Aims: The aims of this research were to develop, through a series of user engagement workshops, the Both Ears (BEARS) training suite, a set of virtual-reality games to train spatial hearing in children and young people (CYP) with bilateral cochlear implants (CIs) and to develop the outcome measures needed to evaluate the effectiveness of the BEARS training suite in a confirmatory clinical trial. Here we focus on the spatial speech-in-noise components of the research.

Methods: Forty CYP (8-16 year olds) with bilateral CIs have helped with the participatory design of the BEARS training suite. This followed an action research methodology with multiple focus groups providing input and feeding back on BEARS games, apps, equipment and assessments to go into the clinical trial. The randomised control trial to evaluate the effectiveness of the BEARS training suite is underway and 140 CYP have completed the baseline assessments of spatial speech-in-noise abilities. These were assessed using the Spatial Speech-in-Noise test (SSiN-VA) and the Adaptive Sentence Lists (Sp-ASLs) which were implemented on an iPad and presented over headphones.

Results: The participatory design phase resulted in an interactive suite of engaging games to train spatial hearing, using speech, music and localisation activities. Following participant feedback, an iPad version was created for individuals for whom using a head-mounted display was difficult due to head size or balance issues. Preliminary results of the BEARS clinical trial can not be unblinded but initial results with the speech assessments indicate that CYP with bilateral CIs show some degree of spatial hearing at the group level but on average their abilities are lower than their typical hearing counterparts.

Interpretation: The participatory design phase indicated the importance of including patients as co-creators of the BEARS training suite because it has resulted in an intervention that is engaging and meaningful to CYP. The virtual spatial speech-in-noise assessments effectively measure spatial hearing abilities and show promise for implementation into clinical practice as a routine approach for measuring spatial hearing.

Conclusion: The BEARS training suite is made up of multiple virtual reality games to train spatial hearing using a head mounted display and virtual acoustics presented over headphones. They were designed using participatory design and the games appear to be engaging for CYP to use for rehabilitation. Virtual assessments of spatial hearing are showing promise as an effective way to evaluate hearing without the need of a speaker array in a booth.