title: A Retrospective Multicenter Study Comparing Speech Perception Outcomes for Bilateral Implantation and Bimodal Rehabilitation.
abstract: OBJECTIVE
  To compare speech perception outcomes between bilateral implantation (cochlear implants [CIs]) and bimodal rehabilitation (one CI on one side plus one hearing aid [HA] on the other side) and to explore the clinical factors that may cause asymmetric performances in speech intelligibility between the two ears in case of bilateral implantation.
  
  
  METHODS
  Retrospective data from 2247 patients implanted since 2003 in 15 international centers were collected. Intelligibility scores, measured in quiet and in noise, were converted into percentile ranks to remove differences between centers. The influence of the listening mode among three independent groups, one CI alone (n = 1572), bimodal listening (CI/HA, n = 589), and bilateral CIs (CI/CI, n = 86), was compared in an analysis taking into account the influence of other factors such as duration of profound hearing loss, age, etiology, and duration of CI experience. No within-subject comparison (i.e., monitoring outcome modifications in CI/HA subjects becoming CI/CI) was possible from this dataset. Further analyses were conducted on the CI/CI subgroup to investigate a number of factors, such as implantation side, duration of hearing loss, amount of residual hearing, and use of HAs that may explain asymmetric performances of this subgroup.
  
  
  RESULTS
  Intelligibility ranked scores in quiet and in noise were significantly greater with both CI/CI and CI/HA than with a CI-alone group, and improvement with CI/CI (+11% and +16% in quiet and in noise, respectively) was significantly better than with CI/HA (+6% and +9% in quiet and in noise, respectively). From the CI/HA group, only subjects with ranked preoperative aided speech scores >60% performed as well as CI/CI participants. Furthermore, CI/CI subjects displayed significantly lower preoperative aided speech scores on average compared with that displayed by CI/HA subjects. Routine clinical data available from the present database did not explain the asymmetrical results of bilateral implantation.
  
  
  CONCLUSIONS
  This retrospective study, based on basic speech audiometry (no lateralization cues), indicates that, on average, a second CI is likely to provide slightly better postoperative speech outcome than an additional HA for people with very low preoperative performance. These results may be taken into consideration to refine surgical indications for CIs.
authors.affiliation: 1Bionics Institute, Melbourne, Australia; 2Department of Audiology and Speech Pathology, The University of Melbourne Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia; 3University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology/Head and Neck Surgery, Cochlear Implant Center Northern Netherlands, Groningen, The Netherlands; 4Graduate School of Medical Sciences (Research School of Behavioural and Cognitive Neurosciences), University of Groningen, Groningen, The Netherlands; 5University of Manchester, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester, United Kingdom; 6Auditory Implants Department, St. Thomas' Hospital, London, United Kingdom; 7Department of Otorhinolaryngology, University Hospital of Zurich, Zurich, Switzerland; 8Otorhinolaryngology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; 9University Department Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium; 10The Eargroup, Antwerp, Belgium; 11Institute of Physiology and Pathology of Hearing, Warsaw, Poland; 12Ophthalmic Diagnostics and Rehabilitation and Sensory Organs Department, Medical University of Warsaw, Warsaw, Poland; 13Centre Hospitalier Universitaire Gui de Chauliac, Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, Montpellier, France; 14Institut Saint Pierre, Service d'Audiophonologie et d'Otorhinolaryngologie, Palavas les flots, France; 15Department of Otolaryngology, The University of Melbourne Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia; 16Hôpital Universitaire Purpan, Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, Toulouse, France; 17Assitance Publique-Hôpitaux de Paris, Université Paris 6, Hôpital de la Pitié-Salpêtrière, Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale, Paris, France; 18Service d'Oto
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mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001302:Audiometry, Speech; D019929:Cochlear Implantation; D015331:Cohort Studies; D012048:Correction of Hearing Impairment / Q000379:methods*; D005260:Female; D006312:Hearing Loss, Bilateral / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013067:Speech Perception; D016896:Treatment Outcome; D055815:Young Adult