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Welcome to Naama's Blog. I hope you will ask any questions you have here in the comment area below. You can also post your thoughts on what I have written or anything else related to adult rehabilitation. Members may comment on any posting by logging into your account. If you are not a member but wish to comment, please send your submission to . If you would like to write to me directly, please email me at: The Blog is intended as both a patient and a professional resource. This printable brochure may be used to refer adults and family members who may benefit.


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Listening Effort and Fatigue: Part 2

Posted By Naama Tsach, PhD, Wednesday, October 31, 2018


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.

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Listening Effort and Fatigue: Part 1

Posted By Naama Tsach, PhD, Tuesday, October 23, 2018

Today we will talk about the fatigue associated with listening effort. Listening involves both auditory and cognitive processing. We hear with our ears but we listen with our brains and consequently people whose auditory input is of a lesser quality may expend more mental effort to listen. The fatigue may be described as a feeling of being tired, exhausted or having low energy or a low motivation to listen.

Fatigue associated with listening effort is reported by many people with hearing loss including those using cochlear implants. Statements such as these are not uncommon from people with hearing loss of all ages.

• I feel that my brain is working nonstop and it takes a lot of energy for me to listen.
• I am bursting with auditory stimuli that I cannot filter.
• My brain needs to process what I am hearing faster than it used to do before.

Such comments are more common with CI recipients who used hearing aids for many years (when they could have benefited more from cochlear implants) and also from those adults who had significant hearing loss at birth or early childhood and were implanted later in life.

People with hearing loss may refer to communication conditions as stress inducing situations since they require significant listening efforts and can potentially involve communication breakdowns and misunderstanding.

What kind of listening effort may be required of people who are deaf and hard of hearing? Why do CI users report fatigue associated with listening?

People with hearing loss may perform complicated auditory processing in order to understand speech because of imperfect auditory perception. They may work hard to: localize sound, identify who is speaking, distinguish speech from background sounds, and recognize speech sounds as well as cues for emphasis and intonation. They may rely upon visual information for speech reading to supplement what they are receiving auditory. In many real-life situations, accessibility to visual cues may be restricted due to imperfect lighting conditions, difficulty in localizing the speaker and other factors.

Consequently auditory and visual cues might not be sufficient and people with hearing loss may need to rely upon previous knowledge regarding a conversation. They may also draw upon their linguistic knowledge (e.g., Is this word likely to be a noun?) and on other kinds of supporting clues. If all of this isn’t difficult enough, they may need to process the spoken information rapidly—based upon the speaker's pace of speech or to stop the speaker to ensure they understood what was said. They also need to remember everything they heard already and use different cognitive and language skills to fill in the whole meaning.

People who have never experienced typical hearing, as well as older adults who had typical hearing in the past, may experience greater difficulties with recalling auditory input and this also contributes to their effort to communicate effectively. Since auditory memory skills are imperfect, the individual with hearing loss must put a great deal of effort into understanding speech—even when they can recognize single words

Consequently, fatigue can be an inevitable consequence of listening with hearing loss. What fatigue in adult CI recipients? How can we manage fatigue and improve quality of life for adults post CI? We’ll talk about it soon, on our next post.

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Being a Personal Auditory Trainer

Posted By Naama Tsach, PhD, Wednesday, April 25, 2018


You’ve been asked to be a personal auditory trainer

What do you need to know? 


You’ve been asked to be a personal auditory trainer by a friend or relative. What does that mean? What’s involved?

You will help them work towards better hearing and ease in communicating. You are going to have the very special opportunity to make an important contribution to your friend’s fascinating journey.

Here are some tips for you—a first time auditory speech perception trainer. I hope you find them to be both practical and applicable.*


  • Pay attention to the space where you are practicing. During the early rehabilitation timeframe, it is important to keep the auditory training environment as quiet as possible. Practice speech perception in an enclosed space. Close the door and the windows and turn off any appliances that you can that create noise. If there is noise in the house, try to reduce it before starting to practice. It’s possible that you will not be aware of all these interfering noises because we often “tune them out unconsciously.” Hence you may be surprised to find out that your CI user friend is more sensitive to noises in the environment than you are. My advice is to look for a quiet room and adjust the conditions together with the trainee.

