A Guide to Unlocking Success in Bimodal Users

Rehabilitation for bimodal hearing device users with a cochlear implant (CI) for one ear and a hearing aid (HA) for the other ear requires a thoughtful and strategic approach. To achieve success on this journey, there are some important considerations to keep in mind:

Develop a Schedule for Device Wear

When introducing a new skill to a bimodal user, you may want to have your patient use both devices at first and then spend part of the session practicing the skill using only their cochlear implant. This will help them get used to their new cochlear implant and also learn how to integrate the information received from both devices.

Although auditory training sessions should sometimes focus on cochlear implant training alone, the primary goal should be enhancing bilateral integration. Therefore, some rehabilitation should involve simultaneous use of both the cochlear implant and the hearing aid.

Make the Most of Hearing With Both Ears

Improving sound localization and speech understanding in noise are important parts of bimodal rehabilitation. By developing these two skills, bimodal users will receive the best binaural benefit. Firszt, J. B., Reeder, R. M., & Skinner, M. W. (2008). Restoring hearing symmetry with two cochlear implants or one cochlear implant and a contralateral hearing aid. Journal of rehabilitation research and development, 45(5), 749–767. https://doi.org/10.1682/jrrd.2007.08.0120[1]Nyirjesy, S., Rodman, C., Tamati, T. N., & Moberly, A. C. (2020). Are There Real-world Benefits to Bimodal Listening? Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 41(9), e1111–e1117. https://doi.org/10.1097/MAO.0000000000002767[2]

Speech understanding in noise training should progress from the easiest to the most difficult. Start with constant noise, non-speech, and higher signal-to-noise ratio. Then you can move on to variable speech.

If a bimodal user is having problems with sound localization, it could be because the timing of their devices is off. You can adjust pitch perception, loudness growth, and timing of a sound in MAESTRO for their RONDO 3 or SONNET 2 to provide them with a closer to natural match.

Monitor Progress to Recognize Successes

In the quest for success, monitoring progress is paramount. Evaluate the performance of both ears regularly to gain insight into your patient’s auditory skills with each device.

The goal is to integrate information from both ears. Patients who had two hearing aids before receiving a cochlear implant will already know how to process sound from their hearing aid. However, hearing with their cochlear implant will come with a learning curve.

Progress with a cochlear implant varies from person to person depending on a range of factors. Some of these factors include cochlear implant wearing time, hearing history, degree of hearing loss, and duration of deafness.

Inform your patients about these factors to help them understand their progress and keep them motivated. Setting realistic expectations and receiving reassurance from their clinician as well as their loved ones will help patients benefit greatly from auditory rehabilitation.

Educate the Families of Recipients

Empower recipients and their families with information about how to improve listening environments. And inform them about communication strategies they can use to make listening and understanding easier, even in difficult listening environments.

Since effective rehabilitation training is key to improving listening abilities, let families of recipients know how they can help their loved one practice auditory rehabilitation at home and in their daily routines.

Schedule Ongoing Expectations Counseling

To ensure cochlear implant recipients continue to make progress and achieve their hearing goals with the help of aural rehabilitation, ongoing expectations counseling is necessary.

Identify and discuss factors that have been playing a role in the patient’s hearing outcomes, and look for ways to improve future outcomes.

It is important to align the rehabilitation plan you have for your patient with their goals. Actively listen to their perspectives, and maintain a physical record of your discussions to refer to in the future.

Listening training for the cochlear implant alone as well as training for simultaneous use of both hearing devices will help your bimodal patients achieve binaural hearing success. Incorporating sound localization exercises and speech in noise exercises and following general good practices for aural rehabilitation will enable your patients to make progress along their hearing journeys.

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