Patient-Reported Benefits of Cochlear Implant Listening Configurations - Project Summary/Abstract Unilateral cochlear implantation is the standard treatment for adults with bilateral moderate to profound hearing loss, and it is estimated that up to 1.2 million Americans could benefit from cochlear implants (CIs).1 Bimodal hearing (CI in one ear and a hearing aid in the contralateral ear) is the most common CI listening configuration.2 Yet, an increasing number of patients are pursuing a second CI.3 Currently, there are no evidence-based criteria for when to recommend a second CI, resulting in a common clinical dilemma: should this patient continue using bimodal hearing, or should a second CI be considered (i.e., transition from bimodal hearing to bilateral CIs)? Previous attempts to provide evidence-based guidance on this clinical dilemma have focused on performance-based auditory tasks such as speech recognition;4-7 however, recent evidence suggests that patient report may have great utility when determining if bimodal hearing or bilateral CIs is right for a particular patient.6 Despite recent findings, the patient-reported advantages and limitations of each listening configuration have remained understudied, thus limiting the potential ability of patient-report in solving the abovementioned clinical dilemma. Our preliminary data demonstrates unexplained patient-reported differences between bimodal hearing and bilateral CIs, but that previously unknown information regarding the benefits and limitations of each listening configuration can be uncovered using qualitative patient interviews. Thus, the present study aims to determine the patient-reported advantages and limitations of bimodal hearing versus bilateral CIs using a mixed methods approach and two research designs (within-subject and between- subject). Aim 1 will compare bimodal hearing, bilateral CI, and bilateral candidates (bimodal patients scheduled to receive a second CI) using clinically relevant Patient-Report Outcome Measures (PROMs) and results of thematic coding obtained from qualitative patient interviews. Aim 2 will follow bilateral candidates through the preoperative (bimodal hearing) and postoperative (bilateral CI) phases using the same measures described in Aim 1 and will assess changes in patient-report across the two timepoints. Our preliminary data demonstrates the feasibility of this project and supports our central hypothesis, that patient reporting can offer valuable information about each listening configuration that can aid in differentiating the advantages and limitations of bimodal hearing and bilateral CIs. The long-term goal of this project is to equip clinicians with an evidence- based approach to counseling bimodal patients on the most beneficial listening configuration determined by individual needs and expectations. The proposed project will provide hands-on training in mixed methods research, advanced statistical analyses and interpretation, and help PI Lewis establish a unique line of clinically relevant research, thus preparing her for a post-doctoral position at an academic institution.
