Beliefs and benefits: clinical approaches towards auditory training for adult cochlear implant users

Despite several published studies on the topic of auditory training (AT), it is still unclear whether this should be delivered for adult cochlear implant (CI) users. While benefits of AT could improve speech understanding and social well-being, studies have shown that AT is not effective for everyone. The last systematic review in this area rated the evidence for AT as very low to moderate and concluded that the evidence was insufficient to guide practice. Therefore, it is still unclear whether resources should be invested in AT for adult CI users. Additionally, few studies have considered how AT is delivered, who is delivering it (i.e. the professional, a significant other, or self administered), what is encompassed under the term AT and clinicians’ belief’s towards its usefulness. The aim of this study was to describe clinicians’ practices in relation to AT for adult CI users in Australia. A survey was developed and distributed through the professional association of audiologists in Australia, to assess whether and how AT was delivered, such as type, duration and resources allocated, as well as factors that may influence decision-making around these aspects. Seventy-eight audiologists who worked with adult CI users responded to the survey, however only 41 responded to all questions, therefore sample size varied across questions. Results suggested that the methods professionals employ with adult CI users fell into four categories: 1. do not deliver, recommend or refer their clients to AT; 2. refer their clients to a colleague for AT; 3. deliver face-to face AT; 4. recommend home-based AT. Over 75% of professionals reported using more than one method. The average time allocated for face-to-face AT was 56 min per month, whereas the average time clinicians recommended for home-based AT was 5.5h per month. The most common factor reported by clinicians when deciding when to provide AT was clinical experience. Qualitative analyses of the open format responses showed that the main measures used to evaluate training benefit are subjective reports from clients or significant others, followed by speech perception measures and questionnaires of functional outcomes. Counselling, involvement of significant others and speech perception performance tracking were the main factors reported that were used to promote compliance with the training program. Overall, clinicians’ beliefs about the value of AT in clients’ motivation and confidence had an important influence in the approach that was chosen. These results highlight that current clinical practice related to AT for adult CI users is variable and spans beyond aspects commonly assessed in AT studies. These considerations are important when making clinical recommendations, evaluating the benefits of interventions, as well as when designing further AT studies.