Introduction to Cochlear Implants for EI Service Providers
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  • Sound is converted into an electrical signal that is delivered to the auditory nerve
  • Other therapists as appropriate
  • FDA first approved CI’s for children in 1990. This was after a process of clinical trials. FDA continues to monitor safety and efficacy of CI.

Introduction to Cochlear Implants for EI Service Providers Presentation Transcript

  • 1. Introduction to Cochlear Implants for EI Service Providers Roxanne J. Aaron, MA, CCC-A, FAAA The Moog Center for Deaf Education March 2005
  • 2. Introduction
    • Hearing Loss Identified at Birth
    • Hearing Aids Fitted by age 3 to 6 months
    • Infants with Profound Hearing Loss Can Receive Cochlear Implants by age 12 months
    • Increased Caseloads of Young Children with CI
  • 3. What is a Cochlear Implant?
    • A surgically implanted medical device that bypasses the damaged part of the inner ear to electrically stimulate the remaining neural fibers of the auditory nerve
    • Electrical current stimulates the remaining auditory nerve fibers in the damaged inner ear to generate sensations of hearing
  • 4. What are the potential benefits of CI?
    • Access to sound
      • Environmental sounds
      • Speech sounds
      • High frequency sounds
      • Soft sounds
    • Development of speech recognition and speech communication
  • 5. Who Can Get a Cochlear Implant?
    • Adults and children with severe to profound sensorineural hearing loss
    • Est. >90,000 recipients worldwide
  • 6. Pediatric Candidacy Criteria
    • 12 months old or older
    • Profound Sensorineural Hearing Loss; (Severe to Profound Sensorineural Hearing Loss if > 2 years old for Cochlear device)
    • Limited benefit from hearing aids
    • Open-Set Speech Perception (e.g.. MLNT; LNT) <20% Advanced Bionics and MED-EL, <30% Cochlear
  • 7. Pediatric Candidacy Criteria
    • No medical contraindications
      • No active middle ear disease
      • No cochlear nerve or auditory pathway lesions
      • Cochlear anatomy allows implantation
    • Able to tolerate surgery
    • Enrolled in an educational program that supports listening and speaking for communication
    • Highly motivated with appropriate expectations (family and child)
  • 8. A Team Decision
    • ENT Specialist
    • CI Surgeon
    • Audiologist
    • Speech/Language Pathologist
    • Educator of the Hearing Impaired
    • Child Psychologist
    • Social Worker
    • Parents
  • 9. The Process of Obtaining a Cochlear Implant
    • 1. Hearing loss identification/diagnosis
    • 2. Hearing aid trial (3-6 months)
    • 3. Audiologic candidacy evaluation
    • 4. Medical candidacy evaluation
    • 5. Other evaluations (speech-language, educational, psychological, etc.)
  • 10. The Process of Obtaining a Cochlear Implant
    • 6. Team meeting
    • 7. Surgery
    • 8. Initial stimulation (a few weeks after surgery)
    • 9. Ongoing CI programming (1 week, 1 month, 2 months, etc.)
