Auditory Training for a Cochlear Implant for Single-Sided Deafness: Two Perspectives A hearing therapist in the United Kingdom and her auditory trainer describe two sides of the CI journey. Features
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Features  |   January 2016
Auditory Training for a Cochlear Implant for Single-Sided Deafness: Two Perspectives
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Hearing & Speech Perception / Hearing Disorders / Hearing Aids, Cochlear Implants & Assistive Technology / Audiologic / Aural Rehabilitation / Features
Features   |   January 2016
Auditory Training for a Cochlear Implant for Single-Sided Deafness: Two Perspectives
The ASHA Leader, January 2016, Vol. 21, online only. doi:10.1044/leader.FTR4.21012016.np
The ASHA Leader, January 2016, Vol. 21, online only. doi:10.1044/leader.FTR4.21012016.np
The user’s perspective
By Gemma Mole
I am a hearing therapist doing auditory rehabilitation in the UK, with adults who have cochlear implants. I also have single-sided deafness.
At age 49 and with no memory of hearing through my right ear, I found myself in the very fortunate position of getting a cochlear implant (CI) for my “dead” ear in June 2014. Like most specialists working with CI patients I had often wondered what hearing through a CI really sounded like, but never thought I’d get to know for myself.
Yes, I had lived with my hearing loss. I had managed as well as I could, and missed quite a lot along the way, especially in background noise. However, my turning point came in 2007, when I experienced bilateral loss of vestibular function. As the mother of 3-year-old twin daughters, I had been able—up to that point—to walk, look down at the daughter on my right and read her lips, and continue walking in a straight line. This became impossible. I veered and tripped all of us up as we crossed roads. They also used to fight over who was going to hold Mummy’s left hand. Not good, I needed to do something!
I had used a bone-anchored aid from 2010 until April 2014. I liked it, as it gave me awareness of sound on the right but was obviously using my good side. At the back of my mind I wondered if I could get anything better.
I knew all about CI assessment, implantation and rehabilitation, but being on the receiving end was very different. My expectations were low but my hopes were high and, like all CI recipients, I had concerns.
Would my longstanding “dead” ear function after at least 46-plus years of non-stimulation? The general feeling from those around me was no. If it did work, would I be able to make sense of what I heard? How was I going to do auditory training without my good ear hearing the work? What auditory training materials could I use—I had used all of mine with my CI recipients, and knew them by heart.
Activation date, July 14, soon arrived. It was a strange experience as I felt sound as well as heard it, which I wasn’t expecting (it certainly adds a little extra to my hearing experience). And like many recipients, I had great difficulty working out what “comfortably loud” was, but by the end of the session I was hearing through my right ear, especially the high-frequency sounds such as “sssss” and “shhhh.”
Now for the hard work …
I was determined to get the most from my CI. From day one I wore it from getting up to going to bed. I set aside two hours a day for auditory training with the CI alone. Instead of live-voice auditory training, I worked through recorded materials, using a direct audio input cable into my CI and an earplug in my left ear. Prior to getting my implant I had the good fortune to work with Geoff Plant (an auditory trainer and executive director of the Hearing Rehabilitation Foundation), who left some of his recorded work with me. I used these recordings until he came to the UK to do some intensive auditory therapy with me at three and 10 weeks post-activation.
Geoff challenged me to the point of getting the maximum I could out of the CI, and then being “saturated” and unable to do any more. It was helpful to find my limits and I really enjoyed it.
Improvement in speech scores demonstrated change:
  • BKB (Bamford-Kowal-Bench) sentences testing at weeks one, three and 10 were 42 percent, 76 percent and 92 percent

  • CRM (Coordinate Response Measure) sentences through a crescent of sound, seven talkers, using good ear and CI: week one, −2.5dB; w three, −3.44dB; week 10, −5.0dB.

