Performance outcomes for borderline cochlear implant recipients with substantial preoperative residual hearing

OBJECTIVE: This study examined whether cochlear implant (CI) recipients with substantial preoperative residual hearing obtained more benefit from a CI than from a hearing aid (HA). STUDY DESIGN: Retrospective records review. SETTING: Tertiary referral center. PATIENTS: Thirty-seven CI recipients (11 children/teens, 26 adults) were identified that met the following inclusion criteria: preimplant sentence recognition scores greater than 50% correct in the implanted ear or greater than 60% in the best-aided/binaural condition (Group 1, n = 18); audiometric thresholds less than 70 dB HL at 2 or more frequencies (i.e., better than a severe-profound hearing loss; Group 2, n = 13 ears in 12 recipients), or those that met both the audiometric and sentence-recognition criteria (Group 3, n = 7). MAIN OUTCOME MEASURE: Postimplant speech-perception scores. RESULTS: Postimplant speech perception was substantially better than the preimplant performance for 12 of 18 recipients in Group 1, 10 of 12 recipients (11/13 ears) in Group 2, and 5 of 7 recipients in Group 3 (total, 73.7%). Five recipients (13.1%) showed no change from preimplant performance levels. Results were inconclusive for 2 recipients (5.3%) because preimplant versus postimplant testing was conducted in different conditions. Three recipients (7.9%) exhibited decreased performance postimplant. CONCLUSION: For most recipients whose hearing was better than that defined by traditional candidacy criteria, performance improved with the CI. These results may help clinicians guide candidates in the decision-making process by providing information on the range of outcomes for recipients with similar preimplant performance levels, identify the need for additional preimplant counseling regarding expectations, and recognize the importance of systematizing preimplant and postimplant testing for longitudinal assessment of performance.