Musical Sound Quality Perception of Low‐Frequency Degradation Across Hearing‐Assistive Devices

OBJECTIVES: To compare low-frequency-degraded musical sound quality perception between users of different hearing-assistive devices. METHODS: Fifty-two adults including 11 normal-hearing (NH) listeners, eight bilateral hearing aid users (HAHA), 17 bimodal users (CIHA), and 16 bilateral cochlear implant users (CICI) were recruited for a cross-sectional observational study. Participants assessed the sound quality of 3-s-long musical segments (15 sets) using the CI-Multiple Stimulus with Hidden Reference and Anchor test. Subjects rated and ranked a hidden Reference ("best"); three high-pass filtered (HPF) versions with low-frequency cutoffs at 200, 400, and 800 Hz; and an anchor (most degraded version). ART ANOVA with post hoc comparisons was conducted to identify between-group differences in average perceived sound quality ratings for each stimulus version. RESULTS: Both cohort and degree of low-frequency degradation had significant effects and interaction on sound quality perception (p < 0.001). HAHA users rated sound quality higher than both CIHA and CICI users for the 200 and 400 Hz HPF conditions (p < 0.001), while CIHA and CICI performed similarly. No difference was seen at 800 Hz HPF, suggesting all three hearing-impaired groups were similarly affected when low-frequency degradation was severe. Additionally, HAHA, CIHA, and CICI all had difficulty identifying the Reference and correctly ordering stimuli compared to NH. CONCLUSION: HAHA users exhibit superior sensitivity to low-frequency sound degradation (≤ 400 Hz) than CI users. These findings elucidate low-frequency perception limitations as a contributing factor to diminished CI-mediated musical sound quality and provide evidence for preoperative counseling of implant candidates regarding their postoperative music-listening experience.