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Semin Hear 2011; 32(1): 053-072
DOI: 10.1055/s-0031-1271948
© Thieme Medical Publishers

Bilateral Cochlear Implants in Children

Richard C. Dowell1 , 2 , Karyn L. Galvin1 , Shani J. Dettman1 , Jaime R. Leigh1 , 2 , Kathryn C. Hughes1 , Richard van Hoesel3
  • 1Audiology, Hearing and Speech Sciences, The University of Melbourne, Melbourne, Australia
  • 2Royal Victorian Eye and Ear Hospital; Melbourne, Australia
  • 3The Hearing Cooperative Research Centre, The University of Melbourne, Melbourne, Australia
Further Information

Publication History

Publication Date:
16 February 2011 (online)

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ABSTRACT

This article provides a brief overview of the advantages of two-ear hearing in children and discusses the limitations, from a psychophysical and a technical perspective, which may constrain the ability of cochlear implant users to gain these benefits. The latest outcomes for children using bilateral cochlear implants are discussed, which suggest that results are more favorable for children who receive both devices before the age of 3.5 to 4 years. The available studies that have investigated electrophysiological responses for children receiving bilateral implants are discussed. These also support the notion that optimum development of binaural auditory skills may be more difficult after the age of 3.5 to 4 years. Studies that investigate the alternative for some children of using a hearing aid on the opposite ear to the cochlear implant are briefly discussed. These indicate that advantages for speech perception in noise and localization can be obtained consistently for children with significant residual hearing in the nonimplanted ear. The article concludes with an attempt to bring the available scientific evidence into the practical clinical context with suggestions that may assist clinicians in making recommendations for families considering bilateral cochlear implantation. Although the evidence remains limited at this time, it is reasonable to suggest that bilateral cochlear implantation can provide improved auditory skills over a single implant for children with severe and profound bilateral hearing loss. The available data suggest that the benefit may be maximized by introducing both implants as early as possible, at least before 3.5 to 4 years of age.

KEYWORDS

Bilateral cochlear implants - children - hearing loss - speech perception - localization

