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Hearing impaired get better hearing with cochlear implant plus hearing aid

Sorry for the cut-n-paste job, but I’m traveling again for work this week without much time to write.  I find this topic fascinating though.  I’ve been wearing my hearing aid in the unimplemented ear (formerly my better ear) for almost 2 months now.  For the next set of hearing tests I’ll ask to be tested with just the CI and with both CI and hearing aid.
Press release – Washington University in St. Louis – August 4, 2009
For an abstract of the artice as cited, in the Journal of the American Academy of Audiology:
Hearing impaired get better hearing with cochlear implant plus hearing aid

By Gwen Ericson

Aug. 4, 2009 — Adults with severe hearing loss benefit from pairing a cochlear implant in one ear with a hearing aid in the other ear, even though the sound signals from each device are very different, according to a study at Washington University School of Medicine in St. Louis published in the June issue of the Journal of the American Academy of Audiology.

The patients were better able to hear spoken words and to locate the direction of a sound with both devices turned on compared with either device alone. Additionally, the patients liked the fuller, richer sound they heard when using both devices.

“It is increasingly common to place cochlear implants in both ears when patients have profound hearing loss on both sides, but the majority of these bilateral implants are done in children,” says lead author Lisa Potts, Ph.D., research instructor in otolaryngology. “Many adults lose their hearing as they age, and it may not be financially or physically possible for them to undergo surgery for two cochlear implants. So it is important to know if there is a benefit to using a hearing aid plus a single cochlear implant.”

Each of the 19 study participants received a cochlear implant in one ear and a hearing aid for the other ear. Washington University surgeons at Barnes-Jewish Hospital performed the implantations. The participants were seen at the Adult Cochlear Implant and Aural Rehabilitation Division at the School of Medicine for cochlear implant programming and hearing aid fitting.

Because the participants were profoundly hearing impaired, the hearing aid restored only partial hearing in one ear, while the cochlear implant gave them a greater level of hearing in the other ear. In addition to the imbalance in sound levels, each device processes sound information in a unique way: a cochlear implant translates sounds into electrical impulses that directly stimulate the hearing nerves of the inner ear, while a hearing aid amplifies sounds so the ear can sense its acoustic vibrations. Specialists have questioned whether patients could adequately integrate the asymmetric signals from implants and hearing aids.

This study showed that when the participants used both a cochlear implant and a hearing aid, speech recognition improved by an average of 14 percent over when they used just an implant or just a hearing aid. When both devices were active, participants also made fewer mistakes in determining sound direction — they were better able to say which loudspeaker emitted sound in a semicircular array of 15 loudspeakers placed 10 degrees apart.

Interestingly, when the participants wore both devices, speech recognition and localization was equally good, no matter the direction of the sound source. That was surprising because of the lower sound correction in the hearing aid ear.

“That result really got our attention,” Potts says. “It shows that even when patients have minimal hearing with a hearing aid, it still helps them get input and helps them catch important sound cues. The two inputs are complimenting each other. Hearing aids are better at giving temporal speech cues, while implants supply a fuller spectrum of sound frequencies.”

Temporal information is important for music appreciation. “Patients report that they actually prefer music with a hearing aid and cochlear implant together. There’s something more natural about that tone,” Potts says.

Potts adds that the brain learns to integrate these two separate signals. The sound signals meet in the brainstem and cross all along the auditory pathway up to the brain’s hearing centers, which interpret the signals as one sound.

When asked about their subjective sense of how well they heard with the devices, most patients said they felt they heard sound better with both devices turned on. When they were both on, they described the sound as “louder, clearer and more natural,” “more complete,” and having “a little extra depth, richness and volume.”

The participants, eight men and 11 women, ranged in age from 26 to 79, with an average age of 50. Almost half had some hearing impairment before age six. But nearly all were adults when diagnosed with severe to profound deafness. The patients’ ages or hearing history had no statistically significant effect on the results of the hearing tests conducted in the study.

