The Role of Hearing Preservation on Electrical Thresholds and Speech Performances in Cochlear Implantation Alessandra D’Elia, Roberto Bartoli, Francesca Giagnotti, and Nicola Quaranta Otolaryngology Department, Section of Otologic and Neurotologic Surgery, University of Bari, Bari, Italy Objective: The purpose of this study was to verify if the pre- servation of residual hearing after cochlear implantation in classic adult cochlear implant candidates implanted with a perimodiolar electrode correlates with the electric thresholds and with speech perception measures. Study Design: Retrospective study. Setting: Cochlear Implant Center at a tertiary referral University Hospital. Patients: Forty-one patients with cochlear implant were involved in our study. They were subdivided into 2 groups according to the average preoperative hearing loss at the frequencies of 125 and 250 Hz (low-frequency pure tone average [LFPTA]). Group A included 21 patients with a mean LFPTA of 90 dB HL or lower; group B included 20 patients with a mean LFPTA of greater than 90 dB HL. They underwent 12 months’ follow-up after cochlear implantation, including standard audiologic investigation, speech discrimination tests, and electrical measurements. Results: No significant differences were found in speech per- ception tests among groups. In group A, hearing was preserved in 8 (group A1) and was lost in 13 patients (group A2); the postoperative LFPTA was significantly better ( p G 0.0001) in A1. Group A1 patients present significantly higher C values ( p G 0.0001) than the other 2 groups, and the dynamic range was therefore significantly wider ( p G 0.001). Conclusion: Preservation of residual hearing should be at- tempted in all cases. In fact, although effects on the speech perception are not evident with the standard evaluation, lar- ger electrical dynamic range can be achieved and may repre- sent a sign of cochlear ‘‘well-being,’’ potentially allowing a more complex electric stimulation of the nerve. Key Words: Electrical thresholdsVHearing preservationVLow-frequency residual hearingVSpeech performances. Otol Neurotol 33:343Y347, 2012. Candidacy criteria for cochlear implantation have evolved from including only patients with profound hearing loss to incorporating patients with more residual hearing. The rationale for including these patients stands on the better auditory perception with a cochlear implant (CI) com- pared with hearing aids (1). Since the description of a ‘‘soft’’ surgical technique aimed at the preservation of residual hearing (2), there has been a growing interest among audiologist in the outcomes for people with cochlear implants in terms of postoperative residual hearing and its influence on speech discrimination results (3,4). The preservation of residual hearing is, in fact, becoming a high priority for the CI surgeon because recent studies have confirmed that it can be achieved, minimizing surgi- cal trauma, in 50% of cases (3). In addition, the possibil- ity to maintain preoperative hearing has allowed a new treatment, namely, electric-acoustic stimulation (EAS) for patients with severe-to-profound high-frequency hearing loss but considerable remaining low-frequency hearing (5). EAS combines the electrical stimulation of the cochlear basal end with the acoustic stimulation of the low fre- quencies; EAS has been shown to confer advantages, such as better speech understanding, especially in the presence of background noise (3,6,7), and better music appreciation (8,9). However, EAS is indicated only in a restricted num- ber of patients, whereas the majority of CI candidates still present with a severe-to-profound HL and a poor low- frequency hearing. The question whether it is useful to preserve hearing residuals and, therefore, to use ‘‘soft’’ surgical techniques also in traditional CI candidates has been recently addressed by Balkany et al. (10). Although, in case of profound hearing loss, low-frequency hearing Address correspondence and reprint requests to Nicola Quaranta, M.D., Clinica Otorinolaringoiatrica ‘‘G. Lugli’’, Microchirurgia Otolo- gica e Otoneurologica, Policlinico di Bari, P.zza G. Cesare 11, 70124 Bari, Italy; E-mail: nicola.quaranta@orl.uniba.it The authors disclose no conflicts of interest. Otology & Neurotology 33:343Y347 Ó 2012, Otology & Neurotology, Inc. 343 Copyright © 2012 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.