The Laryngoscope VC 2013 The American Laryngological, Rhinological and Otological Society, Inc. Does Cochlear Implantation Restore Music Appreciation? Gavriel Kohlberg, MD; Jaclyn B. Spitzer, PhD; Dean Mancuso, AuD; Anil K. Lalwani, MD BACKGROUND The cochlear implant (CI) restores hearing to deaf- ened individuals, allowing most CI users to reach an excellent level of speech discrimination, often to the point of being able to use a telephone. The increased ability to communicate afforded by cochlear implantation has been shown to have a significant positive effect on the quality of life of deafened individuals. 1 Does CI lead to similar restoration of ability to appreciate and con- sume music? LITERATURE REVIEW Despite high levels of speech understanding, CI users have poor perception of basic music elements, which has been thought to decrease their enjoyment of music. During the validation of the University of Wash- ington Clinical Assessment of Music Perception Test developed to quantify music perception, Kang et al. 2 examined pitch direction discrimination, melody recogni- tion, and timbre recognition in 42 postlingually deafened adult CI users and 10 normal hearing (NH) individuals. CI users had a mean pitch direction discrimination of three semitones compared to one semitone for NH indi- viduals. Melodies were recognized 25.1% of the time by CI users compared to 87.5% of the time in NH listeners. In a test of timbre recognition, CI users correctly identi- fied only 45.3% of musical instruments, whereas NH individuals did so at a 94.2% rate. There was a statisti- cally significant difference in performance between CI and NH listeners in each of these tests, with the NH lis- teners performing superiorly. Low resolution, poor tem- poral resolution, and skewed mapping of transmitted frequencies are thought to decrease music perception and thereby music enjoyment. Lassaletta et al. 3 surveyed 65 postlingually deaf- ened CI users about their listening habits and their per- ception of the quality of musical sound. Survey recipients were asked to compare their music listening habits before hearing loss to that after implantation. Prior to hearing loss, 68% of those in this study listened to 3 or more hours of music per week. After implanta- tion, 62% of the study participants listened to 2 hours or less of music per week, a statistically significant decrease in music listening time. Participants were also asked to describe themselves as someone who enjoyed music—from strongly disagree to strongly agree—before hearing loss and after implantation. Although there was a significant decrease in the level at which participants described themselves as enjoying music, 32% still enjoyed or strongly enjoyed music after implantation. Migirov et al. 4 surveyed 53 CI users about their lis- tening habits and enjoyment of music and demonstrated wide variation in music enjoyment in CI users. Overall, the survey respondents had a significantly decreased enjoyment of music from preimplantation to postimplan- tation. However, 73.6% of respondents still listened to music after implantation. Among those patients who still listened to music, there was only a small decrease in music enjoyment, from 7.92 to 7.56 on a 10-point enjoy- ment scale, whereas among those CI users who stopped listening to music, their enjoyment dropped from 8 to 1.93 out of 10. Among all survey respondents, music enjoyment ratings worsened in 50.9%, remained the same in 22.6%, and improved in 26.4%. Furthermore, 30.2% would have undergone implantation just for being able to listen to music. Of note, age at implantation, gen- der, duration of deafness, duration of CI use, type of CI device, speech coding strategy, or speech perception abil- ity were not significantly related to listening versus not listening to music after implantation. In particular, speech discrimination was actually better in the nonlis- teners than in those who listened to music after implan- tation—49.2 versus 43 on the Arthur Boothroyd monosyllabic word test. Mirza et al. 5 assessed music appreciation in CI users through a questionnaire survey. Of 35 respondents, 46% From the Columbia University Cochlear Implant Center, Depart- ment of Otolaryngology–Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A. Dr. Lalwani serves on the Medical Advisory Board of Advanced Bionics Corporation. The authors have no other funding, financial rela- tionships, or conflicts of interest to disclose. Send correspondence to Anil K. Lalwani, MD, Division of Otology, Neurotology and Skull Base Surgery, Department of Otolaryngology, Co- lumbia University College of Physicians and Surgeons, 180 Fort Wash- ington Avenue, Harkness Pavilion, 8th Floor, New York, NY 10032. E-mail: anil.lalwani@columbia.edu DOI: 10.1002/lary.24171 Laryngoscope 124: March 2014 Kohlberg et al.: Music Appreciation With CI 587