Post-lingual
This section outlines the challenges, benefits and influencing factors after cochlear implantation – age group 18 – 64.
Each publication listed below is rated by its importance for patients, using a Hearring key icon scale 🔑— e.g. one key for low importance, three keys for medium importance, and five keys for high importance. (COMING SOON)
🔑
low importance for patients
🔑🔑🔑🔑🔑
the highest importance for patients
Challenges
of hearing loss for adults
1. “In sum, communication with severe hearing loss is an effortful process for the listener.” (Souza et al. 2018)
1. “Hearing loss is associated with both loneliness and depressive symptoms. Longitudinal studies are required to clarify the causal relationships and to further investigate the direct impact of early hearing aid fitting on the progression of loneliness and depression.“ (Döge et al. 2025)
1. “The high cognitive load of speech processing in people with hearing loss may accelerate neurodegeneration and brain atrophy.” (Calvino et al. 2022)
1. “Due to changes in communication patterns, quality of life is strongly reduced in hearing-impaired subjects. According to the National council on the Aging Report comprising 4394 participants only 39% of hearing-impaired elderly have an excellent health compared to 68% in the general population.” (Völter et al. 2020)
1. Profound hearing loss reduces interpersonal contacts, which may result in social exclusion and related psychological consequences, e.g. depression. (Rotkowska et al. 2021)
2. “Hearing loss is associated with both loneliness and depressive symptoms. Longitudinal studies are required to clarify the causal relationships and to further investigate the direct impact of early hearing aid fitting on the progression of loneliness and depression.“ (Döge et al. 2025)
1. “Family and peer support was listed most frequently. Our survey highlights the importance that early-deafened adults ascribe to family support in contributing to successful cochlear implant use. Family members spend the most time with cochlear implant users, are frequently the main caregivers, and are required to be the most patient and understanding in the immediate postimplantation setting.” (Chee et al., 2004)
1. “Health-related disorders will become an increasing problem for the individual and a large socio-economic burden for the general population.” (Völter et al. 2020)
1. “If we would consider the potential indirect cost savings realized by early identification and treatment of hearing loss on the lifelong management of the elderly, the balance between screening costs and cost savings could easily tip the other way.” (Lammers et al. 2025)
1. “The study highlights that hearing impairment-related fatigue is experienced by many but not all, and to different extents. Hearing aids were weakly linked to a beneficial effect on fatigue. In addition to the more widely researched effort-driven fatigue, participants described fatigue linked to the negative emotions related to having a hearing impairment. These findings, in conjunction with the wide-spread utilisation of different coping strategies, demonstrate that the experience of fatigue is varied and likely dependent on personal factors and lifestyle.” (Holman et al. 2019)
Benefits
after cochlear implantation
1. “In addition, post-operative speech perception in quiet was related to post-operative performance in attentional tasks in OA (τ=-0.26, p=0.02 vs MA τ=-0.19, p=0.16), whereas improvement of speech perception significantly correlated to an improvement of M3 in both age groups (MA: τ=-0.27, p=0.048 and OA: τ=-0.23, p=0.03).” (Völter et al. 2020)
1. “After one year of CI usage, we observed a positive change in speech-to-noise ratio (SNR) across the three different configurations explored (delta values: 0.43 dB SNR in S0N0; 0.19dB SNR in S0Nci and 1.4dB SNR in S0Nnh).” (Cuda et al. 2025)
2. “Successful auditory rehabilitation can also be achieved in unilateral deafness (normal hearing on the contralateral side), meaning that CI treatment in the deaf ear: […] Significantly improves speech intelligibility in noise (improvement in the signal-to-noise ratio [SNR] in the Oldenburg sentence test [OLSA] of 2.23 dB)” (Dazert et al. 2020)
1. “Nevertheless, our results clearly indicate that the substantial majority of such patients feel that they have derived benefit from cochlear implantation. This benefit is a consequence of improved communication (lip-reading skills) confidence, environmental awareness, and greater independence.” (Chee et al. 2004)
1. “Among the different dimensions evaluated by the Gabrielsson test, the mean scores for clarity, spaciousness, fullness, nearness, and total impression were significantly higher with tonotopic fitting.” (Creff et al. 2024)