  •  Begin by sitting no more than three feet from the trainee.

  • The first step is to verify that the implant is working. Ask the trainee to turn off the hearing aid in the ear opposite to the CI ear and see if they hear the following sounds: /i/ /a/ /u/ /s/ /sh/ /m/. If the person has two cochlear implants, check each one separately.

  • Encourage the trainee to be attentive to environmental auditory stimuli and help them to identify any sounds that they are hearing (e.g., car noise, a dog barking outside). When unplanned "auditory events" occur during the session (e.g., phone or door bell ringing, someone knocking on the door, an airplane, rain), raise the awareness of your friend to these sounds prior to your own reaction to them.

  • Since the aim is to improve auditory speech perception, you should "hide your mouth" to avoid providing speechreading cues to the trainee. You will probably need to cover your mouth up to your nose. You can use a piece of paper or even better, a speech or acoustic hoop designed restrict visual cues without impacting the intensity or sound quality of one’s voice during therapy. Such hoops can be found online from CI company stores or from other educational institutions such as this one:  You can even make one yourself; there are instructions here:

  •  Speak a little slower than your normal speaking rate, and use comfortable speech intensity (do not raise your voice).

  •  Expect that several repetitions of the stimuli will be needed.

Auditory training should become a part of the CI recipient's life routine, since auditory learning after cochlear implantation is a long-term process. Therefore, your long term commitment, patience, and positive support will be highly valued.

A number of earlier posts suggest specific practice routines. I urge you to go back and take a look at the following. These are perfect ways for a personal auditory trainer to work with an adult recipient.

* For individual assistance, questions and verification requests, please ask your friend to contact their audiologist or speech pathologist.


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Audio Books

Posted By Naama Tsach, PhD, Thursday, November 2, 2017
Updated: Thursday, November 2, 2017

Favorite Home Practice Tools to Improve Speech Understanding:
Audio Books, Speech Sounds, and More


Audio Books: Why people like them for auditory practice

Audio books are widespread and accessible. They include wide-ranging topics and are available for non-fiction, biography and fiction and span many different languages and personal interests. Many adult CI recipients use audio books as a home practice tool to improve their speech understanding skills. Usually the narrator is a clear speaker who is reading at a normal speech pace (meaning not too fast). While listening to audio books, you can read along with the written text if you wish. These are significant positives, making the use of audio books the most common self-practice tool for adult CI recipients.

Audio Books: What’s their downside as a practice tool?

Anyone who has used audio books knows that there are also some negatives associated with their use as a practice tool. First, recorded speech sounds different from natural speech because the acoustic signal is restricted (contains fewer auditory cues) and therefore might be more difficult to process. Secondly, the content is sometimes recorded at a pace which may be too fast and overly challenging for a CI recipient—depending upon where they are in their rehab process. It may be technically impossible to slow down the narrator’s reading speed. (And if it is possible to slow the pace, this could cause distortion of the speech signal.) Some audio books have background music that make the speech even more difficult to understand. In addition, listening to audio books requires more than just good speech perception of everyday language as book text may use less frequently used vocabulary, longer sentences, and more complex syntax.

One can look at the use of audio books from two perspectives:

  • On the one hand, for many people, they are too difficult to use, especially during the early rehabilitation timeframe (when the motivation to practice is the highest but auditory skills are still limited).
  • On the other hand, they provide challenging practice. For individuals who are able to cope with the complexity they provide, audio books can be an effective and engaging practice tool.

