Criteria for Selecting an Optimal Device for the Contralateral Ear of Children with a Unilateral Cochlear Implant.

Objective: To identify clinical criteria for selecting the aiding device for the contralateral ear of children with a unilateral cochlear implant (CI).

Methods: Sixty-five children, including 36 bilateral CI users and 29 bimodal users, participated in the study. A speech perception test (monosyllabic word test) in noise was administered. The target speech (65 dB sound pressure level) was presented from the front loudspeaker, and noise (10 dB signal-to-noise ratio) was presented from 3 directions: from in front of the child and 90° to the child's right and left sides. The test was performed using the first CI alone and under bilateral CI or bimodal conditions. The bilateral benefits to speech perception in noise were compared between bilateral CI users and bimodal users.

Results: Significant benefits in speech perception in noise were evident in bilateral CI users in all 3 noise conditions. In bimodal users, the hearing threshold at low frequencies of ≤1 kHz in the nonimplanted ear affected the bilateral benefit. Bimodal users with a low-frequency hearing threshold ≤90 dB hearing level (HL) showed a significant bilateral benefit in various noise conditions. By contrast, bimodal users with a low-frequency hearing threshold >90 dB HL showed no significant bilateral benefits in all 3 noise conditions.

Conclusions: Bilateral CI and bimodal listening provide better speech perception in noise than unilateral CI alone in children. The contralateral CI is better than bimodal listening for children with a low-frequency hearing threshold >90 dB HL. A hearing threshold at low frequencies of ≤1 kHz may be a good criterion for deciding on the type of device for the contralateral ear of children with a unilateral CI.