Hearing performance in single-sided deaf cochlear implant users after upgrade to a single-unit speech processor

INTRODUCTION: Single-sided deaf (SSD) patients report multiple benefits after cochlear implantation (CI), such as tinnitus suppression, speech perception, and sound localization. The first single-unit speech processor, the RONDO, was launched recently. Both the RONDO and the well-known behind-the-ear (BTE) speech processor work on the same audio processor platform. However, in contrast to the BTE, the microphone placement on the RONDO is different. The aim of this study was to evaluate the hearing performances using the BTE speech processor versus using the single-unit speech processor. Subjective and objective outcomes in SSD CI patients with a BTE speech processor and a single-unit speech processor, with particular focus on spatial hearing, were compared. METHODOLOGY: Ten adults with unilateral incapacitating tinnitus resulting from ipsilateral sensorineural deafness were enrolled in the study. The mean age at enrollment in the study was 56 (standard deviation, 13) years. The subjects were cochlear implanted at a mean age of 48 (standard deviation, 14) years and had on average 8 years' experience with their CI (range, 4-11 yr). At the first test interval (T0), testing was conducted using the subject's BTE speech processor, with which they were already familiar. Aided free-field audiometry, speech reception in noise, and sound localization testing were performed. Self-administered questionnaires on subjective evaluation consisted of HISQUI-NL, SSQ5, SHQ, and a Visual Analogue Scale to assess tinnitus loudness and disturbance. All 10 subjects were upgraded to the single-unit processor and retested after 28 days (T28) with the same fitting map. At T28, an additional single-unit questionnaire was administered to determine qualitative experiences and the effect of the position of the microphone on the new speech processor. RESULTS: Equal hearing outcomes were found between the single-unit speech processor: median PTA(single-unit) (0.5, 1, 2 kHz) = 40 (range, 33-48) dB HL; median Speech Reception Threshold in noise = -1.00 (range, -8.50 to +1.00) dB SNR; median Root Mean Square Error of sound localization = 45 (range, 19-139) degrees; HISQUI = 128 (range, 106-180); SHQ = 68 (range, 45-83); SSQ5 = 6 (range, 3-9) and the BTE speech processor: median PTA(BTE) (0.5, 1, 2 kHz) = 41 (range, 30-53) dB HL; median Speech Reception Threshold in noise = -0.25 (range, -7.00 to +4.00) dB SNR; median Root Mean Square Error of sound localization = 38 (range, 26-164) degrees; HISQUI = 144 (range, 120-183); SHQ = 56 (range, 47-85); SSQ5 = 6 (range, 3-9). The results in the condition with the single-unit speech processor were not significantly influenced by the position of the microphone. CONCLUSION: The study showed that long-term BTE speech processor SSD users are able to be upgraded to a single-unit speech processor without compromising their speech performance, aided hearing thresholds, sound localization, objective speech quality, hearing abilities, sound localization, and tinnitus reduction. Microphone position on the single-unit speech processor did not influence the outcomes measures. Moreover, after a short time of experience, 80% of the users preferred the single-unit processor.