A Phase III, unblinded, multi-centre randomised controlled trial to evaluate whether 3 months of spatial-listening training delivered via the Both EARS training package (BEARS) in addition to Usual Care compared to Usual Care alone improves hearing abilities and quality of life and is cost-effective in older children and teenagers with bilateral cochlear implants
Speech-in-Noise outcomes in older children and teenagers with bilateral cochlear implants
Participants will be randomized using Sealed Envelope, which is an online software application. Intervention: Both EARS training package (BEARS) and Usual Care: BEARS is a compilation of virtual reality games designed specifically for young people with bilateral cochlear implants. The hardware is either: a head-mounted display device or an iPad with headphones. The BEARS training package comprises of three games addressing different hearing functions: speech-in-noise perception, music listening and sound-source localisation. Each game is based on an audio-visual task performed through a virtual-reality interface. Players are guided through on-screen visual prompts to support the gameplay with feedback given on their performance and progress through levels of increasing difficulty. The BEARS training package design allows for the training to be self-administered and played anywhere and at any time. There is no upper limit to the frequency of use of the BEARS training package, it is advised to play the games for a minimum of 1 hour a week over a minimum of 2 x 30-minute sessions, all three games will need to be played. Usual Care: This is an annual review appointment with the patient and their clinician. This could be face-to-face, virtual video consultation, questionnaire, or cochlear remote care checks. As a minimum this review will check the following: microphone covers changed, reported or recorded device use, all external and internal equipment working (known through no reported or recorded degradation in hearing ability). During the appointment, the clinician would establish if there were any concerns regarding the cochlear implant functioning and the patient's rehabilitation programme. They will then make any repairs or adjustments to the device and manage additional support and contact as required. Between the annual review appointments patients can attend the implant centre for repair appointments or have spare equipment posted. There is no limit to the le
1. Participant is a simultaneous or sequential bilateral cochlear implant user*, who either has: 1.1. Congenital severe/profound bilateral sensorineural hearing loss and have received at least one implant ≤36 months of age 1.2. Progressive or acquired severe/profound bilateral sensorineural hearing loss (no age at implant restrictions for these patients) 2. Participant has stable programmes (defined as no longer using progressive programmes to work through) 3. Participant has had at least two usual care checks/clinical appointments with stable aided levels (+/-10 dB across 500 Hz-4 kHz) and no progressive maps to still work through, if they have had re-implantation of internal implant devices. 4. Participant is aged 8-16 years, inclusive *(a bilateral CI user is defined as a patient who uses both CI processors for a minimum of 6 hours per day over a month)
Current exclusion criteria as of 02/12/2024: 1. Participant (or parent/legal representative) does not speak/understand English sufficiently to undertake assessments 2. Participant has an intellectual disability at a level that would prevent their ability to understand the trial the intervention or assessment questions 3. Participant has a comorbid condition impacting ability to participate in intervention and/or outcome assessment 4. Participant has an audiological profile impacting ability to participate in intervention and/or outcome assessments 5. Participant is actively participating in other trials that may affect hearing outcomes or impact their ability to participate in the intervention 6. Participant is currently or anticipated to receive treatment and/or intervention that may affect hearing outcomes or adapt implant settings/programming 7. Participant is refusing to consent to trial activities/protocol 8. Participant is awaiting reimplantation following device failure or infection 9. Participant is a non-user of one or both implant processors (i.e., must use both processors for a minimum of 6 hours per day over a month) 10. Participant is a full-time boarder at a boarding school 11. Participant has unresolvable issues found in device checks that render one of the implants unusable 12. Participant is a female that is pregnant 13. Participant has a diagnosis of epilepsy or history of seizures of any kind Previous exclusion criteria: 1. Participant (or parent/legal representative) does not speak/understand English sufficiently to undertake assessments 2. Participant has an intellectual disability at a level that would prevent their ability to understand the trial the intervention or assessment questions 3. Participant has a comorbid condition impacting ability to participate in intervention and/or outcome assessment 4. Participant has an audiological profile impacting ability to participate in intervention and/or outcome assessments 5. Participant is actively