1. “For newly implanted cochlear implant users, a tonotopic-based fitting (TF) appears beneficial for perceiving complex sound signals, such as music. At study end, 92% of participants chose to keep the TF setting for their daily use.” (Creff et al. 2024)
1. In SSD: “Electrical stimulation via a CI resulted in a significant reduction in tinnitus loudness (mean ± SD; 1 year after implantation, 2.4 ± 1.8; 2 years after implantation, 2.5 ± 1.9; before implantation, 8.5 ± 1.3). With the device deactivated, tinnitus loudness was still reduced to between 6.1 and 7.0 over 24 months. The Tinnitus Questionnaire revealed a significant positive effect of CI stimulation.“ (Van de Heyning et al 2008)
1. In SSD: “After cochlear implantation, subjective listening effort seems to decrease in CI users with SSD and with asymmetric hearing loss (3, 47).” (Dillon et al. 2018, Lopez et al. 2021 cited from Philips et al. 2023)
1. “Statistically significant differences were found in almost all dimensions of health-related quality of life (except pain). Significant improvement (p < 0.001) was observed in the dimensions of independent living, sense, mental health, happiness, coping, relationships, and self-worth, and also in both superdimensions. The overall quality of life (UI) significantly increased after cochlear implantation.” (Rostkowska et al 2021)
1. Many studies, such as those cited in the consensus paper by Buchmann et al. 2020, show that the fitting of a cochlear implant impacts hearing-impaired persons far beyond their ability to hear. Evidence suggests that cochlear implant use can lead to improvement in social isolation, loneliness, and depression of well-being and mental health.” (Buchmann et al. 2020 cited from Illg et al. 2021)
1. “The present study showed a post-implantation decrease in anxiety and depression in more than half of the participants in both age groups. The mean anxiety values went from “borderline” to “normal” and the depression scores decreased significantly.” (Calvino et al. 2022)
1. Quality of life significantly increased (p < 0.001) after cochlear implantation in almost all domains (except the pain dimension). The mean increase in overall quality of life was 0.16, the greatest improvement was found in the dimensions senses (mean change of 0.17) and self-worth (mean change 0.16).” (Rostkowska et al. 2021)
1. “Most of our patients are employed. Some have managed to assume more challenging, responsibilities and attribute this to their cochlear implant. Improved communication skills and greater independence may, in part, be responsible for giving patients the confidence to pursue more fulfilling and perhaps better-paying jobs.” (Chee et al. 2004)
1. “Most of our patients are employed. Some have managed to assume more challenging, responsibilities and attribute this to their cochlear implant. Improved communication skills and greater independence may, in part, be responsible for giving patients the confidence to pursue more fulfilling and perhaps better-paying jobs.” (Chee et al. 2004)
1. “20% of the subjects aged 65–85 years had an abnormal score on at least three out of six subtests before CI provision; this decreased to only 5% after cochlear implantation. In general, cognitive functions significantly improved at six or at 12 months of CI use (22, 24).” (Völter et al. 2022)
More: Zhan et al. 2020, Vasil et al. 2020, Claes et al. 2018
1. “Better hearing not only improved individuals’ ability to communicate verbally, but also their ability to function independently on a daily basis.” (Cuda et al. 2024)
1. “In particular, “Social participation” as a treatment success directly experienced by the patient reaches the level of the general population within only 6 months postoperatively and even exceeds this level 6 years after CI treatment.” (Issing et al. 2024)
1. “They appeared to feel less lonely and felt less handicapped by their hearing loss. Clinically and statistically significant gains in health utility, independence, loneliness, hearing ability and hearing handicap were observed regardless of young, middle or old old age group.” (Cuda et al. 2024)
1. “After 1 year of CI use, the mean depression scores decreased significantly in both age groups: from 5.8±4.3 to 4.4±4.2 in the<60y group and from 7.3±5.3 to 6.3±4.4 in the≥60y group (Fig. 5C). A decrease in the depression scores was reported by 82% of participants in the<60 group and by 50% in the ≥60y group.”
1. “Our study data demonstrate a rapid and stable improvement in quality of life over the 6 years in elderly patients over the age of 65.” (Issing et al. 2024)
1. “Partners described being less concerned about the safety of the CI recipient, a reduction in the need for them to act as an interpreter for their spouse, and a reduction in stress associated with caring for their partner following cochlear implantation. Cochlear implantation has been found to enhance autonomy, normalcy, and social life satisfaction for CI recipients and, importantly, their partners.”