More ways to practice your auditory skills

Speech sounds can be presented either solitary (/s/), as part of a syllable (/sa/), or in a single word context (bus). Good speech understanding does not always indicate that someone has excellent perception of speech sounds. For example, the last word in the following sentence can be perceived—regardless of one’s access to all of the acoustic information: "I bought a new _a_"(car).” If the CI user knew that the person talking had an old car that was always breaking down, he would have contextual knowledge that supports speech understanding even when all of the words heard were not understood.

So if words can be understood based on context cues, why is it so important to improve the accuracy of speech sound perception? In order to capture new words with minimal linguistic redundancy, you must be able to perceive the word's components. This is also true in cases of single word presentations or proper names when there is no context to enable someone to fill in the gaps. In addition, knowing which sounds you perceive less well, or which sounds tend to get mixed up with others (e.g., /b/ with /p/, /k/ with /t/) will help your audiologist fine tune and to monitor your CI.

Practicing understanding simple greetings, questions and simple sentences is easy to do and can be very rewarding when you implement these skills into your everyday life.

  • You might practice recognizing the names of friends, co-workers and relatives.
  • You may find it useful to practice single letters, numbers and other words that may help ("c like Charley") clarify words that you are having difficulty with.

Improving auditory memory skills and capacity may make it easier for you to follow sentences, conversations, and even lectures. You can use word lists that contain letters, numbers, and words related to different topics (i.e., shopping, food ingredients, packing for travel, city and country names) and practice different repetition tasks. Start with two words and gradually increase the number. You can also practice auditory memory by using sentences, such as understanding instructions with ascending complexity (1) take the book and put it on the table, (2) take the pencil and put it on the table, (3) take the pencil and put it on the book. More advanced practice could include recall of details from a short story or recipe, or how to get from your home to another location with specific directions.

Comprehensive practice of hearing skills might include the activities above and more. Many of these suggested activities rely upon the assistance of another person. In the next post, we will discuss some guidelines and tips for relatives or friends who assist you with your home training.

Good luck.


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How to Begin Talking on the Telephone with Your Cochlear Implant

Posted By Naama Tsach, PhD, Tuesday, August 22, 2017

Why is it hard for cochlear implant recipients to hear on the telephone?

Acoustically, the telephone signal has a more limited frequency band than a typical speech signal, the phone instrument distorts voices, and there can be an echo and/or other noises that make comprehension difficult for anyone but most especially for people with hearing loss. These challenges combined with the inability to use speech reading when talking on the phone are significant barriers to fluent telephone conversations. The lack of eye contact that prevents you from receiving visual cues for speech reading also pertains to the person you are speaking to as he or she cannot see your facial expressions or other nonverbal cues either—cues that typically help someone to know that you did not grasp completely what was just said.

Hence it is important to tell the person you are talking to when you don’t understand. The other person may not be aware of your lack of understanding unless you tell them.

Telephone Tips When Starting Out:

