Publications by authors named "Jantien L Vroegop"

15 Publications

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Correction to: A smartphone application to objectively monitor music listening habits in adolescents.

J Otolaryngol Head Neck Surg 2021 Aug 12;50(1):50. Epub 2021 Aug 12.

Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.

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http://dx.doi.org/10.1186/s40463-021-00532-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361637PMC
August 2021

The impact of face masks on the communication of adults with hearing loss during COVID-19 in a clinical setting.

Int J Audiol 2021 Jul 28:1-6. Epub 2021 Jul 28.

Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, Rotterdam, The Netherlands.

Objective: The aim of the study was to investigate the effect of surgical masks and face shields on speech intelligibility of adults with moderate to severe hearing loss.

Design: This study measured speech tracking scores in quiet for life speech in three different conditions: without a mask, with a surgical mask and with a face shield. Acoustic effects of the masks and face shields on the speech signal were also investigated. The study sample consists of 42 patients with moderate to severe hearing loss, 23 cochlear implant users and 19 hearing aid users.

Results: A significant average difference in speech perception scores was found for the use of a surgical mask compared to the listening situation "without mask". The worse the speech understanding in quiet, the larger the impact of the surgical mask. For the worse performers even the face shield had a negative impact on speech perception. The sound distortion for the face shield compared to the surgical mask was greater.

Conclusion: This study shows that even for speech perception in quiet, surgical face masks, and face shields to a lesser extent, have a negative effect for patients with moderate to severe hearing loss.
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http://dx.doi.org/10.1080/14992027.2021.1952490DOI Listing
July 2021

Treatment Outcome of the Bony Obliteration Tympanoplasty Versus Nonobliterative Techniques in Cholesteatoma Surgery: A Retrospective Analysis.

Otol Neurotol 2021 Oct;42(9):1366-1374

Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.

Objective: In cholesteatoma surgery, obliteration of the mastoid and epitympanic space (bony obliteration tympanoplasty, BOT) is an increasingly used technique with low recurrent and residual cholesteatoma rates. While factors as the postoperative hearing level and infection rate are important for the patient as well, these outcome parameters are not frequently reported on in current literature. The objective of this study is to evaluate the recurrent and residual cholesteatoma rates of the BOT technique and nonobliterative canal wall up (CWU) and canal wall down (CWD) mastoidectomy in a large patient cohort. Secondary objectives were to evaluate the infection rate and hearing outcome for all three techniques.

Design: Retrospective cohort study.

Setting: Single-center study.

Patients: All 337 adult patients (≥18 yrs) who underwent primary or revision cholesteatoma surgery between January 2013 and March 2019 were included.

Main Outcome And Measures: Recurrent cholesteatoma rates, residual cholesteatoma rates, postoperative infections and other complications, hearing outcome.

Results: The estimated combined rate of recurrent and residual cholesteatoma at 5 years follow-up was 7.6% in the BOT group, 34.9% in the CWU group, and 17.9% in the CWD group. The postoperative infection rate in the different groups ranged from 4.3% to 4.9%. The median gain in AC threshold level varied from 0.0 dB in the BOT and CWD group to 3.8 dB in the CWU group.

Conclusions: We show that cholesteatoma recurrence rates after the BOT technique in our clinic are significantly lower compared to CWU surgery. There were no differences in infection rate and no clinically relevant differences in postoperative hearing between the BOT, CWU, and CWD technique.
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http://dx.doi.org/10.1097/MAO.0000000000003246DOI Listing
October 2021

Impact of face masks in public spaces during COVID-19 pandemic on daily life communication of cochlear implant users.

Laryngoscope Investig Otolaryngol 2021 Jun 6;6(3):531-539. Epub 2021 May 6.

Department of Otorhinolaryngology and Head and Neck Surgery Erasmus MC Rotterdam The Netherlands.

Objective/hypothesis: Investigate potential problems in the daily life communication of cochlear implant (CI) patients due to the widespread use of face masks in public places during the COVID-19 pandemic.

Study Design: Prospective survey study.