1. “Electrical stimulation via a CI resulted in a significant reduction in tinnitus loudness (mean ± SD; 1 year after implantation, 2.4 ± 1.8; 2 years after implantation, 2.5 ± 1.9; before implantation, 8.5 ± 1.3). With the device deactivated, tinnitus loudness was still reduced to between 6.1 and 7.0 over 24 months. The Tinnitus Questionnaire revealed a significant positive effect of CI stimulation.” (Van de Heyning)
Influencing Factors
Post-operative results
1. SSD: “In addition to intensive modified rehabilitation programs, the patient’s motivation was shown to be definitely decisive in our study” (Arndt et al. 2017)
1. “Daily device use was documented for 24 patients with CNC word data and 21 patients with BKB-SIN data. Figure 1 (right panel) plots performance as a function of daily device use. There was a significant association for CNC words (r(24)=0.56, p=0.002) and BKB-SIN (r(21)=-0.49, p=0.012), with better performance observed with increases in daily device use.” (O‘Rourke et al. 2025)
1. “The postoperative performance with a cochlear implant (CI) highly varies among patients. Patient-specific factors that are associated with postoperative speech perception are 1) the preoperative speech perception (1), 2) the duration of hearing loss (2,3), 3) the etiology of hearing loss (4), and 4) the age at implantation (5,6).” (Breitsprecher et al. 2023)
1. “The postoperative performance with a cochlear implant (CI) highly varies among patients. Patient-specific factors that are associated with postoperative speech perception are 1) the preoperative speech perception (1), 2) the duration of hearing loss (2,3), 3) the etiology of hearing loss (4), and 4) the age at implantation (5,6).” (Breitsprecher et al. 2023)
2. “Some considerations should be taken among the duration of hearing deprivation, and/or the period of inadequate stimulation, as these are reported to negatively influence the outcome of hearing rehabilitation by several authors, as expected.” (Ciorba et al. 2019)
1. “Comorbidities as assessed by ACE-27 are associated with CI performance. Patients with more severe comorbidities have clinically meaningful improvement but have worse outcome compared to patients with no comorbidities.” (Dang et al. 2024)
1. “Speech comprehension with hearing aid at 80 dB can be used as a supplementary preoperative indicator of CI-aided speech comprehension and should be measured regularly in the clinical routine. […] WRSmax and WRS80(HA) were better predictors of CI-aided comprehension than was preoperative speech comprehension at 65 dB with HA.“ (Rieck et al. 2023)
1. “WRSmax [unaided maximum word recognition] and WRS80(HA) were better predictors of CI-aided comprehension than was preoperative speech comprehension at 65 dB with HA.“ (Rieck et al. 2023)
1. “Speech comprehension with hearing aid at 80 dB can be used as a supplementary preoperative indicator of CI-aided speech comprehension and should be measured regularly in the clinical routine. […] WRSmax and WRS80(HA) were better predictors of CI-aided comprehension than was preoperative speech comprehension at 65 dB with HA.“ (Rieck et al. 2023)
1. “Electric CI stimulation of the spiral ganglion apex in the second cochlear turn, combined with TFS (FS4), enables clear low-frequency perception and enhances speech in noise (SPIN) and music quality. This supports the rationale to use 28-, 31- or 34-mm electrodes with apical TFS (FS4), offering near normal hearing quality.” (Van de Heyning 2025)
2. “While the FLEX20 ES [Electric Stimulation-only] and FLEX24 ES groups were still in their learning phase between the 3 to 6 months interval, the FLEX28 ES group was already reaching a performance plateau at the three months appointment yielding remarkably high test scores.” (Büchner et al. 2017)
3. “Seven studies found no significant correlation between insertion depth and speech perception outcomes (9,22,31,37,41,42,44).
