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TMBimodal HearingMaximizing Success in School for Children with Cochlear ImplantsBIMODAL HEARING BASICSDefinition:Bimodal Hearing is the use of a cochlear implant in one ear and a hearing aid in the opposite ear.One Child, Two EarsTo maximize the success of children with hearing loss, each ear must be evaluated and consideredindividually and together as a system. This holds true even for children with cochlear implants. Thecontralateral ear may have usable hearing and should be fitted with a hearing aid if deemed appropriateby the child’s audiologist.Many people wonder how hearing with a hearing aid differs from hearing with a cochlear implant.Ultimately, both devices have the same goal: to improve hearing. Although the mechanics may be different,these devices can work together to provide children with significant benefits and optimal outcomes.The Difference Between Hearing with a Hearing Aid and a Cochlear ImplantHearing AidA hearing aid acoustically amplifies and delivers sounds to the auditory system through sound waves.The sounds delivered must pass through the damaged parts of the auditory system before reaching thebrain for processing. The greater the damage, the more severe the hearing loss. For many people hearingaids are sufficient to improve hearing to an acceptable level of benefit. Cochlear implantation is consideredfor individuals who require access to sound that a hearing aid can not provide.Cochlear ImplantA cochlear implant delivers electrical signals that represent sounds directly to the auditory system. Theelectrical signals bypass damaged areas of the auditory system and stimulate the hearing nerve directly.Cochlear implants are usually recommended for ears with severe to profound hearing loss and cansignificantly improve hearing.AB Makes It Simple for SchoolsWant to learn more details about how a cochlear implant processes soundand stimulates the auditory system? Visit AdvancedBionics.com/TFS and click onTools for Learning about Hearing Loss and Cochlear Implants to downloadthe “Becoming Familiar with a CI” pdf.
Why is Bimodal Hearing becoming the standard of care for children withone cochlear implant?Over the past 10 years, more children have been implanted who use hearing aids. This change has led to agrowing population of children who have usable hearing in their non-implanted ear. These children stand to benefitfrom hearing aid use in combination with a cochlear implant.Which school-age children may benefit from Bimodal Hearing?Children who have usable residual hearing in the unimplanted ear and exhibit any of the following at school maybenefit from Bimodal Hearing: Difficulty following conversation in the noisy cafeteria2–6 Trouble identifying where sound is coming from on the playground or during gym class1–3 Fatigue by the end of the day16 Lack of interest in music5,7,8 Difficulty hearing other students’ comments during class discussions2–6BIMODAL HEARING TERMINOLOGYBinaural Hearing Advantage: the positive outcome that occurs when the brain is able tointegrate and use information from both ears to improve access to important sounds, like speech,resulting in better hearingContralateral Ear: the ear opposite of the cochlear implantSound Localization: use of different loudness and timing cues between ears to determine whatdirection sound is coming fromBIMODAL RESEARCHDoes research demonstrate that adults and children who use one cochlear implantbenefit from Bimodal Hearing?Numerous studies have documented the benefits of Bimodal Hearing compared with the use of a single cochlearimplant. These benefits are realized because hearing in both ears provides the brain with additional cues thatimprove listening across various situations.Research suggests that Bimodal Hearing may provide the following benefits:Sound localization1-3Speech understanding in quiet and noise2-6Music perception and enjoyment5,7,8Acquisition of auditory and language skills9-11Ability to hear low pitch sounds12-13
TMBimodal in the Real World“With both the Link and Implant, I am able to hear sounds that I haven’t heardsince my hearing loss began (including my cat’s incessant meowing which I’m notsure I missed.) I’m able to capture wonderfully clear sounds and speechwith just the implant itself, but the addition of the Link adds such a richersound to my surroundings, adding a more natural tone.”— Jessica, AB recipientWhat are the qualitative benefits of Bimodal Hearing? Reduced effort to hear Feeling balanced Enhanced sound quality Improved awareness of environmental sounds More confidence and spontaneity in social situations2,3,14 More likely to initiate conversations with both familiar and unfamiliar speakers2,3,14 Less need for repetition in conversation2,3,14 Preservation of the auditory pathway on the contralateral side through continued auditory stimulation Nonsurgical alternative for the contralateral ear if bilateral implantation is not an optionBimodal in the Real World“My AB Hearing Aid (Naida Link) was activated last Wednesday, and it isWONDERFUL!! My family, friends, and I are so happy with my hearing using theimplant, and the compatible hearing aid makes it even better! I have a newconfidence hearing conversations in public settings and also using the phone.”— Annie, AB recipientAB Makes It Simple for SchoolsTips for Bimodal Success: Keep a log of the specific technology the child uses in each ear. Be sure to have contact information for the audiologist(s) who manage both thecochlear implant and the hearing aid. Learn if any program numbers have been designated for special listening situations,such as a noisy cafeteria or an auditorium.Need help keeping track of your student’s equipment?Visit AdvancedBionics.com/TFS and click on Bimodal Hearing to download the BimodalTechnology Tracking Form.
