Module 4 (week 4) Cochlear Implants

What are some indications/signs that there might be a problem with the functioning of the CIs? (Look for changes in performance!)

Asking for repetitions Not wearing equipment Turning down volume/sensitivity Negative behavior / Facial stimulation Increase in articulation errors Not responding to auditory stimuli Speech is more slurred Cannot repeat Ling Voice quality has change It's not always the map

What does the sensitivity option in programming do?

Controls the softest level of sound allowed in the processor Controls the "size of your listening world" (e.g. to try to get rid of noise, some soft sounds are considered not important but some speech sounds may fall into this category where they are so soft that the implant processor is set to not catch this type of speech)

What are some ways of troubleshooting CI?

Microphone test (Ling 5 sound test) Lights on processor (Communicate function, low battery, microphone working, headpiece fallen off) Intact external equipment (e.g. children showing up at school without batteries, etc.)

What are some other things that might cause a change in performance, besides the functioning of the CI itself?

Troubleshoot the processor (Are settings correct? Is the microphone clear?) Changes at home or classroom Rapid development of other skills (For example; sometimes when children begin to walk, their vocalizations decrease) Determine if both perception and production are affected "selective listening"

Conditioned Play Audiometry (CPA)

Kids age 24/36 months-5/6 years condition kids to play a game (e.g. put a block in a bucket when they hear a sound)

HINT

...

FDA only has authority in __________________.

America

(INTERNAL COMPONENT) antenna

Receives data delivered by external transmitter via radio frequency

What do we know about the benefits of CI for young children?

The earlier we can get children with HL stimulation, the better off they will be Getting kids hearing aids before the age of 6 months is critical so that they have a chance to function closely along with peers on tests of language and speech development

Describe in steps how the commercially available cochlear implant system with an ear-level speech processor works (as show in figure 3.1)

(The behind-the-ear device consists of a MICROPHONE, SPEECH PROCESSOR, and TRANSMITTER COIL) The MICROPHONE picks up the sound waves and converts the sound wave to an electrical signal The microphone sends the electrical signal to the SPEECH PROCESSOR The speech processor codes the information using a device-specific strategy and sends it to the external TRANSMITTER COIL The coil sends the information through the skin via the FM radio waves to an internal receiver The internal receiver sends the information to the implanted electrodes that stimulate the available auditory nerve fibers The auditory nerve then sends the information to the brain so that the person can perceive sound stimulation ***All occurs in a matter of microseconds***

Regarding pediatric candidacy for CI, what is relevant as far as SPEECH PERCEPTION goes?

- Aided thresholds are outside the speech range for high frequencies - Speech perception testing Lack of progress in auditory skill development (MAIS, 12-24 mos) A 12 month old child needs to present with profound hearing loss and have little benefit from hearing aids <30% on MLNT for children 2-5 y/o <30% on LNT for 5-18 y/o

What was significant that happened in 1957 with Djourno and Eyries in France?

- Djourno (physican studing electrophysiologgy)and Eyries (otolaryngologist) teamed up because they had a patient who had recently been operated on for bilateral cholesteatomas (a non malignant tumor that grows inside the middle ear) - When these tumors were removed, the patient not only lost his hearing, but he also suffered damage to his facial nerve which resulted in facial paralysis. - This patient tried electrical stimulation of the cochlea so they implanted an electrode into his inner ear and the patient appreciated audibility of environmental sounds and could understand several words. - He was unable to understand running speech but this incident proved that electrical stimulation of the cochlea could result in some auditory benefit. - Device then failed 3 times - Discontinued work due to equipment failure and due to personality conflict - Reports of benefits of electrical stimulation were lost for several years due to translation.

What does Programming Strategies refer to, in regards to MAP?

- Each company has proprietary programming strategies that analyze speech/sound and deliver a systematic electrical stimulus to each of the electrodes -The goal of each programming strategy is to represent the complexities of speech and sound as faithfully as possible Keep in mind: The human cochlea consists of thousands of nerves that process speech and sound A cochlear implant is only stimulating a fraction of those nerves

What is a MAP?

- It is not an acronym - It is an individual's specific listening program - Consists of Minimum Levels of Audibility (T-levels) - Consists of Maximum Levels of Comfort - Consists of Programming Strategy (How do we go about deciding what frequency info, timing info etc. to give the person?) - Consists of Other Associated Programming Options

Describe (in the instructors words), how CI work.

- Microphones on processor capture the sound and deliver it to the processor inside the hearing aid (external device) where it's converted to a digital signal - After sound has been processed, it is delivered to the internal receiver through the radio frequency transmission across the skin through the transmitting coil - The radio frequency is a low level frequency that does NOT interfere with any other radio signal - Internal implant converts signals into electrical energy, sending it to an electrode array inside the cochlea -Electrodes stimulate VIIth, (auditory) nerve, bypassing damaged hair cells, and the brain perceives signals as sound. (the endings of the auditory nerve are within the cochlea so they are going to pick up the signal and deliver the electrical signal to the auditory portions of the brain)

Why is "Family's desire to be part of hearing world" an important criteria for CI candidacy?