REFERENCES

  • 1 Hirsh I J. The influence of interaural phase on interaural summation and inhibition.  J Acoust Soc Am. 1948;  20 536-544
    CrossrefPubMedGoogle Scholar
  • 2 Levitt H, Rabiner L R. Predicting binaural gain in intelligibility and release from masking for speech.  J Acoust Soc Am. 1967;  42 (4) 820-829
    CrossrefPubMedGoogle Scholar
  • 3 Zurek P M. Binaural advantages and directional effects in speech intelligibility. In: Studebaker G A, Hochberg I, eds. Acoustical Factors Affecting Hearing Aid Performance. 2nd ed. Boston, MA: Allyn and Bacon; 1993
    Google Scholar
  • 4 Bronkhorst A W, Plomp R. Binaural speech intelligibility in noise for hearing-impaired listeners.  J Acoust Soc Am. 1989;  86 (4) 1374-1383
    CrossrefPubMedGoogle Scholar
  • 5 Van Hoesel R, Ramsden R, Odriscoll M. Sound-direction identification, interaural time delay discrimination, and speech intelligibility advantages in noise for a bilateral cochlear implant user.  Ear Hear. 2002;  23 (2) 137-149
    CrossrefPubMedGoogle Scholar
  • 6 van Hoesel R, Böhm M, Battmer R D, Beckschebe J, Lenarz T. Amplitude-mapping effects on speech intelligibility with unilateral and bilateral cochlear implants.  Ear Hear. 2005;  26 (4) 381-388
    CrossrefPubMedGoogle Scholar
  • 7 van Hoesel R J, Tyler R S. Speech perception, localization, and lateralization with bilateral cochlear implants.  J Acoust Soc Am. 2003;  113 (3) 1617-1630
    CrossrefPubMedGoogle Scholar
  • 8 Nopp P, Schleich P, D'Haese P. Sound localization in bilateral users of MED-EL COMBI 40/40 + cochlear implants.  Ear Hear. 2004;  25 (3) 205-214
    CrossrefPubMedGoogle Scholar
  • 9 Litovsky R Y, Parkinson A, Arcaroli J, Sammeth C. Simultaneous bilateral cochlear implantation in adults: a multicenter clinical study.  Ear Hear. 2006;  27 (6) 714-731
    CrossrefPubMedGoogle Scholar
  • 10 Neuman A C, Haravon A, Sislian N, Waltzman S B. Sound-direction identification with bilateral cochlear implants.  Ear Hear. 2007;  28 (1) 73-82
    CrossrefPubMedGoogle Scholar
  • 11 Grantham D W, Ashmead D H, Ricketts T A, Labadie R F, Haynes D S. Horizontal-plane localization of noise and speech signals by postlingually deafened adults fitted with bilateral cochlear implants.  Ear Hear. 2007;  28 (4) 524-541
    CrossrefPubMedGoogle Scholar
  • 12 van Hoesel R J. Exploring the benefits of bilateral cochlear implants.  Audiol Neurootol. 2004;  9 (4) 234-246
    CrossrefPubMedGoogle Scholar
  • 13 Klumpp R G, Eady H R. Some measurements of interaural time difference thresholds.  J Acoust Soc Am. 1956;  28 859-860
    CrossrefPubMedGoogle Scholar
  • 14 Majdak P, Laback B, Baumgartner W-D. Effects of interaural time differences in fine structure and envelope on lateral discrimination in electric hearing.  J Acoust Soc Am. 2006;  120 (4) 2190-2201
    CrossrefPubMedGoogle Scholar
  • 15 Laback B, Majdak P, Baumgartner W-D. Lateralization discrimination of interaural time delays in four-pulse sequences in electric and acoustic hearing.  J Acoust Soc Am. 2007;  121 (4) 2182-2191
    CrossrefPubMedGoogle Scholar
  • 16 van Hoesel R JM. Sensitivity to binaural timing in bilateral cochlear implant users.  J Acoust Soc Am. 2007;  121 (4) 2192-2206
    CrossrefPubMedGoogle Scholar
  • 17 van Hoesel R JM. Observer weighting of level and timing cues in bilateral cochlear implant users.  J Acoust Soc Am. 2008;  124 (6) 3861-3872
    CrossrefPubMedGoogle Scholar
  • 18 van Hoesel R JM, Jones G L, Litovsky R Y. Interaural time-delay sensitivity in bilateral cochlear implant users: effects of pulse rate, modulation rate, and place of stimulation.  J Assoc Res Otolaryngol. 2009;  10 (4) 557-567
    PubMedGoogle Scholar
  • 19 Long C J, Eddington D K, Colburn H S, Rabinowitz W M. Binaural sensitivity as a function of interaural electrode position with a bilateral cochlear implant user.  J Acoust Soc Am. 2003;  114 (3) 1565-1574
    CrossrefPubMedGoogle Scholar
  • 20 Litovsky R Y, Johnstone P M, Godar S P. Benefits of bilateral cochlear implants and/or hearing aids in children.  Int J Audiol. 2006;  45 (Suppl 1) S78-S91
    CrossrefPubMedGoogle Scholar
  • 21 Galvin K L, Mok M, Dowell R C. Perceptual benefit and functional outcomes for children using sequential bilateral cochlear implants.  Ear Hear. 2007;  28 (4) 470-482
    CrossrefPubMedGoogle Scholar
  • 22 Galvin K L, Hughes K C, Mok M. Can adolescents and young adults with prelingual hearing loss benefit from a second, sequential cochlear implant?.  Int J Audiol. 2010;  49 (5) 368-377
    CrossrefPubMedGoogle Scholar
  • 23 Galvin K L, Mok M, Dowell R C, Briggs R J. Speech detection and localization results and clinical outcomes for children receiving sequential bilateral cochlear implants before four years of age.  Int J Audiol. 2008;  47 (10) 636-646
