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The main problem of rehabilitation of unilateral conductive hearing loss (UCHL) with a hearing device or surgical repair is that the treated impaired ear has to compete with the normal hearing ear. Because of the impressive capacities of a normal hearing ear, rehabilitation results in a significant hearing asymmetry (20 -30 dB in children), and unilateral absence of spectral information processing. We review binaural hearing data as obtained after treatment in a population of subjects with congenital UCHL. Several measures addressing binaural hearing after treatment have been studied, e.g. directional hearing (detection of interaural time and level differences), binaural summation, binaural squelch and the effective use of head shadow. Whenever possible, binaural outcomes are compared with values obtained in normal hearing subjects, using the same tests. Included in this review are 11 papers, describing results in 169 subjects with treated unilateral aural atresia. Six papers presented binaural data gathered after atresia repair and five papers after application of either a percutaneous bone-conduction device (BCD), an active transcutaneous BCD, a passive transcutaneous BCD or an active middle ear implant. Binaural scores were collected and compared to norm values. Mean binaural scores are expressed, as z-scores; if z < 2 then the mean score falls within the normal range. Subjects with unilateral amplification do not perform as good as normal hearing listeners. It remains uncertain to conclude whether subjects with congenital UCHL have an equal chance for optimal rehabilitation compared to subjects with acquired UCHL. Subjects from the latter group can benefit from a maturated auditory system once they are aided. The congenital group might benefit from auditory system development while in the aided situation. When consistent amplification, although resulting in an asymmetrical input, is present during a certain critical period, it might result in better handling of the listening situation. [ABSTRACT FROM AUTHOR]

Traditionally, Auditory Rehabilitation is carried out with support from a Speech and Language Therapist, usually in a clinical centre. Training may be required to acquire optimal performance from a Cochlear Implant, for example, speech recognition in challenging situations such as distance, background noise, different speakers, telephone use, etc. In addition, sequential cochlear implantation and new indications, such as SSD or asymmetrical hearing loss, require intense and specific auditory training. Clinical studies of auditory plasticity following placement of Cochlear implants suggests that additional auditory training may be needed for reorganization of the brain to occur (1). Traditionally, this training has required an economic and time effort on the part of the patient, family or caregivers. The literature also emphasizes many reasons that support the importance of daily practice taking advantage of routine activities and in natural contexts (2). There are software programs designed for this purpose, but there may be barriers to access such as cost and technical equipment requirements, etc.(3) This paper will present one approach to empowering Cochlear Implant recipients to use the opportunities for listening practice and rehabilitation afforded by the Nucleus 7 sound processor and streaming with IOS devices. Options for using a range of different commercially available apps, many of them free, will be shared along with ideas for using data streaming, not always with a specific educational purpose, but through activities that can be more pleasant, engaging and entertaining for the patient such as listening to audiobooks, podcasts and other listening resources to build auditory experience and confidence. This paper will present options for using the N7 MFI processor for self-directed rehabilitation using streaming, to provide the patient with training possibilities tailored to his or her interests and needs, adapted to maximize and motivate their time availability; the incentive being the ability to select and design their own varied listening program. The key elements of how to support and motivate recipients to design their own listening program plus the options and how this has been applied in clinical practice as well as clinical examples and outcomes will be addressed. 1. Polonenko, Melissa Jane,Gordon, Karen Ann, Cushing, Sharon Lynn, Papsin, Blake Croll. Cortical organization restored by cochlear implantation in young children with single sided deafness. Scientific Reports. 04.12.2017. DOI:10.1038/s41598-017-17129-z 2. Lone Percy-Smith, Tenna Lindbjerg Tønning, Jane Lignel Josvassen, Jeanette Hølledig Mikkelsen, Lena Nissen, Eveline Dieleman, Maria Hallstrøm & Per Cayé-Thomasen. Auditory verbal habilitation is associated with improved outcome for children with cochlear implant. Cochlear Implants International Vol. 19, Iss. 1, 2018 3. Olson AD. Options for Auditory Training for Adults with Hearing Loss. Seminars in Hearing. 2015;36(4):284-295. doi:10.1055/s-0035-1564461. [ABSTRACT FROM AUTHOR]

In the past decade, numerous papers have published on variability in speech recognition in adults with a cochlear implant (CI). Many variables thought to influence the outcome of cochlear implantation have been investigated both in retrospective and prospective studies. In this study, we investigated different biographic, audiologic and electrode position related variables for their relation with speech recognition performance in both quiet and in noise. Participants were 134 adults with post-lingual onset of deafness, with Cochlear CI systems (either with a Contour Advanced or with a Slim Straight electrode) implanted at one single CI center. Biographic factors were: age, level of education and psychological screening questionnaires. Audiologic factors were: duration of hearing loss, and pre-implantation speech recognition scores. The electrode position was determined on a high-resolution CTscan post-implantation, using "Matlab" software. Electrode position variables were: electrode scalar position, electrode insertion angle and wrapping factor (electrode proximity to the modiolus). NVA-wordlists, (55 dB and 70 dB) were used to measure speech recognition scores in quiet at three time-points post-implantation: three months, 12 months and at the time of post-implantation CT-scan. Speech recognition scores in noise were assessed using the digits-innoise (DIN) test at 12 or more months post-implantation. To investigate the influence of biographic, audiologic and electrode position related variables of adult CI patients on speech perception performance in quiet and in noise, we used multivariate linear regression analysis. [ABSTRACT FROM AUTHOR]

Having access to the signals at the two ears is important for understanding speech in noisy conditions. One of the contributing mechanisms is better-ear glimpsing (BEG), which takes advantage of the fluctuating signal-to-noise ratios (SNRs) across ears. Even though the spatial benefit provided by bilateral (over unilateral) implantation has been studied widely, the benefit provided by BEG is still poorly understood. Therefore, speech comprehension performance was measured in ten bilateral CI users in a spatially-symmetric masker paradigm. Helen-like questions recorded with a female native English speaker were presented from a loudspeaker in front of the subject (0o) while two female speech distractors were presented either from loudspeakers at ±90o or co-located with the target questions. The subjects' task was to answer the questions. The combined distractor level was kept constant at 60 dBSPL and the level of the target questions was varied adaptively to obtain speech comprehension thresholds (SCTs), i.e., the SNR at which 50% of the questions were answered correctly. SCTs were measured unilaterally and bilaterally. The spatial benefit was calculated as the difference in SCTs between the spatially-separated and co-located condition for bilateral stimulation. The average benefit was 2 dB with individual results varying from -2 to 7 dB. The bilateral benefit was calculated as the difference in SCTs between bilateral and unilateral stimulation in the spatially- separated condition. The average bilateral benefit was 1.4 dB when compared to the better ear and 5.9 dB when compared to the worse ear. Individual results varied from -2.5 to 5 dB and 1.9 to 12.7 dB, respectively. Hence, bilateral CI users can benefit significantly from a second device in spatially-symmetric, fluctuating noise where neither of the ears receives a constant favorable SNR. Future research should further investigate the large inter-subject variability and further improve the observed benefits. [ABSTRACT FROM AUTHOR]