Building skills for children with unilateral hearing loss and cochlear implants

Jane Madell
June 1, 2021

I have received a lot of questions about managing children with unilateral hearing loss, who wear a cochlear implant on the ear with hearing loss. What do we need to do to build skills the cochlear implant ear?

Two ears have significant benefit in the ability to localize sound and in hearing in noise. This is a critical so we should try and do our best to help children hear in both ears as equally as possible. We know that if two ears have significant differences in hearing, the listener feels as if sound is only in the better hearing ear.

While there will likely be some benefit from the poorer hearing ear, it may not be significant.


Unilateral Hearing Loss in Children


Speech perception testing will tell us what a child is hearing in each ear, but only if we can really test each ear separately. In the audiology test booth we can put masking noise in the better hearing ear so that we can test the poorer ear without the good ear participating.

It becomes more difficult to test the poorer hearing ear, especially for children who have acquired language using their better ear alone. Clinicians need to figure out how to block out the better hearing ear while they improve skills on the cochlear implant ear.

If the child is using a hearing aid on the better hearing ear, therapy can begin by removing the hearing aid from that ear. Then try asking questions with both the hearing aid and cochlear implant removed. If the child cannot hear, you know that they are not hearing with the hearing aid ear and when you put the cochlear implant on you will be working with the implant alone.

If the child has normal hearing in one ear, or if with the hearing aid off the child still hears, it will be necessary to work to block that ear. You can start with an earplug but these may not provide enough blockage. Next add noise cancelling earphones. If that is not sufficient, it will be necessary to add noise to that ear. This can be done by placing an insert earphone into the better ear and turning on a talk radio station, and then putting on noise cancelling earphones.


Building Skills


Therapy with the CI will be the same as it would be for any child learning to listen. Start with awareness and be sure the child is aware of sounds. Then build skills moving through detection, on to discrimination (the ability to tell if sounds are the same of different), identification (the child can point to  a sound, word, or object) to comprehension (the child knows what the word or picture means.)

It is critical that we know that work is being done with the CI ear alone.

It is not sufficient for a child to use the CI alone only in therapy one hour/week. It is essential that the child use the CI alone 2-3 hours/day. Noise cancelling earphones can be used on the better hearing ear. Depending on the age of the child the time for listening alone can vary. Young children may do best if the CI is used alone first thing in the morning, and maybe after a nap and then after bath. Older child may use it alone before heading off the school and when they get home. Families need to understand the importance of using the CI alone. Once they start seeing the child responding they will be comfortable doing it.

Once skills in the CI ear are developed so that the child is really hearing the child may not need time with the CI ear alone daily but it is important to keep monitoring performance in each ear alone so that we know if they need changes in management.

Just do it!!!

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