Hearing a clearer sound means the brain can use less energy to hear and understand.
Hearing in Background Noise - How Can Cochlear Implants Help?
Tuesday, October 1, 2024
Difficulty hearing in noise is a common issue, especially when listening to someone speaking. Noise can consist of many sounds at once, and our ears and brain have to work hard to pick out what is important. For those with hearing loss, trying to understand speech in noise is often even harder.
Why hearing in noise is harder for people with hearing loss
People with hearing loss will find hearing some sounds difficult, including speech. Background noise can mask the speech sounds that they are trying to hear. As a result, the brain may have to fill in parts of words or sentences that are missing. This may cause the person to hear or respond incorrectly.
When the brain works harder to hear, it can make the person feel tired. Some might choose to avoid noisy locations altogether as a result. This might include not meeting with friends or family in noisier places, which can have an impact on their quality of life and their relationships with the people around them.
How cochlear implants help with hearing in noise
Cochlear implants help people hear by sending signals to the hearing nerve. This nerve sends a signal to the brain where it is heard as a sound. By directly stimulating the auditory nerve, the cochlear implant bypasses damaged portions of the ear that may not be working effectively.
Hearing a clearer sound means the brain can use less energy to hear and understand. The person may find it easier to focus as a result. This should help them hear speech better in noise.
Cochlear implants use a number of features to help people hear better in noise.
Signal processing
The cochlear implant includes a sound processor worn on the outside of the ear that has microphones that pick-up sound. The processor splits the sound into different parts using filters. Filters help by focusing on useful sounds, such as speech. They can also determine which are less useful, for example, the hum of a fan.
The sound processor can also reduce loud sounds using compression. Compression helps make sure the sound is comfortable in even the loudest places.
The sound processor then sends this information as a message to the implant, which then turns it into an electrical signal and sends it to the hearing nerve. The hearing nerve carries the signal to the brain.
Signal processing essentially helps clean the sound. It reduces sounds that are less beneficial and makes useful ones easier to hear.
Directional microphones
The sound processor may also have microphones on the front and back to catch additional sounds in the environment. Directional microphones are designed to catch sounds that come from a particular direction (usually the front) while sounds from other directions are reduced. This can help the listener hear someone talking from that direction. If noise levels increase the microphone range can narrow. This helps further reduce noise and allow the listener to focus more on the person talking. Features like auto UltraZoom or auto StereoZoom are examples of directional microphones in AB technologies. They can really help in situations such as noisy restaurants.
Automatic sound adjustments or steering
Newer sound processors can automatically adjust to surroundings. Features like AutoSense OS™ is an example. AutoSense OS uses microphones to detect the amount of sound, including noise. If the amount of sound is low, it will not attempt to reduce noise. If the amount of sound is high, it will attempt to reduce unwanted noise levels. The technology will automatically switch on directional microphones or. use filters and compression. This helps ensure that when noise levels change, the listener hears as well as possible.
Newer sound processors can automatically adjust to surroundings.
Wireless connectivity
Modern sound processors such as AB’s Marvel CI can connect to phones, TVs and other devices using Bluetooth. The sound is streamed wirelessly and directly to the cochlear implant, bypassing other sounds and noises around the listener.
What else can help with listening in noise?
We hear best with two ears. In fact, when hearing with both ears, our brain is better able to pick out the sounds we want to hear in noisy places. That’s why when there’s hearing loss in both ears, it’s best to get hearing devices that support better hearing from both sides.
Depending on the hearing loss, this could be two cochlear implants, or a cochlear implant plus another device, such as a hearing aid or CROS.
Note: Advanced Bionics cochlear implants are indicated for users with severe to profound bilateral sensorineural hearing loss (≥ 70 dB HL) and for pediatric users with profound bilateral sensorineural hearing loss (≥ 90 dB HL).
Hearing aids
If mild or moderate hearing loss is diagnosed in one ear, a hearing aid may be used in combination with a cochlear implant. There are hearing aids that have been designed to work with specifically alongside an AB cochlear implant. This includes the Phonak Naída and Phonak Sky Link Marvel hearing aids. These hearing aids use many of the same features mentioned previously, and when used with the cochlear implant, they can be more effective in reducing noise and improving speech understanding.1
CROS (Contralateral Routing of Signal)
If someone with single-sided hearing loss needs additional listening support, a CROS system may also be an option. This system typically consists of a small device with a microphone that sits on the unaided ear. It picks up sound and sends a signal to the cochlear implant. If it is noisy on the cochlear implant side this can make hearing from the other side difficult. A CROS device helps by sending the sound of the voice directly to the cochlear implant. This makes it easier to hear the person’s voice in noisy enviornments.2
Assistive listening devices (ALDs)
Hearing someone further away may specifically be difficult. ALDs, such as wireless microphones may help. The wireless microphone can be worn or used by someone else, sending the sound of the other person’s voice directly to the cochlear implant. This includes microphones such as Roger™ systems. Roger can further reduce noise levels, which can help users hear better in noisy places and over distance. They can also be used in classrooms, lectures, meetings and many other places.3
Auditory training is key to helping the brain hear a clearer sound.
Auditory training
Auditory training is important when getting used to a cochlear implant. This includes activities such as listening and repeating sounds or words. This is often done in quiet environments, as well as places with noise. It may also include lip-reading tasks, so being able to see the person speaking will be helpful in noise. Practicing listening with a cochlear implant in different places is important for the brain to get used to different types of sounds. Auditory training is key to helping the brain hear a clearer sound.
What to do if you have trouble hearing in noise
I have fitted many cochlear implants over the years. Difficulties hearing in noise may well be the most reported issue. Successful outcomes with a cochlear implant cannot be guaranteed, although from experience most people do report improvements hearing in noise. The technology, features, ALDs and auditory training can be key to success. Hearing better in noise means people can start enjoying places or activities they may have avoided, including meeting with friends or family in noisier places. Often people report an improved quality of life as a result.4
Please discuss your options with a hearing healthcare provider. They can advise you on what might be beneficial for your hearing needs. They may refer you to be assessed for a cochlear implant if appropriate.
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Devocht EMJ, Janssen AML, Chalupper J, Stokroos RJ, George ELJ (2016) Monaural Beamforming in Bimodal Cochlear Implant Users: Effect of (A)symmetric Directivity and Noise Type.PLoS ONE 11(8): e0160829.doi:10.1371/journal.pone.0160829
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Dwyer, R.T., Kessler, D., Butera, I.M. and Gifford, R.H. (2018). Contralateral Routing of Signal Yields Significant Speech in Noise Benefit for Unilateral Cochlear Implant Recipients. Journal of the American Academy of Audiology. doi:https://doi.org/10.3766/jaaa.17117.
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Wolfe, J. et al. "Evaluation of Speech Recognition of Cochlear Implant Recipients Using Adaptive, Digital Remote Microphone Technology and a Speech Enhancement Sound Processing Algorithm." Journal of the American Academy of Audiology 2015 May; 26(5): 502-8. doi: 10.3766/jaaa.14099.
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Sousa, A., Couto, M., & Martinho-Carvalho, A. (2018). Quality of life and cochlear implant: results in adults with postlingual hearing loss. Braz J Otorhinolaryngol, 84(4), 494-499.
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