Bilateral Cochlear Implants in Adults and Children

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Abstract
In recent years, there have been improvements in speech-processing strategies used with cochlear implants (CIs). These improvements are particularly evident in speech understanding in quiet.1,2 However, for most CI users, speech reception in a noisy or complex environment is still very poor. To understand speech in noise, CI users need higher signal-noise ratios than normal-hearing listeners.3-6 Although noise reduction and spectral enhancement algorithms may prove to be important in improving speech-in-noise understanding,7,8 lack of binaural hearing and the inability to take advantage of the better-ear effect may also explain poor performance in multisource environments.9,10 Finally, normal-hearing listeners have a very large number of independent information channels, and the location of these channels along the cochlea is matched between the 2 ears, whereas CI users have a finite number of electrodes distributed along the tonotopic axis of the cochlea, and the electrode placement can vary.