Limitations
This was an observational study and enrolment bias may be present in the sample. Investigators were instructed to offer participation to all consecutively implanted adult and adolescent Nucleus® implant recipients. However, recipients who were more motivated which may influence outcomes may have been more likely to agree to participate. As self-assessment was required, those with severe comorbidities and those who are unable to read were less likely to be included. Baseline evaluations were made between the day of the surgery and the first fitting, which may result in a recall bias.