  1. Choose your partners carefully. This is good advice for life in general and is highly recommended when you begin talking on the phone with your CI. Begin with people who will be mindful and tolerant as a conversationalist as they will likely need to make adaptations for you. You probably know which friends or family members have relatively clear speech. You should ask for their help and guide them with some basic principles.
  2. At first, you should be the initiator of phone calls. Call your partner(s) from a quiet room.
  3. Use your preferred method of connecting from your processor to the telephone. There are several connection methods available including Bluetooth, telecoil, or another ALD (Assisted Listening Devices) that can help you. Ask your audiologist and make sure that you have been updated with every device that can work with your CI. I also recommend that you review our previous blog post by Erin Schafer on Assistive Listening Devices for Cochlear Implants.
  4. If you don't use an ALD to connect to the telephone, take care to find the best position to hold the telephone receiver before you make a phone call. This position may be different from where you held the phone with your hearing aid.
  5. Ask your practice partners to take your phone calls when they are also in quiet spaces. Ask them not to converse with you when they are driving a car, sitting in a restaurant, or using a speakerphone. Ask them to wait until they are in an ideal acoustical environment to talk.
  6. Do not feel embarrassed to inform your partners that you did not understand what they just said! Remember that if you do not inform them at the moment when you missed something they said, there is an increased chance of further misunderstandings. Let them know in advance that they should expect that you will not understand every word.
  7. Ask your partners for clarifications such as “I did not understand.” “Please say it again.” “Could you speak slower?" Guide them to use basic clarification strategies such as slowing down their speaking rate and conveying the message using other simple words rather than repeating precisely what they said before. When you miss a name of a place or a person and you are not sure you have understood the word in full, your partner could spell the word ("N" as in Nancy, etc.) or briefly describe the person or the place ("My sister Ann whom we visited last Sunday" or any other significant clue).
  8. If the conversation includes instructions, information regarding meetings and so on, check back by repeating what was said and then writing it down.
  9. One last tip is relevant if your speech is not perfectly clear (i.e., you have imperfect speech intelligibility). Speechreading is an important source of information for many people—not just those with hearing loss. People who have normal hearing may use speechreading in some situations without knowing they are doing it. These situations include understanding speech in noisy environments, especially when the listener is in conversation that is not their native language or they are listening to someone with lower speech intelligibility. If your speech intelligibility is lower than typical speech, a communication partner may need clarification on the telephone as well.
  10. Remember, both of you will need to be patient and use the clarification strategies described above.
  11. You might also try the telephone practice tools from the CI companies, all of which are available for free in the rehab areas of the company websites. These may help you develop the confidence to converse with a real person!

What is the right time to start telephone practice?

I suggest starting telephone practice only after you are able to understand short, simple sentences without speechreading. Some people can do this immediately after device activation, some are able after a few months, and others are ready only after a year of CI use. Not everyone implanted at a later age will be able to understand speech on the phone. Talking on the phone can be a challenging mode of communication for a CI recipient as it requires the person to have robust speech perception skills, to have pursued specific training and practice, and to have high auditory processing abilities (which may be based upon previous hearing experience).

Good luck and have fun!

Naama Tsach

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Can you "fail the test” and still be a successful CI user?

Posted By Naama Tsach, PhD, Tuesday, June 6, 2017


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

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Utilizing Assistive Listening Devices

Posted By Naama Tsach, PhD, Thursday, May 11, 2017
Updated: Wednesday, May 10, 2017


The improved access to sound provided by assistive listening devices is generally accepted for those who use hearing aids. This same benefit extends to cochlear implant users of all ages. Read Erin Schafer’s guest blog post and learn about how these technologies can be used in a variety of settings.

Erin Schafer Ph.D. is an Associate Professor at the University of North Texas in the Department of Audiology and Speech-Language Pathology. She teaches courses and publishes peer-reviewed research on the assessment and (re)habilitation of adults and children with hearing loss or auditory disorders. She is a Board Member of the Auditory Implant Initiative, serves as President of the Educational Audiology Association, and is Editor of the Journal of Educational, Pediatric, and (Re)Habilitative Audiology.

Thank you Erin, for this important blog post, which is an enriching addition to our blog resource library.

Naama Tsach PhD

Assistive Listening Devices for Cochlear Implants

The selection of assistive devices for users of cochlear implants has grown tremendously over the past 10 years with today’s devices offering more affordable, simpler, and easy-to-use wireless products to improve hearing in noisy situations, over the phone and to the television. Although I cannot speak to my personal experiences with these devices, I am able to share with you the findings of our recent published research as well as some practical uses of each device.

Improving Hearing in Noisy Situations

For many years, individuals with cochlear implants have been able to connect their sound processors to frequency modulation (FM) systems, which wirelessly transmit a signal from primary talker to the listener with the implant. These systems were helpful for improving speech recognition and listening ease, particularly in noisy environments. However, many FM systems are expensive, sometimes cumbersome to connect to cochlear implants, and are susceptible to interference from the environment. Many of today’s wireless accessories, however, use digital transmission, which is less susceptible to interference and, in many cases, is much more affordable. Examples of these accessories include the Wireless Mini Microphone and Mini Microphone 2+ that can be used with Cochlear processors (in partnership with GN Resound) and the Phonak ComPilot and RemoteMic accessories that can be used with Advanced Bionics processors. Although MED-EL is not offering wireless accessories, MED-EL processors may still be used with existing FM and digital transmissions systems available from Oticon, Phonak, and many other manufacturers.

