Cochlear Implants
by Parri Tantillo

Bringing Ease and Convenience to Bimodal Control

August 9, 2023
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Since 2011, Cochlear™ and ReSound have collaborated in the Smart Hearing Alliance to provide hearing solutions for people with all types of hearing loss. Whether the need is for hearing aids, hearing implants, or a combination of the two, our solutions work together seamlessly. Through the Smart Hearing Alliance, we are committed to improving bimodal hearing care in partnership with you. Our solutions are evidence-based and designed to help you effectively meet the changing needs of your patients over time.  

For many people, a bimodal hearing solution with a cochlear implant (CI) on one ear and a hearing aid (HA) on the other is the combination that provides them with their best hearing.1-7

Introducing bimodal control in the Nucleus® Smart App

Every day your bimodal patients are exposed to a range of different hearing environments. If they find themselves in a new environment and want to change their volume, program, or manage a True Wireless™ accessory, controlling two hearing devices requires careful attention to how their hearing devices are connected to and controlled by their Bluetooth® connected device. As a result, patients may choose to only adjust one hearing device.

To help your patients get the most out of their hearing in everyday moments, Cochlear has introduced bimodal control in the Nucleus Smart App. Bimodal control is designed to help your patients quickly and easily manage their compatible ReSound ONE™ or ReSound OMNIA™ hearing aid and compatible Cochlear Sound Processor* in the same app. When a patient chooses to set up bimodal control within the Nucleus Smart App, they will be able to make volume adjustments, change programs, and manage wireless accessories for both devices. Additional device features will continue to be available through the Nucleus Smart App and the ReSound Smart 3D™ app, including Find my Hearing Aid.

With bimodal control in the Nucleus Smart App, it’s never been easier or more convenient for your bimodal patients to make common adjustments to help achieve their best possible hearing experience.

Because when both the hearing aid and CI sound processor are delivering the best possible sound, known bimodal benefits are optimized.

Cochlear’s Bimodal Hearing Evidence Summary summarizes some key insights from research studies about the benefits of bimodal hearing solutions for adult CI users.

Bimodal hearing benefits for speech understanding in quiet and noise

The studies here show that for unilateral cochlear implant users with residual hearing in the non-implanted ear, access to these benefits is possible by fitting a hearing aid to that ear. In addition to hearing better in noise, bimodal hearing is also shown to improve the range and quality of the sound being heard.

  • Kelsall D, Lupo J, Biever A. Longitudinal outcomes of cochlear implantation and bimodal hearing in a large group of adults: A multicenter clinical study. 2021 Am J Otolaryngol. 2021 Jan-Feb; 42(1):102773. doi: 10.1016/j.amjoto.2020.102773 Epub 2020 Oct 22. PMID: 33161258.
  • Hoppe U, Hocke T, Digeser F. Bimodal benefit for cochlear implant listeners with different grades of hearing loss in the opposite ear. Acta Oto-Laryngol 2018, 138, 713–721.
  • Gifford RH, Dorman MF. Bimodal hearing or bilateral cochlear implants? Ask the patient. Ear Hear. 2019 ; 40(3): 501–516.

Bimodal hearing benefits for quality of life

The studies here assess quality of life outcomes using a variety of established self-report scales. They examine the overall well-being of participants in several health-domains including daily hearing function and its impact on everyday life. The evidence shows on average, statistically significant benefits for bimodal hearing users on quality-of-life measures compared to their daily listening condition when using one or two hearing aids or a cochlear implant alone.

  • Buchman CA, Herzog JA, McJunkin JL, et al. Assessment of speech understanding after cochlear implantation in adult hearing aid users: A nonrandomized controlled trial. JAMA Otolaryngol Head Neck Surg. Published online August 27, 2020. doi:10.1001/jamaoto.2020.1584.
  • Sanhueza I, Manrique-Huarte R, Calavia D, Huarte A, Manrique M. Hearing impairment and quality of life in adults with asymmetric hearing loss: Benefits of bimodal stimulation. J Int Adv Otol. 2019 Apr;15(1):62-69. doi: 10.5152/iao.2019.6224. PMID: 31058597; PMCID: PMC6483429.
  • Sladen DP, Carlson ML, Dowling BP, Olund AP, DeJong MD, Breneman A, Hollander S, Beatty CW, Neff BA, Driscoll CL. Cochlear implantation in adults with asymmetric hearing loss: Speech recognition in quiet and in noise, and health related quality of life. Otol Neurotol. 2018 Jun;39(5):576-581. doi: 10.1097/MAO.0000000000001763. PMID: 29683995.

