{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T15:02:34Z","timestamp":1775487754419,"version":"3.50.1"},"reference-count":49,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008626","name":"Cochlear Ltd.","doi-asserted-by":"publisher","award":["IIR-1934"],"award-info":[{"award-number":["IIR-1934"]}],"id":[{"id":"10.13039\/100008626","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Audiology Research"],"abstract":"<jats:p>Background\/Objectives: Cochlear implants (CIs) are a common treatment of severe-to-profound hearing loss and provide reasonable speech understanding, at least in quiet situations. However, their limited spectro-temporal resolution restricts sound quality, which is especially crucial for music appraisal. Many CI recipients wear a hearing aid (HA) on the non-implanted ear (bimodal users), which may enhance music perception by adding acoustic fine structure cues. Since it is unclear how the HA should be fitted in conjunction with the CI to achieve optimal benefit, this study aimed to systematically vary HA fitting parameters and assess their impact on music sound quality in bimodal users. Methods: Thirteen bimodal CI recipients participated in a listening experiment using a master hearing aid that allowed controlled manipulation of HA settings. Participants evaluated three music excerpts (pop with vocals, pop without vocals, classical) using the multiple-stimulus with hidden reference and anchor (MUSHRA) test. To assess the reliability of individual judgments, each participant repeated the test, and responses were analyzed with the eGauge method. Results: Most participants provided reliable and consistent sound quality ratings. Compared to a standard DSL v5.0 prescriptive fitting, modifications in compression settings and low-frequency gain significantly influenced perceived music quality. The effect of low-frequency gain adjustments was especially pronounced for pop music with vocals, indicating stimulus-dependent benefits. Conclusions: The study demonstrates that HA fitting for bimodal CI users can be optimized beyond standard prescriptive rules to enhance music sound quality by increasing low-frequency gain, particularly for vocal-rich pieces. Additionally, the testing method shows promise for clinical application, enabling individualized HA adjustments based on patient-specific listening preferences, hence fostering personalized audiology care.<\/jats:p>","DOI":"10.3390\/audiolres15060151","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T17:51:43Z","timestamp":1762451503000},"page":"151","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Music Sound Quality Assessment in Bimodal Cochlear Implant Users\u2014Toward Improved Hearing Aid Fitting"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8267-1846","authenticated-orcid":false,"given":"Khaled H. A.","family":"Abdellatif","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpenerstra\u00dfe 62, D-50937 Cologne, Germany"},{"name":"Jean-Uhrmacher-Institute for Clinical ENT-Research, University of Cologne, Geibelstr. 29-31, D-50931 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Horst","family":"Hessel","sequence":"additional","affiliation":[{"name":"Cochlear Deutschland GmbH & Co. KG, D-30539 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0116-6419","authenticated-orcid":false,"given":"Moritz","family":"W\u00e4chtler","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpenerstra\u00dfe 62, D-50937 Cologne, Germany"},{"name":"Jean-Uhrmacher-Institute for Clinical ENT-Research, University of Cologne, Geibelstr. 29-31, D-50931 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8758-6777","authenticated-orcid":false,"given":"Verena","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpenerstra\u00dfe 62, D-50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Walger","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpenerstra\u00dfe 62, D-50937 Cologne, Germany"},{"name":"Jean-Uhrmacher-Institute for Clinical ENT-Research, University of Cologne, Geibelstr. 29-31, D-50931 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1702-2268","authenticated-orcid":false,"given":"Hartmut","family":"Meister","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Kerpenerstra\u00dfe 62, D-50937 Cologne, Germany"},{"name":"Jean-Uhrmacher-Institute for Clinical ENT-Research, University of Cologne, Geibelstr. 29-31, D-50931 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.heares.2014.08.002","article-title":"The multi-channel cochlear implant: Multi-disciplinary development of electrical stimulation of the cochlea and the resulting clinical benefit","volume":"322","author":"Clark","year":"2015","journal-title":"Hear. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"23312165211072969","DOI":"10.1177\/23312165211072969","article-title":"Listening to music through hearing aids: Potential lessons for cochlear implants","volume":"26","author":"Moore","year":"2022","journal-title":"Trends Hear."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1121\/1.1381538","article-title":"Speech recognition in noise as a function of the number of spectral channels: Comparison of acoustic hearing and cochlear implants","volume":"110","author":"Friesen","year":"2001","journal-title":"J. Acoust. Soc. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1097\/01.moo.0000134452.24819.c0","article-title":"How cochlear implants encode speech","volume":"12","author":"Rubinstein","year":"2004","journal-title":"Curr. Opin. Otolaryngol. Head Neck Surg."},{"key":"ref_5","first-page":"1","article-title":"Editorial: Cochlear implants and music","volume":"28","author":"Vickers","year":"2004","journal-title":"Trends Hear."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/AUD.0000000000001580","article-title":"Music perception and music-related quality of life in adult cochlear implant users: Exploring the need for music rehabilitation","volume":"46","author":"Akbulut","year":"2025","journal-title":"Ear Hear."