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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]

This paper reviews first what is known of outcomes from bilateral implantation, and the challenges of working with cochlear implant users after bilateral implantation, in particular after sequential bilateral implantation. Our investigation of the existing literature to date to determine the best rehabilitative methods and how they should vary for different groups of bilaterally implanted children suggests there is a lack of description of the therapy types and techniques and no attempt to correlate the methods used with the outcomes observed. As a result, a standard or optimal rehabilitative approach cannot be concluded from the literature to date. Based on clinical good practices it will give you some suggestions for maximizing the benefits from bilateral implantation, in therapy, at home and school. [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]

Acoustic measurements have shown that the speech of hearing-impaired (HI) children differs from that of normally hearing (NH) children, even after several years of device use. This study focuses on the perception of HI speech in comparison to NH children's speech. The purpose of this study was to investigate whether adult listeners can identify the speech of NH and HI children. Moreover, it is studied whether listeners' experience and the children's length of device use play a role in that assessment. For this study, short utterances of 7 children with a cochlear implant (CI), 7 children with an acoustic hearing aid (HA) and 7 children with NH were presented to 90 listeners who were required to specify the hearing status of each speech sample. The judges had different degrees of familiarity with hearing disorders: there were 30 audiologists, 30 primary schoolteachers and 30 inexperienced listeners. The results show that the speech of children with NH and HI can reliably be identified. However, listeners do not manage to distinguish between children with CI and HA. Children with CI are increasingly identified as NH with increasing length of device use. For children with HA, there is no similar change with longer device use. Also, experienced listeners seem to display a more lenient attitude towards atypical speech, whereas inexperienced listeners are stricter and generally consider more utterances to be produced by children with HI. [ABSTRACT FROM AUTHOR]

Conclusion: The results show that the DUET2 offers users speech perception that is equivalent to or better than the DUET. Moreover, the DUET2 offers subjective benefits above those provided by the DUET. Background: The DUET is a combination of hearing aid and CI in one device for electric acoustic stimulation. Since its introduction: a second generation, the DUET2, has been developed. This study aimed to investigate the benefits of the DUET2 compared to the DUET. Methods: Speech reception was determined in quiet and in noise. The sound quality of speech and music was rated using a visual analogue scale. Test intervals were at upgrade and at 3 and 6 months after upgrade. Results: Speech reception in quiet and in noise was significantly better than with the DUET after 6 months. For sentence reception in quiet, the SRT with the DUET2 did not change significantly between test intervals. Sentence reception in noise with the DUET2 improved significantly between 3 and 6 months and upgrade and 6 months. After 6 months, speech reception in quiet and in noise with the DUET2 was significantly better than with the DUET. Subjects rated the sound quality of speech and of music with the DUET2 significantly better than with the DUET. [ABSTRACT FROM AUTHOR]

Conclusion: This study demonstrates that electric acoustic stimulation (EAS) using the FLEXEAS electrode is a successful treatment method for preservation and stability of low frequency hearing, and results in significant improvements in speech perception. Objectives: Low frequency hearing preservation and stability following EAS surgery with the MED-EL PULSARCI100 implant using the FLEXEAS electrode and a combined processor in a multicentre setting, and the efficacy and benefits of EAS over time were evaluated. Methods: Eighteen subjects with normal to moderate hearing loss in the low frequencies and severe to profound hearing loss in the high frequencies were implanted with the FLEXEAS electrode. Implantation was performed by different surgeons at three participating centres using either the cochleostomy or the round window approach. Preoperatively, hearing was measured; a battery of speech perception tests and the subjective benefit questionnaire were administered. These tests were subsequently repeated: first at EAS fitting, which was due 3 months after surgery, and then again 3, 6 and 12 months after EAS fitting. Results: Hearing could be preserved in all subjects. Speech understanding showed significant improvement in all tests over time with the EAS condition outperforming the cochlear implant-only condition at all intervals. These considerable effects were also reflected in the subjective benefit outcome. [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]