Central auditory mechanisms associated with cochlear implantation: an overview of selected studies and comment

The effects of early auditory-based intervention on adult bilateral cochlear implant outcomes

OBJECTIVES

The goal of this exploratory study was to determine the types of improvement that sequentially implanted auditory-verbal and auditory-oral adults with prelingual and childhood hearing loss received in bilateral listening conditions, compared to their best unilateral listening condition.

METHODS

Five auditory-verbal adults and five auditory-oral adults were recruited for this study. Participants were seated in the center of a 6-loudspeaker array. BKB-SIN sentences were presented from 0° azimuth, while multi-talker babble was presented from various loudspeakers. BKB-SIN scores in bilateral and the best unilateral listening conditions were compared to determine the amount of improvement gained.

RESULTS

As a group, the participants had improved speech understanding scores in the bilateral listening condition. Although not statistically significant, the auditory-verbal group tended to have greater speech understanding with greater levels of competing background noise, compared to the auditory-oral participants.

DISCUSSION

Bilateral cochlear implantation provides individuals with prelingual and childhood hearing loss with improved speech understanding in noise. A higher emphasis on auditory development during the critical language development years may add to increased speech understanding in adulthood. However, other demographic factors such as age or device characteristics must also be considered.

CONCLUSION

Although both auditory-verbal and auditory-oral approaches emphasize spoken language development, they emphasize auditory development to different degrees. This may affect cochlear implant (CI) outcomes. Further consideration should be made in future auditory research to determine whether these differences contribute to performance outcomes. Additional investigation with a larger participant pool, controlled for effects of age and CI devices and processing strategies, would be necessary to determine whether language learning approaches are associated with different levels of speech understanding performance.

Cochlear implants matching the prosthesis to the brain and facilitating desired plastic changes in brain function

The cochlear implant (CI) is one of the great success stories of modern medicine. A high level of function is provided for most patients. However, some patients still do not achieve excellent or even good results using the present-day devices. Accumulating evidence is pointing to differences in the processing abilities of the "auditory brain" among patients as a principal contributor to this remaining and still large variability in outcomes. In this chapter, we describe a new approach to the design of CIs that takes these differences into account and thereby may improve outcomes for patients with compromised auditory brains.