Stages of Listening for Adults With Cochlear Implants

Understanding a conversation or talking on the telephone doesn’t simply happen as soon as the processor is switched on; several factors can influence your success, such as consistent use of your audio processor. Here we outline four broad stages of listening skill development that adults move through from activation day to becoming proficient cochlear implant listeners.

Detecting Sounds in Your Environment

Detection is the ability to hear whether a sound is present or not. This is the first skill to develop and is typically observed in the first activation appointment when your cochlear implant processor is switched on and you hear the first beeps. After that, in the first weeks, you will begin to detect and pay attention to more and more sounds in your environment.

To develop this skill:

• Wear your cochlear implant processor as much as possible. This will give your auditory brain time to learn to pay attention to the sound it’s now receiving. Use AudioKey 2 to keep track of your auditory processor wear time.
• Go on listening walks with a family member or friend. Pay attention to all the sounds you detect in that environment. You might not be able to identify all the sounds yet, so have your walking buddy label the sounds they hear.

Discriminating Between Sounds

Discrimination refers to the ability to hear that one sound is different from another. At this stage, you might not know what either of the sounds are, just that they sound different. This skill occurs at different levels. For example, in the early stages, you will be able to hear the difference between a car horn and a bird chirping, a simple drum beat and a long saxophone note, or a long sentence compared to a short sentence.

At a more advanced level, you will hear the difference between a long word and a short word—e.g., grandma vs. dad—and then finer contrasts of sounds in words. At this stage, you won’t necessarily understand the word or make out each sound, but you will hear that it is different from the other.

To develop this skill:

• Practice discriminating between sets of long sentences and short sentences, and long words and short words.

Identifying Words

At the identification stage, you will identify environmental sounds and words. Name, repeat, write down, or point to text or a picture matching the sound or word you heard. At first, work on developing this skill in a “closed set” where you have a small number of options to choose from in front of you, as in a multiple-choice test. At this stage, you might rely on contextual cues to help you to identify words. At a more advanced level, you will be able to identify sounds and words without the need for a clear set of options to choose from.

To develop this skill:

• Have a family member list items for you to write on the shopping list or for you to take out of the fridge before cooking dinner. Ask them to list the items one at a time and see if you can identify each item.
• Play Which is Which? Level 1 on pages 6-8 of Adult Rehabilitation Kit 9.
• Hear from Trudi about how she started identifying environmental sounds, and see how she uses a simple game to practice identification of single words.

Comprehending Meaning

Comprehension is the final stage. Comprehension refers to the ability to understand the meaning of speech that you hear by following directions, answering questions, following stories, or simply participating in conversation. Comprehension of speech also requires auditory memory: the ability to hold auditory information in your working memory so you can act on it.

To develop this skill:

• Continue practicing your listening skills with the MED-EL Adult Rehabilitation Kits.
• Use the flag description activity on pages 11-12 of MED-EL Adult Rehabilitation Kit 5. Hearing descriptions requires you to listen and understand more details rather than simply identifying the single-word name of the country.

Step by Step

Understanding these four steps will help you progress along your hearing journey without getting frustrated. Identifying and understanding the step you’re at will enable you to target your rehab activities so you can build upon and develop the listening skills you have. Recognizing the improvements you are making will help you stay motivated as you make your way toward your best hearing.