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Cochlear Implants - An introduction R.Ranjith Audiologist Madras ENT Research Foundation Chennai
What is a cochlear implant  ?   <ul><li>A cochlear implant is a hearing prosthesis designed to restore or provide a level ...
Parts of CI <ul><li>External </li></ul><ul><li>Microphone </li></ul><ul><li>Speech Procressor </li></ul><ul><li>Transmitti...
The Cochlear Implant in situ
Electrode Array in the Cochlea
 
Sound is received by the  microphone Microphone
Sound is sent from  microphone  to  speech processor cable Speech  processor
Speech processor  analyzes and digitizes the sound into coded signals Speech Processor
Coded signals are sent to the  transmitting coil Transmitting coil Cables
Transmitting coil  sends the code across the skin to the  receiver/ stimulator  of internal implant Transmitting coil Rece...
Signals are sent to the  electrodes  to stimulate the remaining nerve fibres electrode
Signals are recognized as sounds by the brain producing a hearing sensation
 
 
<ul><li>1985:  </li></ul><ul><li>First children implanted  </li></ul><ul><li>with Nucleus multichannel </li></ul><ul><li>c...
Selection criteria - Children <ul><li>Twelve months of age or older </li></ul><ul><li>Bilateral severe to profound  sensor...
Candidacy Guideline Audiograms
Selection Criteria - Adults <ul><li>18 years of age or older </li></ul><ul><li>Profound, severe-profound, bilateral sensor...
Factors that may exclude candidacy <ul><li>Absence of auditory nerve or l ack of  auditory  nerve integrity bilaterally </...
Factors that may influence outcomes with an implant <ul><li>Length of profound deafness </li></ul><ul><li>Age at implant <...
The process of getting an implant <ul><li>Pre surgery : </li></ul><ul><li>Initial Referral </li></ul><ul><li>Full medical ...
The process of getting an implant The process of getting an implant <ul><li>Surgery: </li></ul><ul><li>3 to 5 hours </li><...
X-Ray of Cochlear Implant in Situ
Next Details Menu Back
Neural Response Telemetry System Next Details Menu Back Transmitter Receiver Decoder Current Source Transmitter Encoder Am...
Stimulation and Recording Modes Details Next Menu Back Stimulation Recording
Post Surgery: Fitting the externals <ul><li>Switch on </li></ul><ul><li>About three weeks following surgery the implantee ...
Clinical Programming System CPS
What is involved in activating the system? <ul><li>the term referred to as MAPping/programming </li></ul><ul><li>the proce...
<ul><li>Listening training </li></ul><ul><ul><li>An individual program is worked out for each recipient </li></ul></ul><ul...
The Cochlear Implant Team: Core members <ul><li>The Parents </li></ul><ul><ul><li>Need to be involved in all evaluation pr...
   Audallion beam former    Brain Stem Implants    Espirit 3 G speech processor    Neural response telemetry -  NRT Ne...
<ul><li>Completely implantable Implants </li></ul><ul><li>Neuronal regeneration factors </li></ul><ul><li>Improved speech ...
 