Methods: This study used an online questionnaire about the effects of face masks on daily life communication of adult CI users. The questionnaire consists of three parts: (a) A face mask questionnaire, (b) loneliness question (c) three subdomains of the Nijmegen Cochlear Implant Questionnaire to assess quality of life. The questionnaires were send out on October 20, 2020. Four hundred and seven adult CI users were invited to participate in the study. The survey inclusion was closed on November 5, 2020. The study setting was the Rotterdam Cochlear Implant Center, Erasmus MC, a tertiary referral center in The Netherlands. The loneliness question and Nijmegen Cochlear Implant Questionnaire were analyzed for possible differences between the current situation with masks and the situation before, when masks were not commonly used.

Results: Two hundred and twenty one adult CI users (54% female, mean age 62 years) participated in the study. The face mask questionnaire showed that face masks cause considerable problems in daily life communication of 80% of the participants. Also, CI users tend to feel more lonely and all used subdomains of the Nijmegen Cochlear Implant Questionnaire worsened due to the use of face masks.

Conclusion: The widespread use of face masks greatly complicates the daily life communication of CI users and reduces quality of life.

Level Of Evidence: 3.
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http://dx.doi.org/10.1002/lio2.578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223455PMC
June 2021

Objective Measurement of Listening Device Use and Its Relation to Hearing Acuity.

Otolaryngol Head Neck Surg 2021 May 25:1945998211012274. Epub 2021 May 25.

Department of Otorhinolaryngology-Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.

Objectives: To examine whether adolescents exceed recommended noise exposure limits when using personal listening devices (PLDs) and to investigate the relationship between objectively measured PLD use and hearing thresholds.

Study Design: Cross-sectional study.

Setting: This study was embedded within an ongoing prospective birth cohort study in Rotterdam, the Netherlands. Data were collected from May 2017 to September 2019.

Methods: A smartphone application was developed to measure daily noise exposure from PLDs. Listening habits were monitored among 314 adolescents with a mean age of 13 years 7 months (SD, 5 months), of whom 51.6% were male. Hearing acuity was measured by pure tone audiometry, and tympanometry was performed in both ears.

Results: Within the study group, 2.2% adolescents exceeded the recommended daily noise dose (85 dBA as an 8-hour time-weighted average) among all days when the application was active and 9.9% when among only the listening days. No significant correlation was found between the daily noise dose from PLDs and pure tone thresholds.

Conclusions: The majority of adolescents exhibited listening habits that could be considered safe. As noise-induced hearing loss develops slowly over time, it could be that the effects of PLD use on hearing are not evident yet in this young population with a relatively short duration of PLD use.
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http://dx.doi.org/10.1177/01945998211012274DOI Listing
May 2021

A 4-year follow-up study of hearing acuity in a large population-based cohort of children and adolescents.

Laryngoscope Investig Otolaryngol 2021 Apr 9;6(2):302-309. Epub 2021 Feb 9.

Department of Otorhinolaryngology, Head and Neck Surgery Erasmus University Medical Center Rotterdam Netherlands.

Objectives: To describe the prevalence of hearing loss among 13 year old adolescents, and to examine the change in prevalence between ages 9 and 13 years.

Methods: This study was embedded within Generation R, a population-based prospective cohort study from fetal life onwards in the Netherlands. Pure-tone thresholds were obtained at 0.5 to 8 kHz, and tympanometry was performed. Sensorineural hearing loss (SNHL) was defined as a low-frequency and/or high-frequency pure-tone average of more than 15 dB HL in one of both ears. Audiometric signs suggestive of noise-induced hearing loss (NIHL) included the presence of a notch and/or high-frequency hearing loss. The study was conducted from April 2012 to October 2015, and April 2016 to September 2019.

Results: A total of 4572 adolescents with a mean age of 13 years and 7 months (SD, 5 months) were included, of whom 2334 (51.0%) were girls. Within the cohort, 6.4% (95% CI, 5.7%-7.2%) were estimated to have SNHL, and 12.4% (95% CI, 11.5%-13.4%) met the criteria of NIHL. In total, 3675 participants were included in the longitudinal analysis. The prevalence of SNHL decreased from 8.0% to 5.3% between ages 9 and 13 years ( < .001). The prevalence of NIHL increased from 9.8% to 11.7% ( = .004), due to an increase in number of participants with a notch.