Bimodal hearing delivers functional hearing benefits and improved satisfaction with daily hearing

The evidence shows that a significantly higher number of bimodal hearing users report being satisfied or very satisfied with their hearing ability during a variety of daily listening activities, compared to their satisfaction when using hearing aids. In addition to reduced listening fatigue, the studies below also demonstrated significant and clinically important improvements for hearing speech in daily life, quality of sound, and localization of sounds for bimodal hearing users, compared to when they used one or two hearing aids.

  • Plant K, van Hoesel R, McDermott H, Dawson P, Cowan R. Influence of contralateral acoustic hearing on adult bimodal outcomes after cochlear implantation. Int J Audiol. 2016 Aug;55(8):472-82. doi: 10.1080/14992027.2016.1178857. Epub 2016 May 23. PMID: 27216386.
  • Neuman AC, Waltzman SB, Shapiro WH, Neukam JD, Zeman AM, Svirsky MA. Self-Reported Usage, Functional Benefit, and Audiologic Characteristics of Cochlear Implant Patients Who Use a Contralateral Hearing Aid. Trends Hear. 2017 Jan;21:2331216517699530. doi: 10.1177/2331216517699530. PMID: 28351216; PMCID: PMC5435367.
  • Lupo JE, Biever A, Kelsall DC. Comprehensive hearing aid assessment in adults with bilateral severe-profound sensorineural hearing loss who present for Cochlear implant evaluation. Am J Otolaryngol. 2020 Mar-Apr;41(2):102300. doi: 10.1016/j.amjoto.2019.102300. Epub 2019 Sep 11. PMID: 31761407.

Bimodal hearing benefits from direct audio streaming

The studies here demonstrate the advantages of direct audio streaming for bimodal users when compared to using a cochlear implant alone. Results indicate wireless audio streaming accessories may offer further improvement in speech understanding in noisy situations when used with bimodal hearing compared to the cochlear implant alone. Performance with direct audio streaming of phone calls to bimodal devices was also shown to improve communication ability on the phone compared when using only an implant.

  • Vroegop JL, Dingemanse JG, Homans NC, Goedegebure A. Evaluation of a wireless remote microphone in bimodal cochlear implant recipients. Int J Audiol. 2017 Sep;56(9):643-649. doi: 10.1080/14992027.2017.1308565. Epub 2017 Apr 10. PMID: 28395552.
  • Wolfe J, Morais M, Schafer E. Speech recognition of bimodal cochlear implant recipients using a wireless audio streaming accessory for the telephone. Otol Neurotol. 2016 Feb;37(2):e20-5. doi: 10.1097/MAO.0000000000000903. PMID: 26756151.

Bimodal hearing benefits for sound localization

In these studies, the degree of binaural benefit for an individual in terms of sound localization is reported. The benefits obtained may be influenced by the level of hearing in each ear and the resulting degree of asymmetry between the ears.

  • Firszt JB, Reeder RM, Holden LK, Dwyer NY; Asymmetric hearing study team. Results in adult cochlear implant recipients with varied asymmetric hearing: A prospective longitudinal study of speech recognition, localization, and participant report. Ear Hear. 2018 Sep/Oct;39(5):845-862. doi: 10.1097/AUD.0000000000000548. PMID: 29373326; PMCID: PMC6103899.
  • Jang JH, Lee JH, Chang SO, Oh SH. Effect of aided hearing in the nonimplanted ear on bimodal hearing. Otol Neurotol. 2014;35: e270-6.

Bimodal hearing benefits for music appreciation

The studies below found that when listening to music, on average bimodal hearing users achieved better hearing performance when wideband frequency amplification was used in the hearing aid compared to narrower frequency bands. Furthermore, recognition of musical instruments was superior with bimodal configuration compared with using either a cochlear implant or hearing aid alone.

