authors.initials: P
authors.lastname: Van de Heyning
authors.forename: Caroline
authors.initials: C
authors.lastname: Vyncke
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Wasowski
mesh_terms: D000328:Adult; D000368:Aged; D001309:Auditory Threshold / Q000502:physiology*; D019929:Cochlear Implantation; D003054:Cochlear Implants; D005260:Female; D046089:Hearing Loss, Mixed Conductive-Sensorineural / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009622:Noise; D011788:Quality of Life; D013067:Speech Perception / Q000502:physiology*