 
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Cochlear Implant

  1. 1. Cochlear Implants - An introduction R.Ranjith Audiologist Madras ENT Research Foundation Chennai
  2. 2. What is a cochlear implant ? <ul><li>A cochlear implant is a hearing prosthesis designed to restore or provide a level of auditory sensation to adults and children who have a severe to profound bilateral sensori-neural hearing impairment and who get limited benefit from hearing aids </li></ul>
  3. 3. Parts of CI <ul><li>External </li></ul><ul><li>Microphone </li></ul><ul><li>Speech Procressor </li></ul><ul><li>Transmitting coil </li></ul><ul><li>Internal </li></ul><ul><li>Receiver /Stimulator </li></ul><ul><li>Electrode array </li></ul>
  4. 4. The Cochlear Implant in situ
  5. 5. Electrode Array in the Cochlea
  6. 7. Sound is received by the microphone Microphone
  7. 8. Sound is sent from microphone to speech processor cable Speech processor
  8. 9. Speech processor analyzes and digitizes the sound into coded signals Speech Processor
  9. 10. Coded signals are sent to the transmitting coil Transmitting coil Cables
  10. 11. Transmitting coil sends the code across the skin to the receiver/ stimulator of internal implant Transmitting coil Receiver/ stimulator
  11. 12. Signals are sent to the electrodes to stimulate the remaining nerve fibres electrode
  12. 13. Signals are recognized as sounds by the brain producing a hearing sensation
  13. 16. <ul><li>1985: </li></ul><ul><li>First children implanted </li></ul><ul><li>with Nucleus multichannel </li></ul><ul><li>cochlear implant in </li></ul><ul><li>Melbourne. </li></ul><ul><li>Over 50,000 children have been implanted and the age of implantation has dropped significantly. </li></ul>
  14. 17. Selection criteria - Children <ul><li>Twelve months of age or older </li></ul><ul><li>Bilateral severe to profound sensori- neural hearing loss - congenital or acquired </li></ul><ul><li>No or less benefit with the most optimised hearing aid </li></ul><ul><li>Aided audiometric thresholds that fall outside speech range at 2kHz </li></ul><ul><li>No medical or radiological contraindications </li></ul><ul><li>Motivation and good family support. </li></ul>
  15. 18. Candidacy Guideline Audiograms
  16. 19. Selection Criteria - Adults <ul><li>18 years of age or older </li></ul><ul><li>Profound, severe-profound, bilateral sensorineural hearing loss </li></ul><ul><li>Post lingual onset of profound deafness </li></ul><ul><li>Little or no benefit from hearing aids </li></ul><ul><li>No medical or radiological contraindications for surgery </li></ul>
  17. 20. Factors that may exclude candidacy <ul><li>Absence of auditory nerve or l ack of auditory nerve integrity bilaterally </li></ul><ul><li>Neurological damage impeding auditory processing </li></ul><ul><li>Medical risks of surgery that exceed the expected benefits of the cochlear implant </li></ul>
  18. 21. Factors that may influence outcomes with an implant <ul><li>Length of profound deafness </li></ul><ul><li>Age at implant </li></ul><ul><li>- 0 to 5yrs optimal </li></ul><ul><li>- 5 to 7 yrs Results will vary </li></ul><ul><li>-7yrs and above provided good HA use and </li></ul><ul><li>re/habilitation </li></ul><ul><li>Aetiology </li></ul><ul><li>Use of hearing aids prior to implantation </li></ul><ul><li>Amount and quality of re/habilitation before and after implant </li></ul><ul><li>Family support and commitment </li></ul><ul><li>Educational methods and communication mode </li></ul>
  19. 22. The process of getting an implant <ul><li>Pre surgery : </li></ul><ul><li>Initial Referral </li></ul><ul><li>Full medical evaluation </li></ul><ul><li>Full audiological evaluation to assess level and type of hearing loss (PTA.Impedance,ABR,ASSR,OAE and Prom-Stim) </li></ul><ul><li>Optimal hearing aid fitting and evaluation </li></ul><ul><li>Hearing aid trial and auditory training </li></ul><ul><li>Post training evaluation </li></ul><ul><li>Counseling of parents and family members </li></ul><ul><li>Acceptance for implant and final counseling </li></ul>
  20. 23. The process of getting an implant The process of getting an implant <ul><li>Surgery: </li></ul><ul><li>3 to 5 hours </li></ul><ul><li>1 to 2 day hospital stay </li></ul><ul><li>3 to 4 weeks later – switch on </li></ul>
  21. 24. X-Ray of Cochlear Implant in Situ
  22. 25. Next Details Menu Back
  23. 26. Neural Response Telemetry System Next Details Menu Back Transmitter Receiver Decoder Current Source Transmitter Encoder Amplifier Receiver PCI IF5 Card
  24. 27. Stimulation and Recording Modes Details Next Menu Back Stimulation Recording
  25. 28. Post Surgery: Fitting the externals <ul><li>Switch on </li></ul><ul><li>About three weeks following surgery the implantee will return to the clinic to have the external parts of the device fitted </li></ul><ul><li>This first fitting is called the ‘switch on’ or ‘tune up’ of the device </li></ul>
  26. 29. Clinical Programming System CPS
  27. 30. What is involved in activating the system? <ul><li>the term referred to as MAPping/programming </li></ul><ul><li>the procedure required for fine tuning the device to suit each individual’s hearing needs </li></ul><ul><li>requires specialised software and programming interface systems to program the speech processor. </li></ul><ul><li>Is the process of measuring and controlling the amount of electrical current delivered to the cochlea. To provide the patient with comfortable and useful hearing sensations. </li></ul>
  28. 31. <ul><li>Listening training </li></ul><ul><ul><li>An individual program is worked out for each recipient </li></ul></ul><ul><ul><li>Focus is on listening </li></ul></ul><ul><ul><li>For children: Listening training follows normal child speech and language developmental milestones – hearing age vs chronological age </li></ul></ul><ul><ul><li>Family must be involved </li></ul></ul><ul><ul><li>With children the parent is trained to carry over listening to home – in a natural environment </li></ul></ul>Listening training pre and post implant (AVT)
  29. 32. The Cochlear Implant Team: Core members <ul><li>The Parents </li></ul><ul><ul><li>Need to be involved in all evaluation processes and decisions. Must have realistic expectations and fully understand all aspects of process. </li></ul></ul><ul><li>The Surgeon </li></ul><ul><ul><li>Full medical and surgical evaluation, counseling, surgery and post surgical care </li></ul></ul><ul><li>The Audiologist </li></ul><ul><ul><li>Full audiological evaluation, hearing aid fitting, counseling, mapping, adult rehabilitation and ongoing follow up </li></ul></ul><ul><li>The Teacher of the Deaf/ Habilitationist </li></ul><ul><ul><li>Pre and post surgery listening training, full habilitation program planning for individual and full home training program for parents </li></ul></ul>
  30. 33.  Audallion beam former  Brain Stem Implants  Espirit 3 G speech processor  Neural response telemetry - NRT Newer developments
  31. 34. <ul><li>Completely implantable Implants </li></ul><ul><li>Neuronal regeneration factors </li></ul><ul><li>Improved speech coding strategies </li></ul><ul><li>Automated Mapping based on NRT </li></ul>Future
  32. 37. Thank You
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