Getting the Most Out of a Second Implant

Getting the Most Out of a Second Implant

IMG_0557Research has shown that two ears are better than one, especially for locating a sound source and listening in noisy environments. Quality of life questionnaires completed by teens and adults have shown that many find socializing much easier after the 2nd implant and overall many report a huge difference in ease of communication with two cochlear implants.

In order achieve maximum benefit, both ears must be functioning similarly and demonstrate comparable benefit from the devices. For the most part, the closer together the dates of implantation, the greater chance of obtaining this bimodal benefit.

Today, children with profound bilateral hearing loss are generally being recommended for bilateral implantation. The surgery may be recommended simultaneously (both sides on the same date) or sequentially (on two different dates within close proximity (usually within 6 months). While there is a short lag sometimes between surgeries, ultimately, this is considered to be a close enough window to make the most benefit. Children who are implanted simultaneously (or within a short time frame), generally like both implants equally.

For children with asymmetrical hearing loss (one ear better than the other), it is often suggested that the child get implanted on the poorer side, and use the hearing aid in the contraletral ear, as long as they are getting good benefit from the hearing aid. So, how long in between could be too long to wait?

I have had several children that I have worked with who ended up not accepting the second implant. The majority of these children received the first implant at a very young age, prior to learning language.   Then, they were implanted with the 2nd implant several years later, once they had already developed language.

These children, generally don’t have a memory of what the implant sounded like at the beginning and don’t remember learning to listen. When a second implant is decided upon, these children expect that, at activation, it will sound like the first implant. However, that isn’t the case, especially in the beginning. Thus, some of these children start off the process with a negative feeling about the 2nd implant.

After the implant, auditory therapy is required to get the 2nd ear “up and running”. Sometimes, older children dislike this idea, as it requires them to spend time with only the 2nd implant, which is more difficult for them.  However, this step is critical so that the child gets the most benefit out of the second device.  Once the child’s listening skills improve, not only does the binaural benefit “kick in”, but the child begins to accept the device.

What I Recommend

  • Realistic Expectations:  Prior to implantation, explain to the child that listening with the new ear will take some time. It is really important to make sure the child’s expectations are realistic. Explain that it might sound like beeps and strange sounds at first and that with practice it will sound just like the first. Then, explain the ultimate benefits of having two “equal” ears. Be sure the child understands that listening will be easier, especially in noisy, social situations.
  • Listening Therapy:  Listening therapy is necessary at the beginning to get the 2nd ear up and running. This therapy should use the prior experience and language skills which have already been developed to work up the listening hierarchy
  • Daily Practice: Spend time each day listening with just the 2nd implant (taking off the 1st implant). This should not be done during the school day (unless in listening or language therapy), but at home. Read aloud together, listen to books on tape by following along, or just have a conversation.

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