Post Cochlear Implant-What Should an Adult Expect?

Auditory Therapy for Adults

As research continues to show the extensive benefits of cochlear implants, and with frequent advances in technology, more and more adults are getting implanted. It is generally expected that children receiving a cochlear implant will need school services and therapies following implantation.  But what about adults? Do adults need auditory (re)habilitation therapy after receiving a cochlear implant in order to benefit from them?  As an auditory therapist my answer is “YES!”.

Since adults who receive cochlear implants are not a homogenous population, the frequency and number of sessions needed may be different for different populations. So, in order to answer the question, let’s examine different groups.

DISCLAIMER: These are generalizations and do not represent the outcomes for ALL members of a specific group.

The Adult with Sudden Sensorineural Hearing Loss

It has been my experience that for adults who have sudden onset hearing loss and who receive a cochlear implant shortly after losing their hearing, limited to no auditory therapy is needed afterwards.  For these adults the auditory pathways to the brain are fully developed, the language system within the brain is intact, and the cochlear implant provides access to speech. These adults generally report that, at first, voices sounds like a cartoon characters, like the Chipmunks or Mickey Mouse.  Given time, they train themselves through experience and acclimate to the sound, reporting that it sounds “normal”, after some time.  That being said, I do believe that with some formal auditory therapy the process can be faster.

The Adult who Gradually Lost Hearing in Adulthood

For the adult who gradually lost hearing in adulthood or who lost it many years ago, the amount of auditory rehabilitation therapy will likely be greater. The duration of deafness, the amount of time since the auditory nerve and brain have been fully stimulated by sound, will likely correlate with the amount of auditory rehabilitation therapy required. Adults in this category are likely to be verbal communicators, with developed language skills, who used lip reading (speech reading) to supplement the auditory information they received from their hearing aids prior to implantation.  Thus, the language centers of the brain are intact and can be used to help the auditory rehabilitation process.

The Adult who Lost Hearing as a Child, but Post-Lingually

Adults who lost their hearing in childhood, after developing language, have auditory pathways and language systems which had once been fully stimulated.  However, the amount of time since they used those connections is significantly longer than those in the above group.  It is important to consider how long those pathways were used as a child.  There is a difference between losing hearing at 4 years old and losing it at 10 years old.  The duration of deafness will impact the amount of time needed in auditory rehabilitation therapy.  These adults generally use hearing aids with limited benefit until seeking an implant.  Again, here, it is likely that the auditory rehabilitation process doesn’t need to include connecting the auditory and language centers.  It is training the brain to make sense of the electrical stimulation received by the cochlear implant. Often, these adults will report the implant to sound like beeps at the beginning.  They are sometimes disappointed at first, if the expectations were not made clear.  They have “memories” of what it was like to hear, understand and speak and had hoped that it would come with greater ease.

The Pre-Lingually Deafened Adult Who Has Been Oral Since Childhood

Here we are talking about adults who have always received limited benefit from hearing aids.  For this group of adults, the amount of auditory habilitation therapy required post activation is usually significantly more. These adults lost their hearing prior to learning language.  Thus, the auditory pathways were not developed. They learned spoken language via an oral approach using whatever residual aided hearing they had.  Often post activation, these adults report the implant to sound like beeps and whistles.  The whistles are how they perceive the high frequency sounds (like /s/), since these are sounds they never heard, even with hearing aids.  In my experience, this is the group of adults where I have seen people “give up”, especially when the expected outcomes weren’t explicit.  Often, members of this group hope to be able to completely rely on their auditory skills for communication.  While this is definitely possible, it is only with a lot of auditory habilitation therapy and hard work around the clock.

The Pre-Lingually Deafened Adult Who Has Used Sign Language Since Childhood

Some pre-lingually deafened adults who have used sign language since childhood are also seeking implantation.  While these adults are likely involved in communities where sign language is used, they have determined that having access to sound is beneficial to their lives.   For these adults, the auditory therapy process is much more complex and progress is slower.   Since sign language is a language, it has activated the language centers of the brain.  However, as it is a visual system it is completely different from spoken language.  Additionally, the auditory pathways have had little to no stimulation.  This group of adults is generally happy with the access they receive with their cochlear implant.  Some of them only want to hear environmental sounds, use hearing for the purposes of safety, or hear the voices of those around them.  With enough auditory therapy and perseverance, they can often surpass these expectations.

How to Get the Most Out of a Cochlear Implant

While expected outcomes are different for each of these groups of adults, the common denominator is auditory therapy.  Auditory (re)habilitation therapy is a process and follows a hierarchy of skills.   No matter the age of the recipient, moving through the hierarchy is critical to the rehabilitation process (see article on the Auditory Hierarchy).

As an adult there are activities that you can do that can help with the process of auditory (re)habilitation.  These include:

• Reading along with books on tape. Start with children’s books and move up to adult books as you are ready.
• Watch a T.V. episode with the captions first, then watch the same episode without the captions. (This may take some savvy with using your DVR).
• Have simple predictable conversations with close friends and family where you establish a topic (one that you are knowledgable about) in advance and then try not to look at them during the conversation. If at any point you get “lost”, re-establish the topic or ideas being shared.
• Med-El’s Soundscape (http://www.medel.com/us/resources-for-success-soundscape/), Cochlear’s Tiger Speech–Formally Sound and Way Beyond (http://angelsound.tigerspeech.com) and Advanced Bionics’ The Listening Room (http://thelisteningroom.com) are all online programs for auditory rehabilitation that you can also access.