# Evaluation of Replacement Hearing Aids in Cochlear Implant Candidates Using the Hearing in Noise Test (HINT) and Pupillometry

## TL;DR

This study found that replacing hearing aids in people considering cochlear implants does not significantly improve their ability to understand speech in noisy environments.

## Contribution

The study provides evidence on the effectiveness of new hearing aids in cochlear implant candidates using objective speech and engagement measures.

## Key findings

- Replacing original hearing aids with new ones did not significantly change speech recognition thresholds in noise.
- Pupillometry confirmed consistent task engagement during testing with both original and new hearing aids.

## Abstract

Background/Objectives: Advances in cochlear implant (CI) technology have led to the expansion of the implantation criteria. As a result, more CI candidates may have greater residual hearing in one or two ears. Many of these candidates will perform better with a CI in one ear and a hearing aid (HA) in the other ear, the so-called bimodal solution. The bimodal solution often requires patients to switch to HAs that are compatible with the CI. However, this can be a challenging decision, not least because it remains unclear whether this impacts hearing performance. Our aim is to determine whether speech perception in noise remains unchanged or improves with new replacement HAs compared to original HAs in CI candidates with residual hearing. Methods: Fifty bilateral HA users (mean age 63.4; range 23–82) referred for CI were recruited. All participants received new replacement HAs. The new HAs were optimally fitted and verified using Real Ear Measurement (REM). Participants were tested with the Hearing in Noise Test (HINT), which aimed at determining the signal-to-noise ratio (SNR) required for a 70% correct word recognition score at a speech sound pressure level (SPL) of 65 dB. HINT testing was performed with both their original and new replacement HAs. During HINT, pupillometry was used to control for task engagement. Results: Replacing the original HAs with new replacement HAs after one month was not statistically significant with a mean change of SRT70 by −1.90 (95% CI: −4.69;0.89, p = 0.182) dB SNR. Conclusions: New replacement HAs do not impact speech perception scores in CI candidates prior to the decision of cochlear implantation.