## 4 Discussion
In the SNHL group, only one individual had an abnormal result (type C), showing normal peak compensated admittance (\(\Upsilon_{\text{tm}}\)) with negative tympanometry peak pressure in both the implanted (\(-64\) daPa) and non-implanted (\(-97\) daPa) ears (see Table 2 for full details). Thus, in our study, standard tympanometry was unlikely to be sensitive to the effect of the implantation. Several limitations of our study should be mentioned. The electrodes implanted in the participants differed in design and mass. The time from implantation ranged over 16 years, and the post-implantation process, such as fibrosis or ossification, could be progressive with time. Due to the small sample size, we did not perform subgroup analyses according to the model of the implanted electrode arrays, the etiology of SNHL, or the time from implantation. Other limitations of the current study might include the differences in age of our participants. Most of our participants with normal hearing were young, while in the SNHL participants with or without cochlear implants, age varied between young adults (6 ears), middle-aged adults (14 ears), and older adults (14 ears). Age can be associated with changes in the function and size of the external and middle ear and was found in older adults to be associated with WBT findings [51; 52; 53; 54]. The reduced absorbance near 4000 Hz might have been affected by age differences between the normal-hearing and impaired-hearing implanted and non-implanted groups. Further studies with age-matched controls are required to elucidate the association between SNHL and WBT. In conclusion, cochlear implantation can affect middle- and inner-ear mechanics and absorbance patterns in WBT. Based on our study design and the use of two control groups--hearing-impaired non-implanted ears and normal-hearing ears--we propose that a lower significant absorbance at 400-800 Hz and higher absorbance at 1600 Hz are secondary to implantation. Lower absorbance at high frequencies (4000-5000 Hz) can be associated with aging or SNHL. Future research should compare age-matched groups of individuals who have SNHL and a group of normal-hearing individuals to see if there are any differences between the WBT results. Preferably, this should be undertaken for different age groups and different types of hearing loss. The introduction of a non-invasive, quick tool, such as WBT, for detecting the impacts of SNHL with and without cochlear implantation might highlight changes that are overlooked by the standard techniques with important research and clinical implications. Moreover, future research can assess whether the alterations found by WBT could have any correlation with the performance with the CI. Conceptualization, J.A. ; Data curation, C.E., B.W., J.L., E.D., O.Z. and O.H. ; Formal analysis, N.S. ; Investigation, J.A., N.S. and C.E. Methodology, J.A., N.S. and C.E. ; Writing--original draft, J.A. ; Writing--review & editing, J.A., N.S., C.E. and O.H. All authors have read and agreed to the published version of the manuscript. This research received no external funding. Not applicable. The data presented in this study are available on request from the authors. The research project started at the University of Haifa, Israel, and was continued and conducted in the middle ear lab at the University of British Columbia as a part of [PERSON]'s MSc thesis under the supervision of [PERSON] and [PERSON]. [PERSON] and [PERSON] were the surgeons involved in the cochlear implantation of the participants in Canada. [PERSON] was a consultant and reviewer of this project. [PERSON] was the surgeon who was involved in recruiting adults after cochlear implantations in Israel. [PERSON] contributed to the preparation and editing of the manuscript. We thank Interacoustics(r) and Diatec Canada for providing technical support and software and hardware upgrades. The authors declare no conflict of interest.