I no longer have to worry about where I sit, I manage a lot better in groups, and coping in noise is better (but not perfect). Life has become less stressful and less tiring. My twin daughters can now sit on either side of me knowing the sister on my right will no longer be ignored.
I also have a much better idea of what our CI patients are going through. I feel that I can offer more in the pre-counseling stage as well encourage them to really set time aside for rehabilitation.
My CI has opened up a world of sound “around” me, and I love it! I can’t say for sure that I hear in stereo (whatever that is) but I do now hear on both sides.
My thanks to Geoff for all his hard work.
Figure 1.

Results for auditory presentation of sentence lists. Note that two lists were presented on Days 6 and 7.

Results for auditory presentation of sentence lists. Note that two lists were presented on Days 6 and 7.
Figure 1.

Results for auditory presentation of sentence lists. Note that two lists were presented on Days 6 and 7.

×
The trainer’s perspective
By Geoff Plant
I had known Gemma for several years when she asked for my opinion about getting a CI in her deaf ear. Did I think it would be worth the effort, or would it be better to persevere with the bone-anchored system she was using at the time? I thought it would be a good idea. I knew that she was having difficulties in her everyday life because of her unilateral deafness, and offered to provide some training after the CI was activated.
I was, nevertheless, surprised when she set dates for surgery and activation. All of my experience with adults with CIs involved people with bilateral hearing loss, and the training approach I normally adopted—one-to-one sessions with live-voice presentation of materials—was not going to work in Gemma’s case. The only way I could provide training was to record a large number of exercises and then present them directly to the CI, thereby eliminating the possibility of her “good” ear picking up the signal.
I wanted to be in the same room, so that I could see how Gemma performed the various tasks, provide feedback and suggestions, and support her during her first days with the CI. I arranged to provide five days of training in August 2014 and follow up with two more days in late September.
Materials
I recorded a large number of test materials that would provide me with a detailed picture of Gemma’s performance:
  • Nonsense syllables contrasting consonants in an /aCa/ frame.

  • Word lists of 25 pairs of words. One of the words was made up of only voiced consonants combined with vowels or diphthongs with a low second formant (low-frequency words). The other word consisted of only voiceless consonants with vowels or diphthongs with a high second formant (high-frequency words).

  • Sentence lists with words drawn from the 500 most-frequently occurring words in spoken American English.

I also recorded a large number of training exercises and embedded them in PowerPoint files, a readily available format that requires no special equipment, so that Gemma could use them on her own.
The training materials included analytic exercises such as “Consonant Sevens,” which contrasts seven initial consonants in rhyming words as well as exercises contrasting vowels and semi-vowels /w/, /r/ and /l/, three consonants that many CI users find challenging to discriminate.
I also included a number of synthetic training exercises. These included “fill the gap” exercises, where a written text is provided with several words left blank. The task is to listen to the accompanying recording and attempt to identify the missing words.
Other exercises ask the listener to respond to questions about spoken conversations or written text read aloud. I also included a modified speech-tracking exercise that presents Hans Christian Andersen’s “The Emperor’s New Clothes,” rewritten for adults. The story is told in 200-word parts, with each part divided into phrases and sentences, and the listener is asked to repeat what was heard.
Results
Auditory-only testing with the consonants in /aCa/ on Days 1 and 4 of the first training period resulted in overall scores of 58 percent and 56 percent, respectively. Analysis of the response patterns for the two testing sessions revealed small improvements on Day 4 in Gemma’s perception of voicing (from 87 to 92 percent), manner of articulation (from 79 to 87 percent), and place of articulation (from 68 to 71 percent) cues.
The results of the word testing—displayed here—show a steady improvement across the training period.
Figure 2.

Results for auditory presentation of the Composite Word Lists. Columns show overall score (Overall), and scores for the Low Frequency Words (LFW) and High Frequency Words (HFW). Note that two lists were presented on Days 6 and 7.

Results for auditory presentation of the Composite Word Lists. Columns show overall score (Overall), and scores for the Low Frequency Words (LFW) and High Frequency Words (HFW). Note that two lists were presented on Days 6 and 7.
Figure 2.

