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

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Abstract
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. Level of Evidence: 3.

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