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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]

Objectives: Main aim of the cochlear implantation in congenital or acquired total and partial deafness is provision of development of hearing, speech and communicaton skills. Excellent results of rehabilitation in a group of implanted patients made the development of artistic skills of patients a measure of progress in therapy. Results of active and passive music therapy indicate that children rehabilitated with music have accelerated auditory development have as well as developed their cognition. The best results were obtained in patients rehabilitated with active music therapy (systematic music training. Aim of this paper is to present a study of implanted patients whose hearing development was supported with acvtive and passive music therapy. Material and methods: Material includes a group of CI patients presenting musical skills. All patients were operated according to the 6 step Skarzynski's precedure. Patients using active and passive music therapy accelerated the process of hearing rehabilitation. In addition, they have developed other skills, including linguistic, communication, cognitive and general development skills. Results and conclusions: In all operated patients, the standard- shaped, and personalized post-operative rehabilitation program was supplemented with musical activities. Inclusion of musical activities contributed to the intensification of the rehabilitation program and quick acquisition of auditory, linguistic and additionally musical skills. At the same time, in the group of teenage and adult patients, the positive influence of music contributed to the reduction or elimination of tinnitus. Results: Supplementing the traditional post-operative rehabilitation program after cochlear implantation in various types of deafness and profound sensorineural hearing loss with properly selected musical elements has a significant impact on the acquisition of auditory, linguistic, musical and general development skills. It also reduces tinnitus. [ABSTRACT FROM AUTHOR]

Background: An increased number of children and adults with SSD receiving cochlear implants over the past 10 years has guided clinical protocols for evaluation and ongoing management. The benefits of CI are clear for hearing in background noise, localising sound, and decreased overall listening effort. This paper will provide an outline of SCIC's protocols including pre-operative support and counselling, guidelines for device programming, & rehabilitation. Outcomes and rate of progress will also be discussed. Methods: A total of 65 people with SSD were included in this retrospective review of management pathways. This included 5 groups of children that received specialist advice, assessment and management by a multidisciplinary team. These groups included those with absent auditory nerves, benefit from conventional devices, no devices who received ongoing monitoring, children who received a CI, and those suitable for CI, but did not proceed to surgery. Results: In adults, approximately 30% of those assessed chose to use a conventional device or have no intervention. Children who received CI's for SSD comprised only 29% of the children in the entire sample of those assessed. Auditory nerve was absent in 43% of the children. Recipients showed functional benefit on one or more of the subtests of the Speech Spatial Qualities questionnaire. Methodologies for device programming and rehabilitation varied across the cohort. A review of these processes was required for ensuring protocols were addressing client need. Conclusions: Evaluation and intervention protocols for SSD must take into account the onset and duration of the hearing loss; integrity of the cochlear nerve on the affected side; benefit received from other hearing devices; current functional hearing performance, and the investment in time and resources that will be required to facilitate the integration of the acoustic hearing from the better ear and electrical hearing. [ABSTRACT FROM AUTHOR]

Background: Auditory training (AT) is a sound-based intervention aimed at improving individuals' speech and hearing skills through varied listening exercises. It has been used with individuals using hearing aids and/or cochlear implants (CIs) to maximize benefit of hearing devices. Objective: The purpose of this systematic review PROSPERO (2017:CRD42017057346) is to evaluate the published research in AT for pediatric CI recipients. This review investigates whether AT in children with CIs leads to improvements in speech and language, cognition, and/or quality of life; and whether improvements, if any, remain over time post AT intervention. Outcomes of this review may help clinicians to make informed decisions about the usefulness and type of AT for pediatric CI users. Method: A systematic search of seven databases identified 96 papers published up until January 2017, 9 of which met the set criteria. Data were extracted and independently assessed for risk of bias and quality of study against a PICO framework. Results: All studies reported improvements in the trained AT tasks including speech discrimination/identification and working memory tasks. Retention of improvements overtime was found whenever it was assessed. Transfer of learning was measured in four out of six studies, which assessed generalization. Quality of life was not assessed in any of the reviewed studies. Level of evidence for the included studies was determined to be low. Conclusion: Benefits of AT were clearly illustrated through the improvement of all trained tasks across all studies regardless of the duration or type of training. Transfer of improvement to other domains and retention of benefits post AT were evident when assessed. However, higher quality evidence to further examine outcomes of AT in pediatric CI recipients is needed. [ABSTRACT FROM AUTHOR]

In far the most cases spiral canal ossification primarily affects the descending part of the basal turn. In this paper the method of atraumatic drilling of the ossified spiral canal is proposed. In the experimental procedure on 25 cadaveric temporal bones we revealed that the distance between round window membrane and basal turn curvature equals 8.0 mm; the width of labyrinthine capsule which borders spiral canal and internal auditory canal amounts to 0.36 mm and its width between spiral canal and internal carotid artery accounts for 0.77 mm. The original method, which is based on atraumatic drilling out of the ossification, was put forward. The drilling starts from the ossified round window membrane and proceeds till the basal turn curvature. Notable color difference between otic capsule and ossified tissue is observed: labyrinth capsule tends to look greyish and ossified tissue -- whitish. This enables gradual drilling out of the ossification along the descending part of the cochlea basal turn and preservation of modiolus. Taking into consideration close adjacency of the internal auditory canal and internal carotid artery lateral basal turn wall should always be kept in mind the landmark. The above-described surgical technique was applied in 62 patients with the ossification of the basal turn descending part. In 22 cases the length of the ossified spiral canal varied from 1 to 3 mm, in 40 patients it was in the interval of 4-6 mm and proceeded till the basal turn curvature. In all the 62 patients the proposed method enabled adequate approach to the cochlea spiral canal and full CONCERTO (MED-EL, Innsbruck, Austria) standard electrode insertion. In these cases only straight rigid electrode can be used to make its way through the drilled out spiral canal lumen. Postoperative audiological performance of the implanted patients correlated with the ones without ossification. [ABSTRACT FROM AUTHOR]

