Background For cochlear implant (CI) recipients, speech recognition in noise is consistently poorer compared with recognition in quiet. Directional processing improves performance in noise and can be automatically activated based on acoustic scene analysis. The use of adaptive directionality with CI recipients is new and has not been investigated thoroughly, especially utilizing the recipients' preferred everyday signal processing, dynamic range, and/or noise reduction. Purpose This study utilized CI recipients' preferred everyday signal processing to evaluate four directional microphone options in a noisy environment to determine which option provides the best speech recognition in noise. A greater understanding of automatic directionality could ultimately improve CI recipients' speech-in-noise performance and better guide clinicians in programming. Study Sample Twenty-six unilateral and seven bilateral CI recipients with a mean age of 66 years and approximately 4 years of CI experience were included. Data Collection and Analysis Speech-in-noise performance was measured using eight loudspeakers in a 360-degree array with HINT sentences presented in restaurant noise. Four directional options were evaluated (automatic [SCAN], adaptive [Beam], fixed [Zoom], and Omni-directional) with participants' everyday use signal processing options active. A mixed-model analysis of variance (ANOVA) and pairwise comparisons were performed. Results Automatic directionality (SCAN) resulted in the best speech-in-noise performance, although not significantly better than Beam. Omni-directional performance was significantly poorer compared with the three other directional options. A varied number of participants performed their best with each of the four-directional options, with 16 performing best with automatic directionality. The majority of participants did not perform best with their everyday directional option. Conclusion The individual variability seen in this study suggests that CI recipients try with different directional options to find their ideal program. However, based on a CI recipient's motivation to try different programs, automatic directionality is an appropriate everyday processing option.

A counseling tool routinely used by pediatric audiologists and early intervention-specialists is the often-named “common sounds audiogram” (CSA). Typically, a child's hearing detection thresholds are plotted on the CSA to indicate that child's audibility of speech and environmental sounds. Importantly, the CSA may be the first item that parents see when their child's hearing loss is explained. Thus, the accuracy of the CSA and its associated counseling information are integral to the parents' understanding of what their child can hear and to the parents' role in the child's future hearing care and interventions. Currently available CSAs were collected from professional societies, early intervention providers, device manufacturers, etc., and analyzed (n = 36). Analysis included quantification of sound elements, presence of counseling information, attribution of acoustic measurements, and errors. The analyses show that currently-available CSAs are wildly inconsistent as a group, not scientifically justified, and omit important information for counseling and interpretation. Variations found among currently available CSAs can lead to very different parental interpretations of the impact of a child's hearing loss on his/her access to sounds, especially spoken language. Such variations, presumably, could also lead to different recommendations regarding intervention and hearing devices. Recommendations are outlined for the development of a new, standard CSA.