Bilateral Cochlear Implants in Adults and Children

Litovsky, Ruth Y.; Parkinson, Aaron; Arcaroli, Jennifer; Peters, Robert W.; Lake, Jennifer; Johnstone, Patti M.; Yu, Gonqiang

doi:10.1001/archotol.130.5.648

Cited by 196 publications

(162 citation statements)

References 27 publications

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“…It is important to note that this finding is based on the CRISP-Spondee closed-set test, but has not been confirmed for other measures of speech intelligibility. Results with the CI-CI children group are consistent with prior reports of bilateral advantages in adults with bilateral CIs (Gantz et al, 2002;Tyler et al, 2002;Muller et al, 2002;Litovsky et al, 2004;Schleich et al, 2004). There is an important difference between most adults and children with bilateral CIs.…”

Section: Discussionsupporting

confidence: 87%

“…One other consideration, however, is that the benefit in this condition is not likely to be due to binaural effects such as "squelch" (e.g., Tyler et al, 2003;Schleich et al, 2004). Previous studies on the advantages of bilateral CIs in adults have also confirmed that squelch effects are somewhat minor compared with other bilateral benefits, such as head-shadow (van Hoesel, 2004;Litovsky et al, 2004;Schleich et al, 2004), most likely due to limitations in current fittings and speech processing strategies that do not maximize binaural information. Measures of MAA obtained here suggest that bilateral listening modes are helpful to both groups of children, but significantly more beneficial for children with bilateral CIs than children with bimodal (CI-HA) hearing.…”

Section: Discussionmentioning

confidence: 99%

“…NIH-PA Author Manuscript NIH-PA Author Manuscript users when both ears are activated compared with a monaural condition (Gantz et al, 2002;Tyler et al, 2002;Muller et al, 2002;Litovsky et al, 2004;Schleich et al, 2004). The benefits are thought to arise from a combination of effects, including the head shadow effect, binaural squelch and binaural summation, all of which can be achieved at least to some extent without requiring fine-structure information or precise inter-aural time difference (ITD) resolution.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

“…More stringent measures of localization precision in a multi-speaker array have also been made in a number of studies. Errors are generally smaller when bilateral CI users listen with both CIs compared with either ear alone (e.g., van Hoesel & Tyler, 2003;Litovsky et al, 2004;Nopp et al, 2004). When a coordinated stimulation approach is used, such that both implants are controlled by a single research processor, adults with BI-CIs have excellent sensitivity to inter-aural level differences (ILDs) and many have very good sensitivity to ITDs (e.g., van Hoesel & Tyler, 2003;van Hoesel et al, 2002;Litovsky et al, 2005).…”

mentioning

confidence: 99%

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Benefits of bilateral cochlear implants and/or hearing aids in children

Litovsky

Johnstone

Godar

2006

International Journal of Audiology

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237

198

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This study evaluated functional benefits from bilateral stimulation in 20 children ages 4 -14, 10 use two CIs and 10 use one CI and one HA. Localization acuity was measured with the minimum audible angle (MAA). Speech intelligibility was measured in quiet, and in the presence of 2-talker competing speech using the CRISP forced-choice test. Results show that both groups perform similarly when speech reception thresholds are evaluated. However, there appears to be benefit (improved MAA and speech thresholds) from wearing two devices compared with a single device that is significantly greater in the group with two CI than in the bimodal group. Individual variability also suggests that some children perform similarly to normal-hearing children, while others clearly do not. Future advances in binaural fitting strategies and improved speech processing schemes that maximize binaural sensitivity will no doubt contribute to increasing the binaurally-driven advantages in persons with bilateral CIs. KeywordsBilateral; Binaural; Cochlear implant; Hearing aid; Children; Speech; Localization Cochlear implants (CIs) have become a powerful means of providing hearing to deaf persons. Although the vast majority of CI users can understand speech in a quiet situation (Zeng, 2004;Stickney et al, 2004;Holt & Kirk, 2005), and report improvement in quality of life postimplantation (Summerfield et al, 2002), they have continued difficulties under many circumstances. For instance, most CI users have difficulty locating sounds in their environments; all sounds appear to be coming either directly from their ear, or inside their head. In addition, their ability to understand speech in everyday, noisy and reverberant environments is quite poor (e.g., Fu et al, 1998;Nelson & Jin, 2004;Stickney et al, 2004Stickney et al, , 2005. Continuous efforts are being made to improve performance with single CIs by developing better speech processing strategies (e.g., Rubinstein & Hong, 2003;Green et al, 2005;Nie et al, 2005;Yang & Fu, 2005).Bilateral CIs (BI-CIs) are also being provided to a growing number of patients in an attempt to increase quality of life and to improve listening in everyday noisy situations. This clinical approach is primarily rooted in the assumption that, since normal-hearing people rely on two ears (binaural hearing) for sound localization and speech understanding in noise, deaf individuals should also have two good ears in order to maximize their performance. Bilaterally implanted adults show some clear and significant benefits when using two CIs compared with a single CI. As in normal hearing persons, speech understanding in noise is better in bilateral NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript users when both ears are activated compared with a monaural condition (Gantz et al, 2002;Tyler et al, 2002;Muller et al, 2002;Litovsky et al, 2004;Schleich et al, 2004). The benefits are thought to arise from a combination of effects, including the head shadow effect, binaural squelch and binaural...

