How Do I Know if the Cochlear Implant is Working?

How Do I Know if the Cochlear Implant is Working?

Gail S. Murray, Ph.D., CCC-A

Associate Professor, CWRUDirector, Audiology Services

Clinical Director, Cochlear Implant ProgramUH Case Medical Center

Rainbow Babies & Children’s HospitalAugust 5, 2009

Gail.murray@uhhospitals.org

Introduction

• Cochlear Implant Manufacturers– Cochlear Americas (Nucleus)– Advanced Bionics (AB)

• Also known as Clarion

– Med-EL

Introduction• Each manufacturer supports multiple

sound processor models.• Each manufacturer has “current”

sound processor technology that is back-ward compatible with “older” implant technology.

• Each sound processor requires slightly different troubleshooting procedures.

Identical Main Modules

Different Controllers

Troubleshooting made easy . . .

Recommendations for Schools

• At least one person at school become familiar with the student’s sound processor.

• Learn the model name of your student’s sound processor.

• Learn the components or parts of the sound processor by name.

• Practice preventative maintenance

Troubleshooting Toolbox• Be prepared to troubleshoot • Work with the parents & audiologist

to have the following on hand:– Appropriate back-up batteries – Appropriate battery holder/rack– Monitor Headphones– Signal Check– Back-up transmitting cables– Lapel or Auxiliary Microphone

Nucleus Freedom Standard BTE Sound Processor

• Sound Processing Module

• Microphone(s)• Transmitting

Coil/Cable Coil• Coil & Magnet• Controller• Batteries or

Rechargeable Battery Module

Nucleus Freedom Body Worn Sound Processor

• Sound Processing Module

• Microphone(s)• Transmitting

Cable/Coil• Coil & Magnet• Controller• Controller Shoe &

Cable• Batteries or

Rechargeable Battery Module

Nucleus Esprit 3G Sound Processor

• Sound Processor• Microphone(s)• Transmitting

Cable/Coil (missing in slide)

• Coil & Magnet• (missing in slide)• Controls• Battery module

Advanced Bionics Harmony BTE Sound Processor and Components

• Sound Processing Module & Controller

• Microphone & Ear Hook

• Transmitting Cable/ Coil

• Coil & Magnet• Rechargeable Battery

Module

There are two other models of BTE processors

Auria Platinum/CII BTE

Advanced Bionics Harmony BTE Sound Processor and Components

MED-EL Ear-level Speech Processors

• Tempo+/OPUS 1– Program/volume

switches– Sensitivity dial

• OPUS 2– Switch free design– FineTuner™

MED-EL Tempo+ BTE Sound Processor

• Sound Processing Module & Controller

• Microphone(s)• Transmitting

Coil & Magnet• Transmitting

Cable• Ear Hook• Battery Module

MED-EL Opus BTE Sound Processor

• Sound Processing Module & Microphone(s)

• Coil & Magnet• Transmitting

Cable• Earhook• Battery Module• Connecting piece

Basic Troubleshooting Concepts

• Establish a two-way communication & notification method with the student’s parent.

• Incorporate an action plan for daily equipment checks into the student’s IEP

Basic Troubleshooting Concepts

• Establish reliable speech-base feedback tools to use for daily listening check.– Ling 6 sounds test (aa, oo, ee, sh, ss, mm)– Closed set spondees (baseball, airplane)– Closed set words (colors, familiar names)– Open set words/sentences (What did you

eat for breakfast; Who drove you to school).

Ling 6 Sound Check

Cochlear Implant Accessories – to have on hand

• Monitor Headphones• Lapel or Auxiliary Microphone• Signal Check or System Sensor• Battery Charging System• Earhooks (T-Mic, Direct Connect, etc)• Audio or Interface Cables• User Manual (CD)

Nucleus Freedom BTE Accessories

• Monitor Headphone• Lapel or Auxiliary

Microphone• Signal Check/System

Sensor• Battery Charging System• Earhooks (T-Mic, Direct

Connect, etc)• Audio or Interface Cables• User Manual (CD)

Sprint Body Worn Accessories

• Monitor Headphone• Lapel or Auxiliary

Microphone• Signal Check/System

Sensor• Battery Charging

System• Audio or Interface

Cables• User Manual (CD)

