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Care of children who use cochlear implants

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Care of children who use cochlear implants

  1. 1. Care of Children Who Use a Cochlear Implant
  2. 2. Overview
  3. 3. Overview
  4. 4. Overview
  5. 5. Overview
  6. 6. Overview● T levels – thresholds levels – Measured behaviorally or generated in software● M or C levels – comfort levels – Measured behaviorally or estimated by electrical compound action potential or electrical stapedial reflex threshold● Range between T level and M/C level between 40 to 60 dB
  7. 7. Overview● T levels – thresholds levels – Measured behaviorally or generated in software● M or C levels – comfort levels – Measured behaviorally or estimated by electrical compound action potential or electrical stapedial reflex threshold● Range between T level and M/C level between 40 to 60 dB
  8. 8. Overview● T levels – thresholds levels – Measured behaviorally or generated in software● M or C levels – comfort levels – Measured behaviorally or estimated by electrical compound action potential or electrical stapedial reflex threshold● Range between T level and M/C level between 40 to 60 dB
  9. 9. Overview● T levels – thresholds levels – Measured behaviorally or generated in software● M or C levels – comfort levels – Measured behaviorally or estimated by electrical compound action potential or electrical stapedial reflex threshold● Range between T level and M/C level between 40 to 60 dB
  10. 10. Overview● T levels – thresholds levels – Measured behaviorally or generated in software● M or C levels – comfort levels – Measured behaviorally or estimated by electrical compound action potential or electrical stapedial reflex threshold● Range between T level and M/C level between 40 to 60 dB
  11. 11. Candidacy● FDA approval for Cochlear Implants is device- specific (slight differences between manufacturers)● Minimum age approved by FDA = 12 months for children with bilateral, profound hearing loss and 24 months for severe hearing loss (bilateral or better ear)● Implanting under 12 months for special cases but increased risk
  12. 12. Candidacy● FDA approval for Cochlear Implants is device- specific (slight differences between manufacturers)● Minimum age approved by FDA = 12 months for children with bilateral, profound hearing loss and 24 months for severe hearing loss (bilateral or better ear)● Implanting under 12 months for special cases but increased risk
  13. 13. Candidacy● FDA approval for Cochlear Implants is device- specific (slight differences between manufacturers)● Minimum age approved by FDA = 12 months for children with bilateral, profound hearing loss and 24 months for severe hearing loss (bilateral or better ear)● Implanting under 12 months for special cases but increased risk
  14. 14. Candidacy● Audiologist assesses word recognition with either questionnaires (e.g., IT-MAIS, MAIS) or speech audiometry (MLNT, LNT, HINT-Q).● Speech-language evaluation● Developmental evaluation● Otological/Radiological evaluation
  15. 15. Candidacy● Audiologist assesses word recognition with either questionnaires (e.g., IT-MAIS, MAIS) or speech audiometry (MLNT, LNT, HINT-Q).● Speech-language evaluation● Developmental evaluation● Otological/Radiological evaluation
  16. 16. Candidacy● Audiologist assesses word recognition with either questionnaires (e.g., IT-MAIS, MAIS) or speech audiometry (MLNT, LNT, HINT-Q).● Speech-language evaluation● Developmental evaluation● Otological/Radiological evaluation
  17. 17. Candidacy● Audiologist assesses word recognition with either questionnaires (e.g., IT-MAIS, MAIS) or speech audiometry (MLNT, LNT, HINT-Q).● Speech-language evaluation● Developmental evaluation● Otological/Radiological evaluation
  18. 18. Intraoperative Testing● Impedance telemetry to detect short or open circuits – Short circuit = impedance too low – Open circuit = impedance to high● Measure the electrically-evoked compound action potential (a.k.a., NRT, NRI, or ART)
  19. 19. Intraoperative Testing● Impedance telemetry to detect short or open circuits – Short circuit = impedance too low – Open circuit = impedance to high● Measure the electrically-evoked compound action potential (a.k.a., NRT, NRI, or ART)
  20. 20. Intraoperative Testing● Impedance telemetry to detect short or open circuits – Short circuit = impedance too low – Open circuit = impedance to high● Measure the electrically-evoked compound action potential (a.k.a., NRT, NRI, or ART)
  21. 21. Intraoperative Testing
  22. 22. Activation of CI● Activation is 1 to 4 weeks post­surgery● Familiarization prior to activation (toys, books)  
  23. 23. Activation of CI● Activation is 1 to 4 weeks post­surgery● Familiarization prior to activation (toys, books)●  At activation/programming, audiometry may be  performed (depending on age) ● Electrically­evoked compound action potentials may also  be performed in the office during programming – Better than in operating room (less electrical  interference) – But exposes child to loudness discomfort
  24. 24. Activation of CI● Activation is 1 to 4 weeks post­surgery● Familiarization prior to activation (toys, books)●  At activation/programming, audiometry may be  performed (depending on age) ● Electrically­evoked compound action potentials may also  be performed in the office during programming – Better than in operating room (less electrical  interference) – But exposes child to loudness discomfort
  25. 25. The Other Ear● Contralateral stimulation is often beneficial (hearing aid or cochlear implant) --- bimodal hearing● Bilateral implants (re: unilateral implant) eliminates the head shadow effect and provides superior sound localization, detection of soft sounds, speech perception in noise.
  26. 26. The Other Ear● Contralateral stimulation is often beneficial (hearing aid or cochlear implant) --- bimodal hearing● Bilateral implants (re: unilateral implant) eliminates the head shadow effect and provides superior sound localization, detection of soft sounds, speech perception in noise.
  27. 27. The Other Ear● Contralateral stimulation is often beneficial (hearing aid  or cochlear implant) ­­­ bimodal hearing● Bilateral implants (re: unilateral implant) eliminates the  head shadow effect and provides superior sound  localization, detection of soft sounds, speech perception in  noise.
  28. 28. Monitoring● Unaided audiogram every 12 months● Aided audiogram every 6 months● Aided thresholds should typically be between 20  to 30 dB HL (pulsed tones in soundfield)● Questionnaires to track progress● Aided speech perception testing (closed vs open  set)
  29. 29. Monitoring● Unaided audiogram every 12 months● Aided audiogram every 6 months● Aided thresholds should typically be between 20  to 30 dB HL (pulsed tones in soundfield)● Questionnaires to track progress● Aided speech perception testing (closed vs open  set)
  30. 30. Monitoring● Unaided audiogram every 12 months● Aided audiogram every 6 months● Aided thresholds should typically be between 20  to 30 dB HL (pulsed tones in soundfield)● Questionnaires to track progress● Aided speech perception testing (closed vs open  set)
  31. 31. Monitoring● Unaided audiogram every 12 months● Aided audiogram every 6 months● Aided thresholds should typically be between 20  to 30 dB HL (pulsed tones in soundfield)● Questionnaires to track progress● Aided speech perception testing (closed vs open  set)

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