From Clinic to Reality: Integrating Sound Field Testing and Hearing Quality Measures in Cochlear Implant Users

Background: Traditional audiological assessment often does not properly reflect the challenges experienced by cochlear implant (CI) users in complex listening environments. Deficits in speech recognition and sound localization ability persist despite clinically satisfactory audiometric thresholds. Objective: The objective of this study is to evaluate the impact of acoustic environment complexity on speech recognition and sound localization ability in CI users compared to normal-hearing (NH) individuals and to assess subjective auditory performance using validated questionnaires. Methods: Thirty-four unilateral CI users and fifty NH participants were evaluated in a sound environment audiometric room equipped with an eight-speaker 360° array. The variables examined were pure-tone average (PTA), word recognition score (WRS) in quiet and noise (sea, traffic, cafeteria), sound localization ability, and the SSQ-12 auditory quality questionnaire. Correlation, regression, and MANOVA analyses examined associations among objective and subjective outcomes. Results: CI users exhibited significantly lower WRS in quiet and noise conditions, reduced sound localization, and decreased SSQ-12 scores compared to NH participants, with performance declining as noise complexity increased. Pre-implant PTA was the strongest predictor of post-implant speech recognition. No significant differences were observed between unilateral CI users and those with bimodal fittings. The SSQ-12 questionnaire correlated with objective measures, supporting its clinical relevance. Conclusions: CI users exhibit persistent deficits in ecologically valid listening conditions not demonstrated by standard audiometry. Integrating sound field testing and validated hearing quality questionnaires may provide a more comprehensive assessment to guide personalized rehabilitation and device programming.