CSD 5400REHABILITATION

PROCEDURES FOR THE HARD OF HEARING

AmplificationImplantable Hearing Aids

Cochlear Implants

Cochlear Implants

At present, cochlear implantation is an option available to profoundly deaf children and adults whose hearing levels are 90 dB HL or worseEstimated at 1% of the deaf and hard-of-

hearing population in the USAbout 1 million users

Children vs Adults

By and large, the differences in the candidacy and types of implants FDA approved between these two groups are small

For the most part, the requirements for an adult user are less restrictive

We’ll limit our discussion to children

Audiological Candidacy-Kids1. Child must be between the ages of 18

mo and 17 yrs2. The child must present with a profound

bilateral SNHL3. The child must demonstrate little or no

benefit from appropriate binaural HAs4. The child must participate in a 3-6 mo

hearing aid trial (can include vibrotactile HAs) if there has been no previous aided experience

Opposition fromthe Deaf Community

Deaf Community leaders have long opposed the implantation of children

School for the Deaf enrollment figures in the US over the past 20 years have dropped more than 50%Deaf Community views cochlear implants a

threat to their existence and a major reason for enrollment trends in these state centers of deaf culture

Parents need to be aware of the impact of cochlear implants within medical, educational, social and political contexts

Components to the Implant

Internal (implanted) componentsElectrodes, receiver

stimulator, antenna, magnet

External (worn) componentsMicrophone, external

transmitter, cords, speech processor (body worn or BTE)

Components to the ImplantIncoming sound detected by

the microphone and transmitted through a cord to the speech processor

Processed signal is forwarded through a cord to the external transmitter placed over the internal receiver via internal and external magnets

Signal reaches the internal receiver via FM transmission and then delivered to the electrodes

Currently Available Systems

Nucleus 22 and 24 System manufactured by Cochlear Corporation

Here is their latest generation Nucleus 24 Sprint and ESPrit, which has an ear-level signal processorAlso FDA approved for

adult users

Currently Available Systems

The Clarion System manufactured by Advanced Bionics CorporationAlso FDA approved

for adult users

Currently Available Systems

The Med El Combi 40+ manufactured by Med El CorporationNot FDA approved

yet for adultsUndergoing current

clinical trials

Approved for kids, though

Process of Implantation

Stages of the implantation process include:Candidacy selectionSurgeryImplant ActivationHabilitation

Candidacy Selection--kids

Typically performed by a multi-disciplinary team of professionals that includeAudiologist, SLP, surgeon, teacher of the deaf and

sometimes a psychologist and social worker

Adequate trial (3-6 mo) with conventional forms of amplification is mandatory

Need to demonstrate a maximum level of auditory speech perception using standardized assessment measuresTypically no better than 20%

Cochlear Implant Activation

MappingProcedure that requires the user to respond to

an electrical signal that’s delivered to each electrode individually

ThresholdsElectrical pulses are delivered to a designated

electrode at a particular current level and the lowest level the listener consistently identifies sound sensation is the T-level

Comfort levelsElectrical pulses are delivered to a designated

electrode at a particular current level and the highest level the listener finds comfortable is the C-level

Current Trends

Current Issues with Cochlear ImplantsPatient Management and Aural

RehabilitationVideos by

Mary Jo OsbergerNancy Tye-Murray