双侧人工耳蜗植入者在噪声环境下的言语辨别能力

目的 探讨双侧人工耳蜗植入患者的言语辨别能力。方法 用2例双侧人工耳蜗植入者比较双侧与单侧人工耳蜗在不同信噪比下对广东话声调的辨别能力。结果 在 15, 10和 5的信噪比下,双侧人工耳蜗的平均能力为96%,92%和88%,而左耳及右耳单侧人工耳蜗的平均成绩为86%,83和74%。在0,-5,-10及-15的信噪比下,单侧人工耳蜗的平均能力近于0%,而双侧人工耳蜗的平均成绩为80%,72%,68%和54%。结论 在不同信噪比下,双侧人工耳蜗植入更有助于提高对广东话声调的辨别能力。进一步证明了双侧人工耳蜗植入患者运用双耳听力的优势。     

刺激速率对广东话人工耳蜗使用者声调认知能力的影响

目的 探讨人工耳蜗装置中刺激速率的改变对人工耳蜗植入者在噪声环境下对广东话声调认知能力的影响。方法 受试对象为18例以广东话为母语的成人人工耳蜗植入者。实验选取1515，800和400脉冲／秒／通道以分别代表高，中、低3种不同刺激速率。在随机选取一种刺激速率后，患者需要在安静及不同信噪比的噪声环境下分别完成对广东话声调辨别能力及识别能力的测试。结果 在安静及不同信噪比的噪声环境下，两项声调认知能力测试的成绩均随刺激速率的减低而下降。在0， 5及 10的信噪比下，高速率刺激与低速率刺激下的声调辨别能力的测试成绩存在显著性差异。在-5及0的信噪比下，高速率刺激与低速率刺激下的声调识别能力测试成绩存在显著性差异。结论 高速率刺激可以为人工耳蜗植入者提供更好的时间信息，有助于提高在噪声环境下的广东话声调认知能力。     

人工耳蜗植入儿童听力言语辨别能力研究

目的 评估人工耳蜗植入儿童听力言语辨别能力,为听力言语康复训练提供科学依据.方法 应用儿童听力言语康复分类训练及评估的汉语视听系统对32例人工耳蜗植入儿童进行字词长短、声调辨别、元音辨别及辅音辨别测试,通过分析其言语辨别得分情况,评估人工耳蜗植入儿童的听力言语辨别能力.结果 字词长短、声调辨别、元音辨别及辅音辨别得分分别为96.69、81.52、87.96和69.28分,经统计学分析,不同测试项目和不同受试者间的辨别差异均具有统计学意义. 结论 ①人工耳蜗植入儿童对于字词长短、声调辨别、元音辨别及辅音辨别的难易度具有显著性差异,听力言语康复训练应遵从难易程度循序渐进的开展;②人工耳蜗植入儿童在声调辨别、元音辨别及辅音辨别测试中呈现出较大的个体差异;③人工耳蜗植入儿童声调辨别得分与其在语音学中难易程度相比明显下降.     

双侧人工耳蜗植入术后言语识别效果的评估

目的评估双侧人工耳蜗植入者汉语普通话短句、双音节词单音节词及汉语声调的识别效果,探索双侧人工耳蜗植入者双耳听觉产生的机制及对言语识别率的影响。方法选取双侧人工耳蜗植入患者6人,自制问卷收集受试者的基本信息并评估他们的主观听觉状况。首先测试受试者在使用双侧人工耳蜗（BCI）、单独使用一侧人工耳蜗（RCI/LCI）的听阈,随后测试他们在BCI和RCI/LCI两种听觉模式下的七音节短句、双音节词、声调、韵母、声母识别率,测试背景环境包括安静环境和嘈杂语噪声环境,言语信号强度为65dB SPL,固定信噪比为+10 dB SPL。随后将BCI和RCI/LCI两种听觉模式下的识别效果进行比较。结果除噪声状态下韵母识别测试中其余测试结果均为BCI言语识别率得分高于RCI/LCI。结论对于符合双侧人工耳蜗植入术适应证标准的患者而言,双侧植入人工耳蜗可以在不同程度上提高安静和噪声环境下的短句、双字词、声母、韵母及声调的识别率,降低其声场听阈。     

