Trade-offs between better hearing and better cosmetics.

A case study is reported of an adult bilateral cochlear implant patient who owns both a pair of ear-level and body-worn speech processors and chooses to wear them in unique configurations, knowingly compromising his auditory performance. The aim was to determine if differences in hearing could be quantified between these devices and to examine the size of these effects that would lend themselves to trading between performance and cosmetics. The patient reported wearing bilateral ear-level speech processors (programmed with the Cochlear Corporation spectral PEAK [SPEAK] coding strategy) 75% of the time for cosmetic and convenience reasons even though he "heard the best" with bilateral body-worn speech processors (programmed with the Cochlear Corporation advanced combination encoder strategy [ACE]). Speech perception and localization tests confirmed that this patient performed significantly better on monosyllabic phonemes in quiet (a difference from 60% to 75%) and localization (a total root-mean-squared-error difference from 22 degrees to 12degrees ) with bilateral body-worn speech processors and consistently rated various speech sounds as more clear than with bilateral ear-level units. There was a 2-dB difference in sentence reception threshold in noise, which was not statistically significant. These results suggest that clinicians should consider and provide options to patients when there are trade-offs to be made regarding understanding performance and cosmetics. Some individuals may choose better speech perception over cosmetics, and the ability to choose might result in greater compliance. The observations made here are relevant to hearing aid users as well.