Authors: Marta Álvarez-Cendrero¹; Manuel Lazo-Maestre²; María A. Callejón-Leblic²
¹Hospital Universitario La Merced; ²Hospital Universitario Virgen Macarena
Background: Conventional audiological assessments often fail to capture the real-world listening difficulties experienced by cochlear implant (CI) users, particularly in complex acoustic environments. Limitations in speech recognition and sound localization may persist despite clinically acceptable audiometric outcomes.
Objective: This study aims to investigate how acoustic environment complexity affects speech recognition and sound localization in CI users compared to normal-hearing (NH) individuals, and to evaluate subjective auditory performance using validated questionnaires.
Method: Thirty-four unilateral CI users and fifty NH participants were tested in a sound-treated room equipped with a 360° eight-speaker array. Measures included pure-tone average (PTA), word recognition scores (WRS) in quiet and in noise (sea, traffic, cafeteria), sound localization ability, and the SSQ-12 questionnaire. Relationships between objective and subjective outcomes were analysed using correlation, regression, and MANOVA.
Results: CI users showed significantly poorer WRS in both quiet and noisy conditions, reduced localization accuracy, and lower SSQ-12 scores compared to NH participants. Performance declined with increasing noise complexity. Pre-implant PTA emerged as the strongest predictor of post-implant speech recognition. No significant differences were found between unilateral and bimodal CI users. SSQ-12 scores were significantly associated with objective measures, supporting its clinical utility.
Conclusion: CI users continue to experience deficits in realistic listening environments that are not captured by standard audiometry. Combining sound field assessments with validated auditory questionnaires may offer a more comprehensive evaluation to inform individualized rehabilitation and device optimization.
