Introduction to Cochlear Implants for EI Service Providers Roxanne J. Aaron, MA, CCC-A, FAAA The Moog Center for Deaf Educ...
Introduction <ul><li>Hearing Loss Identified at Birth </li></ul><ul><li>Hearing Aids Fitted by age 3 to 6 months </li></ul...
What is a Cochlear Implant? <ul><li>A surgically implanted medical device that bypasses the damaged part of the inner ear ...
What are the potential benefits of CI? <ul><li>Access to sound </li></ul><ul><ul><li>Environmental sounds </li></ul></ul><...
Who Can Get a Cochlear Implant? <ul><li>Adults and children with severe to profound sensorineural hearing loss </li></ul><...
Pediatric Candidacy Criteria <ul><li>12 months old or older  </li></ul><ul><li>Profound Sensorineural Hearing Loss; (Sever...
Pediatric Candidacy Criteria <ul><li>No medical contraindications </li></ul><ul><ul><li>No active middle ear disease </li>...
A Team Decision <ul><li>ENT Specialist </li></ul><ul><li>CI Surgeon </li></ul><ul><li>Audiologist </li></ul><ul><li>Speech...
The Process of Obtaining a Cochlear Implant <ul><li>1. Hearing loss identification/diagnosis </li></ul><ul><li>2. Hearing ...
The Process of Obtaining a Cochlear Implant <ul><li>6. Team meeting </li></ul><ul><li>7. Surgery </li></ul><ul><li>8. Init...
The Process of Obtaining a Cochlear Implant <ul><li>CI Surgery </li></ul><ul><ul><li>A 2 to 4 hour procedure completed und...
Cochlear Implant Components <ul><li>Internal Device </li></ul><ul><ul><li>Surgically implanted under the skin </li></ul></...
Cochlear Implant Components <ul><li>The external components of the CI system pick up sounds, analyze them, and convert the...
Cochlear Implant Components <ul><li>The internal device decodes the signal and sends electrical current to each electrode ...
Cochlear Implant Components
Cochlear Implant Companies <ul><li>Devices from 3 manufacturers are FDA approved for implantation in children </li></ul><u...
Advanced Bionics  (www.cochlearimplant.com) <ul><li>Clarion and Bionic Ear </li></ul><ul><ul><li>HiRes 90K internal </li><...
Cochlear  (www.cochlear.com) <ul><li>Nucleus </li></ul><ul><ul><li>Contour and Contour Advance internals </li></ul></ul><u...
MED-EL  (www.medel.com) <ul><li>Combi 40+ internal </li></ul><ul><li>Tempo+ BTE processor with 5 modular options </li></ul...
Common Features of CI Sound Processors <ul><li>Power Switch </li></ul><ul><ul><li>On-Off </li></ul></ul><ul><li>Battery </...
Common Features of CI Sound Processors <ul><li>Volume Control </li></ul><ul><ul><li>Adjusts level of loud sounds within a ...
Know the Child and the Device <ul><li>Know which CI the child is using </li></ul><ul><li>Know which settings have been rec...
Know the Child and the Device <ul><li>Talk to the CI audiologist about child's status, the device, and the recommended set...
CI Programming Basics <ul><li>Audiologists select the parameters for each listening program </li></ul><ul><ul><li>Speech e...
CI Programming Basics <ul><li>The child participates in tasks to help set the minimum and maximum amount of electrical cur...
CI Programming Basics <ul><li>The settings derived during the CI programming session form a listening program or MAP that ...
EI Therapists and CI Programming <ul><li>EI therapists can assist the audiologist in CI programming directly or indirectly...
EI Therapists and CI Programming <ul><li>Offer to directly assist the audiologist in CI programming </li></ul><ul><ul><li>...
EI Therapists and CI Programming <ul><li>Give feedback to the audiologist about how the child is responding to sound durin...
Acknowledgements <ul><li>Special thanks to the cochlear implant manufacturers for the images and support materials used fo...
Thank You
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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

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

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