Conclusions: The prevalence of SNHL significantly decreased by 2.7% (95% CI, 1.6%-3.9%) between ages 9 and 13 years, probably due to a change in alertness during assessment at the age of 13 years. Other possible explanations include the presence of selection bias or a decline in prevalence of conductive hearing loss. The number of participants with audiometric signs suggestive of NIHL increased by 1.9% (95% CI, 0.5%-3.3%).

Level Of Evidence: Level 3.
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http://dx.doi.org/10.1002/lio2.529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035936PMC
April 2021

A smartphone application to objectively monitor music listening habits in adolescents : Personal listening device usage and the accuracy of self-reported listening habits.

J Otolaryngol Head Neck Surg 2021 Feb 15;50(1):11. Epub 2021 Feb 15.

Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.

Background: Listening to music through personal listening devices (PLDs) has become more prevalent during last decades. The aim of this study was to evaluate music listening habits through PLDs in adolescents with a smartphone application, and to assess the accuracy of self-reported listening habits.

Methods: This study was embedded in the Generation R Study, a population-based prospective birth cohort in Rotterdam, the Netherlands. A smartphone application for Android operating systems was developed to objectively monitor music listening habits for a period of 35 days. A postal questionnaire was used to subjectively assess listening habits. The level of agreement between the objectively measured and self-reported listening habits were evaluated using weighted kappa coefficients. Data were collected from May 2017 to March 2019.

Results: A total of 311 adolescents aged 12 to 15 years were included, of whom 237 (76.2%) completed the postal questionnaire. The results of the smartphone application showed that the median listening frequency was 2.1 days a week (IQR 1.0-3.4), the median listening time 21.1 min a day (IQR 9.1-53.7), and the mean listening level 54.5% (SD 18.1%). There was a slight to fair agreement between the objectively measured, and self-reported listening habits according to the weighted kappa coefficients (k = 0.179 to 0.364).

Conclusions: The results of the current study suggest that self-reported measures of listening habits are not always accurate. We consider a smartphone application to monitor listening habits of added value in future research investigating the possible damaging effects of PLDs on hearing acuity.
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http://dx.doi.org/10.1186/s40463-020-00488-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885602PMC
February 2021

Comparing the Effect of Different Hearing Aid Fitting Methods in Bimodal Cochlear Implant Users.

Am J Audiol 2019 Mar;28(1):1-10

Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands.

Purpose The aim of the study was to investigate the effect of 3 hearing aid fitting procedures on provided gain of the hearing aid in bimodal cochlear implant users and their effect on bimodal benefit. Method This prospective study measured hearing aid gain and auditory performance in a cross-over design in which 3 hearing aid fitting methods were compared. Hearing aid fitting methods differed in initial gain prescription rule (NAL-NL2 and Audiogram+) and loudness balancing method (broadband vs. narrowband loudness balancing). Auditory functioning was evaluated by a speech-in-quiet test, a speech-in-noise test, and a sound localization test. Fourteen postlingually deafened adult bimodal cochlear implant users participated in the study. Results No differences in provided gain and in bimodal performance were found for the different hearing aid fittings. For all hearing aid fittings, a bimodal benefit was found for speech in noise and sound localization. Conclusion Our results confirm that cochlear implant users with residual hearing in the contralateral ear substantially benefit from bimodal stimulation. However, on average, no differences were found between different types of fitting methods, varying in prescription rule and loudness balancing method.
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http://dx.doi.org/10.1044/2018_AJA-18-0067DOI Listing
March 2019

A directional remote-microphone for bimodal cochlear implant recipients.

Int J Audiol 2018 11 27;57(11):858-863. Epub 2018 Sep 27.

a ENT-Department , Erasmus Medical Center , Rotterdam , The Netherlands.