双侧同期人工耳蜗植入儿童声源定位能力长期随访研究北大核心CSCD

目的本项研究评估双侧同期人工耳蜗植入声源定位能力是否好于单侧耳蜗植入;评估双侧同期人工耳蜗植入经过5年以上长期佩戴,其声源定位能力与正常听力儿童的区别。方法选取2007年接受双侧同期人工耳蜗植入的6例患者,根据年龄、性别、耳聋时间等配对选取6例术前未佩戴过助听器的单侧人工耳蜗植入者,还根据年龄选取正常听力对照组8例。采用单因素方差分析比较双侧同期人工耳蜗植入受试者双耳佩戴、分别左右侧佩戴状态下的水平方位声源定位能力差别。采用单因素方差分析比较双侧同期人工耳蜗植入、单侧人工耳蜗植入、正常听力儿童的声源定位能力差别。结果双侧同期人工耳蜗植入者双侧佩戴时角度偏差数值为38.73°±8.17°;仅左侧或右侧佩戴时角度偏差数值为78.46°～81.35°。双侧佩戴人工耳蜗声源定位能力要明显好于仅佩戴任一侧人工耳蜗,P<0.01。单侧人工耳蜗植入受试者的角度偏差数值为62.27°±8.72°。正常听力受试者角度偏差数值为5.82°±4.27°。正常听力受试者声源定位能力最好,双侧同期人工耳蜗组次之,单侧人工耳蜗组最差,差异有显著统计学意义,P<0.01。结论双侧同期人工耳蜗植入后,受试者声源定位能力明显好于单侧耳蜗植入。但由于耳蜗设备的局限性,其声源定位能力与正常儿童仍有很大的差距。     

先天性聋儿人工耳蜗植入后的汉语普通话声调辨别

目的考察先天性聋儿人工耳蜗植入后的汉语普通话声调辨别,探索其特点及影响因素。方法编制含单字词及双字词共64个的《声调测试词表》,标准普通话口语给声,用听说复述法对28名植入人工耳蜗的先天性聋儿及20名同龄正常儿童的声调辨别率进行开放项测试,由听力师、聋儿亲属及语训老师共同判断儿童的辨别结果。分析植入年龄、耳蜗使用时间及实际年龄对声调辨别率的影响,比较人工耳蜗组和正常对照组的声调辨别率,并比较耳蜗组以植入年龄3岁为界分组后的辨别率。结果植入年龄与声调辨别率呈负相关,耳蜗使用时间与辨别率呈正相关。耳蜗组儿童的辨别率显示出很大的个体差异性,平均水平显著低于正常对照组。结论植入年龄、耳蜗使用时间是影响人工耳蜗术后聋儿汉语普通话声调辨别的重要因素,3岁前植入人工耳蜗较3岁后植入可获得更好的声调辨别。     

有低频残余听力感音神经聋的人工耳蜗植入术

目的介绍一种有低频残余听力感音神经聋的人工耳蜗植入技术,探讨人工耳蜗植入手术对有残余听力患者的治疗效果和价值。方法15例有残余听力的患者接受了保护残余听力的人工耳蜗植入手术。术中电极植入深度在19mm～24mm左右。术后分别检测单纯使用助听器、单纯使用人工耳蜗、人工耳蜗结合助听器三种不同状态下的听力。结果15例患者中,有13例术后残余听力保存良好,仅分别丢失5～20dB听力,但另2例术后残余听力全部丧失。术后在安静、信噪比15dB和10dB三种不同状态下的言语测试结果显示,人工耳蜗结合助听器使用者测试得分始终保持在很高水平;单纯使用人工耳蜗者也有较好的成绩,但在信噪比达10dB的条件下,测试成绩下降;而单纯使用助听器者,不仅在安静状态下听力成绩不甚理想,一旦加入竞争性噪声,听力测试成绩急剧下降。结论保护和利用残余听力的人工耳蜗植入技术,使人工耳蜗植入手术对象从重度或极重度聋扩大到高频为重度或极重度聋,低频（≤500Hz）为中、轻度聋的患者。接受这项技术患者的听力和言语识别能力均明显优于其单纯配戴助听器和单纯使用人工耳蜗时的听力和言语识别能力。     