Freedom Sound ProcessorHelp Messages

Freedom Sound ProcessorHelp Messages

• H1 = Battery flat– Check for proper battery insertion– Change batteries; change battery holder

• H2 = Battery low– Change batteries

• H3 = Coil error– Check for proper coil insertion & placement– Check for cable damage– Change coil

Freedom Sound ProcessorHelp Messages

• H4 = Sound/stimulation error– Turn processor “Off”, “On”– Check/change microphone protector cover– Check/change coil– Check sensitivity & volume settings > 0– Use the lapel microphone to sound processor

check microphone– Contact parent &/or student’s cochlear

implant center

Freedom Sound ProcessorHelp Messages

• H5 = MAP corrupt– Try alternate program– Contact student’s cochlear implant

center

• H6 = RF interference– Contact student’s cochlear implant

center

Harmony Sound ProcessorHelp Messages

Harmony BTE 3 Color Help Messages

• Red: – A communication error with implant– Processor/ear is mismatched– Headpiece off or loss of communication

• Green: – Microphone is working– Program slot is empty

• Orange: – Battery is low– Battery needs to be changed/dead– Battery charge status

MED-EL: Verifying normal equipment function

• The red LED will illuminate 4-5 seconds when the processor is first activated (brief flashes for Opus 2)

• This uploads the map, & performs a diagnostic check.

• LED light continues to blink only when communicating a problem.

LED Indicator in MED-EL Processors • Processor status• Program errors• Low battery • Flashing patterns can

be deactivated by the CI audiologist

MED-EL TEMPO+/OPUS 1

FineTuner Tips• Not needed during the

day unless:– Child has need of the

telecoil feature– Child needs to make a

program or volume change

• If processor batteries are changed, it reverts to the same settings previously in use– One exception: Telecoil on

reverts to mic on

Basic Troubleshooting Concepts

• Check for power– Processor turned on

& in proper program– Check for visible

signal light or LCD display

– Replace batteries

Power Options

• Ask parents to provide disposable battery pack option

Basic Troubleshooting Concepts• Check for visible defects

– Frayed cables– Cracked casing or controller– Loose connections

• Cables, component parts, batteries

Basic Troubleshooting Concepts• Check Transmitting Coil & Cables – Steps:

1. Confirm that cable(s) is plugged in correctly.

2. Hold the signal check over the transmitting coil when power is on.

Basic Troubleshooting Concepts• Check Transmitting Coil & Cables – Steps:

3. Red light should illuminate.

4. Replace transmitting coil one at a time; apply signal check after each component change.

5. Check microphone if no transmission.

MED-EL signal check: Nucleus:

Basic Troubleshooting ConceptsAdvanced Bionics

Basic Troubleshooting ConceptsAdvanced Bionics

Microphone Check

Basic Troubleshooting Concepts• Microphone Check Steps:

– Turn off sound processor– Attach monitor headphones– Turn sound processor on– Perform listening check

• Use Ling sounds & running speech• Own voice should be clear & static free• Move cables around & listen for static or

intermittency

– Apply Aux mic & compare sound

Use of Auxiliary Microphone• When the student’s headset or sound

processor microphone produces no sound or sound of poor quality, the Aux/Lapel microphone may be used until a replacement microphone is available

• Attach the lapel mic outside the student’s shirt, near the chin, and away from objects that may produce sound interference (e.g. jewelry).

Don’t forget about the internal device• When all else fails – refer the student back to the implant

center &/or surgeon

Other Learning Tools

• Join the hands-on demonstration at today’s Break-Out Sessions.

• Accompany your student to the CI Center for a mapping session.

• Attend the Greater Cleveland Cochlear Implant Support Group Meetings – 3 per year.

Help by Phone . . .

• Cochlear Americas 800-523-5798• Advanced Bionics 800-678-2575• MED-EL 888-633-3524

Ask for Customer Service, or for the “Audiologist on call”

• The student’s Cochlear Implant Audiologist

Help on the Web . . .

• http://www.cochlearamericas.com/PDFs/TeachersGuide.Chpt6.pdf

• http://www.bionicear.com/tfs_– Interactive Troubleshooting guide on-line

• http://www.medel.com/ENG/INT/60_Contact_and_support/020_download_center.asp

All questions will be honored and answered at the end of the morning proceedings. Please write your questions on a provided note card.