To evaluate whether speech recognition in noise differs according to whether a wireless remote microphone is connected to just the cochlear implant (CI) or to both the CI and to the hearing aid (HA) in bimodal CI users. The second aim was to evaluate the additional benefit of the directional microphone mode compared with the omnidirectional microphone mode of the wireless microphone. This prospective study measured Speech Recognition Thresholds (SRT) in babble noise in a 'within-subjects repeated measures design' for different listening conditions. Eighteen postlingually deafened adult bimodal CI users. No difference in speech recognition in noise in the bimodal listening condition was found between the wireless microphone connected to the CI only and to both the CI and the HA. An improvement of 4.1 dB was found for switching from the omnidirectional microphone mode to the directional mode in the CI only condition. The use of a wireless microphone improved speech recognition in noise for bimodal CI users. The use of the directional microphone mode led to a substantial additional improvement of speech perception in noise for situations with one target signal.
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http://dx.doi.org/10.1080/14992027.2018.1508896DOI Listing
November 2018

The Effect of Binaural Beamforming Technology on Speech Intelligibility in Bimodal Cochlear Implant Recipients.

Audiol Neurootol 2018 22;23(1):32-38. Epub 2018 Jun 22.

Although the benefit of bimodal listening in cochlear implant users has been agreed on, speech comprehension remains a challenge in acoustically complex real-life environments due to reverberation and disturbing background noises. One way to additionally improve bimodal auditory performance is the use of directional microphones. The objective of this study was to investigate the effect of a binaural beamformer for bimodal cochlear implant (CI) users. This prospective study measured speech reception thresholds (SRT) in noise in a repeated-measures design that varied in listening modality for static and dynamic listening conditions. A significant improvement in SRT of 4.7 dB was found with the binaural beamformer switched on in the bimodal static listening condition. No significant improvement was found in the dynamic listening condition. We conclude that there is a clear additional advantage of the binaural beamformer in bimodal CI users for predictable/static listening conditions with frontal target speech and spatially separated noise sources.
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http://dx.doi.org/10.1159/000487749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172793PMC
May 2019

Comparing Two Hearing Aid Fitting Algorithms for Bimodal Cochlear Implant Users.

Ear Hear 2019 Jan/Feb;40(1):98-106

Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, the Netherlands.

Objectives: To investigate the possible advantage of the use of a dedicated bimodal hearing aid fitting formula, the Adaptive Phonak Digital Bimodal (APDB), compared with a frequently used standard hearing aid fitting formula, the NAL-NL2. We evaluated the effects of bimodal hearing aid fitting on provided hearing aid gain and on bimodal auditory functioning in a group of experienced bimodal cochlear implant (CI) users. A second aim of our study was to determine the effect of broadband loudness balancing on the prescribed gain of those two fitting formulas.

Design: This prospective study used a crossover design in which two fitting methods were compared varying in basic prescription formula (NAL-NL2 or APDB fitting formula). The study consisted of a three-visit crossover design with 3 weeks between sessions. Nineteen postlingually deafened experienced bimodal CI users participated in this study. Auditory functioning was evaluated by a speech in quiet test, a speech in noise test, and a questionnaire on auditory performance.

Results: Significant differences between the two fitting formulas were found for frequencies of 2000 Hz and above. For these frequencies, less gain was provided by the APDB fitting formula compared with NAL-NL2. For the APDB fitting formula, a higher compression ratio for frequencies of 1000 Hz and above was found compared with the NAL-NL2 fitting formula. Loudness balancing did not result in large deviations from the prescribed gain by the initial fitting formula. Bimodal benefit was found for speech perception in quiet and for speech perception in noise. No differences in auditory performance were found between the two fitting formulas for any of the auditory performance tests.

Conclusions: The results of this study show that CI users with residual hearing at the contralateral ear can benefit from bimodal stimulation, regardless of the fitting method that was applied. Although significant differences between the output and compression ratio of the NAL-NL2 and the APDB fitting formula existed, no differences in bimodal auditory performance were observed. Therefore, NAL-NL2 or the APDB fitting prescription both seem suited for bimodal fitting purposes. Additional loudness balancing has a marginal effect on the provided hearing aid output.
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http://dx.doi.org/10.1097/AUD.0000000000000597DOI Listing
April 2019

How to Optimally Fit a Hearing Aid for Bimodal Cochlear Implant Users: A Systematic Review.