  • D’Onofrio KL and Gifford RH. Bimodal benefit for music perception: Effect of acoustic bandwidth. JSLH; 2021, 64: 1341–1353.
  • Duret S, Bigand E, Guigou C, Marty N, Lalitte P, Bozorg Grayeli A. Participation of Acoustic and Electric Hearing in Perceiving Musical Sounds. Front Neurosci. 2021 May 5;15:558421. doi: 10.3389/fnins.2021.558421. PMID: 34025335; PMCID: PMC8131516.
  • Shukor NFA, Lee J, Seo YJ, Han W. Efficacy of Music Training in Hearing Aid and Cochlear Implant Users: A Systematic Review and Meta-Analysis. Clin Exp Otorhinolaryngol. 2021 Feb;14(1):15-28. doi: 10.21053/ceo.2020.00101. Epub 2020 Jul 11. PMID: 32646208; PMCID: PMC7904420.

* For compatibility information and devices visit www.cochlear.com/compatibility and for more information regarding the compatibility of ReSound hearing aids, visit resound.com/compatibility

For more information regarding ReSound hearing aids, visit pro.resound.com.

The Bluetooth® word mark and logos are registered trademarks owned by Bluetooth SIG, Inc. and any use of such marks by Cochlear is under license.

The Cochlear Nucleus Smart App is available on App Store and Google Play. For compatibility information visitwww.cochlear.com/compatibility.

1. Farinetti A, Roman S, Mancini J, et al. Quality of life in bimodal hearing users (unilateral cochlear implants and contralateral hearing aids). Eur Arch Otorhinolaryngol (2015 Nov); 272, 3209–3215.

2. Ching TY, Incerti P, Hill M. Binaural benefi ts for adults who use hearing aids and cochlear implants in opposite ears. Ear Hear (2004 Feb); 25, 9–21.

3. Potts LG, Skinner MW, Litovsky RA., et al. Recognition and localization of speech by adult cochlear implant recipients wearing a digital hearing aid in the nonimplanted ear (bimodal hearing). J Am Acad Audiol (2009 Jun); 20, 353–373.

4. Morera C, Cavalle L, Manrique M, et al. Contralateral hearing aid use in cochlear implanted patients: Multicenter study of bimodal benefi t. Acta Otolaryngol (2012 Jun); 132, 1084–1094.

5. Giff ord RH, Dorman MF, McKarns SA, Spahr AJ. Combined electric and contralateral acoustic hearing: Word and sentence recognition with bimodal hearing. Journal of Speech, Language, and Hearing Research. (2007 Aug) 1;50(4):835-43.

6. Sucher CM, McDermott HJ. Bimodal stimulation: benefi ts for music perception and sound quality. Cochlear Implants International. (2009 Jan); 1;10(S1):96-9.

7. Buchman CA, Herzog JA, McJunkin JL, et al. Assessment of Speech Understanding After Cochlear Implantation in Adult Hearing Aid Users: A Nonrandomized Controlled Trial. JAMA Otolaryngol Head Neck Surg. Published online (2020 Aug). doi:10.1001/jamaoto.2020.1584

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baby with cochlear implant

Journal Club: Pediatric cochlear implant wear time and early language development

December 16, 2019

By Amy Donaldson, Professional Education Manager, Cochlear Americas

Gagnon, Erika B., Eskridge, Hannah, Brown, Kevin D.

Pediatric cochlear implant wear time and early language development

Sep 29, 2019:1-6

Cochlear Implants Journal

In today’s busy clinical environment, clinicians who value research-based practice often struggle to keep up with current literature.  To help, we’re excited to offer a new ProNews Blog monthly feature – Journal Club!  Each month, rotating guest authors will present a current journal article summary.

This month’s Journal Club explores a recent study by the team at the University of North Carolina published in September 2019, Pediatric Cochlear Implant Wear Time and Early Language Development. This article may be especially useful for those clinics working with pediatric recipients as a resource for counseling on device use.

What did the study investigate?

This study was designed to examine the relationship between device wear time in pediatric recipients and their language development. 

For children with hearing loss, consistent access to auditory information with either hearing aids or cochlear implants is associated with better speech and language development.1,2,3,4 Unfortunately, clinicians can’t always rely on parental report of device use – some studies have shown that they overestimate device use by an average of 2.6 hours per day.5 

Modern cochlear implant systems now have datalogging available to help clinicians objectively track device use, but it can be unclear how these results should be interpreted or what is the impact of differences in wearing time.  If a one-year-old uses their device seven hours per day, is that enough to provide access to spoken language?  What about the same use per day for a five-year-old?  This study attempted to answer these questions.

How did they do it?

