Functional Benefits of Behind-the-Ear Processors Compared With Off-the-Ear Processors in Adult Cochlear Implant Users

Objective Cochlear implant (CI) devices are fitted with two external processor styles—a behind-the-ear (BTE) or an off-the-ear (OTE) option. Although previous research has predominantly focused on speech recognition abilities between processor styles, the current study aims to examine the potential real-world functional differences between processor types. Study Design Retrospective case-control, matched at a 1:2 ratio. Setting Tertiary Otolaryngology Referral Center. Patients Patients with bilateral sensorineural hearing loss Intervention Cochlear implantation Main Outcome Measures Cochlear Implant Quality of Life 35 Profile (CIQOL-35 Profile), and CNC word (CNCw) and AzBio sentence (quiet) recognition. Results A total of 36 patients were included (n = 12 OTE and n = 24 BTE users). The overall study population demonstrated improvements in CNCw ( d = 1.9 [1.3, 2.4]), AzBio sentences in quiet ( d = 2.1 [1.5, 2.6]), and medium-to-large effect sizes for domains of the CIQOL-35 ( d range: 0.5–0.9) after cochlear implantation. Between-group analysis demonstrated that BTE users performed better in CNCw ( d = 0.4 [−0.3, 1.1]) and AzBio quiet ( d = 0.5 [−0.2, 1.2]) than their OTE counterparts. However, there were minimal differences identified between processor types based on CIQOL domain and global scores ( d range: 0.04–0.2). Conclusion BTE users may have a better speech recognition ability than their OTE counterparts. However, CIQOL domain and global scores are comparable between the two processor types. A prospective, randomized controlled trial will be needed to address the limitations of a retrospective analysis.