According to our research, the Mini Mic is was able to substantially improve average speech recognition in quiet by 10% and in noise by up to 65% in 16 adults with Advanced Bionics implants when compared to performance with the cochlear implant alone. A more recent study that is in progress included two groups—a group of listeners with bilateral cochlear implants and a group of listeners with a cochlear implant on one ear and a hearing aid on the other. This study showed that, in both groups, use of the Mini Microphone 2+ was able to improve speech recognition substantially, and the benefit achieved with the Mini Microphone 2+ was similar to the benefit obtained with a higher-end remote-microphone system. Results of these studies provide evidence that the new wireless devices are beneficial. A 65% increase is a huge benefit!

Although use of these wireless accessories requires a cochlear implant user to adjust processor settings and to ask the primary talker to use a small microphone, the benefits are notable, particularly in noisy situations. This accessory will be helpful in the car, when the primary talker is at a distance (e.g., church or lecture), or at large family gatherings, parties, or other social situations.

Improving Hearing Over the Phone

Hearing over a mobile telephone may also be improved with new wireless accessories available from Cochlear (Phone Clip) and Advanced Bionics (Phonak EasyCall Accessory). Both of these wireless accessories connect to mobile phones via Bluetooth and allow users to communicate hands-free through the small device that is clipped near the user’s lapel. The benefit of using the Phone Clip was documented in a study including 16 adults with Cochlear sound processors where speech recognition was improved by 18% in quiet and 29% in noise when compared to performance in a test condition where the phone was held close to the processor microphone.

All listeners, including those with normal hearing, experience difficulty hearing over the phone when in noisy listening situations, such as parties, grocery stores, and restaurants, and sometimes these calls are really important! A trial period with a wireless phone device may offer a solution to some difficulties over the phone and result in more fluid conversations. Regardless of the manufacturer, all CI processors have a telecoil setting that can be coupled to telecoil-enabled mobile devices and landline phones to improve hearing and ease conversational difficulties.

Improving Television Listening

Signals from the television may be streamed directly to the ears of individuals with cochlear implants via new wireless accessories, such as the ComPilot and TVLink II for Advanced Bionics processors and the TV Streamer for Cochlear sound processors. These devices are fairly simple to set up and can provide substantial benefit. For example, we conducted a study with 16 adults with Cochlear sound processors who completed a test of auditory and visual recognition through a television. Their performance improved by 8% in quiet and 23% with noise in the background when compared performance with their cochlear implant alone.

The potential benefits of a streaming device for the television are obvious and may serve as a mediator for your household, especially if you like to turn up the volume quite a bit. Some individuals with implants have difficulty hearing the television, particularly when other sounds are present including the washing machine, dishwasher, water running, and children playing (or yelling in my house). A wireless device allows the user to hear the television at a normal and comfortable volume, regardless of the noise in the background.

I hope you will consider giving some of these new wireless devices a listen because many adults with cochlear implants have experienced great benefit from these devices. Happy Listening!

Erin C. Schafer, Ph.D.
University of North Texas

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Auditory training using your own word lists can be fun!

Posted By Naama Tsach, PhD, Tuesday, March 21, 2017




In my last post, we discussed building your own word lists. Now let’s review how best to use those lists in your home practice.

Repeating words read aloud can help reinforce your auditory memory. However, over time you may experience two shortcomings of this practice tool: (1) You may memorize the words after some practice and/or (2) The process may become boring.

