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...
Children with sequential BI cochlear implants represent a unique population of individuals who have undergone variable amounts of auditory deprivation in each ear. Our findings suggest that many but not all of these children perform better on measures of localization acuity with two cochlear implants compared with one and are better at the task than children using the cochlear implant + hearing aid. These results must be interpreted with caution, because benefits on other tasks as well as the long-term benefits of BI cochlear implants are yet to be fully understood. The factors that might contribute to such benefits must be carefully evaluated in large populations of children using a variety of measures.
Objective: To measure the benefit (ie, sound localization and speech intelligibility in noise) of bilateral cochlear implants (CIs) in adults and in children.Design, Setting, and Patients: Seventeen adults and 3 children underwent testing 3 months after activation of bilateral hearing. Adults received their devices in a simultaneous procedure and children in sequential procedures (3-8 years apart). Adults underwent testing of sound localization and speech intelligibility, with a single CI and bilaterally. Children underwent testing of sound localization, right/left discrimination, and speech intelligibility, with the first CI alone and bilaterally. We used computer games to attract the children's attention and engage them in the psychophysical tasks for long periods of time.Results: Preliminary findings suggest that, for adults, bilateral hearing leads to better performance on the lo-
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