Effects of Multimodal Acoustic Therapy for Children With Cochlear Implants: A Randomized Clinical Trial

Purpose: The aim of this study was to evaluate the efficacy of a smartphone-based rehabilitation method, Multimodal Acoustic Therapy (MAT), integrating linguistic and nonlinguistic auditory training in improving hearing outcomes in cochlear implant (CI) users. Method: A double-blind, active-controlled randomized clinical trial was conducted at Seoul National University Hospital, South Korea. Thirty-three CI users aged 8–20 years with over 2 years of device use were randomized to MAT or control groups. Participants underwent 8 weeks of home-based training using a smartphone-based digital therapeutic. The MAT group received structured training designed to improve frequency and phoneme discrimination using both linguistic stimuli and nonlinguistic auditory stimuli with auditory–visual feedback. The control group listened to a curated playlist of various music genres through a smartphone application. The primary outcome was a change in melodic contour identification score for music perception. Secondary outcomes were changes in consonant, vowel, and monosyllabic word tests for speech perception. Outcomes were compared at baseline and after 8 weeks of training. Results: Of 33 randomized participants, 28 completed the trial (MAT, n = 13; control, n = 15). Compared with the control group, the MAT group demonstrated greater improvements in melodic contour identification (mean change = +11.5 percentage points, 95% CI [+3.6, +19.4] vs. +0.1 percentage points, 95% CI [−2.8, +3.0]; p = .010) and consonant identification (+14.1 percentage points [+8.0, +20.2] vs. +5.9 percentage points [+2.3, +9.5]; p = .028). Vowel identification (median change = +7.1 percentage points, interquartile range [IQR, 0, +7.1]) and monosyllabic word recognition (median change = +5.6 percentage points, IQR [0, +11.1]) also showed significant gains in the MAT group ( p = .016 and p = .007, respectively), whereas the control group showed minimal or no ( p = .831 and p = .114, respectively) improvement. Conclusions: MAT improved hearing outcomes in experienced pediatric and adolescent CI users. These findings support the use of digital therapeutics as a feasible and practical approach to auditory rehabilitation. Supplemental Material: https://doi.org/10.23641/asha.32129725