Cochlear implants (CIs) provide severe to profoundly deaf recipients with substantial speech intelligibility in quiet. In difficult listening situations such as background noise however, communication often remains challenging. For unilateral CI recipients with a bilateral hearing loss, speech intelligibility for speech sources on the non-implanted side is further impaired by the head-shadow effect. One possibility to overcome this impairment is the use of Contralateral Routing of Signal (CROS) systems, which capture sounds from the non-implanted side and wirelessly transmit them to the implant processor, therefore increasing audibility. With the Phonak Naída Link CROS, a wireless CROS system is now available that is compatible with the latest generations of Advanced Bionics sound processors, Naída CI Q70 and Q90. Several studies have investigated the speech intelligibility benefit such a system is able to provide to unilateral CI users. In addition to acute speech intelligibility tests, all studies also included chronic trial phases. The subjects' feedback was gathered regarding sound quality, subjective speech intelligibility benefit as well as the practical usability of the device in everyday life. The Naída Link CROS enables consistent listening performance regardless of the target speaker location. For speakers located on the non-implanted side, benefits of up to 8 dB SRT and 30% speech intelligibility were shown, compared to listening with the CI alone. Subjects reported high satisfaction with the device itself as well as perceived speech intelligibility benefits. The wireless CROS system provides a viable option to improve upon unilateral implantation for rehabilitating bilateral deafness. Such a system is most applicable in cases where medical or financial reasons only permit unilateral implantation. [ABSTRACT FROM AUTHOR]

Malawi is the 7th poorest country in the world however ten implants in post lingually deaf children have now been implanted in the country. The surgery has been carried out without complication and the switch ons, with subsequent audiological programming, have been carried out with the input of local audiological professionals. The details of the 10 patients will be presented but all have made good progress and have now returned to full time education. The development of the service has been possible due to a collaboration between UK & Malawi professionals and charitable support (including a CI manufacturer). Further plans are in place to develop the service including rehabilitation within families and the educational environment. The rehabilitation of such a small number of patients is, however, simply a 'drop in the ocean' with regard to the need in Sub-Saharan Africa. Our aim however is to show that it is possible to do implants in a poor country and that, with appropriate follow up and support (including long term), they do vastly improve the lives of those who have been fitted As well as outlining how the Malawian program has come about, including the major challenges arising, the presentation will also highlight the issues facing those looking to treat patients with severe to profound loss in the developing world. It will utilize our experience in detailing lessons learned but also outline how future developments could potentially radically change the outlook for those patients in the poorest countries in the world. [ABSTRACT FROM AUTHOR]

Objective: To analyse the experience in Chinese auditory rehabilitation and CI programs. Method: Hearing loss (HL) is a common sensory impairment in humans, with significant economic and social impacts. With nearly 20% of the world's population, China has focused on economic development and health awareness to improve the care for its hearing-impaired population. Recently, the Chinese government has initiated national programs such as the China Disabled Persons Federation to fund prevention, treatment, and rehabilitation of hearing impairment. Newborn hearing screening and auditory rehabilitation programs in China have expanded exponentially with government support. While facing many challenges and overcoming obstacles, cochlear implantation (CI) programs in China have also experienced considerable growth. We discuss the implementation of CI programs for HL in China and presents current HL data including epidemiology, newborn hearing screening, and determination of genetic etiologies. Generally, we analyze the total information in a Cochlear Implantation Center, one of the biggest one in China, from Chinese PLA General Hospital, and the primarily outcome of postoperative speech rehabilitation of cochlear implantation in Chinese patients. Results and conclusion: During 1996-2017, totally 3717 cases were performed in our centre. Among the CI patients, the age ranged from 3 months to 89years, and there were about 80%with prelingual deafness in children and only about 20% post-lingual deafness. Cochlear implantation was safe and stable in our CI centre, and outcomes of postoperative speech rehabilitation were satisfactory in Chinese patients, as well as the long-term outcomes of required further study in Mandarin patient. Sharing the experience in Chinese auditory rehabilitation and CI programs will shine a light on the developmental pathway of healthcare infrastructure to meet emerging needs of the hearing-impaired population in other developing countries. [ABSTRACT FROM AUTHOR]

Currently, there are no studies assessing everyday use of cochlear implant (CI) processors by recipients by means of objective tools. The Cochlear™ Nucleus® 6 System sound processor features a data logging system capable of realtime recording of CI use in different acoustic environments and under various categories of loudness levels. In this study, we report data logged for the different scenes and different loudness levels of 1366 CI patients, as recorded by SCAN, gathered from 30 Italian ENT clinics. Monitoring device use in cochlear implant recipients of all ages provides important information about the listening conditions encountered in recipients' daily lives that may support counseling and assist in the further management of their device settings. The findings for this large cohort of active CI users confirm differences between age groups concerning device use and exposure to various noise environments, especially between the youngest and oldest age groups, while similar levels of loudness were observed. We found that child groups spend more time in noisy environments at high levels of loudness, whereas adult groups spend more daily time in the quiet scene at lower levels of loudness. The data are shown in Percentile of scene and loudness exposure (Speech, Speech in Noise, Quiet, Noise, Music and Wind) on age classes (from 1 to over 75 years old). Our results can provided valuable reference information for clinicians for the purpose of troubleshooting, counseling, program optimization, and therapeutic intervention planning for CI recipients. [ABSTRACT FROM AUTHOR]