The researchers are now studying whether a second cochlear implant gives additional benefit over that of an implant plus hearing aid in some of the same patients who participated in this study. But Potts indicates that for some adults with profound deafness, a single implant with a hearing aid may be the best solution.

“A high-power hearing aid may cost a couple thousand dollars, while a cochlear implant costs tens of thousands of dollars,” Potts says. “Implantation is a relatively low-risk surgery, but as you grow older, elective surgery is always something that has to be carefully considered. Our studies are providing information that will help determine the best treatment options for these patients.”

Potts LG, Skinner MW, Litovsky RA, Strube MJ, Kuk F. Recognition and localization of speech by adult cochlear implant recipients wearing a digital hearing aid in the nonimplanted ear (bimodal hearing). Journal of the American Academy of Audiology. 2009 Jun;20(6):353-73.

The Widex Corporation donated the hearing aids used in this study.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.



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7 replies on “Hearing impaired get better hearing with cochlear implant plus hearing aid”

  1. Share

    Sara says:

    “A high-power hearing aid may cost a couple thousand dollars, while a cochlear implant costs tens of thousands of dollars,”

    Not really a practical argument when it comes to your pocketbook if insurance pays for the cochlear implant and not the hearing aids.

  2. Share

    I can definitely attest to the music sounding better with both CI and hearing aid. Using either one or the other seems to give an incomplete experience, but using both is like putting 2 and 2 together and getting 5. Or should I say 1 + 3 = 5 😉

    1. Share

      Sara says:

      Same here… music is much better with the acoustic / electric combination.

  3. Share

    I wear hearing aids, and my loss is moderate, not profound. I often wonder if CI would be an option; it might not, given that mine is a nerve loss. This combination therapy sounds fascinating.

  4. Share

    Interesting, but I agree. The cost thing is not the best argument, and I’m sure there are plenty of seniors who would be more than happy to have a second implant. With that said, I find it really annoying that they never do studies on CI+HA vs. 2 CI’s. They’re either 1 CI vs. 1 CI+HA or 1 vs. 2 CI’s. I mean, no duh that if you’re hearing something out of your other ear it’s going to help somewhat!

    I, personally, like music (and everything else) much better with 2 implants. With my hearing aid, music often sounded more distorted and I could just wear my CI and not tell much of a difference if I had my hearing aid in. Now, I feel like I enjoy music much more. With that said, I also retained some residual hearing in both ears. I haven’t had a booth test (yet) but it seems that my left ear can only hear higher frequencies (weird, I know), and my right can only hear the lows. If I turn my headphones loud enough so that I can hear it with my “natural hearing”, even though it comes through very faintly, the combination is really awesome! It adds more dimension, but I don’t like my music quite that loud, so I rarely do that!

  5. Share

    I agree with PinkLAM — what’s the difference between 2 CIs and 1 CI plus 1 hearing aid? I”m very curious. It seems an no-brainer that having at least something in the ear (be it 2 hearing aids, 1 CI plus 1 hearing aid, or 2 hearing aids) will increase understanding of sound. Has anyone tried to study how the brain becomes “wired” for sounds? Identify what changes with diferent hearing devices?

  6. Share

    Paul Michalski says:


    I’m actually being evaluated for a CI by Lisa Potts, Phd., one of the authors of the paper about the benefits of bimodal hearing. I noticed in your blog that you are an engineer. What kind of engineer are you? I’m an electrical engineer at Boeing (the former McDonnell Douglas). I wear a BTE HA in my right ear and nothing in my left ear (which has a profound loss). The concern that Lisa Potts has is that since I have not used a hearing aid in my left ear in so long (nearly 40 years), how it will respond to stimulation from the CI? I’m going to follow your blog since I’m supposed to meet with those who’ve had CI’s and read about other’s experiences. I’ll let you know how it goes for me.


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