Ear Hear 2018 Nov/Dec;39(6):1039-1045

Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, The Netherlands.

Objectives: Bimodal hearing has shown to improve speech recognition in quiet and in noise and to improve sound localization compared with unilateral cochlear implant (CI) use alone. Fitting the CI and hearing aid (HA) separately has been described well, but HA fitting procedures for bimodal CI users are not well researched or widely accepted. The aim of the present study was to systematically review the literature on the effect of different HA fitting strategies on auditory performance in bimodal CI users.

Design: Original articles, written in English, were identified through systematic searches in Medline (OvidSP), Embase, Web of Science, Scopus, CINAHL, Cochrane, PubMed publisher, and Google Scholar. The quality of the studies was assessed on five aspects: methodologic quality (with the methodological index for nonrandomized studies score), number of subjects, quality of the description of contralateral hearing loss, quality of HA verification, and direct comparison of HA fitting procedures based on auditory performance.

Results: A total of 1665 records were retrieved, of which 17 were included for systematical reviews. Critical appraisal led to three high-quality studies, 10 medium-quality studies, and four low-quality studies. The results of the studies were structured according to four topics: frequency response, frequency translation/transposition, dynamic range compression, and loudness. In general, a bimodal benefit was found in most studies, using various strategies for the HA fitting. Using a standard prescription rule such as National Acoustics Laboratory formula-non-linear 1, National Acoustics Laboratory formula-non-linear 2, or desired sensation level is a good starting point in children and adults.

Conclusions: Although a bimodal benefit was found in most studies, there is no clear evidence how certain choices in HA fitting contribute to optimal bimodal performance. A generally accepted HA prescription rule is an essential part of most fitting procedures used in the studies. Current evidence suggests that frequency lowering or transposition is not beneficial. Individual fine tuning based on loudness or general preference is often applied, but its additional value for auditory performance should be investigated more thoroughly. Good quality comparative studies are needed to further develop evidence-based fitting procedures in case of bimodal listening.
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http://dx.doi.org/10.1097/AUD.0000000000000577DOI Listing
April 2019

Effects of a transient noise reduction algorithm on speech intelligibility in noise, noise tolerance and perceived annoyance in cochlear implant users.

Int J Audiol 2018 05 15;57(5):360-369. Epub 2018 Jan 15.

a Department of ENT , Erasmus Medical Center , Rotterdam , The Netherlands.

Objective: To evaluate the validity and efficacy of a transient noise reduction algorithm (TNR) in cochlear implant processing and the interaction of TNR with a continuous noise reduction algorithm (CNR).

Design: We studied the effects of TNR and CNR on the perception of realistic sound samples with transients, using subjective ratings of annoyance, a speech-in-noise test and a noise tolerance test.

Study Sample: Participants were 16 experienced cochlear implant recipients wearing an Advanced Bionics Naida Q70 processor.

Results: CI users rated sounds with transients as moderately annoying. Annoyance was slightly, but significantly reduced by TNR. Transients caused a large decrease in speech intelligibility in noise and a moderate decrease in noise tolerance, measured on the Acceptable Noise Level test. The TNR had no significant effect on noise tolerance or on speech intelligibility in noise. The combined application of TNR and CNR did not result in interactions.

Conclusions: The TNR algorithm was effective in reducing annoyance from transient sounds, but was not able to prevent a decreasing effect of transients on speech understanding in noise and noise tolerance. TNR did not reduce the beneficial effect of CNR on speech intelligibility in noise, but no cumulated improvement was found either.
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http://dx.doi.org/10.1080/14992027.2018.1425004DOI Listing
May 2018

Evaluation of a wireless remote microphone in bimodal cochlear implant recipients.

Int J Audiol 2017 09 10;56(9):643-649. Epub 2017 Apr 10.

a Department of ENT , Erasmus Medical Center , Rotterdam , the Netherlands.

