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ARGUMENTS FOR BILATERAL IMPLANTATION 1. A spare ear The value of a spare ear is immeasurable, from the day-to-day advantages to the more catastrophic. When batteries die, it no longer means no hearing. Classes don’t have pause buttons, nor do meetings at work or most of life. If a student with a CI is in class, he/she can keep listening with one ear while changing the batteries in the processor for the other ear. When one CI fails completely, as they eventually will all do, the benefit of a second ear is invaluable. Not only does it mean that the user does not have to endure any time of total deafness, but also, because the readjustment period for a reimplanted ear can vary from a few months to a couple of years, the user has the benefit of one good, continuously working ear and so suffers less disruption in life. 2. Better hearing in background noise Improved hearing with two ears in background noise is well documented. The measured benefit is as high as a 30% improvement. 3. Ability to localize sound The ability to localize sound is important for safety and in school -- to hear where warning sounds are coming from as a young child playing outside, to hear warning sounds while driving, such as horns, sirens, or someone shouting “Stop!,” to hear which elevator dings in a crowded lobby – All of these require the ability to localize sound. In school, especially in the middle and upper school grades, class discussions become an integral part of the curriculum. In order to better follow the discussion, students need to be able to know who is talking and turn quickly to focus on that person. 4. Neural Plasticity Research has shown that a child’s brain starts to lose its plasticity at age 7, and by age 12 it is equivalent to an adult’s ear. Thus, in order to take advantage of that window of opportunity for the brain to fully utilize hearing from a second ear, children should receive bilateral implants by age 7. 5. Nerve fiber atrophy We now know that, left unstimulated, the auditory nerve fibers begin to atrophy. Thus, the earlier argument to implant only one ear and save the other for future technology no longer holds true. To save an ear that receives no benefit from hearing aids instead means that the ear is being wasted. Even if new technology comes along when the child is an adult, he/she will never realize the full benefit of that technology because the nerve fibers in the unstimulated ear will atrophy. To implant that ear while the child is still young and so to stimulate those nerve fibers means that the auditory nerve and the rest of the auditory pathway will be preserved for future technology. Rachel’s and Jessica’s Results with Bilateral CIs Rachel 1 Nucleus 22 CI Single syllable word test Hearing in quiet: 90% Hearing in 10 db signal-to-noise ratio, noise to unimplanted ear: 30% Hearing in 5 db signal-to-noise ratio, noise to implanted ear: 0% Bilateral Nucleus 24C CIs Single syllable word test Hearing in quiet: 88% Hearing in 5 db signal-to-noise ratio: 64% H.I.N.T. (Hearing In Noise Test) sentences Hearing in quiet: 100% Hearing in 5 db signal to noise ratio: 91% Jessica 1 Nucleus 22 CI Single syllable word test Hearing in quiet: 90% Hearing in 10 db signal-to-noise ratio, noise to unimplanted ear: 84% Hearing in 5 db signal-to-noise ratio, noise to implanted ear: 60% Bilateral CIs, N22 in left ear, N24 in right ear Single syllable word test Hearing in quiet: 96% Hearing in 5 db signal-to-noise ratio: 84% H.I.N.T. (Hearing In Noise Test) sentences Hearing in quiet: 98% Hearing in 5 db signal to noise ratio: 92%