BIMODAL HEARING TECHNOLOGYWho are the professionals involved in the Bimodal fitting process?The cochlear implant audiologist may fit both the cochlear implant and hearing aid or may work in conjunctionwith a hearing aid audiologist or specialist.Can any hearing aid be used for a Bimodal fitting?Yes, any type of appropriately fit hearing aid can be worn on the contralateral ear and provide Bimodal hearing.However, for children who have an AB cochlear implant, there are advantages to using a Phonak Naída Link hearing aid. The Link hearing aid in combination with AB’s Naída CI sound processor provides a unique BimodalHearing Solution and optimizes Bimodal benefit.How does the Bimodal Hearing Solution maximizethe benefits of Bimodal Hearing?The Naída Bimodal Hearing Solution from AB and Phonak providesthe first hearing aid specifically designed to work with a cochlearimplant system. It features the AB Naída CI sound processor andPhonak Naída Link hearing aid. Because they use the sameplatform, the Naída CI sound processor and Naída Link are able tocommunicate with each other in a way no other hearing aid andcochlear implant combination can match.Naída CISound ProcessorNaída LinkHearing AidBimodal fitting withthe Bimodal Hearing SolutionNaída CISound ProcessorNaída Link Hearing AidThe Naída CI sound processor and NaídaLink hearing aid use the same platform,process sound in a similar way, share soundsignals, and communicate with each other.Standard Bimodal FittingNaída CISound ProcessorAny appropriatelyfit hearing aidThe Naída CI sound processor and hearingaid work as two separate systems.
TMBIMODAL HEARING TERMINOLOGYBimodal Hearing Solution: use of a Naída CI sound processor in one ear and a Naída Linkhearing aid in the other ear for optimal Bimodal benefitBimodal Streaming: the ability to simultaneously receive auditory input in both the Naída CIand a compatible Phonak hearing aid wirelesslyBinaural VoiceStream Technology : allows the Naída CI and the Naída Link toshare sound signals and communicate with each other in real time to maximizehearing performance.INDUSTRYFIRST!ComPilot: a versatile accessory that can be used as a remote control* or to streamaudio input wirelessly to the Naída CI and/or a compatible Phonak hearing aidNaída CI: cochlear implant sound processorNaída Link Hearing Aid: a behind-the-ear hearing aid specifically created to work withthe Naída CI*Available with SoundWave 3.0What are the distinct advantages of the Bimodal Hearing Solution?Easy to HearThe Phonak Naída Link is the only hearing aid designed to treat sound in the same way as the Naída CI soundprocessor, making it easy for children to hear with them together. Specifically, the devices share sound processingtechnology, volume behavior, and program alerts. Studies show that individuals experience greater listeningcomfort and a proven advantage for hearing in noise compared to using a cochlear implant and any otherhearing aid.15School Advantage: Children feel that their hearing is balanced between both ears as they walk into the auditoriumfor a lecture and both Naída devices adapt similarly.Easy to UseBoth the Naída CI sound processor and Naída Link use the same advanced automatic technology to react to andadjust in the same way and at the same time to changing sound situations.Shared automatic technologies include:QuickSync* Provides one-touch control of the child’s processors for easy, instant, simultaneous adjustments tovolume and program settings on both ears.SoundRelax* Softens sudden loud sounds, such as slamming doors or clanging dishes.UltraZoom* Focused listening on a small group of voices in front while reducing distracting noise for improvedcommunication in noisy environments.WindBlock* Reduces wind noise to improve comfort and ease of listening in windy conditions.School Advantage: Children can enjoy focused listening with classmates for a small group assignment while thechatter from other small groups around them is reduced.