This document provides training for speech-language pathologists on cochlear implants. It explains why SLPs need to understand cochlear implants, including performing listening checks and troubleshooting malfunctions. The document covers the basic components and functions of cochlear implants, signs of malfunction, how to perform listening checks using Ling sounds, and troubleshooting techniques. The goal is to equip SLPs with the knowledge and skills to ensure clients are receiving maximum benefit from their cochlear implants.

1. K I M B E R L Y W A R D , A U . D . , C C C - A
U N I V E R S I T Y O F S O U T H E R N M I S S I S S I P P I
COCHLEAR IMPLANTS:
TRAINING FOR
SPEECH-LANGUAGE
PATHOLOGISTS

2. WHY THIS TRAINING?
• Understanding the proper functioning of a cochlear implant is
key to knowing how to troubleshoot the cochlear implant
when it is malfunctioning.
• To do so, the SLP must have the knowledge and skills to carry
out this task.
• Also, the SLP is often asked to perform teacher in-services on
various topics related to speech, language, and hearing.
• The purpose of this power point is to train and equip the SLP
with the knowledge needed to be knowledgeable on
cochlear implants and troubleshooting techniques. It also
provides the SLP with a “ready-made” in-service training on
troubleshooting cochlear implants. The SLP has permission to
use this power point and make any changes necessary to
assist them in giving in-services on cochlear implants.

3. SYMPTOMS OF HEARING LOSS IN
CHILDREN (ASHA, 2011)
• The child is inconsistently responding to sound.
• Language and speech development is delayed.
• Speech is unclear.
• Volume is turned up high on electronic equipment
(radio, TV, CD player, etc.).
• Your child does not follow directions.
• Your child often says, "Huh?”
• Your child does not respond when called.

4. WHAT SLPS SHOULD KNOW ABOUT
COCHLEAR IMPLANTS
• Different types/styles
• Basic components
• Tools needed for listening checks/troubleshooting
of cochlear implants
• How to perform a listening check
• How to troubleshoot cochlear implants

5. BASIC FACTS ABOUT COCHLEAR
IMPLANTS
• A cochlear implant is a small implantable device
that uses electrical stimulation to provide hearing
sensations to those with sensorineural hearing loss
• Cochlear implants are different than hearing aids
• Cochlear implants require special programming
called “MAPping” by specialized audiologists
• When the child does not wear his/her hearing aid,
he/she may hear some environmental or speech
sounds. When a child does not wear his/her
cochlear implant, he/she does not hear anything
• Can be bilateral or unilateral

6. MYTHS ABOUT COCHLEAR IMPLANTS
• MYTH: Once a child is implanted, he/she will
automatically start hearing normally
• MYTH: Once a child is implanted, no additional
therapies or (re)habilitation is needed
• MYTH: Cochlear implantation and (re)habilitation is
a quick and easy process for the affected individual
• MYTH: Without the client wearing his/her cochlear
implant, it is okay to continue with therapy

7. PICTURE OF A COCHLEAR
IMPLANT

8. COCHLEAR IMPLANT
MANUFACTURERS
• Cochlear
• Advanced Bionics
• Med El

9. COCHLEAR PROCESSORS YOU MAY SEE
Nucleus 5
Processor
Freedom
Processor

10. ADVANCED BIONICS PROCESSORS YOU
MAY SEE
Neptune ProcessorHarmony
Processor
Naida CIQ70

11. MED EL PROCESSORS YOU MAY SEE
Opus 2
Processor
Rondo
Processor

12. HOW COCHLEAR IMPLANTS WORK
• http://youtu.be/puoFhKYm2EU
• Video courtesy of Cochlear Americas

13. COCHLEAR IMPLANT PARTS
1. Earhook 5. Coil and magnet
2. Processor 6. Internal implant
3. Battery compartment 7. Electrode array
4. Cable
2
1
3
4
5
6
7

14. COCHLEAR IMPLANT PARTS AND
FUNCTIONS
• 1. Earhook: used for retention purposes only to hold the
processor on the ear
• An earmold is sometimes fit to the earhook for retention but no sound
is delivered through the earmold as it is a hearing aid
• 2. Processor: contains the patient’s information (MAPs)
• 3. Battery compartment: holds and stores the batteries
• Can be rechargeable or non-rechargeable
• 4. Cable: sends the information from the processor to the coil
• 5. Coil: used for attachment to magnet which is implanted
internally and sends information to internal implant
• 6. Internal implant: processes the information received from
the external processor
• 7. Electrode array: takes the processed information and
electronically stimulates the cochlea to produce sound

15. CANDIDACY CRITERIA: 12-24 MONTHS
• Age 12 months to 24 months:
• Profound SNHL, bilaterally
• Lack of progress in development of auditory skills
• No medical contraindications
• High motivation and appropriate expectations from the
family
• Limited to no benefit from hearing aids