    • 10.Verification of performance with CI
  • 11. The Process of Obtaining a Cochlear Implant
    • CI Surgery
      • A 2 to 4 hour procedure completed under general anesthesia
      • The internal device is placed under the skin behind the ear into a well created in the mastoid bone
      • The electrode array is inserted into the cochlea
  • 12. Cochlear Implant Components
    • Internal Device
      • Surgically implanted under the skin
      • Electronics package (receiver-stimulator) with magnet
      • Electrode array placed inside the cochlea
    • External Device
      • Worn on the body or at ear level
      • Sound/speech processor
      • Microphone
      • Coil with magnet
  • 13. Cochlear Implant Components
    • The external components of the CI system pick up sounds, analyze them, and convert them into an electrical signal that is sent to the internal device located under the skin
    • Internal and external components are held close to each other by a pair of magnets and communicate via transcutaneous transmission of a radio-frequency signal
  • 14. Cochlear Implant Components
    • The internal device decodes the signal and sends electrical current to each electrode
    • When the electrodes stimulate the nerve fibers of the auditory nerve, the signal is received by the brain and interpreted as sound
  • 15. Cochlear Implant Components
  • 16. Cochlear Implant Companies
    • Devices from 3 manufacturers are FDA approved for implantation in children
    • Each company has their own internal and external components that are only compatible with each other
      • Advanced Bionics
      • Cochlear
      • MED-EL
  • 17. Advanced Bionics (www.cochlearimplant.com)
    • Clarion and Bionic Ear
      • HiRes 90K internal
      • Platinum Series Processor
      • Auria BTE Processor
  • 18. Cochlear (www.cochlear.com)
    • Nucleus
      • Contour and Contour Advance internals
      • SPrint processor
      • ESPrit 3G BTE Processor
  • 19. MED-EL (www.medel.com)
    • Combi 40+ internal
    • Tempo+ BTE processor with 5 modular options
    • CIS-PRO+ body processor
  • 20. Common Features of CI Sound Processors
    • Power Switch
      • On-Off
    • Battery
      • Charge Meter
        • Display
        • Lights
    • Program Control
      • Selects Program or MAP loaded into the processor
        • Individual programs may have differing parameters such as speech encoder strategy, rate of stimulation, pulse width
        • Individual programs have different electrical dynamic ranges for each electrode which affect the perception of soft, average, and loud sounds
  • 21. Common Features of CI Sound Processors
    • Volume Control
      • Adjusts level of loud sounds within a program
    • Sensitivity Control
      • Determines if distant or very soft sounds will be processed
  • 22. Know the Child and the Device
    • Know which CI the child is using
    • Know which settings have been recommended for the external processor
      • Observe current settings
      • Change to the recommended settings if needed
    • Verify the system is working prior to therapy
      • Are the appropriate lights or displays working?
      • Does child look up or alert to sound?
      • Does child localize to sound?
      • Can the child participate in a Ling or word sound check?
      • Use monitor earphones
  • 23. Know the Child and the Device
    • Talk to the CI audiologist about child's status, the device, and the recommended settings
    • Talk to parents about the child and the device
      • Does the child use the device during all waking hours?
      • Are the parents comfortable with maintaining and troubleshooting the device?
    • Request support materials from the CI company (Educator Guides, Teacher Guides, Troubleshooting Guides, Videos)
      • Advanced Bionics 1-800-678-2575
      • Cochlear (Customer Service) 1-877-883-3101
      • MED-EL 1-888-633-3524
  • 24. CI Programming Basics
    • Audiologists select the parameters for each listening program
      • Speech encoder strategy
      • Stimulation rate
      • Number of electrodes stimulated, etc.
    • Audiologists work with each child to set the program(s) within the CI sound processor
  • 25. CI Programming Basics
    • The child participates in tasks to help set the minimum and maximum amount of electrical current required for each electrode
      • Threshold assessment
        • Behavioral observation
        • Conditioned response (VRA, CPA)
      • Loudness scaling/balancing
      • Electrophysiological measures (NRT, NRI, ESRT)
  • 26. CI Programming Basics
    • The settings derived during the CI programming session form a listening program or MAP that is loaded into the sound processor
    • The listening program or MAP contains information about the amount of electrical current required by the child for hearing
    • CI programming is an ongoing process designed to satisfy the child’s need for electrical stimulation to optimize the perception of speech
  • 27. EI Therapists and CI Programming
    • EI therapists can assist the audiologist in CI programming directly or indirectly
      • Due to more frequent contact, the therapist may know the child better
        • What toys does the child like or dislike?
        • What motivates the child?
        • Under what conditions does the child work best?
        • How does the child behave when tired or bored with a task?
  • 28. EI Therapists and CI Programming
    • Offer to directly assist the audiologist in CI programming
      • May be billable as “consultation with others” if preauthorized
    • Offer to work on tasks in therapy that will facilitate CI programming
      • Auditory detection tasks
      • Concepts such as “big” vs. “little” to assist with loudness scaling
  • 29. EI Therapists and CI Programming
    • Give feedback to the audiologist about how the child is responding to sound during therapy
      • What sounds can child detect?
      • Are any sounds uncomfortable?
    • Keep the audiologist informed about the child’s progress in learning to communicate
  • 30. Acknowledgements
    • Special thanks to the cochlear implant manufacturers for the images and support materials used for this presentation
    • Advanced Bionics
    • Cochlear
    • MED-EL
  • 31. Thank You