*Not approved for pediatric use in the United States Available with SoundWave 3.0
Easy to CommunicateThe Naída CI sound processor and Naída Link do not process sound independently like other Bimodal systems.Through Binaural VoiceStream Technology these devices are able to share sound signals and communicatewith each other. They work together to intelligently focus on the most important sounds while significantly reducingunwanted noises. This breakthrough technology allows children to hear clearer sound simultaneously in both ears.Binaural VoiceStream Technology Includes:DuoPhone* Automatically streams phone calls to both ears for stereo hearing and easier conversations in noisewhile using the telephone.School Advantage: A child can call their parent for a ride home from the noisy locker room after basketballpractice and easily hear the conversation in both ears.StereoZoom* Extraction of a single voice from a noisy crowd so one-on-one conversation requires less effort.Requires a Naída Q90 sound processor.School Advantage: A child can listen to their best friend in the cafeteria while background noise is reduced.ZoomControl* Focused listening on a speaker to the front-back or right-left for improved communication in noisy environments.School Advantage: A child can talk with a friend seated next to them on the bus.*Not approved for pediatric use in the United States. Available with SoundWave 3.0.Frequency (Hz)Bimodal HearingSolution Fitting RangeHearing Threshold (dBHL)Mild to SevereHearing LossNaída Link RIC Hearing AidSevere to ProfoundHearing LossNaída Link UP Hearing AidNaída CI Sound Processor
TMEasy to ConnectChildren can wirelessly stream music, television, cell phone calls, Roger /FM, and input from tablets to both ears,and enjoy the benefits of stereo hearing. There is a wide selection of Phonak wireless accessories that stream audiodirectly to both devices for effortless hearing.School Advantage: A child can wirelessly stream audio to both ears while completing an assignment on aschool tablet.EasyCall*Visit phonak.com for details on the benefits each accessory provides.Phonak ComPilot AccessoryA remote control* and streamer that wirelessly connects audio input fromany Bluetooth-enabled device to a Naída CI sound processor and/or acompatible Phonak hearing aid.*Available with SoundWave 3.0Bimodal in the Real World“I can carry on conversations in a restaurant with ease, hear my boyfriend callingme from another room, and even talk on the phone with the T-Mic or my Roger penstreaming into both ears. It’s astounding how clear I am able to localize sounds throughthese intelligent and cohesive devices; two ears are definitely better than one!”— Jessica, AB recipientHow can I keep track of my student’s Bimodal system?Advanced Bionics has created a simple form you can use to keep track of your student’s technology.Visit AdvancedBionics.com/TFS and click on Bimodal hearing to download the Bimodal Technology Tracking Form.
