Participant-generated Cochlear Implant Programs: Speech Recognition, Sound Quality, and Satisfaction

Objective: To determine whether patient-derived programming of one's cochlear implant (CI) stimulation levels may affect performance outcomes. Background: Increases in patient population, device complexity, outcome expectations, and clinician responsibility have demonstrated the necessity for improved clinical efficiency. Methods: Eighteen postlingually deafened adult CI recipients (mean = 53 years; range, 24-83 years) participated in a repeated-measures, within-participant study designed to compare their baseline listening program to an experimental program they created. Results: No significant group differences in aided sound-field thresholds, monosyllabic word recognition, speech understanding in quiet, speech understanding in noise, nor spectral modulation detection (SMD) were observed (p>0.05). Four ears (17%) improved with the experimental program for speech presented at 45 dB SPL and two ears (9%) performed worse. Six ears (27.3%) improved significantly with the self-fit program at +10 dB signal-to-noise ratio (SNR) and four ears (26.6%) improved in speech understanding at +5 dB SNR. No individual scored significantly worse when speech was presented in quiet at 60 dB SPL or in any of the noise conditions tested. All but one participant opted to keep at least one of the self-fitting programs at the completion of this study. Participants viewed the process of creating their program more favorably (t = 2.11, p = 0.012) and thought creating the program was easier than the traditional fitting methodology (t = 2.12, p = 0.003). Average time to create the self-fit program was 10 minutes, 10 seconds (mean = 9: 22; range, 4: 46-24: 40). Conclusions: Allowing experienced adult CI recipients to set their own stimulation levels without clinical guidance is not detrimental to success.