Objectives/Hypothesis To determine the improvement in word recognition score (WRS65) after cochlear implant (CI) surgery in hearing aid (HA) users with preoperative hearing threshold ≤80 dB HL and inadequate speech recognition scores with HA. Secondarily, to identify predictive factors for WRS65 with a CI (WRS65[CI]) 6 months after surgery, derived from the standard German CI preoperative assessment. Study Design Retrospective chart review. Methods Retrospective review of all adult patients who received a Nucleus cochlear implant in the ear, nose, and throat department of the University Hospital of Erlangen between January 2010 and April 2019. The inclusion criteria were a preoperative hearing threshold ≤80 dB HL in the ear to receive the implantation, German as the native language, and at least 6 months postimplantation care at our center. Results The inclusion criteria were met by 128 patients. All but two patients (98.4%) showed a significant improvement, WRS65(CI) versus WRS65 with an (HA) (WRS65[HA]), of at least 15 percentage points (pp). The median improvement was 55 pp with a median WRS65(CI) of 70%. Three preoperative audiometric measures, the maximum word recognition score, age at implantation, and WRS65(HA) were identified as predictive factors for WRS65(CI). For three‐quarters of the CI recipients, the score was not poorer than 12 pp below the predicted WRS65(CI). Conclusions For patients with a hearing loss ≤80 dB HL, cochlear implantation should be considered when speech perception with an HA is insufficient. The prediction model can support counseling in this patient group. Level of Evidence 4 Laryngoscope, 131:E940–E945, 2021

Objective This study investigated the speech perception of cochlear implant (CI) recipients with measurable preoperative ipsilateral speech perception. These data should support improved individual counselling of CI candidates. Materials and methods Pre- and postoperative speech audiometric parameters were analyzed, including maximum score for phonemically balanced words (PB max ) and monosyllabic score at a normal conversational level of 65 dB SPL , with hearing aids one hand and CI on the other. Data of 284 experienced adult CI wearers were grouped and evaluated in terms of preoperative PB max . Results The preoperative PB max was exceeded by the postoperative monosyllabic score in 96% of cases. The overall median postoperative score was 72.5%. The groups with preoperative PB max > 0% showed significantly better speech perception scores with CI than the group with PB max = 0%. Median improvement compared to the preoperative monosyllabic score with hearing aids was 65 percentage points, independent of preoperative PB max . Conclusion The preoperatively measured PB max may be used as a predictor for the minimum speech perception obtained with CI. This is of high clinical relevance for CI candidates with a PB max above zero.

CI candidacy can be predicted based on commonly used audiometric measures.Cochlear implant candidacy may be considered if the difference between the average pure-tone threshold (in decibels) and PBmax (in percent) exceeds 8.

For larger groups, average pure-tone hearing loss and speech perception correlate significantly. However, prognosis for individuals is not possible. In particular for higher degrees of hearing loss substantial deviations could be observed. Speech performance with hearing aids cannot be predicted sufficiently from speech audiograms. Above the age of 80, speech perception is significantly worse.

There is no supporting evidence from our evaluations of word and sentence perception in quiet and noise that elderly CI users older than 75 years of age perform more poorly than those younger than 75 years of age.