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"10430","DOI":"10.1073\/pnas.1301228110","article-title":"From perception to pleasure: Music and its neural substrates","volume":"110","author":"Zatorre","year":"2013","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1177\/108471380400800203","article-title":"Music perception with cochlear implants: A review","volume":"8","author":"McDermott","year":"2004","journal-title":"Trends Amplif."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.ics.2004.08.038","article-title":"Pitch discrimination and melody recognition by cochlear implant users","volume":"1273","author":"Looi","year":"2004","journal-title":"Int. Congr. Ser."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/00003446-199706000-00008","article-title":"Perception of rhythmic and sequential pitch patterns by normally hearing adults and adult cochlear implant users","volume":"18","author":"Gfeller","year":"1997","journal-title":"Ear Hear."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/000348940211100412","article-title":"Effects of frequency, instrumental family, and cochlear implant type on timbre recognition and appraisal","volume":"111","author":"Gfeller","year":"2002","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1177\/108471380300700402","article-title":"Hearing aid satisfaction: What does research from the past 20 years say?","volume":"7","author":"Wong","year":"2003","journal-title":"Trends Amplif."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/14670100.2021.1948716","article-title":"Self-reported music perception is related to quality of life and self-reported hearing abilities in cochlear implant users","volume":"23","author":"Fuller","year":"2022","journal-title":"Cochlear Implant. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/AUD.0000000000001423","article-title":"Comparison of tonotopic and default frequency fitting for speech understanding in noise in new cochlear implantees: A prospective, randomized, double-blind, cross-over study","volume":"45","author":"Creff","year":"2024","journal-title":"Ear Hear."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e240","DOI":"10.1097\/MAO.0000000000000529","article-title":"Evaluation of the bimodal benefit in a large cohort of cochlear implant subjects using a contralateral hearing aid","volume":"35","author":"Illg","year":"2014","journal-title":"Otol. Neurotol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1002\/cii.398","article-title":"Bimodal stimulation: Benefits for music perception and sound quality","volume":"10","author":"Sucher","year":"2009","journal-title":"Cochlear Implant. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1177\/108471380500900403","article-title":"The Desired Sensation Level multistage input\/output algorithm","volume":"9","author":"Scollie","year":"2005","journal-title":"Trends Amplif."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.4081\/audiores.2011.e24","article-title":"The NAL-NL2 prescription procedure","volume":"1","author":"Keidser","year":"2011","journal-title":"Audiol. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1044\/2018_AJA-18-0067","article-title":"Comparing the effect of different hearing aid fitting methods in bimodal cochlear implant users","volume":"28","author":"Vroegop","year":"2019","journal-title":"Am. J. Audiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.3109\/00016489.2014.914244","article-title":"Exploring the clinical approach to the bimodal fitting of hearing aids and cochlear implants: Results of an international survey","volume":"134","author":"Scherf","year":"2014","journal-title":"Acta Oto-Laryngol."},{"key":"ref_21","first-page":"58","article-title":"Fitting and evaluating a hearing aid for recipients of a unilateral cochlear implant: The NAL approach, part 1. Hearing aid prescription, adjustment, and evaluation","volume":"14","author":"Ching","year":"2004","journal-title":"Hear. Rev."},{"key":"ref_22","first-page":"618","article-title":"The master hearing aid: A PC-based platform for algorithm development and evaluation","volume":"92","author":"Grimm","year":"2006","journal-title":"Acta Acust. United Acust."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1159\/000206491","article-title":"How much residual hearing is \u2018useful\u2019 for music perception with cochlear implants?","volume":"14","author":"James","year":"2009","journal-title":"Audiol. Neurootol."},{"key":"ref_24","unstructured":"Lartillot, O., and Toiviainen, P. (2007, January 10\u201315). A MATLAB toolbox for musical feature extraction from audio. Proceedings of the 10th International Conference on Digital Audio Effects (DAFx-07), Bordeaux, France."},{"key":"ref_25","unstructured":"(2014). Method for the Subjective Assessment of Intermediate Quality Level of Audio Systems (Standard No. ITU-R BS.1534-2). BS Series, Broadcasting Service (Sound)."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/AUD.0000000000000771","article-title":"Music is more enjoyable with two ears, even if one of them receives a degraded signal provided by a cochlear implant","volume":"41","author":"Landsberger","year":"2020","journal-title":"Ear Hear."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1121\/1.4908235","article-title":"Factors limiting vocal-tract length discrimination in cochlear implant simulations","volume":"137","author":"Gaudrain","year":"2015","journal-title":"J. Acoust. Soc. Am."},{"key":"ref_28","unstructured":"Gaudrain, E. (2019, June 18). Vocoder, v1.0. Online Code. Available online: https:\/\/github.com\/egaudrain\/vocoder."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2592","DOI":"10.1121\/1.399052","article-title":"A cochlear frequency-position function for several species\u201429 years later","volume":"87","author":"Greenwood","year":"1990","journal-title":"J. Acoust. Soc. Am."