Comparison of hearing performance in patients with borderline indication for active middle ear or cochlear implants: clinical outcomes to guide preoperative counseling and decision making.

PURPOSE: The aim of the presented study was to compare the audiological benefit achieved in cochlear implant (CI) patients who, in principle, could still have been treated with an active middle ear implant (AMEI) with a group of AMEI users.

METHODS: Results of 20 CI patients with a pure-tone average (PTA) of 70 dB HL prior to surgery were compared with a group of 12 subjects treated with a Vibrant Soundbridge (VSB). Pre-surgical comparison included PTA for air conduction and bone conduction, maximum speech recognition score for monosyllabic words (WRSmax), and aided monosyllabic word recognition at 65 dB SPL. One year after surgery, aided monosyllabic speech recognition score at 65 dB SPL was compared.

RESULTS: Mean PTA for air conduction in the VSB group was significantly lower than in the CI group (4.8 dB, Z =  - 2.011, p < 0.05). Mean PTA for bone conduction in the VSB group was also significantly lower than in the CI group (23.4 dB, Z =  - 4.673, p < 0.001). WRSmax in the VSB group was significantly better than in the CI group (40.7%, Z =  - 3.705, p < 0.001). One year after treatment, there was no significant difference in aided speech perception in quiet between both subject groups.

CONCLUSION: Comparison of the two methods showed equivalent results for both treatments in subjects with a borderline indication. Not only pure-tone audiometry results but, particularly, speech perception scores pre-surgery should be taken into account in preoperative counseling.