In the last post, Part 1 on fatigue, we discussed in detail why people with hearing loss may experience fatigue when listening. In this section, we will explore what happens when someone receives a cochlear implant, and what can be done to lessen fatigue associated with listening.

The auditory input provided by a cochlear implant is different from that which is provided by hearing aids. In addition to the extended frequency and intensity ranges provided by a CI, the cochlear implant converts the acoustic signal into an electrical signal and performs frequency and intensity compression's. Therefore, CI users should acquire new connections between auditory input and its meaning. These connections are acquired by learning to interpret the new signal and requires the listener’s attentiveness.

CI users cope with many environmental sounds that were not accessible to them before. Throughout the initial period of CI use, people strive to interpret and learn the meaning of sounds, which may require a lot of concentration. Understanding environmental sounds is rewarding as it improves one’s sense of orientation, safety, and independence. At the same time, these sounds that are now within the hearing range and have meaning, may distract CI users’ attention while they are trying to understand speech.

As was mentioned in the previous post, restricted auditory memory—especially among people who have never experienced typical hearing and older adults (who had typical hearing in the past)—also contributes to more difficult listening effort. Even when sounds are audible and speech perception has been greatly improved with cochlear implantation, listening can still be very demanding.

The process of adjusting to the CI is not always an easy one. In addition to extensive auditory learning, there is a process of experiencing and investigating the technology boundaries. Besides the feelings of gratefulness and relief, people might feel overwhelmed, frustrated and even disappointed. These feelings need to be addressed. This is a process of change, growth and re-organization that is not necessarily obvious. Coping with these challenges can be exhausting.

As CI users improve their ability to perceive speech, they may gradually and naturally become less dependent on speech reading. This is a great gift and an important achievement. On the other hand, people may report negative changes in their family and friends’ behaviors. They can even occur among colleagues at work. People who knew the person before he or she received a CI may now perceive them as having better hearing than they actually have. They challenge them by being less careful in making eye contact, talking to them from a distance, and speaking too fast. The consequences are an increased load and effort required by CI users to keep up.

What can you do?
• Try to arrange your schedule keeping in mind expected fatigue and level of alertness needed for specific activities. If need be, plan for a “time out” (i.e. taking a rest or removing the CI for a short time).
• Be aware of challenging environments that may cause stressful communication conditions. Some of these situations can be managed.
• Organize and accommodate the acoustic conditions at home and at any other relevant space to make them as comfortable as possible:

• Small room + closed door + covered walls + acoustic ceiling: YES
• Open space + open/no door + bare walls + high ceiling: NO
  

• Whenever possible, turn off or quiet appliances such as the dishwasher, air conditioner, microwave, fish tank.
• Try various sound processor programs or adjustments that may help you manage communication in challenging acoustic environments. It might take some time for you to investigate and understand your options but it is definitely worth trying.
• Use assistive listening devices in daily situations that are challenging for you such as lectures, phone calls, and meetings.
• Consider/improve your bilateral hearing.
• Share your experiences with your family and friends and guide them to support and help you communicate with them.
• There is a link between fatigue and motivation, so keep yourself highly motivated. It can be done by setting practical and meaningful goals (e.g., I wish to improve my understanding and active contribution in work meetings and/or family gatherings or I wish to go out to a nice quiet restaurant with friends). Your mood can also affect your motivation, your energy level, and your overall functioning. Try to focus on your gains rather than on your difficulty. This is easier said than done but with the right attitude and support, it is attainable. Focus on the rewards such as the intellectual and social benefits you gain rather than on the listening effort; this may help you to not feel fatigued.
• A guided auditory rehabilitation program may provide you with goals, motivation, and strategies (such as auditory training materials) that may improve your auditory skills as well as your ability to use other resources involved in the listening process.

We can summarize by saying that cochlear implantation enables access to expanded auditory information; some CI recipients may need to work hard in order to accommodate a life filled with new sounds. Such efforts may result in additional fatigue. Know that this is an integral part of the CI journey. Be patient, try to ease the burden by managing your daily environment, and share your experiences with those who can help you get through the process.

Good Luck!

Recommended Reading
McGarrigle R, Munro KJ, Dawes P, Stewart AJ, Moore DR, Barry & Amitay S. (2014): Listening Effort and Fatigue: What Exactly Are We Measuring? A British Society of Audiology Cognition in Hearing Special Interest Group White Paper, International Journal of Audiology, Early Online: 1–13.

Pichora-Fuller MK, Kramer SE, Eckert MA, Edwards B, Hornsby BWY, Humes LE, Lemke U, Lunner T, Matthen M, Mackersie CL, Naylor G., Phillips NA, Richter M, Rudner M, Sommers MS, Tremblay KL & Wingfield A (2016): Hearing Impairment and Cognitive Energy: The Framework for Understanding Effortful Listening (FUEL), Ear and Hearing, 37, 5S-27S.