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Wearing a hearing aid and a cochlear implant

Wearing a hearing aid and a cochlear implant: The views and experiences of adults

This study has kindly been supported by Advanced Bionics (AB). The full report is available to download here. For queries or comments, please contact: sarah@earfoundation.org.uk

Summary

A survey was conducted to explore the views and experiences of cochlear implanted adults who use a hearing aid on the contra lateral side (bimodal hearing) and those who do not. 72 responses were received in total for the survey.

  • Responses were from a wide range of respondents across age (45-65 years), number of years after implantation (0.5-28 years, with average of 10.8 years), hearing aid usage and benefit from implants
  • Of the total sample three responses were excluded from further data analysis as they did not complete the survey.   Sixty-nine responses were analysed, of those 70% (48/69) were cochlear implant users only (CI users), in other words those who did not use a hearing aid on the contra lateral side to the cochlear implant. About 26% (18/69) were Bimodal users, those who used a hearing aid on the contra lateral side to the cochlear implant. One respondent reported to have bilateral implants (due to dual sensory loss) and two others reported to be not wearing hearing aid or implants currently, but they were both implant wearers in the past.
  • Bimodal users reported clear advantages of bimodal hearing in terms of sound quality and perception as compared to those who wore a cochlear implant only. Although there was a variation in the perceived level of bimodal benefit, respondents reported advantages such as better music perception, better localisation, spatial discrimination and clarity. CI users did not report these benefits although they reported advantages of wearing a CI.
  • The biggest influence in making the decision to wear a hearing aid and a cochlear implant was the advice of professionals, usually the audiologist.
  • Those who did not use a hearing aid (CI users) fell into three categories;
  1. users who stopped wearing a hearing aid on the contra lateral side to the implant (18),
  2. users who were not offered a hearing aid by the professionals on the contra lateral side to the implant (7)
  3. users who were told by professionals that a hearing aid would be of no use on the contra lateral side to the implant (23).
  • In Group 1 (those who chose to stop using hearing aids), the main reasons for not using a hearing aid in the contra lateral ear were that they found no real benefit and did not like the sound through both implant and hearing aid together.
  • Lack of residual hearing was reported by Groups 2 and 3 as the main reason for not using bimodal hearing.
  • Discrepancy in the advice and information provided to the users across clinics with was evident.
  • The majority of bimodal respondents receive follow up care for the hearing aid and cochlear implant in different clinics, but would prefer it to be at the same time and location.

Recommendations

  • The variability of benefit from bimodal use needs to be acknowledged in the advice and counselling provided to prospective users to establish realistic expectations
  • Consistent information and advice is essential in the decision making process, not only for prospective users, but also for professionals; a uniform protocol and training for both implant and hearing aid audiologists is recommended
  • Development of a cohesive protocol for bimodal use and fitting
  • Integration of hearing aid and CI services to address issues of access and appropriate bimodal management and enhance patient centred care