诺尔康人工耳蜗植人者的声调识别与生活质量评价

目的：评估诺尔康人工耳蜗植入者对普通话的声调识别能力和术后生活质量。方法：49例植入诺尔康人工耳蜗1年的受试者，使用课题组前期编制的声调识别测试软件，评估植入者的声调识别能力；使用Ni-jmegen人工耳蜗植入量表（NCIQ），评估植人者术后生活质量。结果：①安静条件下声调识别率平均为67．26％，全部高于机会水平；②噪声条件下声调识别率平均为51．92％，除2例植入者的声调识别率低于机会水平外，其余均高于机会水平；③声调识别混淆矩阵结果显示，三声为较容易辨别的声调；④术后NCIQ总分及基本声音感知、高级声音感知、言语能力、自信心、活动能力和交流能力均获得改善，分别为55．4、72．4、54．0、63．4、50．7、47．3和44．7分。结论：诺尔康人工耳蜗植入者术后具有声调识别能力并可获得生活质量的改善。     

人工耳蜗电极植入部位对人工耳蜗使用者言语理解影响的研究

目的:探讨人工耳蜗电极覆盖耳蜗基膜范围对汉语普通话人工耳蜗使用者的言语识别能力,特别是声调识别能力的影响.方法:使用人工耳蜗调试软件通过开启(关闭)不同电极通道设置7种测试条件,以模拟人工耳蜗电极覆盖耳蜗基膜范围的不同状态.并对各测试条件下人工耳蜗使用者元音、辅音、声调识别能力进行测试.结果:不同测试条件下元音识别平均得分56%～91%(P<0.05);辅音识别平均得分72%～85%(P<0.05);声调识别平均得分68%～81%(P>0.05).但随着人工耳蜗电极覆盖基底膜范围的扩大,人工耳蜗使用者元音、辅音成绩呈现显著性改善,声调识别成绩亦有所提高.结论:增加人工耳蜗电极覆盖基膜的范围、积极利用耳蜗各个区域有利于改善人工耳蜗使用者的言语识别能力,进而对提高人工耳蜗使用者言语交流和社会交往能力是非常重要的.     

人工耳蜗植入后对侧耳是否联合使用助听器声调识别的对比研究

目的 探讨人工耳蜗植入后对侧耳联合使用助听器对声调识别的影响;同时探讨人工耳蜗开机时间、康复训练时间、听障儿童的学习能力等因素对声调识别的影响。 方法 选择3~7岁的人工耳蜗植入儿童27例,采用《言语听觉反应评估》(EARS)中的“封闭式声调测试”作为测试材料,分别单独使用人工耳蜗(CI)和在人工耳蜗对侧耳联合使用助听器(CIHA)在安静和噪声两种环境下进行声调识别的测试,使用SPSS 17.0对测试结果进行统计学分析。 结果 无论在安静环境还是噪声环境下,CIHA的声调测试成绩均优于CI,此优势在噪声环境下更明显;人工耳蜗开机时间、康复训练时间较长者声调测试成绩均优于较短者;听障儿童的希-内学习能力测试结果学习能力DIQ≥100与DIQ<100者声调测试成绩差异无统计学意义。 结论 建议听障儿童人工耳蜗植入后对侧耳联合使用助听器,但助听器需要优化和调整。     

Superiority of bilateral cochlear implantation over unilateral cochlear implantation in tone discrimination in chinese patients

PURPOSE: The benefits of bilateral cochlear implants (CIs) versus unilateral CIs were evaluated by comparing the Cantonese lexical tone discrimination scores conducted in a quiet environment and against a background noise. MATERIALS AND METHODS: Four postlingually deafened Cantonese-speaking adults (2 men and 2 women) with bilateral CIs were included in this study. The subjects were their own control in the monaural hearing condition. Both the Cantonese lexical tone stimuli and the speech-weighted background noise were presented at 0(0) azimuth and at a distance of 1 m from the subject. The speech stimuli, which were maintained at 65 dB sound pressure level, were presented in both a quiet environment and against a background noise at signal to noise ratios (SNRs) of +15, +10, +5, 0, -5, -10, and -15. RESULTS: Against a background noise, the bilateral CIs required +5 dB SNR only to obtain significant scores in discriminating Cantonese lexical tones and to achieve discrimination scores that were comparable to the optimal discrimination scores obtained in quiet. No significant difference in the discrimination scores was observed between binaural and monaural hearing conditions when the tests were conducted in quiet. CONCLUSIONS: Our study showed that in the presence of background noise, bilateral CIs were better than unilateral CIs in discriminating Cantonese lexical tones.     

