Cochlear Implant Qualification in Noise Versus Quiet: Do Patients Demonstrate Similar Postoperative Benefits?

Abstract Objective To assess patient factors, audiometric performance, and patient‐reported outcomes in cochlear implant (CI) patients who would not have qualified with in‐quiet testing alone. Study Design Retrospective chart review. Setting Tertiary referral center. Methods Adult CI recipients implanted between 2012 and 2022 were identified. Patients with preoperative AzBio Quiet > 60% in the implanted ear, requiring multitalker babble to qualify, comprised the in‐noise qualifying (NQ) group. NQ postoperative performance was compared with the in‐quiet qualifying (QQ) group using CNC, AzBio Quiet, and AzBio +5 dB signal‐to‐noise ratio. Speech, Spatial and Qualities of Hearing Scale (SSQ), Cochlear Implant Quality of Life scale (CIQOL‐10), and daily device usage were also compared between the groups. Results The QQ group (n = 771) and NQ group (n = 67) were similar in age and hearing loss duration. NQ had higher average preoperative and postoperative speech recognition scores. A larger proportion of QQ saw significant improvement in CNC and AzBio Quiet scores in the CI‐only listening condition (eg, CI‐only AzBio Quiet: 88% QQ vs 51% NQ, P < .001). Improvement in CI‐only AzBio +5 dB and in all open set testing in the best‐aided binaural listening condition was similar between groups (eg, Binaural AzBio Quiet 73% QQ vs 59% NQ, P = .345). Postoperative SSQ ratings, CIQOL scores, and device usage were also equivalent between both groups. Conclusion Patients who require in‐noise testing to meet CI candidacy demonstrate similar improvements in best‐aided speech perception and patient‐reported outcomes as in‐QQ, supporting the use of in‐noise testing to determine CI qualification for borderline CI candidates.