16. CANDIDACY CRITERIA: 2-17 YEARS
• Age 2 years to 17 years, 11 months:
• Severe to profound SNHL hearing loss, bilaterally
• Speech perception sentence testing 30% or less in best
aided condition
• Multi-Lexical Neighborhood Test (MLNT) scores of 30% or
less in the best aided condition
• (25 months-4 years, 11 months)
• Lexical Neighborhood Test (LNT) scores of 30% or less in
best aided condition
• (5 years-17 years, 11 months)
• Word Identification by Picture Identification (WIPI)
• Early Speech Perception (ESP)
• Lack of progress in development of auditory skills
• No medical contraindications
• High motivation and appropriate expectations of family
(and child when appropriate)
• Limited to no benefit from hearing aids

17. CANDIDACY CRITERIA: ADULTS
• Adults, 18 years of age and older:
• Moderate to profound SNHL, bilaterally
• Preoperative speech perception sentence
testing scores of 50% or less in the ear to
be implanted AND 60% or less in the
opposite ear OR binaurally
• AZBio
• HINT
• Prelingual or postlingual onset of hearing
loss
• No medical contraindications
• A desire to be part of the hearing world
• Limited to no benefit from the hearing aids

18. ERADICATING THAT MYTH -
CONCEPT OF AUDITORY AGE
• Auditory age/hearing age are terms
used to put the language
development of a child in perspective
• The child’s hearing age begins once
he has access to the sounds of his
world
• Normal infants do not speak the day
they are born – normally they say their
first words after ~ a year
• We cannot expect the hard-of-hearing
child to speak “right away”.

19. HOW TO KNOW WHEN A COCHLEAR
IMPLANT IS MALFUNCTIONING
• Children may produce symptoms of hearing loss not
previously seen in therapy
• The child does not respond to the LING sound
check as he/she did previously
• The Listening Check of the cochlear implant
microphone prior to therapy indicates a problem

20. SYMPTOMS WHEN CHILDREN WHO HAVE
HA’S/CI NEED REPROGRAMMING
• Poor/unusual voice quality
• Relies on vision for input
• Poor speech perception
• Inappropriate/unusual consonant development
• Consistent omission or substitution of specific
phonemes
• Speech production not improving
• Speech perception poor in competing noise
• The child does not respond as he had previously to
the LING sound check
(Hewitt, Madell & Rotfleisch, 2011)

21. LING SOUNDS
• The goal of amplification is to make ALL speech sounds
audible to the child
• The LING sound check is a listening test that is often used with
children who wear hearing aids/CI.
• This test is comprised of 6 sounds that represent the entire
speech spectrum from low pitch sounds to high pitch sounds
• If the CI is functioning properly, the child should be able to
repeat these sounds
• Have client repeat LING sounds without visual input (stand
behind them/use speech hoop)
• Do this with each ear individually and then together BEFORE
THERAPY OR A SPEECH EVALUATION

22. THE LING SOUNDS
• The 6 LING SOUNDS:
• AHHHH
• OOOO
• EEEEEE
• SSSSSS
• SSHHHHH
• MMMM

23. IMPORTANCE OF USING LING SOUNDS TO
IDENTIFY NEED FOR REPROGRAMMING
• Allows a quick and easy way to check that a
person is able to detect and identify sounds within
the speech range.
• Provides information regarding an individual's
distance of hearing or earshot.
• Results ensure that the cochlear implant is
functioning properly and individual is receiving
maximum benefit from his/her device
• Represents all frequencies across the speech
banana
(Archer & Crosby-Quinatoa, 2009)

24. WHEN TO DO THE LING SOUND CHECK
• The teacher should do the LING sound check at the
beginning of class each day to ensure the child has
access to all the speech she will use in class.
• The SLP should do the LING sound check at the
beginning of therapy each day or the beginning of an
evaluation.
• If the child cannot accurately produce the LING sounds
as well as he/she was able to before, a listening check
and troubleshooting of the cochlear implant should
occur.
• If the cochlear implant microphone sounds fine and the
battery is good, then contact the audiologist to see if a
referral is warranted.