双侧植入人工耳蜗对儿童选择性听取能力影响的个案研究

目的探讨双侧人工耳蜗植入儿童在噪音环境下的选择性听取能力。方法采用实验法,研究个案在不同信噪比条件（SNR=0,10,20）下,单,双侧耳识别双音节词和短句的能力。测试使用计算机导航系统给声。结果在双音节词识别方面,当SNR=20和SNR=10时,单、双耳的识别率都为100％;但当SNR=0时,单、双耳识别率同时下降,结果较为接近。在短句识别方面,SNR=20和SNR=10时的结果相似,但单。双耳之间的差异较为明显;当SNR=0时,单、双耳识别率同时下降,结果较为接近。结论双侧人工耳蜗提高了该儿童在背景噪声中的选择性听取技能。SNR=20和SNR=10时,单耳和双耳的选择性听取能力都没有显著差异,但双耳明显好于单耳。在SNR=0时,单耳和双耳的选择性听取能力明显下降,且双耳和单耳差异缩小。     

Benefits of bilateral cochlear implantation: a review

PURPOSE OF REVIEW: Although unilateral cochlear implantation generally provides good speech understanding under quiet conditions, cochlear implantation patients frequently report difficulty understanding speech when exposed to background noise and with sound localization. Since these two listening functions require binaural stimulation for normal individuals and hearing aid recipients, it is not surprising that there is growing interest in binaural implants. This update reviews the basics of binaural listening and the advantages and disadvantages of binaural cochlear implantation. RECENT FINDINGS: Although the psychoacoustic literature has long demonstrated the benefits of binaural hearing, only recently have studies shown improvement in speech intelligibility with bilateral implants compared with unilateral implants. Of the three known binaural mechanisms, the head shadow effect provides greater benefit than binaural squelch or summation. In addition, binaural cochlear implants improve the ability to localize sound. SUMMARY: Bilateral implantation provides multiple benefits to patients with severe to profound hearing loss. Research is currently directed at improving speech intelligibility by utilizing evolving technologies in speech-processing strategies.     

Benefits of bilateral electrical stimulation with the nucleus cochlear implant in adults: 6-month postoperative results.

OBJECTIVE: To evaluate the benefits of bilateral electrical stimulation for hearing-impaired adult subjects using the Nucleus 24 cochlear implant in a multicenter study, and to compare and quantify performance on speech perception measures in quiet and in noise and localization ability for unilateral and bilateral cochlear implant use. DESIGN:: Repeated single subject measures were carried out for each subject, with each subject serving as their own control. Assessment of unilateral and bilateral listening conditions for performance on tests of speech comprehension and sound localization were performed. Speech comprehension measures were performed in quiet at 0 degree azimuth and in the presence of background noise simultaneously presented from the same speaker and spatially separated by 90 degrees, at S+45 degrees N45 degrees and at S-45 degrees N+45 degrees . Test materials included Freiburger monosyllabic words, Oldenburger sentences, and the Hochmair-Schulz-Moser sentences. Tests of localization were performed in the horizontal plane with 12 speaker locations 30 degrees apart using a shortened sentence stimulus from the Hochmair-Schulz-Moser sentences at two possible presentation levels of 55 and 70 dB sound pressure level for assessment of directionality. The binaural advantage provided by bilateral stimulation was calculated with respect to each ear separately, classified as either the better or poorer performing ear for each speech material in quiet and in noise test conditions. For localization of sound, the binaural advantage was compared with left and right ears separately. Paired comparisons for performance data in all conditions were carried out by considering measurements for each subject in different conditions as paired observations and applying the Student's t test to determine the statistical difference between the data sets. SETTING: Tertiary referral centers with a cochlear implant program. PATIENTS: Thirty-seven profoundly hearing-impaired adults were enrolled in the study, 22 simultaneously and 15 sequentially bilaterally implanted. All patients received the Nucleus 24 cochlear implant and used the Nucleus SPrint or ESPrit 3G speech processor, with the vast majority using the ACE speech coding strategy. RESULTS: For spatially separated speech in noise conditions, an interaural performance advantage for the ear closest to the speech source (i.e., with a superior signal to noise ratio) compared with that for the ear closest to the noise source (i.e., with an inferior signal to noise ratio) is consistently demonstrated regardless of whether it is the better or poorer performing ear closest to the speech signal. This is referred to as a significant binaural head-shadow benefit, resulting in a mean improvement between -10 dB and -11.4 dB in the critical signal to noise ratio required for 50% speech comprehension for the Olden-burger sentences and a mean improvement in the maximum score of 42% to 55% for the ear closest to the speech signal over the ear farthest away for the Hochmair-Schulz-Moser sentences. Bilateral stimulation is always observed to provide a performance advantage over the unilateral listening condition for either ear when ipsilateral to the noise source. In addition, as demonstrated by approximately half the subjects tested in noise with the Hochmair-Schulz-Moser sentences, a performance advantage of bilateral stimulation may be observed over the better ear alone when positioned ipsilateral to the speech signal, which is referred to as a binaural squelch effect. On average, for the group, this resulted in a statistically significant improvement in speech comprehension scores of 8% in the bilateral listening condition compared with the scores for the better ear alone. Through assessment of comprehension of coincidental speech in noise and speech in quiet, a significant benefit of binaural redundancy was noted for the group for Oldenburger sentence scores in noise and in quiet compared with unilateral scores for either ear and for the Freiburger monosyllabic words in quiet in comparison with the better ear alone scores. Binaural stimulation also led to a significant improvement in localization ability over either monaural condition, with the root mean square degrees of error reduced by 38 degrees compared with that observed for unilateral stimulation. CONCLUSION: Similar to what has been observed for bilateral acoustic stimulation in the past, bilateral electrical stimulation provides the foundation for the potential advantages of the head-shadow effect, providing a binaural head-shadow benefit and binaural auditory processing such as binaural redundancy and binaural squelch effects, all of which combine to lead to improved speech comprehension over unilateral listening conditions. The combination of improved speech comprehension and improved localization ability made available through bilateral electrical stimulation provides the necessary foundation to further assist the hearing-impaired listener to better cope with communication in the everyday listening situation both in noise and in quiet.     

