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The Enigma of Poor Performance by Adults With Cochlear Implants

Moberly, Aaron C.; Bates, Chelsea; Harris, Michael S.; Pisoni, David B.

doi: 10.1097/MAO.0000000000001211

Objective: Considerable unexplained variability and large individual differences exist in speech recognition outcomes for postlingually deaf adults who use cochlear implants (CIs), and a sizeable fraction of CI users can be considered “poor performers.” This article summarizes our current knowledge of poor CI performance, and provides suggestions to clinicians managing these patients.

Method: Studies are reviewed pertaining to speech recognition variability in adults with hearing loss. Findings are augmented by recent studies in our laboratories examining outcomes in postlingually deaf adults with CIs.

Results: In addition to conventional clinical predictors of CI performance (e.g., amount of residual hearing, duration of deafness), factors pertaining to both “bottom-up” auditory sensitivity to the spectro-temporal details of speech, and “top-down” linguistic knowledge and neurocognitive functions contribute to CI outcomes.

Conclusions: The broad array of factors that contribute to speech recognition performance in adult CI users suggests the potential both for novel diagnostic assessment batteries to explain poor performance, and also new rehabilitation strategies for patients who exhibit poor outcomes. Moreover, this broad array of factors determining outcome performance suggests the need to treat individual CI patients using a personalized rehabilitation approach.

*Department of Otolaryngology, The Ohio State University Wexner Medical Center, Ohio

Department of Psychological and Brain Sciences, Indiana University, Indiana

Address correspondence and reprint requests to Aaron C. Moberly, M.D., Division of Otology, Neurotology, & Cranial Base Surgery, 915 Olentangy River Road, Suite 4000, Columbus, OH 43212; E-mail:

Financial disclosures: Some of the findings reported in this manuscript arose from studies supported by R01 DC00111-36 and R01 DC009581-05 from the NIDCD (NIH) to David Pisoni.

The authors disclose no conflict of interest.

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