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

mentioning

confidence: 99%

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Benefits of bilateral cochlear implants and/or hearing aids in children

Litovsky

Johnstone

Godar

2006

International Journal of Audiology

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237

198

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“…In general and compared with unilateral implant conditions, adult recipients of bilateral implants perform fairly well in localization tasks in the horizontal plane [75,78,[84][85][86][87][88][89][90][91][92][93]. For example, in five subjects using pink noise bursts presented from eight loudspeakers that spanned 108°, unilateral conditions resulted in 20° to 60°R MS errors, but only 10° RMS errors were noted for bilateral conditions [93].…”

Section: Localizationmentioning

confidence: 99%

Restoring hearing symmetry with two cochlear implants or one cochlear implant and a contralateral hearing aid

Firszt

Reeder²,

Skinner³

2008

JRRD

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Abstract-With today's technology and the demonstrated success of cochlear implantation, along with expanded candidacy criteria, the opportunity to provide optimal hearing to both ears for individuals with severe-to-profound hearing loss is greater than ever. This article reviews the advantages of binaural hearing and the disadvantages of hearing with only one ear or hearing with two ears with significantly different sound thresholds. A case study is presented that demonstrates the benefit of bimodal hearing (i.e., a cochlear implant [CI] in one ear and a contralateral hearing aid [HA]) in a nontraditional CI candidate with asymmetrical hearing thresholds. Then, selected studies in adult recipients who use a CI and contralateral HA or who use two CIs are summarized. The data overall demonstrate that bilateral CI recipients, traditional bimodal recipients, and nontraditional bimodal recipients experience substantial binaural hearing advantages, including improved speech recognition in noise, localization, and functional everyday communication. These results indicate that bilateral stimulation of the auditory system through a CI and contralateral HA or two CIs is beneficial and should become standard clinical practice.

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Cochlear Implantation in Adults

Gaylor

Raman²,

Chung³

et al. 2013

JAMA Otolaryngol Head Neck Surg

218

101

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Importance: Sensorineural hearing loss is the third leading cause of years lived with disability worldwide. Cochlear implants may provide a viable alternative to hearing aids for this type of hearing loss. The Coverage and Analysis Group at the Centers for Medicare & Medicaid Services was interested in an evaluation of recently published literature on this topic. In addition, this metaanalysis is to our knowledge the first to evaluate qualityof-life (QOL) outcomes in adults with cochlear implants.Objective: To evaluate the communication-related outcomes and health-related QOL outcomes after unilateral or bilateral cochlear implantation in adults with sensorineural hearing loss. Study Selection: Published studies of adult patients undergoing unilateral or bilateral procedures with multichannel cochlear implants and assessments using openset sentence tests, multisyllable word tests, or QOL measures.Data Extraction: Five researchers extracted information on population characteristics, outcomes of interest, and study design and assessed the studies for risk of bias. Discrepancies were resolved by consensus.Results: A total of 42 studies met the inclusion criteria. Most unilateral implant studies showed a statistically significant improvement in mean speech scores as measured by open-set sentence or multisyllable word tests; meta-analysis revealed a significant improvement in QOL after unilateral implantation. Results from studies assessing bilateral implantation showed improvement in communication-related outcomes compared with unilateral implantation and additional improvements in sound localization compared with unilateral device use or implantation only. Based on a few studies, the QOL outcomes varied across tests after bilateral implantation. Conclusions and Relevance:Unilateral cochlear implants provide improved hearing and significantly improve QOL, and improvements in sound localization are noted for bilateral implantation. Future studies of longer duration, higher-quality reporting, and large databases or registries of patients with long-term follow-up data are needed to yield stronger evidence.

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Bilateral Cochlear Implants in Adults and Children

Cited by 196 publications

References 27 publications

Benefits of bilateral cochlear implants and/or hearing aids in children

Benefits of bilateral cochlear implants and/or hearing aids in children

Restoring hearing symmetry with two cochlear implants or one cochlear implant and a contralateral hearing aid

Cochlear Implantation in Adults

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