After repeating words from your lists, try using them in other ways. Here are some tasks that might be performed using your word lists in enjoyable and challenging ways that will encourage you to practice your auditory skills. These tasks require you to use abilities other than auditory perception. You might use judgment, auditory memory, and your sense of humor. Tasks may require implementing world and linguistic knowledge, social understanding, and more. Therefore you should expect to find these tasks more challenging, even if you have already easily identified these words as they were presented to you from a list. Don’t hesitate to ask your practice partner for repetitions.

Speech perception tasks that involve understanding and thinking (not just identification of a single word from a known list) serves to better simulate the communication challenges you experience in everyday life. So now, after this long introduction, let’s move on to some practical examples.

Foods: Instead of simply reading the words, ask the person who is practicing with you to share their shopping list for his or her next supermarket visit. You can also ask them to read you a list of ingredients and then you could guess what might be prepared with those foods (e.g., "What might be prepared with vinegar, lemon juice, honey, mustard, salt and garlic?"). If there are words that you’ve not practiced before, include them anyway (and add them to your list).

Numbers: Instead of simply repeating random numbers, ask your trainer to read you useful telephone numbers and then feel free to add them to your contacts. Hey, how did you manage not having the phone number of the best pizza take-out in town? If you easily recognize one-digit numbers, ask them to read you phone numbers as a group of two 3-digit numbers (e.g., 202-354-097-1). If you can grasp two and three-digit numbers, ask them to read you prices of products. You can also ask them to occasionally tell you the wrong price so you will have to initially recognize the number you heard and then to decide whether it is correct as a price. You can ask your trainer to tell you about their relatives' ages, or even practice solving simple math problems using your auditory perception skills.

Letters: Instead of reading you random letters, ask your trainer to spell out the names of family and friends (or places around the world). After you cite the word, have the person tell you something you did not know about it. Another exercise might be to ask your trainer to spell out short words but to state the letters in reverse order. If you recognize letters very easily, your trainers can say more than one letter at a time, which can be great training for your working memory (e.g., a/I, r/p, l/a, n/e).

Find the word that doesn't match: Ask your trainer to say four words, each word separately or two at a time (e.g., train, bus, car, bicycle) and identify the word that doesn't fit.

Auditory perception of a word in a sentence: Your trainer could read simple sentences, including target words from your word training lists. You could use speechreading to help you grasp the entire sentence—except the target word or words will be voiced with a covered mouth—no visual information would be provided for these specific words. Prior to the sentence presentation, you need to define the semantic field (or topic of the target words. For example, days of the week: "I am taking Yoga class every Monday" and the covered word would be Monday. Or sports activities and days of the week: "I am taking Yoga class every Monday" with the covered words being Yoga and Monday. Or names of the states: "Which state has the larger population—Maryland or Ohio?"

Syntax and morphology: The first step would be to set the task words; then you could be asked to judge whether the covered word is in the correct form. For example, for have/has/had: "She have a birthday last week" or walk/walking/walked: "I saw him walking away".

These examples illustrate some of the ways you can practice identifying specific words in meaningful contexts while reinforcing auditory understanding in communicative situations.

Before we conclude, I want to address the important issue of preventing access to speechreading while practicing auditory skills. There are different ways to do so. For example, you could ask your trainer to sit or stand behind you. I personally do not recommend that particular approach because it precludes any eye contact between the person practicing and his/her trainer. This makes the exercise unrealistic and not very pleasant.

Rather, you may want to sit side by side and agree that during the training, you will not look towards the speaker's face. Tasks that require a combination of speechreading and auditory-only perception (such as in a sentences that should be presented visually with certain covered words), the speaker can use a sheet of paper to cover the lower part of their face. You should guide your trainer to do it in a way that will prevent visual information or speechreading but not distort the sound (i.e., avoid placing the paper on the mouth).

In future posts, I will offer more ideas for auditory training exercises involving not only single words but also complete sentences, telephone use, auditory memory skills, listening in different acoustic conditions, listening to different language materials, and more.

All that remains for me is to encourage you to continue practicing, being creative, and enjoy your auditory training!

Good luck!

