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A dynamic listening environment best captures the benefits of binaural hearing in bilateral and EAS
cochlear implant listeners
Loiselle L.H. , Dorman M.F. , Yost W.A.
Arizona State University, Speech and Hearing Science, Scottsdale, United States, 2Arizona State University, Speech and Hearing Science,
Tempe, United States
Traditional testing using a single loud speaker in front of the patient may show summation effects but cannot
capture other benefits of binaural hearing, e.g. squelch and head shadow. Our traditional testing in quiet and with
speech and noise coincident in space showed on average less than a 7% advantage for listeners using bilateral
cochlear implants (CI) compared to the better CI ear alone. An even smaller benefit was demonstrated for EAS
(electric plus acoustic stimulation in the same ear) listeners in the combined condition (bilateral acoustic hearing
plus a single CI) compared to the bimodal condition. The benefits of binaural hearing, either bilateral electric or
bilateral acoustic hearing, require a more dynamic testing environment. We designed a dynamic test, the 'Roving
Cocktail', to capture more accurately 1) the benefit of bilateral CI compared to the better CI ear and 2) the benefit
of a second acoustic ear, e.g. the benefit of preserving hearing compared to the bimodal condition for EAS
listeners. A roving target was used to more closely mimic daily life encounters that CI users engage in
particularly when they are in a group setting. Ten bilateral listeners using the MED-EL CI device and 10 EAS
listeners using the MED-EL EAS or the Cochlear Nucleus Hybrid device were tested in RSpace™, a test
environment that creates a virtual restaurant setting with the listener surrounded by an eight loudspeaker array.
Target sentences were comprised of the BabyBio sentences, and were presented randomly from five loud
speakers in the frontal horizontal plane amid a background of restaurant noise emanating from all eight
loudspeakers. A signal to noise ratio (SNR) was calculated using the better CI ear for the bilateral listeners and
the EAS condition for the EAS listeners to achieve 40-60% understanding to reduce ceiling effects. Results for
the Roving Cocktail test demonstrated a mean of 28 percentage points for bilateral CIs compared to the better CI
ear alone. Bilateral CI listeners had the benefit of an improved SNR despite from which side the target was
presented. The EAS listeners gained a mean of 13 percentage points in the combined condition when compared
to the bimodal condition indicating the benefit of preserving hearing in the implanted ear. The EAS listeners may
have been penalized due to the deficiency of high frequency information when the target was presented on the
unimplanted side, but they had the benefit of squelch from bilateral acoustic hearing. A roving target shows
increased benefit of having a second ear, whether electric or acoustic, and captures the binaural effects of head
shadow, squelch, and summation. The 'Roving Cocktail' test is a sensitive measure that can be used to provide
surgeons, clinicians, and potential CI candidates with expected outcomes for bilateral implantation and
underscores the benefit of preserving hearing for EAS candidates.