Advanced Bionics AGLaubisrütistrasse 28, 8712 Stäfa, SwitzerlandT: 41.58.928.78.00F: mAdvanced Bionics LLCReferences1. Potts L, Skinner M, Litovsky RY, Kuk F, & Strube M. (2009). Recognition and Localization of Speech byAdult Cochlear Implant Recipients Wearing a Digital Hearing Aid in the Non-implanted Ear (BimodalHearing). International Journal of Audiology 20:353-373.2. Ching TY, Hill M, Brew J, Incerti P, et al. (2005). The effect of auditory experience on speech perception,localization, and functional performance of children who use a cochlear implant and a hearing aidin opposite ears. International Journal of Audiology 44(12):677-90.3. Ching TYC, Psarros C, Hill, M, et al. (2001). Should children who use cochlear implants wear hearingaids in the opposite ear? Ear and Hearing 22(5)365-380.28515 Westinghouse PlaceValencia, CA 91355, United StatesT: 1.877.829.0026T: 1.661.362.1400F: [email protected] Sonova brandFor information on additional AB locations, please visitAdvancedBionics.com/contact4. Jang JH, Lee JH, Chang SO, Oh SH. (2014).Effect of Aided Hearing in the Nonimplanted Ear on BimodalHearing. Otology and Neurotology. 35(10):e270-6.5. Dorman MF, Gifford RH, Spahr A J, McKarns SA. (2008). The benefits of combining acoustic andelectric stimulation for the recognition of speech, voice and melodies. Audiology and Neurotology,13(2): 105-1126. Holt RF, Kirk KI, Eisenberg LS, Martinez AS, & Campbell W. ( 2005). Spoken word recognitiondevelopment in children with residual hearing using cochlear implants and hearing aids in oppositeears . Ear and Hearing, 26, 82S-91S.7. El Fata F, James CJ, Laborde ML, Fraysse B. (2009). How much residual hearing is ‘useful’ for musicperception with cochlear implants? Audiology and Neurotology. 14(Suppl 1):14–21.8. Kong YY, Stickney GS, Zeng FG. (2005). Speech and melody recognition in binaurally combinedacoustic and electric hearing. J Acoust Soc Am. Mar117(3Pt 1): 1351-619. Marsella P, Giannantonio S, Scorpecci A, Pianesi F, Micardi M, Resca A. (2015). Role of bimodalstimulation for auditory-perceptual skills development in children with a unilateral cochlear implant.Acta Otorhinolaryngologica Italica 35(6):442-8.10. Nittrouer S, Chapman C. (2009). The effects of bilateral electric and bimodal electric-acousticstimulation on language development. Trends In Amplification 13:190–205.11. Moberly AC, Lowenstein JH, Nittrouer S. (2016). Early Bimodal Stimulation Benefits LanguageAcquisition for Children With Cochlear Implants. Otology and Neurology 37(1):24-30.12. Shpak T, Most T, Luntz M. (2014). Fundamental Frequency Information for Speech Recognition viaBimodal Stimulation: Cochlear Implant in One Ear and Hearing Aid in the Other. Ear and Hearing35(1):97-109.The AB recipients featured have not beencompensated for the use of their quotesin this material. Not all products listed areavailable in all territories and not all featuresdescribed here are available on all devices.Talk to your hearing healthcare professionalto find the solution best suited to you or yourchild’s needs.13. Ching T. (2005). The evidence calls for making binaural-bimodal fittings routine. (2005). HearingJournal November 2005 Volume 58 - Issue 11 - pp 32,34,36,38,40–41.14. Farinetti A, Roman S, Mancini J, Baumstarck-Barrau K, Meller R, Lavieille JP, Triglia JM. (2015). Qualityof life in bimodal hearing users (unilateral cochlear implants and contralateral hearing aids).European Archives of Oto-rhino-laryngology 272(11):3209-15.15. Veugen LC, Chalupper J, Snik AF, van Opstal AJ, Mens LH. (2016) Matching automatic gain controlacross devices in bimodal cochlear implant users. Ear and Hearing. (2015 Dec 10, epub ahead of print).16. Bess, FH, & Hornsby, BWY. (2014). The Complexities of Fatigue in Children with Hearing Loss. SIG 9Perspectives on Hearing and Hearing Disorders in Childhood, 24(2), 25-39027-M804-03 2016 Advanced Bionics AG and affiliates. All rights reserved.
Bimodal Hearing is the use of a cochlear implant in one ear and a hearing aid in the opposite ear. One Child, Two Ears To maximize the success of children with hearing loss, each ear must be evaluated and considered individually and together as a system.
