Effectiveness of auditory training for adult cochlear implant users

Clinicians working with adult cochlear implant (CI) users often recommend auditory training (AT) as an intervention to improve listening abilities. Lack of robust evidence and inconsistencies in AT studies, however, limits confidence in the usefulness of this intervention. This thesis assessed the effectiveness of AT for adult CI users in the context of clinical decision-making, resource allocation and evidence-based practice in a series of three manuscripts. First, AT practices and their associated costs were assessed using data from a survey distributed to Australian audiologists working with adult CI users (n=78, 33% response rate). Is was demonstrated that clinicians believe AT is beneficial, and adopt varied methods to deliver AT. Costs incurred for clients who receive AT were estimated to range from AUD 0 to AUD 1438.98 per program, depending on the AT method of delivery. Second, a randomised crossover study investigated the effectiveness of a computer-based auditory training (CBAT) program, in comparison to a computer-based visual training (VT) program, on measures of listening and cognitive abilities, and self-reported communication and quality of life in 26 adult CI users. It was demonstrated that although on-task improvement occurred for both the AT and the VT programs, these improvements did not transfer to the outcome measures assessed post-training and at follow-up. Finally, a rapid review of nine CBAT studies in adult CI users was conducted. Inconsistencies in training stimuli, outcome measures and study findings associated to risk of bias present within and across studies, indicated that current evidence provides very low confidence that AT can improve speech perception, and low confidence that it can improve cognitive abilities, self-reported listening and quality of life in adult CI users. This thesis provides practical and up-to-date evidence about AT in adult CI users which can influence both current clinical practices and future research studies.