Objectives The objectives were to characterize the effects of wearing face coverings on: 1) acoustic speech cues, and 2) speech recognition of patients with hearing loss who listen with a cochlear implant. Methods A prospective cohort study was performed in a tertiary referral center between July and September 2020. A female talker recorded sentences in three conditions: no face covering, N95 mask, and N95 mask plus a face shield. Spectral differences were analyzed between speech produced in each condition. The speech recognition in each condition for twenty‐three adult patients with at least 6 months of cochlear implant use was assessed. Results Spectral analysis demonstrated preferential attenuation of high‐frequency speech information with the N95 mask plus face shield condition compared to the other conditions. Speech recognition did not differ significantly between the uncovered (median 90% [IQR 89%–94%]) and N95 mask conditions (91% [IQR 86%–94%]; P = .253); however, speech recognition was significantly worse in the N95 mask plus face shield condition (64% [IQR 48%–75%]) compared to the uncovered ( P < .001) or N95 mask ( P < .001) conditions. Conclusions The type and combination of protective face coverings used have differential effects on attenuation of speech information, influencing speech recognition of patients with hearing loss. In the face of the COVID‐19 pandemic, there is a need to protect patients and clinicians from spread of disease while maximizing patient speech recognition. The disruptive effect of wearing a face shield in conjunction with a mask may prompt clinicians to consider alternative eye protection, such as goggles, in appropriate clinical situations. Level of Evidence Level 3 Laryngoscope , 2021

A prospective clinical trial evaluated the effectiveness of cochlear implantation in adults with asymmetric hearing loss (AHL). Twenty subjects with mild-to-moderate hearing loss in the better ear and moderate-to-profound hearing loss in the poorer ear underwent cochlear implantation of the poorer hearing ear. Subjects were evaluated preoperatively and at 1, 3, 6, 9, and 12 months post-activation. Preoperative performance was evaluated unaided, with traditional hearing aids (HAs) or with a bone-conduction HA. Post-activation performance was evaluated with the cochlear implant (CI) alone or in combination with a contralateral HA (bimodal). Test measures included subjective benefit, word recognition, and spatial hearing (i.e., localization and masked sentence recognition). Significant subjective benefit was reported as early as the 1-month interval, indicating better performance with the CI compared with the preferred preoperative condition. Aided word recognition with the CI alone was significantly improved at the 1-month interval compared with preoperative performance with an HA and continued to improve through the 12-month interval. Subjects demonstrated early, significant improvements in the bimodal condition on the spatial hearing tasks compared with baseline preoperative performance tested unaided. The magnitude of the benefit was reduced for subjects with AHL when compared with published data on CI users with normal hearing in the contralateral ear; this finding may reflect significant differences in age at implantation and hearing sensitivity across cohorts.

Objective: Assess the influence of cochlear implant (CI) use on the perceived listening effort of adult and pediatric subjects with unilateral hearing loss (UHL) or asymmetric hearing loss (AHL). Study design: Prospective cohort. Setting: Tertiary referral center. Patients: Adults and children with UHL or AHL. Intervention: Cochlear implantation. Subjects received their CI as part of a clinical trial assessing the effectiveness of cochlear implantation in cases of UHL and AHL. Main outcome measures: Responses to the Listening Effort pragmatic subscale on the Speech, Spatial, and Qualities of Hearing Scale (SSQ) or SSQ for Children with Impaired Hearing (SSQ-C) were compared over the study period. Subjects or their parents completed the questionnaires preoperatively and at predetermined postactivation intervals. For the adult subjects, responses were compared to word recognition in quiet and sentence recognition in noise.Results: Forty adult subjects (n ¼ 20 UHL, n ¼ 20 AHL) and 16 pediatric subjects with UHL enrolled and underwent cochlear implantation. Subjects in all three groups reported a significant reduction in perceived listening effort within the initial months of CI use ( p < 0.001; h 2 ! 0.351). The perceived benefit was significantly correlated with speech recognition in noise for the adult subjects with UHL at the 12-month interval (r (20) ¼ .59, p ¼ 0.006). Conclusions: Adult and pediatric CI recipients with UHL or AHL report a reduction in listening effort with CI use as compared to their preoperative experiences. Use of the SSQ and SSQ-C Listening Effort pragmatic subscale may provide additional information about a CI recipient's experience beyond the abilities measured in the sound booth.

Objectives/Hypothesis To assess whether early, significant improvements in sound source localization observed in cochlear implant (CI) recipients with normal hearing (NH) in the contralateral ear are maintained after 5 years of CI use. Study Design Prospective, repeated measures study. Methods Participants were recruited from a sample of CI + NH listeners (n = 20) who received their device as part of a prospective clinical trial investigating outcomes of CI use for adult cases of single‐sided deafness. Sound source localization was assessed annually after the clinical trial endpoint (1‐year post‐activation). Listeners were asked to indicate the perceived sound source for a broadband noise burst presented randomly at varied intensity levels from one of 11 speakers along a 180° arc. Performance was quantified as root‐mean‐squared (RMS) error. Results Linear mixed models showed superior post‐activation performance was maintained with long‐term CI use as compared to preoperative abilities (P < .001). Unexpectedly, a significant improvement (P = .009) in sound source localization was observed over the long‐term post‐activation period (1–5 years). To better understand these long‐term findings, the response patterns for the 11 participants who were evaluated at the 1‐ and 5‐year visits were reviewed. This subgroup demonstrated a significant improvement in RMS error (P = .020) and variable error (P = .031), indicating more consistent responses at the 5‐year visit. Conclusion Adult CI + NH listeners experience significant improvements in sound source localization within the initial weeks of listening experience, with additional improvements observed after long‐term device use. The present sample demonstrated significant improvements between the 1‐year and 5‐year visits, with greater accuracy and consistency noted in their response patterns. Level of Evidence 3 Laryngoscope, 132:2453–2458, 2022

Purpose: The U.S. Food and Drug Administration indications for cochlear implantation in children is currently 9 months of age and older for children with bilateral profound sensorineural hearing loss (SNHL). Studies have shown that earlier activation of a cochlear implant (CI) can lead to better spoken language outcomes. As auditory skills are a precursor to the development of spoken language, this study was developed to investigate the influence of age at CI activation on auditory skill acquisition in young children. A secondary aim was to describe the auditory skills of children implanted prior to 9 months of age as compared to children with older ages of activation. Method: Functional Listening Index (FLI) scores obtained during routine clinical visits were reviewed for 78 pediatric CI recipients with congenital bilateral profound hearing loss who were activated before 2 years of age. A linear mixed-effects model assessed the effect of age at CI activation on cumulative FLI scores over time. Results: There was a significant interaction between age at activation and chronological age at the time of evaluation, indicating that children with earlier access to sound achieved a greater number of auditory skills than those with later CI activations when measured at the same chronological age. Children activated before the age of 9 months approximated scores expected of children with typical hearing, whereas children activated between 9 and 24 months of age did not. Conclusions: Younger age at CI activation is associated with increased auditory skills over time. Children who undergo cochlear implantation and CI activation before 9 months achieve more auditory skills by 4 years of age than children who are activated at later ages. These data suggest that reducing the approved age at cochlear implantation for children with congenital bilateral profound SNHL may support optimal auditory skill acquisition.