Fifteen studies reported a positive effect or significant positive correlation between insertion depth and speech perception (11,13,29,30,32–36,38–40,43,45,46) (Table 2).” (Breitsprecher et al. 2023)
4. “Longer electrode insertions (and greater insertion angles) appear to offer better speech perception performance in the early postactivation period when using the same implant system.” (Buchman et al. 2014)
1. “Hearing preservation has been shown to confer the following audiologic benefits: better speech understanding in complex listening environments, superior sound localization, and improved music appreciation.” (O’Connell et al. 2017)
1. “Higher sound quality ratings were associated with better QOL [Quality Of Life] outcomes. The strongest correlations with sound quality were observed in the communication domain (r = 0.65, p < 0.001), followed by the listening effort and emotional domains (both r = 0.50, p < 0.001), then the environment domain (r = 0.46, p < 0.001), while the entertainment (r = 0.39, p < 0.001) and social domains (r = 0.35, p < 0.001) demonstrated relatively weaker, though still significant, correlations.” (Berg et al. 2025)
1. “Electrical stimulation via a CI resulted in a significant reduction in tinnitus loudness (mean ± SD; 1 year after implantation, 2.4 ± 1.8; 2 years after implantation, 2.5 ± 1.9; before implantation, 8.5 ± 1.3). With the device deactivated, tinnitus loudness was still reduced to between 6.1 and 7.0 over 24 months. The Tinnitus Questionnaire revealed a significant positive effect of CI stimulation.” (Van de Heyning et al. 2008)
1. “The user must have open access to the CI center (or a designated local partner service) for rehabilitation and counseling as required. To allow progress to be monitored, appropriate standardized audiological, speech perception, and quality of life measures should be performed after initial tuning; this should be done at least twice but preferably 4 times […] in the first year following implantation and at regular intervals thereafter. After the first year following implantation, the user should be offered an annual audiological review.” (Távora-Vieira et al. 2020)
1. “Waiting times for diagnostic testing and treatment should be as short as possible and comply with current national and local targets. Current HEARRING targets are 6 weeks for diagnostic and 18 weeks for treatment.“ (Távora-Vieira et al. 2020)
1. “Thus, early fitting not only enhances immediate auditory outcomes but also contributes to sustained and increased usage of the device, promoting better long-term developmental outcomes. Early fitting is safe and feasible for many patients. This approach allows for earlier rehabilitation and may have long-term benefits for stimulation levels and dynamic range.” (Almuhawas et al. 2025)
2. “No major or minor complications were reported and all patients could perform the early fitting. Activation modality influenced impedance values only in the short term but the differences were not statistically significant (p > 0.05). Mean MCL values in the early fitting group were lower than MCL of the late fitting in all follow-up sessions, and the difference was statistically significant (p < 0.05). The mean PTA was lower in the early fitting group but the difference was not statistically significant (p < 0.05).“ (Soncini et al. 2024)
1. “The IG [Intervention Group: Group that had been activated much earlier than the Control Group] achieved better results 7 weeks after implantation and completion of rehabilitation, both at quiet and with background noise, than the CG [Control Group] after 15 weeks (at the start of rehabilitation). This is relevant for situations in everyday life. The results thus prove that the Frankfurt concept provides CI patients with the benefit of the CI significantly earlier and thus achieves an earlier improvement in speech perception.” (Bruschke et al. 2024)
2. “Early fitting of cochlear implants is safe, allows for an early rehabilitation and can have possible beneficial effects on stimulation levels and dynamic range.” (Soncini et al. 2024)
3. “Systematic postoperative rehabilitation should begin after initial fitting according to the individual needs of the user, to:
1. Facilitate acclimatization to the new sensation of sound and the integration of the CI with the contralateral acoustic ear. Extensive rehabilitation and training of the CI ear alone-for instance, through a direct signal input to the audio processor-is mandatory.
2. Reassure the user and their family/caregiver.
3. Outline the rehabilitation program.” (Távora-Vieira et al. 2020)
4. “Thus, early fitting not only enhances immediate auditory outcomes but also contributes to sustained and increased usage of the device, promoting better long-term developmental outcomes. Early fitting is safe and feasible for many patients. This approach allows for earlier rehabilitation and may have long-term benefits for stimulation levels and dynamic range.” (Almuhawas et al. 2025)
1. “Recent meta-analyses and systematic reviews demonstrate that AR is safe and effective in both adult and pediatric populations. Computer-based auditory training (CBAT) is the most common rehabilitation modality reported in the literature. In adult patients, there is evidence that both computer-based and in-person AR strategies improve speech perception outcomes.“ (Harvey et al. 2024)