The authors utilized datalogging in the Nucleus® sound processor and applied a measurement called “Hearing Hour Percentage” or HHP to track the amount of device use: 

HHP = total wear time/median awake time * 100

This measurement provides more information than just hours per day since it considers the waking hours of each day for children of different ages.  For example, according to the American Academy of Sleep Medicine6 the average median awake time for a one-year-old is 11.5 hours; for a five-year-old, it’s 12.5 hours.  That makes sense – younger children sleep more.  So seven hours of device use for the one-year-old is 61% of their awake day; but for the five-year-old, it is only 56%.  See table below:

Here are the key features of the study:

  • 37 children implanted prior to age 5
  • Average age of implantation: 1.97 years
  • Followed for the first year of device use
  • All using Nucleus 6 technology or later
  • Language tests: The Preschool Language Scale: Fifth Edition (PLS-5) or Oral and Written Language Scales: Second Edition (OWLS-II)

Results

The study found HHP of the 37 children ranged from 18% to 117% with an average of 63%.  More than half of the group achieved an HHP of over 60% by the end of their first year of device use.  This is interesting since many professionals would recommend device use during “all waking hours” but this study demonstrated that average usage of cochlear implants in children may only be about 60% of waking hours. 

The study found a positive correlation between HHP and receptive language abilities – the more recipients used their device, the better their receptive language – although the correlation was not significant for expressive language abilities.  This may have been because they only followed the children for one year after device use and expressive language development lags behind receptive language development.  Device use accounted for 40% of the variability in receptive language for the children confirming that while device use is important, it is still only one variable in outcomes for children.

Discussion

The results of this study support the importance of consistent device use for language development in children and highlight device datalogging as a critical tool in measuring progress.  The findings may also encourage professionals to consider how they counsel parents of young children who are using cochlear implants.  Combining datalogging with information about average awake time allows clinicians to determine the HHP for an individual child.  Counseling a parent to have their child use the device “all waking hours” may be helpful, but it might be even more useful to encourage use for a percentage of the child’s awake time and measure their progress by increasing that percentage. 

Pediatric clinicians encourage families to achieve “full time” device use.  This study helps define what that number should look like for children of different ages and gives parents and caregivers specific goals.  While datalogging can help clinicians track progress during clinic visits, Hearing Tracker is now available for parents to use between visits.  Hearing Tracker is available for the Nucleus 7 sound processor in the Nucleus Smart App, and is available in both iOS and Android™ devices. 

With Hearing Tracker, datalogging and device use information is not just available to clinicians but can be seen real-time by parents and caregivers, supporting device use and helping to support language development in children who use cochlear implants. 

Learn  more about this exciting clinical strategy by accessing the publication here and stay tuned for next month’s edition of Journal Club!

About our guest author:

Amy Donaldson is an Audiologist and Professional Education Manager for Cochlear Americas.  She received her Master’s Degree in Audiology from the State University of New York at Buffalo and her AuD from the University of Florida.  She was privileged to begin her career as a pediatric audiologist and gain extensive clinical experience in implantable hearing devices at the University of Michigan in Ann Arbor and at the Manchester Cochlear Implant Programme in the United Kingdom.  After working for several years as an Educational Audiologist and Technical Support Audiologist in the hearing aid industry, she returned to hearing implants and Cochlear in 2011. 

References:

  1. Weisman KB, Warner-Czyz AD (2018) Inconsistent device use in pediatric cochlear implant users; Prevalence and risk factors. Cochlear Implants International, 19, 131-141.
  2. Toblin, JB, Harrison, M, Ambrose, S, Walker EA, Oleson, JJ, Moeller MP. (2015) Language outcomes in young children with mild to severe hearing loss. Ear and Hearing, 36(Suppl 1):76S-91S.
  3. Easwar V, Sanfilippo J, Papsin, B, Gordon, K. (2018) Impact of consistency in daily device use on speech perception abilities in children with cochlear implants: datalogging evidence. Journal of the American Academy of Audiology, 29:835-846.
  4. Guerzoni L, Cuda D (2017) Speech processor datalogging helps in predicting early linguistic outcomes in implanted children. International Journal of Pediatric Otorhinolaryngology, 101:81-86.
  5. Walker EA, Spratford M, Moeller MP, Oleson J, Hua O, Roush P, Jacobs S. (2013) Predictors of hearing aid use time in children with mild-to-severe hearing loss. Language, Speech & Hearing Services in the Schools, 44(1):73-88.
  6. Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA et al (2016) Recommended amount of sleep for pediatric populations: A consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 12(6):785-786.