Objective: To evaluate the benefit of a wireless remote microphone (MM) for speech recognition in noise in bimodal adult cochlear implant (CI) users both in a test setting and in daily life.

Design: This prospective study measured speech reception thresholds in noise in a repeated measures design with factors including bimodal hearing and MM use. The participants also had a 3-week trial period at home with the MM.

Study Sample: Thirteen post-lingually deafened adult bimodal CI users.

Results: A significant improvement in SRT of 5.4 dB was found between the use of the CI with the MM and the use of the CI without the MM. By also pairing the MM to the hearing aid (HA) another improvement in SRT of 2.2 dB was found compared to the situation with the MM paired to the CI alone. In daily life, participants reported better speech perception for various challenging listening situations, when using the MM in the bimodal condition.

Conclusion: There is a clear advantage of bimodal listening (CI and HA) compared to CI alone when applying advanced wireless remote microphone techniques to improve speech understanding in adult bimodal CI users.
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http://dx.doi.org/10.1080/14992027.2017.1308565DOI Listing
September 2017

Self-Adjustment of Upper Electrical Stimulation Levels in CI Programming and the Effect on Auditory Functioning.

Ear Hear 2017 Jul/Aug;38(4):e232-e240

Erasmus Medical Center, ENT Department, Rotterdam, the Netherlands.

Objectives: With current cochlear implants (CIs), CI recipients achieve good speech perception in quiet surroundings. However, in acoustically complex, real-life environments, speech comprehension remains difficult and sound quality often remains poor. It is, therefore, a challenge to program CIs for such environments in a clinic. The CI manufacturer Cochlear Ltd. recently introduced a remote control that enables CI recipients to alter the upper stimulation levels of their user programs themselves. In this concept, called remote assistant fitting (RAF), bass and treble controls can be adjusted by applying a tilt to emphasize either the low- or high-frequency C-levels, respectively. This concept of self-programming may be able to overcome limitations associated with fine-tuning the CI sound processor in a clinic. The aim of this study was to investigate to what extent CI recipients already accustomed to their clinically fitted program would adjust the settings in daily life if able to do so. Additionally, we studied the effects of these changes on auditory functioning in terms of speech intelligibility (in quiet and in noise), noise tolerance, and subjectively perceived speech perception and sound quality.

Design: Twenty-two experienced adult CI recipients (implant use >12 months) participated in this prospective clinical study, which used a within-subject repeated measures design. All participants had phoneme scores of ≥70% at 65 dB SPL in quiet conditions, and all used a Cochlear Nucleus CP810 sound processor. Auditory performance was tested by a speech-in-quiet test, a speech-in-noise test, an acceptable noise level test, and a questionnaire about perceived auditory functioning, that is, a speech and sound quality (SSQ-C) questionnaire. The first session consisted of a baseline test in which the participants used their own CI program and were instructed on how to use RAF. After the first session, participants used RAF for 3 weeks at home. After these 3 weeks, the participants returned to the clinic for auditory functioning tests with their self-adjusted programs and completed the SSQ-C.

Results: Fifteen participants (68%) adjusted their C-level frequency profile by more than 5 clinical levels for at least one electrode. Seven participants preferred a higher contribution of the high frequencies relative to the low frequencies, while five participants preferred more low-frequency stimulation. One-third of the participants adjusted the high and low frequencies equally, while some participants mainly used the overall volume to change their settings. Several parts of the SSQ-C questionnaire scores showed an improvement in perceived auditory functioning after the subjects used RAF. No significant change was found on the auditory functioning tests for speech-in-quiet, speech-in-noise, or acceptable noise level.

Conclusions: In conclusion, the majority of experienced CI users made modest changes in the settings of their programs in various ways and were able to do so with the RAF. After altering the programs, the participants experienced an improvement in speech perception in quiet environments and improved perceived sound quality without compromising auditory performance. Therefore, it can be concluded that self-adjustment of CI settings is a useful and clinically applicable tool that may help CI recipients to improve perceived sound quality in their daily lives.
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http://dx.doi.org/10.1097/AUD.0000000000000404DOI Listing
May 2018
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