Quicksin, Speech Perception, and Bi-CROS Use on Aidable Ears

What if QuickSin results on one ear show that while the loss is aidable, you need +30dB for any chance at speech perception in noise while the other ear is at +6dB? What if QuickSin results on one ear show that you may never be able to deliver speech perception in one ear, while the other aidable ear will manage with a decent hearing aid? Is there an argument against fitting an aid to the worst ear, or is there an argument for fitting a Bi-CROS system? These and other things are the things that spin through my head, you really don’t want to know about the other things in there. Even me and the voices are a little scared some times!

QuickSin Monaurally

The question first occurred to me recently when discussing the failure of the fitting of binaural hearing aids for some Patients with hearing losses that appeared to be eminently suitable for amplification. In the hypothetical case it was put forward that the Patient would get on better with just one hearing aid, fitted in the ear that they perceived to be better. The possibility of poor or no speech perception in one ear because of some unknown neuro cognitive difficulty could be the answer. Something that we could assess if QuickSin tests were undertaken monaurally giving us separate scores for each ear.

What if?

So my brain went on overdrive, as it is want to do sometimes, and worried at the problem. First I considered monaural fit, however, then I thought that perhaps a Bi-CROS fit would be a better option, allowing us to deliver a wider source of auditory data and delivering spatial awareness without the problems caused by direct amplification to the worse ear.

Auditory Deprivation

Here is the problem I see though, with what we know about auditory deprivation and the gathering evidence in relation to untreated hearing loss, is it cavalier or negligent of us not to deliver amplification to the worse ear? I would put forward that a well fit Bi-CROS will reduce the cognitive load needed to hear better, therefore may well meet the requirements. However, I am not sure and I don’t think we really can be until we know more about the connection between un-treated hearing loss and neuro cognitive disorders.

Does a happy Patient trump established thought?

Here is the kicker, if we fit the Patient with this type of presentation with a Bi-CROS and they get on exceptionally well, does that trump the established and scientifically validated fitting protocol? I have discussed this with a couple of people, now I would like to hear from you, let me know what you think?

About Geoffrey Cooling

my name is Geoffrey Cooling and I am the author here at Just Audiology Stuff. I have been involved in the Hearing Healthcare Profession for several years now. I initially worked as a Hearing Healthcare Professional for a large national retailer in Ireland. After several years in Practice I was approached to work for a manufacturer, where I was employed for five years. I am now the Co Founder of a business called Audiology Engine. We design websites, undertake content marketing and generally look after everything digital for audiological practices. I am also a contributor to many hearing profession periodicals and websites. I have written two commercially available books, The Little Book of Hearing Aids which is written for hearing aid consumers and Audiology Marketing in a Digital World which is written for Audiology Practice Owners. They are both available in Paperback and Kindle versions on Amazon. I also write for consumers on the website Hearing Aid Know, which is a website with the mission of demystifying hearing aids, their types and their technology. I have a great interest in commercial strategy as it applies to Healthcare in general and specifically to Hearing Healthcare. I also have a great interest in the psychology of sales and human interaction. I have been involved with social media for some time, both personally and professionally. I find the engagement and discourse on some social media channels fascinating. I instituted social media strategy for the company I worked for as an experiment. That experiment soon spread throughout the company and I am proud to say that the company is probably one of the most active in the industry. I would like to point out that all views, opinions and thoughts here are mine own. Unless of course they have been planted by the pod people, you just can’t take your eyes off the pod people. Those views do not necessarily reflect upon any views or opinions held by my employer, if I ever get another one. I think that our industry is in the middle of a time of huge change, I think that the change will be forced by both internal and external pressure. I think that private Independent Healthcare Practices will have to be smart and lithe of feet in order to meet these changes. I hope that some of my blatherings are of benefit to those Practices, Independent Hearing Healthcare Practices need to survive. I believe that if that occurs it will be of real benefit to Patients. I hope that I, and my writings will play a small part in their continued success.


  1. There is a piece of the puzzle which is missing, and one we also find in “bimodal” CI-HA fittings, as sometimes the aided speech perception goes *down* when the hearing aid is worn on the unimplanted ear. The missing piece of the puzzle is the aided speech perception in quiet in that ear, as that indicates whether the loss is purely sensorineural, or if there is neural firing dys-synchrony present, i.e. the speech is distorted or clear.

    Basically, BiCROS would be used if amplifying the bad ear causes the speech perception to drop.

    Part and parcel to this is determining if there are any cochlear dead zones, and also screening for ANSD by measuring ipsi acoustic reflex thresholds across the speech range.

    Dan Schwartz
    Editor, The Hearing Blog

  2. A really interesting proposal, Geoff! I would suggest that QuickSIN results should be combined with the ANL test for an even better understanding of why some hearing aid fittings, bilateral or unilateral, provide lower than expected benefit in noisier listening conditions. Even the results of both tests won’t improvement management in all cases but at least it informs decisions about the most appropriate technology/rehabilitation strategy to a much greater extent than reliance only on a pure-tone audiogram. Best regards, Barry

  3. Thank you both for your contributions

Let me know what you think