Optimizing the Combination of Acoustic and Electric Hearing in the Implanted Ear

Objectives: The aim of this study was to determine an optimal approach to program combined acoustic plus electric (A+E) hearing devices in the same ear to maximize speech-recognition performance. Design: Ten participants with at least 1 year of experience using Nucleus Hybrid (short electrode) A+E devices were evaluated across three different fitting conditions that varied in the frequency ranges assigned to the acoustically and electrically presented portions of the spectrum. Real-ear measurements were used to optimize the acoustic component for each participant, and the acoustic stimulation was then held constant across conditions. The lower boundary of the electric frequency range was systematically varied to create three conditions with respect to the upper boundary of the acoustic spectrum: Meet, Overlap, and Gap programming. Consonant recognition in quiet and speech recognition in competing-talker babble were evaluated after participants were given the opportunity to adapt by using the experimental programs in their typical everyday listening situations. Participants provided subjective ratings and evaluations for each fitting condition. Results: There were no significant differences in performance between conditions (Meet, Overlap, Gap) for consonant recognition in quiet. A significant decrement in performance was measured for the Overlap fitting condition for speech recognition in babble. Subjective ratings indicated a significant preference for the Meet fitting regimen. Conclusions: Participants using the Hybrid ipsilateral A+E device generally performed better when the acoustic and electric spectra were programmed to meet at a single frequency region, as opposed to a gap or overlap. Although there is no particular advantage for the Meet fitting strategy for recognition of consonants in quiet, the advantage becomes evident for speech recognition in competing-talker babble and in patient preferences.