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Adult CI recipients with normal or near-normal hearing in the contralateral ear experienced significant improvement in localization after 1 month of device use, and continued to improve through the 6-month interval. The present results show that binaural acclimatization in CI users with unilateral hearing loss can progress rapidly, with marked improvements in performance observed after only 1 month of listening experience.

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Hypothesis The compound action potential (CAP) is a purely neural component of the cochlea’s response to sound, and may provide information about the existing neural substrate in cochlear implant (CI) subjects that can help account for variance in speech perception outcomes. Background Measurement of the ‘total response’ (TR), or sum of the magnitudes of spectral components in the ongoing responses to tone bursts across frequencies, has been shown to account for 40–50% of variance in speech perception outcomes. The ongoing response is composed of both hair cell and neural components. This correlation may be improved with the addition of the CAP. Methods Intraoperative round window electrocochleography (ECochG) was performed in adult and pediatric CI subjects (n=238). Stimuli were tones of different frequencies (250 Hz–4 kHz) at 90 dB nHL. The CAP was assessed in two ways, as an amplitude and with a scaling factor derived from a function fitted to the response. The results were correlated with CNC word scores at 6 months post-implantation (n=51). Results Only about half of the subjects had a measurable CAP at any frequency. The consonant-nucleus-consonant (CNC) word scores correlated weakly with both amplitude (r2=0.20, p < 0.001) and scaling factor (r2=0.25, p < 0.01). In contrast, the TR alone accounted for 43% of the variance, and addition of either CAP measurement in multiple regression did not account for additional variance. Conclusions The underlying pathology in CI patients causes the CAP to be often absent and highly variable when present. The TR is a better predictor of speech perception outcomes than the CAP.