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Julia Drouin

Research spotlight with Dr. Julia Drouin: Leveraging Auditory Training to Optimize Cochlear Implant Adaptation

May 11, 2022

This Q&A with Dr. Julia Drouin, AuD, PhD, explores highlights from her related article, Leveraging interdisciplinary perspectives to optimize auditory training for cochlear implant users, to explore auditory training optimization for cochlear implant users.

What inspired you to research this topic?

As clinician-scientist, I have always been interested in research areas that bridge basic science with patient care. My early research examined the mechanisms that support adaptation to variation in speech input, which is something that all listeners encounter in everyday life. For example, consider the last time you had a conversation with someone who had an accent or dialectal difference; initially, you likely had to work a little harder to track what that individual was saying, but given enough exposure you’re able to comprehend the speech signal and follow the conversation without problem. A running theme in that line of research was that lexical context, or the word context in which you hear a sound, helps to drive the speech adaptation process.

While I was completing this research, I was in the clinic working with cochlear implant patients and observing tremendous variability in speech adaptation following implantation. Seeing the clinical need to improve patient outcomes drove my desire to merge basic research on speech learning with translational research to improve speech adaptation.

You take an interdisciplinary perspective to highlight the role of top-down lexical feedback on adaptation to atypical speech input – why is active auditory training important?

Active auditory training following cochlear implantation allows the reorganization of brain regions that are sensitive to spoken language. I think about auditory training as exercise for the brain; while receiving the cochlear implant is an important part of the process, learning to adapt to the newly transmitted acoustic signal takes time, effort and continuous practice.

Active auditory training integrates listening exercises from the lowest levels of sound processing (e.g., dissociating the difference between two different speech sounds) to higher levels of sound processing (e.g., putting together words to form a sentence). While many cochlear implant users adapt to their device passively, meaning without structured auditory training in place, it may be more time-consuming and effortful to learn to understand spoken language than engaging in auditory training immediately after implantation.  

How can auditory training be optimized in the rehabilitation process?

Optimizing the rehabilitation process for individuals with cochlear implants is a primary focus of my research program and an area of active investigation across the field. The ultimate goal is to maximize patient success with a hearing device and maximize spoken language comprehension early in the rehabilitation process. Auditory training is one of many clinical tools to support the rehabilitation process. We hope that our continued research helps to integrate custom recommendations to support individual patient needs.

Based on your research, what’s the relationship between the role of aural rehab and neuroplasticity?

Neuroplasticity is the mechanism that supports our brain’s ability to change as we learn. While our brains are flexible and change in response to experience, research has shown that age drives this process differently. Consider the last time you tried to learn a new language in adulthood – for most adults, learning a new language can be challenging and slow, whereas children seemingly pick up a new language quickly and with less effort. While both children and adults can learn new skills, children show heightened brain plasticity relative to adults. This has important implications for monitoring how quickly/efficiently a listener adapts to their cochlear implant during the aural rehabilitation process.

For listeners who are adapting to devices like cochlear implants, there’s a significant learning period because the auditory signal transmitted through a cochlear implant is markedly different than the auditory signal available to a normal-hearing listener. Because of this, auditory training can improve the process of learning to map the auditory signal onto speech meaning. The brain reorganizes in response to improved spoken language processing. An important note is that there is individual variability in how much auditory training is needed to observe significant speech comprehension improvements and it may be related to neuroplasticity differences.

Any key takeaways that professionals should know?

The aural rehabilitation process is a critical component of cochlear implantation. Auditory training implemented early in the rehabilitation process can help to support spoken language adaptation. Both children and adults can be good candidates to participate in auditory training during the rehabilitation process. Apps like Cochlear™ CoPilot can be a great tool for supporting spoken language processing after implantation.

Read more about auditory perception and training for adults with cochlear implants and read the CoPilot Evidence Summary here.

About the author:

Julia Drouin

Dr. Julia Drouin is an assistant professor at California State University Fullerton in the department of Communication Sciences and Disorders and faculty affiliate at the Center for Hearing Research at the University of California Irvine. She is the principal investigator of the Auditory Language Learning (ALLears) Laboratory.

She earned an Au.D. and Ph.D. from the University of Connecticut in 2020, with interdisciplinary training in the neurobiology of language. She completed her clinical residency at the Yale Hearing and Balance Center. Her research program examines how listeners adapt to the acoustic signal of speech, with emphasis on how listeners with hearing loss adapt to devices like cochlear implants.

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