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How to Build your Own Auditory Training Word List

Posted By Naama Tsach, PhD, Wednesday, February 22, 2017
Updated: Wednesday, February 22, 2017

This post was written at the request of a reader who noted:

I would like to involve my family in my auditory training by having them read words or sentences to me. Can you provide suggestions of home practice tools for this purpose?

This is a wonderful request that will help others looking for home practice materials.
I do have mixed feelings about this request. On the one hand, I believe that after receiving a cochlear implant, recipients of all ages benefit from working with a professional trained in auditory rehabilitation. Such professionals can help recipients choose and adapt auditory training materials to meet their needs. On the other hand, we know that most adults do not receive such support post CI and their auditory practice is likely to be done independently. Hence, I will do my best to guide you. I would also be more than happy to respond to any comments or inquiries from our readers regarding their experiences in using home practice techniques.

Our current goal is to create lists of words that could serve as a foundation of your auditory listening inventory and will later serve you when you create lists of sentences for further auditory training. So, let's roll up our sleeves and get to work.

Creating Word Lists

The first part is fun. Think of words that are most useful to you—at home, at work and in other everyday situations. Include important words such as names of relatives and friends, nouns, pronouns (i.e., I, we, you, she, her, them, it, this, that), verbs, auxiliary verbs (i.e., be, can, could, do, have, may, might, must, shall, should, will, would), adverbs, and adjectives. Include same verbs in different morphological forms (drive, drives, driving). For future practice, add common question words (i.e., what, why, where). In addition, include numbers (1-100), colors, and letters. Update the list occasionally with relevant words. At the end of this process, you should have a very long list from which you can build various auditory training lists.

Example of a (partial) List:

Bob, John, Kathy, Mom, Dad, Rockville, Maryland, yes, no, don't, what, how, when, why, who, do, does, are, is, want, take ,give, build, drive, clean, play, tired, happy, coffee, tea, water, soda, lunch, dinner, breakfast, egg, nuggets, guacamole, room, car, big, small, green, great, beautiful, one, two, A, B .

In addition to the word list, you should make a list of everyday phrases and greetings. These might include:

  • Good morning
  • What's up?
  • Have a good one
  • Thank you

Congratulations! You now have a very long list of working materials. The next step is to build your training lists. I will illustrate how to create lists of words that require different levels of auditory perception skills. Practicing speech perception of the same word in different environments (different word lists) will help you identify specific differences between speech sounds, which will enhance your word perception (even beyond the words that you have included in your original list).

Example #1: Word lists based on letters

  1.  Beginner level (easy): w,s,b,I,k,m,o,q. To make it easier, you can divide the list into two groups.
  2. For more advanced training you can use the following list of letters: a,c,e,f,i,j,h,l,m,o,u,r,t,v,w,x,b. Again, to make it easier, you can divide the list into two or three groups.
  3. The following lists would demand even higher auditory perception skills: b,c,d,e,g,p,t,v or f,h,j,k,l,m,n,s,x

Example #2: Word lists based on food names

  1.  Beginner level: Include words of different lengths and varying vowel patterns: avocado, tomato, cheese, egg, lettuce, rice, cucumber, corn, chicken, and cream cheese.
  2. For more advanced training, you can use the following list of mid-length (two syllable) words: chicken, onion, nuggets, pizza, orange, lettuce, mango, pumpkin, ice cream, pasta, ketchup, and mayonnaise.
  3. This next list would be even more difficult since it includes only short (one-syllable) words: soup, bread, rice, cream, bean, corn, egg, cheese, toast, beef, steak.
  4. For an even greater challenge, you can use short words with very similar vowels sounds, such as: bean, cream, cheese, beef, mint.

Start with short lists of disparate words

When you adjust your practice materials to your auditory ability, note that the more similar the words (in their length, vowel and/or consonant sounds) and the longer the list, the greater the level of difficulty. Therefore, my advice is to start practicing using relatively short lists that include words that differ in as many parameters as possible, and then move on to longer lists that include words that are more similar to each other.