- Parents need to be committed to the use of hearing and the development of spoken language - If a parent decides that they want their child to be able to hear environmental sounds and use sign language as the base of communication, the implant will not work as well because there has to be SPEECH INPUT for the child to be able to use the CI - This is not to say sign language is a detriment - There is not evidence to show that children were "hurt" by sign language when they were implanted. But we do see from people reporting the results, that if a person is implanted but no one spoke to them and only used sign language, then of course the implant is not going to work. The child is not going to learn those patterns that they need to learn to be able to use the information the implant provides.

Describe the history of cochlear implants in the U.S

- Work in United States began with William House in CA (a patient somehow found a translated copy of the journals of Djourno and Eyries and took it to William House) -Several US scientists continued exploration of electrical stimulation. - The Bilger Report was a pivotal moment in cochlear implant history

Why is CI controversial for children younger than 12 months?

- growth of the head can affect CI - migration of the implant underneath the head, skull isn't completely solidified

Describe how the magnets, antenna, electrode array, and receiver stimulator work together

- internal and external magnets hold things in place so that the antenna on the INSIDE (along the outsides of the small round piece connected to internal magnet) in close proximity to the transmitter (or coil) on the OUTSIDE - the antenna picks up the information through radio transmission - once the ANTENNA gets the radio signal, it decodes the signal and analyzes the data from the radio transmission coming from the outside EXTERNAL TRANSMITTER and deliver this data to the ELECTRODE ARRAY which is the tiniest end piece. The wires travel through the middle ear space, so it's just the last little tiny curly end piece that is implanted in the inner ear of the cochlea

(Review) What is the acoustic reflex?

- loud sound in goes in the ear - the brain stem tells the stapedic muscle to contract *these reflex should be absent for someone to qualify for CI

Who was Allesandro Volta?

- the "volt" was named after him (measure of electrical power) - put some electrodes in his external ears and ran an electrical shock up there and reported hearing a boom and then some electrical "frying" sound -

LNT

...

MLNT

...

compete flashcards for chapter 3, page 84-93

...

What do CI sound like? (not covered)

1 Channel Simulation What was actually spoken. 2 Channel Simulation What was actually spoken. 4 Channel Simulation What was actually spoken. 8 Channel Simulation What was actually spoken

Most audiogists like to see the CI turned on after surgery for about a month after the surgery.

1.) Hook-up- usually occurs about a month post-surgery -Two days - within same week -One month follow-up -Three month follow-up 2.) Routine follow-ups -For kids linguistically up to age 3 Every 3 months -For kids linguistically up to age 5 Every 6 months - For kids developmentally over age 5 Annual 3.) Some educational models make small changes to maps as problems arise in school

What you should know about the MAP?

1.) Program options - How does the child do with Everyday listening? - How does the child do with Noise? - How does the child do with Music? - How does the child do with FM (in classrooms)? 2.) Processors contain multiple program options - Are all programs the same? - What is the difference between the programs? - How do I know which one to use when? (Communication with the audiologist is critical because there is no other way for anyone to know the contents of the processor)

How Does a CI Work (4 main steps)?

1.) Via Microphones, the external sound processor captures sound and converts it into digital signals 2.) Processor sends digital signals to internal receiver via the transmitting coil. 3.) Internal implant converts signals into electrical energy, sending it to an electrode array inside the cochlea 4.) Electrodes stimulate VIIth, (auditory) nerve, bypassing damaged hair cells, and the brain perceives signals as sound.

Currently, the FDA has approved the use of CI in persons over the age of _______.

12 months

Concept of electrical stimulation has been around since the ___________.

1950s *The idea of electrical stimulation in relation to hearing actually goes back to Allesandro Volta

Multi-electrode devices came into wide use in the _________.

1980s *With these systems, limited frequency cues became available to patients and many patients were achieving open-set speech understanding

What are 2 major influencing events that occurred during the 80s and 90s with the FDA regarding CI?

1985 - FDA approved use of Nucleus 22- Channel Cochlear Implant System for ADULTS with postlingual deafness 1990 - FDA approved the use of the Nucleus 22- Channel Cochlear Implant System for CHILDREN over the age of 2 years.

From 1985-2000, the qualifications for CI changed significantly. Describe some of the key points in this progression.

1985 - only adults 18 or older were candidates, CI were considered experimental Children were NOT candidates Profound hearing loss 1990 - Adults and children 2 yrs and older can get CI as long as they meet a certain criteria (eg. post-lingual, etc) Profound 1998 - Adults and children 1.5 years older can get CI as long as they meet a certain criteria Severe- Profound hearing loss (adults) Profound - children 2000 - Adults and children as young as 12 months can be implanted

The most advanced implant now has ______ electrodes.

26

William House resumed work on cochlear implants after the Bilger Reports, and he developed the _________________.

3M/House single channel cochlear implant

________ of children born with severe hearing loss are born to hearing parents.

90%

What is a contraindication?