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S92","DOI":"10.1080\/14992027.2016.1220680","article-title":"Modifications of the MUlti Stimulus test with Hidden Reference and Anchor (MUSHRA) for use in audiology","volume":"57","author":"Bisitz","year":"2018","journal-title":"Int. J. Audiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2331216516669329","DOI":"10.1177\/2331216516669329","article-title":"Perception of sung speech in bimodal cochlear implant users","volume":"20","author":"Crew","year":"2016","journal-title":"Trends Hear."},{"key":"ref_32","unstructured":"Ewert, S.D. (2013, January 18\u201321). AFC\u2014A modular framework for running psychoacoustic experiments and computational perception models. Proceedings of the AIA-DAGA 2013 International Conference on Acoustics, Merano, Italy."},{"key":"ref_33","unstructured":"Lorho, G., Le Ray, G., and Zacharov, N. (2010). eGauge\u2014A measure of assessor expertise in audio quality evaluations. Int. Conf., 191\u2013200. Available online: https:\/\/www.researchgate.net\/publication\/287636913_eGauge_-_A_measure_of_assessor_expertise_in_audio_quality_evaluations."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/0950-3293(95)00025-9","article-title":"The role of permutation tests in exploratory multivariate data analysis","volume":"6","author":"Dijksterhuis","year":"1995","journal-title":"Food Qual. Prefer."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1177\/0194599818760559","article-title":"Music appreciation after cochlear implantation in adult patients: A systematic review","volume":"158","author":"Riley","year":"2018","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1097\/AUD.0000000000000170","article-title":"Musical sound quality in cochlear implant users: A comparison in bass frequency perception between fine structure processing and high-definition continuous interleaved sampling strategies","volume":"36","author":"Roy","year":"2015","journal-title":"Ear Hear."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.anl.2021.07.002","article-title":"Temporal coding and music perception in bimodal listeners","volume":"49","author":"Ballantyne","year":"2022","journal-title":"Auris Nasus Larynx"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1159\/000095607","article-title":"An overview of binaural advantages for children and adults who use binaural\/bimodal hearing devices","volume":"11","author":"Ching","year":"2006","journal-title":"Audiol. Neurootol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1097\/AUD.0b013e31829d14cb","article-title":"Psychophysics, fitting, and signal processing for combined hearing aid and cochlear implant stimulation","volume":"34","author":"Francart","year":"2013","journal-title":"Ear Hear."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1097\/AUD.0000000000001145","article-title":"Cochlear implant compression optimization for musical sound quality in MED-EL users","volume":"43","author":"Gilbert","year":"2022","journal-title":"Ear Hear."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2331216516630549","DOI":"10.1177\/2331216516630549","article-title":"Dynamic range across music genres and the perception of dynamic compression in hearing-impaired listeners","volume":"20","author":"Kirchberger","year":"2016","journal-title":"Trends Hear."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1177\/1084713812465493","article-title":"Musical sound quality impairments in cochlear implant users as a function of limited high-frequency perception","volume":"16","author":"Roy","year":"2012","journal-title":"Trends Amplif."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1179\/1754762813Y.0000000037","article-title":"Effects of various electrode configurations on music perception, intonation and speaker gender identification","volume":"15","author":"Landwehr","year":"2014","journal-title":"Cochlear Implants Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"23312165221120017","DOI":"10.1177\/23312165221120017","article-title":"Effect of frequency response manipulations on musical sound quality for cochlear implant users","volume":"26","author":"Mo","year":"2022","journal-title":"Trends Hear."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"120","DOI":"10.3766\/jaaa.19.2.3","article-title":"Multivariate predictors of music perception and appraisal by adult cochlear implant users","volume":"19","author":"Gfeller","year":"2008","journal-title":"J. Am. Acad. Audiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"294","DOI":"10.3109\/14992027.2013.873955","article-title":"Music mixing preferences of cochlear implant recipients: A pilot study","volume":"53","author":"Buyens","year":"2014","journal-title":"Int. J. Audiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1002\/lary.30324","article-title":"The impact of vocal boost manipulations on musical sound quality for cochlear implant users","volume":"133","author":"Limb","year":"2023","journal-title":"Laryngoscope"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2331216521989900","DOI":"10.1177\/2331216521989900","article-title":"Perceived sound quality dimensions influencing frequency-gain shaping preferences for hearing aid-amplified speech and music","volume":"25","author":"Vaisberg","year":"2021","journal-title":"Trends Hear."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"23312165251368669","DOI":"10.1177\/23312165251368669","article-title":"Perception of recorded music with hearing aids: Compression differentially affects musical scene analysis and musical sound quality","volume":"29","author":"Hake","year":"2025","journal-title":"Trends Hear."}],"container-title":["Audiology Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4349\/15\/6\/151\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T05:15:51Z","timestamp":1762578951000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4349\/15\/6\/151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":49,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["audiolres15060151"],"URL":"https:\/\/doi.org\/10.3390\/audiolres15060151","relation":{},"ISSN":["2039-4349"],"issn-type":[{"value":"2039-4349","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,6]]}}}