25. TOOLS SLP’S SHOULD HAVE HANDY
FOR CARE OF HEARING AIDS
• Battery tester
• Extra batteries
• Listening earphones
• Dri-Aid kit
• An audiologist can help you put a kit together
• Most cochlear implant companies supply kits

26. BATTERY TESTER

27. SAMPLE PICTURE OF DRI-AID KIT

28. PERFORMING THE
LISTENING CHECK

29. EASY TIPS IN ORDER TO PERFORM A
LISTENING CHECK
• How do you do it?
• Before you put the cochlear implant on the child, listen to the
microphone yourself.
• Make sure cochlear implant is turned on
• Plug in the listening earphones into the microphone port
• Talk into hearing aid and listen to the aid
Use the Ling Sounds (ooo, aahh, eee, sss, shhh, mmm)
• Talk normally into the microphone
• Important to note that you are only listening to the
microphone in the listening check, you are not listening to
the child’s MAPs or programs.
• Important to complete a listening check with the child once
the cochlear implant is placed and turned on

30. LISTENING EARPHONES/MICROPHONE
PORT

31. LISTENING CHECK
• What are you listening for?
• Dead cochlear implant
• Distortion
• Crackling
• Intermittence/cutting in or out
• Weak
• Clarity

32. TROUBLESHOOTING
• Troubleshooting requires a visual inspection of the
cochlear implant.
• Examine all parts while looking for cracks, breaks,
dirt, missing pieces, broken connectors, or any
unusual connection.
• The parts to examine include the processor, the
microphones, the cable, the coil and magnet, and
the battery compartment
• If wax or dirt is seen, one should gently brush these
parts of the cochlear implant using a small brush
made for this purpose.

33. CRITICAL SKILLS FOR SLP’S
• Troubleshooting the cochlear implant processor and
performing a listening check are critical skills for the SLP
who works with clients who are hard-of-hearing.
• It is also important for the SLP to perform a battery
check. Several battery testers are available.
• Batteries come in a variety of sizes. Cochlear implants
have non-rechargeable or standard batteries as well as
re-chargeable batteries.
• Cochlear implants use standard batteries in size 675
(blue)
• The rechargeable batteries are housed in the battery
compartment and are not removable

34. PICTURES OF STANDARD BATTERIES

35. BATTERY LIFE
• The length of battery life that a given battery has
depends on the MAP settings in each particular
processor.
• Each child’s battery life will be different and will vary
• The SLP should keep a battery tester with him/her
when working with clients with cochlear implants as
a dead battery is a frequent culprit for a “dead”
processor and the client not being able to respond
to sound.

36. TIPS FOR AMPLIFICATION USAGE
Keep them on during ALL waking hours
• It is critical that the cochlear implants are used during all
waking hours to ensure auditory access to speech and
language and environmental sounds.
• During academic classes, an FM system is most often
recommended. If the child does not use an FM system,
contact the audiologist to see if it was recommended.
• If retention of a cochlear implant is an issue, there are
retention supplies and strategies that may be helpful- ask
your audiologist

37. REFERENCES
• Advanced Bionics www.advancedbionics.com
• American Speech-Language-Hearing Association. (2001b). Knowledge and skills required for the practice of audiologic/aural rehabilitation [Knowledge
and Skills], from
www.asha.org/policy.
• American Speech-Language-Hearing Association. (2007). Scope of practice in speech-language pathology [Scope of Practice]. Available from
www.asha.org/policy.
• American Speech Language Hearing Association. (2011). Self-test for hearing loss.http://www.asha.org/public/hearing/Self-Test-for-Hearing-Loss/
• Archer, J., & Crosby-Quinatoa, G. (2009). Cochlear implant program: Strategies for treating children with hearing impairments in the schools.
http://www.asha.org/Events/convention/handouts/2009/1431_Archer_Jamy_Claire/
• Bentler, R.A. (1993). Amplification for the hearing impaired child. J.G. Alpiner &
P.A. McCarthy (Eds.). In Rehabilitative audiology: Children and adults,2nd ed. (pp. 115 – 160). Baltimore: Williams and Wilkins.
• Hewitt, J., Madell, J., & Rotfleisch, S. (2011). Listening to kids: Optimizing Technology http://www.asha.org/Events/convention/handouts/2011/Hewitt-Madell-
Rotfleisch/
• Cochlear Americas www.cochlear.com
• Med El www.medel.com
• Mueller H.G., Johnson E.E., & Carter A.S. (2007). Hearing aids and assistive devices.
In R. Schow & M. Nerbonne (Eds.). Introduction to audiologic rehabilitation, 5th ed. (pp.31-76). Boston: Allyn and Bacon.
• Wayner, D.S. (2004). What every SLP needs to know about hearing: Fingertip Facts. Latham, NY: Hearing Again, Inc.
• Woodford, C.M. (1987). Speech-language pathologists’ knowledge and skills
Regarding hearing aids. Language, Speech, and Hearing Services in
Schools, 18, 312-322.

38. PICTURE REFERENCES
• www.cochlear.com
• Advanced bionics
• Med el
• www.cochlearimplanthelp.com
• http://dryandstore.com/zephyr_imgs/zephyr.jpg