The speech perception evaluations done as part of the follow-up for CI recipients are typically reflected by a percentage, which some people perceive as a “grade.” However, unlike grades in school, there are no standards and there is not a simple definition for what is a good grade. Some people would consider 30% on a test of understanding words in sentences in quiet as a huge success because they never had any auditory speech understanding before CI. Other people, after the same period of CI experience, would consider a score of 90% in quiet and 50% in noise as successful; those individuals might have had a pre-CI “grade” of 40% of words in sentences in quiet and 10% in noise. There are speech perception tests that simulate comprehension in more realistic conditions, such as recognition of common sentences in noise. Other tests are used to evaluate perception of speech sounds, words, and sentences in quiet conditions in closed set (i.e., multiple choice) or in open set (i.e., words or sentence repetition task). Recipients should always seek the help of their CI audiologist to help them understand their outcomes and what they mean in terms of personal improvement.

Objective Versus Subjective Assessments

One should take these scores with a grain of salt. Remember that they represent specific speech perception skills (those that are directly evaluated by these tests) and do not represent your overall CI outcomes. For example, a score of 95% word recognition in quiet conditions may not cheer up a CI user when they realize that a colleague approached them with a short question and they missed it. For others, a "lower" grade (of say, 40%) does not represent the significant advancement they’ve experienced in being able to combine speechreading with listening much more effectively—an advancement that makes them feel very positive about their decision to undergo cochlear implantation.

Therefore, if a recipient feels that numerical scores don’t seem consistent with their own perceived experience and (s)he then asks "Am I doing well?", one should consider other ways of representing a subjective evaluation.

How did hearing loss affect the person’s life before the cochlear implant?

The goal is to evaluate the contribution of the CI to one’s communication and how it is reflected in different situations in life. It's important to consider how hearing loss affected an individual before CI and what kinds of difficulties affected his or her decision to undergo cochlear implantation. For example, someone might contemplate:

• Could you understand some speech without speechreading?
• If you could, what restrictions did you have? Did you need to stay close to the talker, listen in a quiet room, and close the door?
• Did you understand certain talkers better than others?
• Did you ask people to slow down when they were speaking?
• Do you remember how much effort you put into having a conversation, especially with unfamiliar speakers?
• Do you remember how often you asked people to repeat or speak more slowly?
• Did you give up the chance to fully understand people, given the frustration in getting it right?
• Did people touch or tap you to get your attention? 

Assessing Quality of Life Changes

To assess the CI contribution to one’s quality of life and sense of successful CI use, an individual should consider improvements in the ease of communication, sense of security and orientation, and enjoyment in listening.

• Does the CI make it easier for the person to have a conversation?
• Can the person now understand a more rapid pace of speech?
• Does (s)he ask people to repeat less frequently?
• Does (s)he feel that it is easier to understand people whose voices were previously very difficult to understand, such as children or those with heavily accented speech?

If a person answers “yes” to some of these examples, it indicates benefit in daily situations that contribute to quality of life.

Satisfaction Isn’t Easy to Quantify

In addition to improvements in auditory speech perception, an individual may simply enjoy listening to the voices of beloved people, to street noise, animals and nature sounds, and music. These feelings of pleasure are priceless. It is true that there are people who will respond to daily greetings and understand simple questions, even without having any eye contact with the speaker. There are also CI recipients who will talk on the phone. However, they are not the only successful CI users. Everyone may define the benefits they derive from their CI and can feel satisfied and accomplished by them.

Satisfaction following cochlear implantation can be affected by the extent to which the CI enables someone to meet their own communication needs. These needs vary depending upon whether the recipient relies upon written communication at their work place or if they need to use spoken language extensively, whether an individual is working in a quiet or noisy environment, whether they use sign language with relatives and friends or not. The sense of self-accomplishment should mainly rely on the person’s recognition of the different contributions that a cochlear implant makes to their everyday life.
Keep in mind that the reason for someone to undergo cochlear implantation is typically to improve their quality of life, not to get As on tests. The auditory information provided by cochlear implantation provides much more than numeric results on clinical tests.

CI recipients should share their insights regarding benefits and expectations with relatives and friends as well as with their CI professionals. Accepting diversity, appreciating achievements, and continuing to improve hearing skills is all part of one’s CI enjoyment.

Naama Tsach
naama@acialliance.org