This is a very common complaint. In everyday life people tend to talk to each other from a variety of distances and angles in relation to the ear wearing the sound processor - so not everything that is said is fully captured by the microphones. In addition, the implant recipient may only realise something was said to them after a few seconds delay, which means they missed the beginning of the sentence. Let’s say they heard: ‘... left on the kitchen bench.’ The first few words would have told whether it was a question or a statement and whether they have to acknowledge it or answer it. The missed words might have also told them if the information relates to something today, yesterday, tomorrow or someone/something in particular. So, having missed the beginning, they have no option but to ask to hear it again. Then they are completely ready to listen to the beginning, and bingo, they understand the second time round. The key lesson is to have the implant recipient’s full attention before talking, especially if they only have one good hearing ear and are of ‘mature’ age. One strategy is for the partner to attract attention first by saying their name or start with a standard phrase, such as ‘by the way...’ A strategy for the implant recipient is to mirror what they heard and ask for clarification: ‘what about the kitchen bench’? It is not surprising that having spent years hearing poorly, people’s listening attention becomes weak. It takes effort and practice for the auditory attention to strengthen, as it is a skill that requires rehabilitation - just as much as children with implants need to learn to pay attention to listen (parents and teachers don’t start to talk until they have the child’s attention). Engaging the listening function is particularly challenging for the elderly, whose general attention, information processing and reaction times are naturally slowing down. And implant recipients, elderly or not, can become absorbed in a task or immersed in thought, which means they are not quite aware of what is going on around them, even if they hear well in a face to face situation. Audiologists always involve close communication partners during the communication rehabilitation so that everyone’s expectations can be fine-tuned for a successful fit. 

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