title: A Within-Subject Comparison of Bimodal Hearing, Bilateral Cochlear Implantation, and Bilateral Cochlear Implantation With Bilateral Hearing Preservation: High-Performing Patients.
abstract: OBJECTIVE
  To compare speech understanding with bimodal hearing and bilateral cochlear implants (CIs).
  
  
  METHODS
  Within-subjects, repeated-measures.
  
  
  METHODS
  Speech understanding was assessed in the following conditions: unilateral hearing aid (HA) in the non-implanted ear, unilateral CI, bimodal (CI + HA), and bilateral CI. In addition, three participants had bilateral hearing preservation and were also tested with bilateral CIs and bilateral HAs (BiBi).
  
  
  METHODS
  Tertiary academic CI center.
  
  
  METHODS
  Eight adult sequential bilateral recipients who, despite achieving incredibly high performance with the first CI, self-selected for bilateral cochlear implantation.
  
  
  METHODS
  Bilateral cochlear implantation.
  
  
  METHODS
  Speech understanding for the adult minimum speech test battery as well as sentences in semidiffuse noise using the R-SPACE system.
  
  
  RESULTS
  Bilateral CIs afforded significant individual improvement in a complex listening environment even for individuals demonstrating near perfect sentence scores with both the first CI alone as well as the bimodal condition. The 3 BiBi participants demonstrated additional significant benefit over the bilateral CI condition-presumably because of the availability of interaural time difference cues.
  
  
  CONCLUSIONS
  These data suggest that, for noisy environments, adding a second implant can significantly improve speech understanding-even for high-performing unilateral CI with bimodal hearing. In diffuse noise conditions, bilateral acoustic hearing can yield even greater benefits beyond that offered by bilateral implantation.
authors.affiliation: *Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tennessee; †Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota; ‡School of Medicine, Northwestern University, Chicago, Illinois; and §Department of Speech and Hearing Science, Arizona State University, Tempe, Arizona, U.S.A.
authors.forename: René H
authors.initials: RH
authors.lastname: Gifford
authors.forename: Colin L W
authors.initials: CL
authors.lastname: Driscoll
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Davis
authors.forename: Pam
authors.initials: P
authors.lastname: Fiebig
authors.forename: Alan
authors.initials: A
authors.lastname: Micco
authors.forename: Michael F
authors.initials: MF
authors.lastname: Dorman
mesh_terms: D000368:Aged; D001309:Auditory Threshold; D019929:Cochlear Implantation; D003054:Cochlear Implants; D003463:Cues; D005260:Female; D006309:Hearing; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D059629:Signal-To-Noise Ratio; D013017:Sound Localization; D013063:Speech Discrimination Tests; D013067:Speech Perception; D016896:Treatment Outcome