Results for auditory presentation of the Composite Word Lists. Columns show overall score (Overall), and scores for the Low Frequency Words (LFW) and High Frequency Words (HFW). Note that two lists were presented on Days 6 and 7.

×
Gemma’s scores for the modified speech tracking task illustrate how well she was able to perceive connected speech. After three days of training, she scored better than 90 percent correct for all parts presented, as shown here.
Figure 3.

Results for the modified Speech Tracking task. Each datum point is the score for a 200-word part of the story. Three parts were presented on each of the seven training days.

Results for the modified Speech Tracking task. Each datum point is the score for a 200-word part of the story. Three parts were presented on each of the seven training days.
Figure 3.

Results for the modified Speech Tracking task. Each datum point is the score for a 200-word part of the story. Three parts were presented on each of the seven training days.

×
Gemma’s performance with all of the training and testing materials was impressive, especially given her lack of usable hearing in the implanted ear for most of her life. She made rapid progress in her performance during the training period, and participated in two to three hours of listening practice each day. Her performance with the nonsense syllable and word materials indicate that her access to the acoustic-phonetic signal was limited, but she was able to use top-down processes to achieve very high scores for the sentence and speech-tracking materials.
Before receiving her CI, Gemma had the most difficulty hearing in noise and from her right side. Following the fourth day of training, I had dinner with Gemma and her family in a local pub. Despite the high level of background noise, Gemma was now able to understand speech. The next morning, I sat on her right on a train ride, and again, I was impressed by how well she was now able to cope with this previously difficult situation. I know that these two incidents lack control, but what they lack in scientific credibility, they more than make up for with real-life credibility.
Figure 1.

Results for auditory presentation of sentence lists. Note that two lists were presented on Days 6 and 7.

Results for auditory presentation of sentence lists. Note that two lists were presented on Days 6 and 7.
Figure 1.

Results for auditory presentation of sentence lists. Note that two lists were presented on Days 6 and 7.

×
Figure 2.

Results for auditory presentation of the Composite Word Lists. Columns show overall score (Overall), and scores for the Low Frequency Words (LFW) and High Frequency Words (HFW). Note that two lists were presented on Days 6 and 7.

Results for auditory presentation of the Composite Word Lists. Columns show overall score (Overall), and scores for the Low Frequency Words (LFW) and High Frequency Words (HFW). Note that two lists were presented on Days 6 and 7.
Figure 2.

Results for auditory presentation of the Composite Word Lists. Columns show overall score (Overall), and scores for the Low Frequency Words (LFW) and High Frequency Words (HFW). Note that two lists were presented on Days 6 and 7.

×
Figure 3.

Results for the modified Speech Tracking task. Each datum point is the score for a 200-word part of the story. Three parts were presented on each of the seven training days.

Results for the modified Speech Tracking task. Each datum point is the score for a 200-word part of the story. Three parts were presented on each of the seven training days.
Figure 3.

Results for the modified Speech Tracking task. Each datum point is the score for a 200-word part of the story. Three parts were presented on each of the seven training days.

×
1 Comment
January 5, 2016
Yvonne Loucks
Speech Language Pathologist with a unilateral CI
Gemma's story of hearing recovery was very impressive, and confirmed my own experience of left unilateral deafness treated with CI. I had experienced a sudden hearing loss around 2002, and though aided, all that I had was the sense of sound which provided better balance and localization. I also have a moderate to severe loss in the right ear, so I had almost given up being able to converse except in a quiet room with only one person. Being a Speech/Language Pathologist that was difficult. I tested several times for a CI, but always had just a little too much hearing to qualify. In February 2014 I learned that the criteria had changed, and I had the procedure. Like Gemma, I find myself in places with a lot of background noise and still able to participate. For anyone wondering whether or not it is a good idea, I side with Gemma and say that it is.
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January 2016
Volume 21, Issue 1