Optimising hearing aid fittings of children who also use cochlear implants

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Binaural benefits from using a cochlear implant
and a hearing aid in opposite ears
Teresa Ching1,3, Colleen Psarros 2,3, Mandy Hill
1,3 Jane Brew 2,3, Paula Incerti 2,3
1 National Acoustic Laboratories 2 Sydney
Cochlear Implant Centre, Australia
Australia 3 Cooperative Research Centre for
Cochlear Implant Hearing aid Innovation,
Australia
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How should hearing aids be selected?
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2. Equate loudness of speech
How should hearing aids be selected?
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Best frequency response close to NAL-NL1
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NAL-NL1 provides appropriate gain on average
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Would a hearing aid interfere with a cochlear
implant?
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Speech perception in noise
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Bimodal hearing led to binaural benefits. No
interference at all!
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Other advantages Localization
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Other advantages Functional performance in
everyday life
Use of devices Listening in quiet Listening in
noise Environmental awareness
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Preferred frequency response close to NAL-NL1
prescription
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NAL prescription provides appropriate gain on
average
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Speech benefits for children retrospectively
fitted with hearing aids?
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Localising sounds
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Functional performance in real life
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When children used hearing aids with cochlear
implants, their parents commented that ...

• He could copy the expression in my voice when we
  practised reading aloud
• She could hear the music better when she played
  the piano
• She could recognise whos called her from behind
• She could discriminate between different dog
  barks
• When I called her in a shopping centre, she
  looked straight to me instead of looking around
  to try and locate my voice
• He could hear me at the soccer field

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When children used hearing aids with cochlear
implants, their parents commented that ...

• his/her speech is clearer
• shes happy to converse with unfamiliar persons
• she picks up other peoples conversations
• she is more alert to environmental sounds

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Summary

• Use of a cochlear implant with a hearing aid does
  not lead to confusion
• On the contrary, Binaural benefits in speech
  perception, localization, and aural/oral function
  in real life can be obtained.
• NAL-NL1 provides appropriate frequency response
  on average, individual fine-tuning can facilitate
  integration of signals from both ears.

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Do adult users of unilateral cochlear implants
derive binaural benefits from using a hearing aid
in the contralateral ear?
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Audiogram of non-implanted ear
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Adults amplification requirements
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Method
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Diotic listening
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Dichotic listening
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Adults localization performance
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Functional assessment -21 adults
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When using both devices,adults commented that ...

• Voices sound more natural melodious
• Adds more brilliance to voices
• Overall, a better balance
• Other peoples speech is louder clearer at
  conferences, meetings, etc
• Can now enjoy the music on the car radio
• Gives movies on TV an extra dimension
• More comfortable at round-table discussions
  because its easier to identify the speaker
• Helped with tennis better coordination

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Conclusions

• All adults and children benefit from using
  hearing aids with cochlear implants
• speech perception in quiet and in noise
• localisation
• functional performance in real life
• Hearing aids should be fitted using NAL-NL1
  prescription

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Significance

• People who use unilateral cochlear implants can
  derive binaural benefits from using hearing aids
  in their contralateral ears
• Use residual hearing in non-implanted ear
• Improved habilitation for children and adults
• Counselling and management programs for
  children/adults need to include the use of a
  hearing aid in the non-implanted ear

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References

• Ching TYC, Psarros C, Hill M, Dillon H, Incerti P
  (2001) Should children who use cochlear implants
  wear hearing aids in the opposite ear? Ear and
  Hearing 22(5), 365-380.
• Ching TYC, Psarros C, Hill M (2001) Hearing aid
  benefit fro children who switched from the SPEAK
  to the ACE strategy in their contralateral
  Nucleus 24 cochlear implant system. Australian
  New Zealand Journal of Audiology 22, 123-132.
• Ching TYC, Psarros C, Incert P, Hill M (2003)
  Management of children using cochlear implants
  and hearing aids. The Volta Review 103(1), 39-57.
• Ching TYC, Ching, TYC. Psarros C, Hill M,
  Smither J. (2002) Should children who wear a
  cochlear implant in one ear use a hearing aid in
  the opposite ear? In Seewald, R.C. and Gravel,
  J.S. (Fds.) 2002. A Sound Foundation through
  early amplification 2001. Proceedings of the
  second international conference. Stafa,
  Switzerland Phonak AG. Pp. 195-202. (Also
  available in Japanese from Ms Mihoko Waki at
  Phonak Ltd, Japan.)

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www.nal.gov.au
Teresa.Ching_at_nal.gov.au National Acoustic
Laboratories, Sydney, Australia. Colleen_at_ccic.nsw
.gov.au Sydney Cochlear Implant Centre, Sydney,
Australia.