The Reality of Hearing Preservation in Cochlear Implantation: Who Is Utilizing EAS?

Objective To report the proportion of subjects successfully fit with combined electroacoustic stimulation (EAS) compared with those with preserved hearing (HP) after cochlear implantation (CI). In addition, to 1) report the trends in HP and EAS fit rates over time and 2) identify and characterize those patients who preferred the electric only condition. Study design Retrospective chart review. Setting Tertiary referral center. Patients Two hundred five postlingually deafened adults with bilateral SNHL and a preoperative low-frequency pure-tone average 80 dB HL or better in the ear to be implanted. Interventions Subjects underwent CI from 2013 to 2018 with routine pre- and postoperative audiometric testing performed at 6- and 12-months. Main outcome measures Percentage of patients fit with EAS, low-frequency pure-tone average, and threshold shift. Results Overall, 141 patients (78.6%) had HP at activation and 42.6% were fit with EAS. Rates of EAS fitting improved from 36.4% in 2013 to 69.0% in 2018. 93.5% of patients had hearing preserved in 2018 compared with 57.9% in 2013. Six patients rejected EAS after a trial period either because of discomfort or poor sound quality. Eight patients had EAS removed because of loss of aidable hearing over time (between activation to 12 mo). Conclusions Despite the high percentages of HP in the literature, EAS may be under-utilized in the adult CI population. Moving toward a universal definition of HP across institutions may better represent the potential for EAS fitting and a clinical measure capable of identifying patients best suited to benefit from EAS.