Measuring listening effort expended by adolescents and young adults with unilateral or bilateral cochlear implants or normal hearing

Abstract

Objectives

To compare the listening effort expended by adolescents and young adults using implants versus their peers with normal hearing when these two groups are achieving similar speech perception scores. The study also aimed to compare listening effort expended by adolescents and young adults with bilateral cochlear implants when using two implants versus one.

Methods

Eight participants with bilateral cochlear implants and eight with normal hearing aged 10–22 years were included. Using a dual-task paradigm, participants repeated consonant–nucleus–consonant (CNC) words presented in noise and performed a visual matching task. Signal-to-noise ratios were set individually to ensure the word perception task was challenging but manageable for all. Reduced performance on the visual task in the dual-task condition relative to the single-task condition was indicative of the effort expended on the listening task.

Results

The cochlear implant group, when using bilateral implants, expended similar levels of listening effort to the normal hearing group when the two groups were achieving similar speech perception scores. For three individuals with cochlear implants, and the group, listening effort was significantly reduced with bilateral compared to unilateral implants.

Discussion

The similar amount of listening effort expended by the two groups indicated that a higher signal-to-noise ratio overcame limitations in the auditory information received or processed by the participants with implants. This study is the first to objectively compare listening effort using two versus one cochlear implant. The results provide objective evidence that reduced listening effort is a benefit that some individuals gain from bilateral cochlear implants.     

Auditory localization abilities in bilateral cochlear implant recipients.

OBJECTIVE: To quantify binaural advantage for auditory localization in the horizontal plane by bilateral cochlear implant (CI) recipients. Also, to determine whether the use of dual microphones with one implant improves localization. METHODS: Twenty subjects from the UK multicenter trial of bilateral cochlear implantation with Nucleus 24 K/M device were recruited. Sound localization was assessed in an anechoic room with an 11-loudspeaker array under four test conditions: right CI, left CI, binaural CI, and dual microphone. Two runs were undertaken for each of five stimuli (speech, tones, noise, transients, and reverberant speech). Order of conditions was counterbalanced across subjects. RESULTS: Mean localization error with bilateral implants was 24 degrees compared with 67 degrees for monaural implant and dual microphone conditions (chance performance is 65 degrees). Normal controls average 2 to 3 degrees in similar conditions. Binaural performance was significantly better than monaural performance for all subjects, for all stimulus types, and for different sound sources. Only small differences in performance with different stimuli were observed. CONCLUSIONS: Bilateral cochlear implantation with the Nucleus 24 device provides marked improvement in horizontal plane localization abilities compared with unilateral CI use for a range of stimuli having different spectral and temporal characteristics. Benefit was obtained by all subjects, for all stimulus types, and for all sound directions. However, binaural performance was still worse than that obtained by normal hearing listeners and hearing aid users with the same methodology. Monaural localization performance was at chance. There is no benefit for localization with dual microphones.     