    CrossrefPubMedGoogle Scholar
  • 24 Beijen J W, Snik A FM, Mylanus E AM. Sound localization ability of young children with bilateral cochlear implants.  Otol Neurotol. 2007;  28 (4) 479-485
    CrossrefPubMedGoogle Scholar
  • 25 Gordon K A, Valero J, Papsin B C. Binaural processing in children using bilateral cochlear implants.  Neuroreport. 2007;  18 (6) 613-617
    CrossrefPubMedGoogle Scholar
  • 26 Gordon K A, Valero J, Papsin B C. Auditory brainstem activity in children with 9-30 months of bilateral cochlear implant use.  Hear Res. 2007;  233 (1-2) 97-107
    CrossrefPubMedGoogle Scholar
  • 27 Sharma A, Dorman M F, Spahr A J. A sensitive period for the development of the central auditory system in children with cochlear implants: implications for age of implantation.  Ear Hear. 2002;  23 (6) 532-539
    CrossrefPubMedGoogle Scholar
  • 28 Sharma A, Gilley P M, Martin K, Roland P, Bauer P, Dorman M F. Simultaneous versus sequential bilateral implantation in young children: effects on central auditory system development and plasticity.  Audiol Med. 2007;  5 4218-4223
    PubMedGoogle Scholar
  • 29 Galvin K L, Leigh J R, Hughes K C. How we do it: clinical management of the child receiving a second, bilateral cochlear implant.  Cochlear Implants Int. 2009;  10 (2) 84-91
    CrossrefPubMedGoogle Scholar
  • 30 Scherf F W, van Deun L, van Wieringen A et al. Functional outcome of sequential bilateral cochlear implantation in young children: 36 months postoperative results.  Int J Pediatr Otorhinolaryngol. 2009;  73 (5) 723-730
    CrossrefPubMedGoogle Scholar
  • 31 Hughes K C, Galvin K L, Mok M, Tomov A, Holt C, Hill K. Potential adaptation difficulties for children under 4 years receiving a second side implant. Presented at: the 9th European Symposium on Pediatric Cochlear Implantation May 14–17, 2009 Warsaw, Poland;
    Google Scholar
  • 32 Galvin K L, Hughes K C, Mok M et al. Documenting progress with sequential, bilateral cochlear implants: reported device use and performance milestones achieved by toddlers, children and young adults. Presented at: the 9th European Symposium on Pediatric Cochlear Implantation May 14–17, 2009 Warsaw, Poland;
    Google Scholar
  • 33 Dettman S J, D'Costa W A, Dowell R C, Winton E J, Hill K L, Williams S S. Cochlear implants for children with significant residual hearing.  Arch Otolaryngol Head Neck Surg. 2004;  130 (5) 612-618
    CrossrefPubMedGoogle Scholar
  • 34 Eisenberg L S, Martinez A S, Sennaroglu G, Osberger M J. Establishing new criteria in selecting children for a cochlear implant: performance of “platinum” hearing aid users.  Ann Otol Rhinol Laryngol Suppl. 2000;  85 30-33
    PubMedGoogle Scholar
  • 35 Winton L, Hollow R, Dettman S J et al. Cochlear implant speech perception selection criteria: who is a candidate now?. Presented at: the XXVI International Congress of Audiology March 17–21, 2002 Melbourne, Australia;
    Google Scholar
  • 36 Cheng A, Niparko J K. Analyzing the effects of early implantation and results with different causes of deafness: meta-analysis of the pediatric cochlear implant literature. In: Niparko J K, Kirk K I, Mellon A M, Tucci D E, Wilson B S, eds. Cochlear Implants: Principles & Practices. Philadelphia, PA: Lippincott Williams & Wilkins; 2000: 259-265
    Google Scholar
  • 37 Dowell R C, Dettman S J, Blamey P J, Barker E J, Clark G M. Speech perception in children using cochlear implants: prediction of long-term outcomes.  Cochlear Implants Int. 2002;  3 (1) 1-18
    CrossrefPubMedGoogle Scholar
  • 38 Geers A E, Brenner C, Davidson L S. Factors associated with development of speech perception skills in children implanted by age five.  Ear Hear. 2003;  24 (1 Suppl) 24S-35S
    CrossrefPubMedGoogle Scholar
  • 39 McConkey Robbins A, Koch D B, Osberger M J, Zimmerman-Phillips S, Kishon-Rabin L. Effect of age at cochlear implantation on auditory skill development in infants and toddlers.  Arch Otolaryngol Head Neck Surg. 2004;  130 (5) 570-574
    CrossrefPubMedGoogle Scholar
  • 40 Pulsifer M B, Salorio C F, Niparko J K. Developmental, audiological, and speech perception functioning in children after cochlear implant surgery.  Arch Pediatr Adolesc Med. 2003;  157 (6) 552-558
    CrossrefPubMedGoogle Scholar
  • 41 Leigh J R, Dettman S J, Sarant J, Hollow R, Dowell R C, Briggs R JS. Pushing the boundaries: changing selection criteria for paediatric cochlear implant recipients. Presented at: the 10th International Conference on Cochlear Implants and other Implantable Auditory Technologies April 10–12, 2008 San Diego, CA;
    Google Scholar
  • 42 Eisenberg L S, Kirk K I, Martinez A S, Ying E A, Miyamoto R T. Communication abilities of children with aided residual hearing: comparison with cochlear implant users.  Arch Otolaryngol Head Neck Surg. 2004;  130 (5) 563-569
