Care of children who use cochlear implants

Care of Children Who Use a Cochlear Implant

Overview

Overview

Overview

Overview

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

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

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

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

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

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

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

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

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

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

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

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

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)

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)

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)

Intraoperative Testing

Activation of CI● Activation is 1 to 4 weeks post­surgery

● Familiarization prior to activation (toys, books)

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

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

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.

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.

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.

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)

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)

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)

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)