User satisfaction with cochlear implant audio processors: population norms derived from a large-scale survey campaign.

Introduction: Cochlear implants (CIs) require an external audio processor (AP), which can impose responsibilities and challenges for the user. Monitoring user satisfaction is crucial to identify and address issues that may lead to reduced device usage. The audio processor satisfaction questionnaire (APSQ) was developed to measure user satisfaction across three subscales: user comfort, social life, and device usability. Methods: We analyzed 861 APSQ responses collected between 2019 and 2023 from CI users in Germany and the UK. Multivariable quantile and ordinal logistic regression models were used to examine factors associated with satisfaction and daily usage duration. Population norm values were established for the total score and subscales. Results: Median total APSQ scores were high (8.7/10). Males and users with single-sided deafness (SSD) reported slightly lower satisfaction. Off-the-ear (OTE) processors produced marginally higher usability ratings. Higher APSQ scores were strongly associated with longer daily CI usage. Each additional point on the total score was associated with 44% higher odds of using the CI at least 3 h longer per day. SSD and bimodal users showed higher odds of shorter use relative to bilateral CI users. Item-level comparisons indicated greater wearing comfort with glasses for OTE users and with headwear for behind-the-ear (BTE) users. Conclusion: CI user satisfaction, as measured by the APSQ, is generally high and is positively associated with daily usage duration. The APSQ is a valuable tool for monitoring user experience and identifying populations at risk of reduced CI use. The population norm values facilitate the interpretation of clinically acquired APSQ scores.