    CrossrefPubMedGoogle Scholar
  • 43 Nabelek A K, Mason D. Effect of noise and reverberation on binaural and monaural word identification by subjects with various audiograms.  J Speech Hear Res. 1981;  24 (3) 375-383
    PubMedGoogle Scholar
  • 44 Day G A, Browning G G, Gatehouse S. Benefit from binaural hearing aids in individuals with a severe hearing impairment.  Br J Audiol. 1988;  22 (4) 273-277
    CrossrefPubMedGoogle Scholar
  • 45 Byrne D, Noble W. Optimising sound localisation with hearing aids.  Trends Amplif. 1998;  3 51-73
    CrossrefPubMedGoogle Scholar
  • 46 Kimberley B P, Dymond R, Gamer A. Bilateral digital hearing aids for binaural hearing.  Ear Nose Throat J. 1994;  73 (3) 176-179
    PubMedGoogle Scholar
  • 47 Sargent E W, Herrmann B, Hollenbeak C S, Bankaitis A E. The minimum speech test battery in profound unilateral hearing loss.  Otol Neurotol. 2001;  22 (4) 480-486
    CrossrefPubMedGoogle Scholar
  • 48 de Boer E, Dreschler W A. Auditory psychophysics: spectrotemporal representation of signals.  Annu Rev Psychol. 1987;  38 181-202
    CrossrefPubMedGoogle Scholar
  • 49 Dillon H. Binaural and Bilateral Considerations in Hearing Aid Fitting. Hearing Aids. Sydney, Australia: Boomerang Books; 2001
    Google Scholar
  • 50 Javer A R, Schwarz D WF. Plasticity in human directional hearing.  J Otolaryngol. 1995;  24 (2) 111-117
    PubMedGoogle Scholar
  • 51 Ching T Y, Psarros C, Hill M, Dillon H, Incerti P. Should children who use cochlear implants wear hearing aids in the opposite ear?.  Ear Hear. 2001;  22 (5) 365-380
    CrossrefPubMedGoogle Scholar
  • 52 Ching T Y, Incerti P, Hill M. Binaural benefits for adults who use hearing aids and cochlear implants in opposite ears.  Ear Hear. 2004;  25 (1) 9-21
    CrossrefPubMedGoogle Scholar
  • 53 Ching T Y, Incerti P, Hill M, van Wanrooy E. An overview of binaural advantages for children and adults who use binaural/bimodal hearing devices.  Audiol Neurootol. 2006;  11 (Suppl 1) 6-11
    PubMedGoogle Scholar
  • 54 Chmiel R, Clark J, Jerger J, Jenkins H, Freeman R. Speech perception and production in children wearing a cochlear implant in one ear and a hearing aid in the opposite ear.  Ann Otol Rhinol Laryngol Suppl. 1995;  166 314-316
    PubMedGoogle Scholar
  • 55 Holt R F, Kirk K I, Eisenberg L S, Martinez A S, Campbell W. Spoken word recognition development in children with residual hearing using cochlear implants and hearing AIDS in opposite ears.  Ear Hear. 2005;  26 (4 Suppl) 82S-91S
    CrossrefPubMedGoogle Scholar
  • 56 James C J, Fraysse B, Deguine O et al. Combined electroacoustic stimulation in conventional candidates for cochlear implantation.  Audiol Neurootol. 2006;  11 (Suppl 1) 57-62
    PubMedGoogle Scholar
  • 57 Dettman S J, Wai H, van Hoesel R JM, Dowell R C, Cowan R SC. Bimodal-binaural device use for children: speech perception and sound source identification. Presented at: the 6th European Symposium on Paediatric Cochlear Implantation; February 27 to March 2, 2002 Canary Islands, Spain;
    Google Scholar
  • 58 Mok M, Grayden D, Dowell R C, Lawrence D. Speech perception for adults who use hearing aids in conjunction with cochlear implants in opposite ears.  J Speech Lang Hear Res. 2006;  49 (2) 338-351
    CrossrefPubMedGoogle Scholar
  • 59 Dettman S J. Primary caregiver input and communication development for children using the cochlear implant [unpublished doctoral thesis]. University of Melbourne, Melbourne, Australia 2005
    Google Scholar
  • 60 Nittrouer S, Chapman C. The effects of bilateral electric and bimodal electric—acoustic stimulation on language development.  Trends Amplif. 2009;  13 (3) 190-205
    CrossrefPubMedGoogle Scholar
  • 61 Jusczyk P W, Luce P A. Speech perception and spoken word recognition: past and present.  Ear Hear. 2002;  23 (1) 2-40
    CrossrefPubMedGoogle Scholar
  • 62 Boothroyd A. Auditory capacity of hearing-impaired children using hearing aids and cochlear implants: issues of efficacy and assessment.  Scand Audiol Suppl. 1997;  46 17-25
    PubMedGoogle Scholar
  • 63 Davidson L S. Effects of stimulus level on the speech perception abilities of children using cochlear implants or digital hearing aids.  Ear Hear. 2006;  27 (5) 493-507
    CrossrefPubMedGoogle Scholar
  • 64 Ramsden J D, Papsin B C, Leung R, James A, Gordon K A. Bilateral simultaneous cochlear implantation in children: our first 50 cases.  Laryngoscope. 2009;  119 (12) 2444-2448
    CrossrefPubMedGoogle Scholar

Richard C DowellPh.D. 

Professor of Audiology and Speech Science, The University of Melbourne, Director of Audiological Services, Royal Victorian Eye and Ear Hospital

550 Swanston Street, Parkville, Victoria 3010, Australia

Email: rcd@unimelb.edu.au

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