Unilateral Auditory Performance Before and After Bilateral Sequential Cochlear Implantation *Stanley Pelosi, *George B. Wanna, †Rene H. Gifford, †Allyson Sisler-Dinwiddie, ‡Gabriela P. Bom Braga, *Marc L. Bennett, *Robert F. Labadie, *Alejandro Rivas, and *David S. Haynes *Department of Otolaryngology, and ÞDepartment of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.; and þUniversidade de Sa ˜o Paulo, Sa ˜o Paulo, Brazil Objective: The relationship between unilateral preimplantation and postimplantation auditory performance in patients undergo- ing sequential cochlear implantation (SCI) has not been clearly defined. A greater understanding of this relationship could affect preoperative counseling to patients regarding choice of initial side to implant. Study Design: Retrospective case series. Setting: Tertiary otologic practice. Patients: Adult/pediatric SCI recipients. Outcome Measures: Unilateral auditory performance preim- plantation and postimplantation was assessed. To compare inter- aural preimplantation performance, we defined a ‘‘better-hearing ear’’ as better pure tone average or speech awareness/reception threshold by at least 10 dB or open/closed-set speech perception score at least 10 percentage points higher. Results: Ninety patients underwent SCI from 1997 to 2011; 34 children and 22 adults with at least 6 months of bilat- eral implant use underwent further analysis. Preoperatively, the first-implanted ear was better hearing in 6 cases, poorer hearing in 15 cases, and equal hearing in 35 individuals. The propor- tion of SCI recipients exhibiting better long-term performance of the first-implanted ear was not significantly different from the proportion exhibiting equal or better performance of the second-implanted ear ( p = 0.79, W 2 ), irrespective of preoperative hearing status. The first-implanted ear exhibited better closed/ open-set speech perception scores in 41% (9/22) adult and 59% (20/34) pediatric patients at a mean most recent test point of 25 and 39 months, respectively. Conclusion: Preimplantation unilateral hearing status was not found to influence relative interaural performance differences after SCI. This finding highlights the relative unimportance of preoperative audiometry and speech recognition scores for guiding clinical decisions regarding implant ear selection. Key Words: Auditory performanceVSequential cochlear implantationVSpeech perceptionVUnilateral hearing. Otol Neurotol 34:1642Y1647, 2013. Several factors influence auditory performance after cochlear implantation (CI). Duration of deafness, age at implantation, level of residual hearing, and prior hearing aid use have all been associated with post-CI outcomes (1Y4). Of these variables, duration of deafness has consis- tently been shown to have the strongest relationship with postimplantation speech perception testing scores (1,3). The influence of unilateral hearing status of the im- planted ear on post-CI auditory performance is the sub- ject of considerable discussion. Current literature suggests a strong role for central auditory pathways in influencing speech perception outcomes after CI, deemphasizing the relative importance of unilateral peripheral auditory func- tion (5Y7). Several reports have demonstrated no signifi- cant differences in postoperative auditory performance between patients who underwent CI in their better- or poorer-hearing ear (5,6). Even for patients with unilateral long-term auditory deprivation in one ear, it has been shown that implantation of the deprived ear will yield similar post-CI auditory performance as the better ear if combined with a contralateral hearing aid (7). A common theme to all of these studies is that the combined level Address correspondence and reprint requests to Stanley Pelosi, M.D., Department of OtolaryngologyYHead and Neck Surgery Vanderbilt University Medical Center, 7209 Medical Center East-South Tower, 1215 21st Avenue, South Nashville, TN 37232; E-mail: stanley.pelosi@ vanderbilt.edu Conflict of interest: D. S. H., Advisory Board for Cochlear, Advanced Bionics, Anspach; Consultant for Grace Medical; R. F. L., Advisory Board for Med-El, Ototronix; Consultant for Cochlear IRB approval number: 111625; Principal investigator S. P. No outside funding was provided for this project. The material in this article has not been submitted for publication and is not under consideration for publication in another journal. Otology & Neurotology 34:1642Y1647 Ó 2013, Otology & Neurotology, Inc. 1642 Copyright © 2013 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.