Dissertations, Theses, and Capstone Projects

Date of Degree

6-2025

Document Type

Doctoral Capstone Project

Degree Name

Doctor of Audiology

Program

Audiology

Advisor

Meital Avivi-Reich

Subject Categories

Speech and Hearing Science

Keywords

hearing loss; cochlear implant; hearing aid

Abstract

While guidelines exist for cochlear implant candidates, there are no specific established guidelines for bimodal users who are considering a 2nd cochlear implant. The objective of this paper is to critically review the literature addressing the question of comparative performance outcomes for bimodal hearing (one hearing aid in combination with a cochlear implant) and bilateral cochlear implants (two cochlear implants). The inclusion criteria were publications comparing bimodal and bilateral cochlear implant performance on speech perception, localization, and subjective quality. Fifteen qualifying papers were identified and analyzed. The results indicate that there are possible advantages to bilateral cochlear implants when assessing speech perception, but these benefits seem to be observed primarily in individuals who do not exhibit high performance when using bimodal rehabilitation devices. Localization skills were found to be more accurate among bilateral cochlear implant users across all results as compared to their counterparts. Additionally, bilateral cochlear implant users reported higher subjective benefit and perceived quality of life as compared to bimodal users. Given that the observed speech perception results do not provide a clear-cut answer as to when a better performance can be expected with a 2nd CI, the Minimum Speech Test Battery for candidacy that has been used is likely not a sensitive enough measure to determine whether bilateral cochlear implantation is a more optimal hearing modality for a patient. Dividing the performance of the bimodal users into “good” and “poor” performers based on measures, such as audiometric thresholds, may help identify those who are more likely to gain from a 2nd CI. More research is needed to investigate varying levels of performance in bimodal users, particularly those with aidable mid-to-high frequency thresholds due to their contribution to speech frequencies. Further research is required to define performance measures and audiometric findings that can effectively identify bimodal patients who will likely perform better upon obtaining a second cochlear implant.

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