During practice sessions, you may have difficulty distinguishing between some words. Try practicing your auditory discrimination skills using specific words that are difficult (e.g., fun and sun). Ask your practice partner to read you the words and highlight the sounds that distinguish them (i.e., “f” and “s” in this example) by emphasizing or prolonging the first consonant. Repeat difficult exercises a week later and see if you have improved.

Share your experience with your audiologist

When you next visit your audiologist, share your experiences. (S)he may be able to explain why you have difficulty with specific auditory features and suggest how to move forward with your auditory training.
I hope that some of these tips will be helpful to you in getting started. Please feel free to send me any questions and I will do my best to assist you.

How can you use your word lists? In the next post I will share some practical uses for your lists. Hopefully you'll discover that auditory training can be fun.

Good luck!

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A First Anniversary Blog Post

Posted By Naama Tsach, PhD, Wednesday, January 25, 2017
Updated: Tuesday, January 24, 2017


Last month was my blog's first anniversary so I thought it would be a good time to sum-up what we have done over the past year. If someone had told me two years ago that I would write a blog on adult rehabilitation for the ACI Alliance, I would have never believed them. Yet, life presents us with opportunities and this blog has given me a new and unexpected way to express my love for my profession and my patients.

It all started when Donna Sorkin and I spoke about my experience with adult rehabilitation following cochlear implantation. Many of the people I had worked with had congenital hearing loss though some had lost their hearing later in life. Of the total population of CI recipients, 60% are adults. Unlike pediatric recipients, most adults do not receive auditory rehabilitation services as part of their rehabilitation process. Moreover, adult CI recipients have difficulty finding resources to support their rehabilitation journey.

18 Posts Published So Far

Consequently, in Donna's kitchen, this blog was born. Eighteen posts have been published to date, aimed to present a broad perspective and offer practical advice to enhance the challenges faced by a diverse population of adult CI recipients. This diversity includes wide-ranging expectations, rehabilitation needs, and outcomes.

I wrote about perception of environmental sounds, music appreciation, emotional effects and improvement in recipients’ quality of life. These topics demonstrate the various CI benefits and suggest that subjective evaluation of benefits made by recipients themselves, is as important as objective assessments of speech perception ability performed by professionals.

Some of the posts included practical advice on topics related to constructive communication with family, professionals and friends to facilitate support and cooperation following implantation. In addition, there were posts that presented the questions faced by audiologists in the process of evaluation of CI candidates, and issues regarding bilateral CI. Although I emphasized the importance of auditory rehabilitation provided by speech pathologists, tips for self- auditory training were also suggested. Linda Daniel, an audiologist and Auditory Verbal Therapist shared her moving experience in initiating a support group for adult cochlear implant recipients. Thank you Linda! Another writer we were privileged to host is musician Richard Reed, who lost his hearing later in life and was implanted after nearly 10 years of significant hearing loss. His touching story demonstrates some of the challenges, as well as achievements, he experienced during his unique rehabilitation journey. I take this opportunity to invite other writers to contribute to our blog.

Future Posts

What about future blog posts? The next posts will include instructions on how to develop your own training materials and use them in creative and fun ways. Other posts will discuss related topics such as speechreading, how to deal with noisy environments, and strategies to improve listening on the telephone. You are most welcome to suggest other relevant topics.

As both a speech pathologist and audiologist who previously relied on direct face-to-face communication, writing a blog is a very different kind of communication. Therefore, I would like to thank the readers who wrote to me; your questions and comments were thought provoking and you helped me focus on important topics of interest.

I would like to thank the extraordinary Donna Sorkin, who presented me with this exceptional platform, enabled me to freely express my professional insights and perspectives, and supported me all the way with her positive encouragements and suggested edits. I also want to thank Susan Thomas—without her dedication and technical support, I might be writing these posts only for myself.

Best wishes for a healthy and thriving 2017.

Naama Tsach

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