BEARS (Both Ears) – Virtual Reality Training to Improve Binaural Hearing in Children with Bilateral Cochlear Implants

Authors: Helen Cullington1, Bhavisha Parmar2, Marina Salorio-Corbetto2, Merle Mahon3, Sandra Driver4, Christine Rocca4, Dan Jiang4, Yuli Levtov5, Lorenzo Picinali6, Elizabeth Arram3, Debi Vickers2

1University of Southampton
2University of Cambridge
3University College London
4Guy’s and St Thomas’ NHS Foundation Trust
5Reactify Music
6Imperial College London

Background: People with bilateral cochlear implants (CI) typically have better sound localisation and speech-in-noise perception than those with one implant, but these skills are far below people with normal hearing.

Methods: We used participatory design to develop virtual reality (VR) games to help children with bilateral CI hear better. The stakeholders were 40 children and young people with bilateral CI, family, friends, teachers, engineers, developers, speech and language therapists, music therapists, and audiologists. From this we developed the BEARS training suite of multiple VR games to train spatial hearing (using speech, music and localisation activities) with virtual acoustics presented over headphones. We also developed the outcome measures needed to evaluate BEARS. We are running an 11-centre randomised clinical trial for children aged 8 to 16. Participants are randomised to either use the VR games at home for 3 months or follow their usual care pathway, with testing at baseline, 3 months and 12 months. The primary outcome measure is the difference between baseline and 3-month score on the spatial speech-in-noise test, with secondary outcomes of scores at 3 and 12 months on other measures of spatial hearing, language, and quality of life. We are also doing a process evaluation and measuring health economic outcomes.

Results: A virtual implementation of the Spatial Speech in noise test (SSiN-VA), the Adaptive Sentence Lists (Sp-ASLs) and a centring game (i-balance) have been developed. Trial recruitment began in May 2023. We need 384 participants, and have recruited 110 so far.

Conclusions: The games appear to be engaging and encourage young people to do rehabilitation in a gaming environment. Virtual assessment of spatial hearing is effective and does not require a speaker array.
If using the BEARS games significantly improves spatial hearing and/or quality of life, we will scale up the intervention to all UK centres offering bilateral CI to children.