Simultaneous bilateral cochlear implantation in adults: a multicenter clinical study

OBJECTIVE: To determine the efficacy of "simultaneous" bilateral cochlear implantation (both implants placed during a single surgical procedure) by comparing bilateral and unilateral implant use in a large number of adult subjects tested at multiple sites. DESIGN: Prospective study of 37 adults with postlinguistic onset of bilateral, severe to profound sensorineural hearing loss. Performance with the bilateral cochlear implants, using the same speech processor type and speech processing strategy, was compared with performance using the left implant alone and the right implant alone. Speech understanding in quiet (CNCs and HINT sentences) and in noise (BKB-SIN Test) were evaluated at several postactivation time intervals, with speech presented at 0 degrees azimuth, and noise at either 0 degrees , 90 degrees right, or 90 degrees left in the horizontal plane. APHAB questionnaire data were collected after each subject underwent a 3-wk "bilateral deprivation" period, during which they wore only the speech processor that produced the best score during unilateral testing, and also after a period of listening again with the bilateral implants. RESULTS: By 6-mo postactivation, a significant advantage for speech understanding in quiet was found in the bilateral listening mode compared with either unilateral listening modes. For speech understanding in noise, the largest and most robust bilateral benefit was when the subject was able to take advantage of the head shadow effect; i.e., results were significantly better for bilateral listening compared with the unilateral condition when the ear opposite to the side of the noise was added to create the bilateral condition. This bilateral benefit was seen on at least one of the two unilateral ear comparisons for nearly all (32/34) subjects. Bilateral benefit was also found for a few subjects in spatial configurations that evaluated binaural redundancy and binaural squelch effects. A subgroup of subjects who had asymmetrical unilateral implant performances were, overall, similar in performance to subjects with symmetrical hearing. The questionnaire data indicated that bilateral users perceive their own performance to be better with bilateral cochlear implants than when using a single device. CONCLUSIONS: Findings with a large patient group are in agreement with previous reports on smaller groups, showing that, overall, bilateral implantation offers the majority of patients advantages when listening in simulated adverse conditions.     

Monaural versus binaural hearing: ease of listening, word recognition, and attentional effort.

Forty-eight normal-hearing subjects performed ease of listening, word recognition, and attentional effort tasks for speech in noise under binaural and two simulated unilateral conductive hearing loss (monaural) conditions. The two monaural conditions differed as a function of unoccluded ear orientation to the primary signal (monaural-near and monaural-far). Ease of listening ratings and word recognition scores were significantly poorer during monaural listening and significantly affected by ear orientation to the speech signal. Attentional effort was not significantly affected by changing from binaural to monaural-near listening, but was significantly poorer in the monaural-far condition than in either of the other listening conditions. There was a significant correlation between ease of listening ratings and word recognition, but no correlation between attentional effort and either ease of listening or word recognition.     

Bilateral cochlear implants: a way to optimize auditory perception abilities in deaf children?

OBJECTIVES: The Würzburg bilateral cochlear implant (CI) program was started with the aim to improve the patients' communicative abilities in complex listening situations. In this study, the auditory skills of children using bilateral cochlear implants were evaluated. STUDY DESIGN AND SETTINGS: Qualitative data based on free observations in the rehabilitation setup were collected in 39 bilaterally implanted children. A speech discrimination in noise test was performed in 18 of these children; lists of bisyllabic words were presented in noise at a signal to noise ratio (SNR) of +15 dB. RESULTS: Qualitative and quantitative data show clearly that bilateral CI improves the children's communicative behaviour, especially in complex listening situations. Children examined with the speech in noise test scored significantly better under the bilateral condition compared to the unilateral condition. Integration of the second implanted side and use of binaural information was observed to be easier and faster in children with a short time lag between both implants. CONCLUSIONS: To be able to obtain optimal benefit from bilateral cochlear implants, an intensive rehabilitation program is necessary. The important aspects of such a program are creating realistic expectations in older children before implantation; performing the first processor fitting of the second side with the first side switched on; and separate intensive training with the new system in order to balance out the hearing competence of the second CI with that of the first.