Cochlear Implant Rehabilitation for Adults
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Auditory adjustment, spontaneous auditory learning, and auditory rehabilitation following Cochlear Implantation

Posted By Naama Tsach, PhD, Monday, June 22, 2020

Yesterday I noticed that I was hearing without even trying.

Adults who receive cochlear implants rarely are offered clinician-guided auditory rehabilitation after their surgery. They are often told that the process they will go through, in learning to access the new auditory signal via their cochlear implant, will occur spontaneously as they adjust to their new hearing.

This approach works for many people, especially if individuals had typical hearing as children and experienced hearing loss as adults and their period of deafness was relatively short prior to receiving a CI. However, this process of spontaneous adjustment does not occur for all adults. Learning to use the new signal from a cochlear implant is especially difficult for those who were deaf as children and received their CI as adults.

What impacts spontaneous auditory learning?

Spontaneous auditory learning during daily routines is impacted by various factors including one’s ability to understand speech while occupied with other daily activities, opportunities to listen at work and at home, and whether the individual has feedback on their mistakes. Being able to constructively address such feedback is key to helping an individual improve their listening skills.

Following cochlear implantation, people who had typical hearing for most of their lives learn to adjust to sounds that are different from what they remember as sound. Sounds may seem strange or confusing at the beginning but typically become meaningful over time. One’s auditory memory will help an individual interpret the sounds they hear. A recipient may experience some ups and downs during the first year following implantation especially if they have very high expectations regarding their improvement rate. Some people will struggle in complex communication listening situations such as listening in noise or listening with multiple speakers. In most cases, the CI recipient will learn to handle these challenges over time and with experience, their comprehension will improve.

Later Deafened CI Recipients

People who have lost hearing later in life will generally become acoustically attentive to their surroundings. Before implantation, given that their auditory function was limited, such individuals tend to have been selective in their auditory attention focusing mainly on speech directed at them. After a period of time using their CI, a late deafened person will typically find themselves unintentionally perceiving and reacting to speech and sounds around them. They will grasp words and sentences from the radio and TV, parts of a conversation held between colleagues without even looking at them, and many other auditory stimuli. "Yesterday I noticed that I was hearing without even trying" is an important milestone and a great accomplishment, one that most people can expect to experience after few months. As they become active listeners, they will naturally practice their hearing in many daily situations.

In addition, most people will continue to strive to hear better. They will challenge themselves to function as close as possible to the level in which they did before losing their hearing. They have the drive and the knowledge of what good hearing is, and they will find their own ways to achieve the most out of their CI, including the use of additional technologies as needed such as assistive listening devices, apps, and making full use of programming options on their sound processor.

Early Deafened Adults

In contrast to CI users who had typical hearing for much of their lives and lost their hearing as adults, there are a growing number of adult CI users who were deaf as children. For this group, the decision to pursue a cochlear implant entails some uncertainty. They may have questions that cannot be answered with certainty about their outcomes. Since they either have no memory of typical hearing (either because they never had it or it was for a short period time during early childhood), it is difficult for such individuals to know what to expect regarding CI outcomes.
For an early deafened adult, the acoustic information provided by a CI may be confusing, overwhelming, and exhausting. Some people are bothered by the sound level they receive from their CI and perceive it as “noise.” It takes time to learn to interpret both environmental and speech sounds and attach meaning to them.

Not only do such recipients need to learn to attach meaning to the sounds they are hearing, they must also deal with many sounds they may not have even known existed. In addition to adjusting to their new hearing, they will deal with some key questions:

• What constitutes typical hearing?
• What are the limitations of typical hearing?
• To what extent can a CI allow someone to function like a person with typical hearing?
• Will I be able to enjoy music?

With regard to music, some early deafened adults will be interested in listening to music including songs they may have learned about from others but have never actually heard.

New Listening Opportunities and Challenges

 This group of early deafened CI adults will need to learn how their ability to listen is affected by factors related to the environment, the speaker, the content and more. Like late deafened individuals, they should seek accommodations that may improve communication. They will need support and guidance in practicing tasks that previously seemed impossible to them, such as talking on the phone. Since most in this group are accustomed to concentrating on speech that is targeted directly at them, they will need to work to consciously change their old habits to become acoustically attentive to a larger sphere of sound. All of these challenges may be challenging especially if they attempt it without a clinician-guided auditory rehab program. 

The speech perception outcomes of adults with early deafness are typically lower than those of people who had generally typical hearing in the past. To understand speech without lipreading, CI adult users with early deafness rely heavily on contextual strategies. The differences show not only in their ability to perceive speech sounds and sentences in quiet but especially in their ability to understand speech in noise. If their use of auditory information was limited during most of their life, they may have great difficulty in processing auditory information. These tasks will be more difficult still with speech that is normal to fast-paced or require auditory memory skills.

Adult CI recipients with early deafness often struggle to learn how to identify speech sounds, separate several sounds that are occurring at the same time, and understand speech in noise. In addition. their auditory processing skills limit their speech understanding to a slow speech pace, and to tasks that do not overload their limited short-term auditory memory skills. This means that, over a long period of time, they would have to train their hearing and listening skills in accommodated conditions of quiet rooms, slowly paced speech, and individually-tailored training tasks. These conditions do not exist in most everyday situations, which is what makes their chances to experience spontaneous auditory learning nearly impossible.


Cochlear implantation is the beginning of a rehabilitation process that requires learning, adjustment, and training. There are CI users who will be able to negotiate the process using self-training resources with the support of their audiologist, family, and friends. They will adjust and quickly regain speech perception skills. These skills, combined with previous listening habits and cognitive and auditory abilities, will allow them to cope with the communication and acoustic challenges of everyday life.

Others will need the support provided through a clinician-guided auditory rehab program. Such programs allow an assessment of the patient’s speech perception, listening, and use of hearing in everyday life. Typically, such patients require individualized training before being able to say “yesterday I noticed that I was hearing without even trying.” Spontaneous auditory learning is possible for some of these patients. It’s a real breakthrough and a dream come true.

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The mission of the American Cochlear Implant (ACI) Alliance is to advance access to the gift of hearing provided by cochlear implantation through research, advocacy and awareness.