A contraindication is a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person. (definition from the internet)

(AUDIOLOGIC EVALUATIONS) ABR/ASSR

ABR - focuses on wavorm measured with a click that covers low to high frequencies ASSR - allows us to test at louder levels than ABR allows us to test with sounds like pure tones, longer tones, so that we can check each individual frequency to see the shape of the child's hearing loss

Regarding the audiologic evaluation (for pediatric candidacy for cochlear implants), what audiologic tests does the hearing loss portion of this evaluation consist of?

ABR/ASSRs (used for infants) Immitance Audiometry (to make sure there is normal middle ear function, to make sure there aren't problems with ear infections, fluid in the middle ear space Otoacoustic Emissions (test of the inner ear to see if the hair cells are functioning) Unaided thresholds

Who is a candidate for cochlear implants?

ADULTS must have had at least 3-6 month trial period with appropriate amplification and show limited benefit from the hearing aids as defined by 50% or less auditory-only speech recognition performance with open set sentences must have strong support system must have motivation must have realistic expectations must want to be part of the hearing world CHILDREN children under 24 months should have at least a 3-month trial period with appropriate and consistent binaural hearing aid use older children should have at least a 6-month trial period with appropriate and consistent binaural hearing aid use must have strong support system family must have realistic expectations

As of the year 2000, give examples of the CI candidacy criteria for speech scores for chidlren and adults.

Adults: 50% or less (HINT) in ear to be implanted with 0% or less in contralateral ear or binaurally Children: Lack of auditory progress (MAIS, < 30% (MLNT/LNT) (depending on age)

Three CI Manufacturers in the US The External Hardware

Advanced Bionics 'Harmony' Cochlear Corp. 'Nucleus Freedom' MedEl 'Opus 2'

Three CI Manufacturers in the US Internal Hardware

Advanced Bionics 'Hi Res 90K' Cochlear Corp. 'Nucleus 5' MedEl 'Sonata'

What was the "Bilger Report"

After William House developed the single electrode device that caused cochlear stimulation, Robert Bilger was asked to look at the speech perception and cochlear implants by the U.S. government A pivotal moment in cochelar impant history came about in the 1970s when the Bilger Report came out Bilger Report was the first scientific objective assessment of cochlear implant performance Study of 13 adult subjects who were implanted with a single channel cochlear implant

What are some of the outcome predictors for children, regarding CI?

Age at time of implantation Parental support Educational placement Strong emphasis in auditory and oral speech input

ABR

Auditory Brain Stem Response Tests *Electrodes are placed on the OUTSIDE of a child's head, present sounds to their ears, and then measure the response of the auditory nerve through these electrodes

ASSR

Auditory Steady State Response Tests *Electrodes are placed on the OUTSIDE of a child's head, present sounds to their ears, and then measure the response of the auditory nerve through these electrodes

"No response" is usually the criteria for cochlear implants in regards to the OAE (Otoacoustic emissions). What is the exception to his?

Auditory neuropathy *Hair cells might be functioning the way they should but somehow the connection between the hair cells and auditory nerve, OR the ability of the auditory nerve to fire synchronously is not functioning well. Still a lot of debate on how to treat these children. In the case that the problem is synchronous firing of the auditory nerve, the CI would help because the implant would help improve synchronous firing *More research is needed on this

How does a cochlear implant work?

Basic parts and functionality is similar across the implant companies Consist of External Components and Internal Components

Why is one of the criteria for cochlear implants typically the ABSENCE of otoacoustic emissions?

Because most hair cells don't survive implants! The process of implantation has the potential of ripping out all of the structures inside The process of implanting electrodes in the cochlea is potentially damaging to the cochlea, so it's important to be careful when deciding if this procedure is appropriate. A person no otoacoustic emissions has nothing to lose in a sense. In other words, their hair cells in the cochea are already damaged. When electrodes are put in the cochlea, most of the time it damages the cochlea when it goes in, so in a way, we are really damaging a normal cochlea by putting the electrodes in there You can't go back to the hearing aid once you have cochlear implants

Regarding the audiolgic tests that are part of the hearing loss portion of evaluations, what are the criteria for cochlear implants?

COCHLEAR IMPLANT CRITERIA: ABR/ASSRs: Profound range Immitance Audiometry: Normal middle ear function Otoacoustic emissions: No response Unaided thresholds: Profound hearing loss

Pediatric Candidacy

Candidacy Evaluations consist of: Medical Evaluation (Status of the cochlea, General health of the patient) Audiologic Evaluation (Evaluation of degree of hearing loss, Evaluation of speech perception, Evaluation of hearing aid)

What was the first company to receive FDA approval for multichannel devices in 1985?

Cochlear Corporation

Currently, the FDA has granted approval to 3 companies for cochlear implant systems for general use with both children and adults in the US. What are these 3 companies?

Cochlear Corporation -headquartered in Melbourne, Austrailia - first company to receive FDA approval for multichannel devices in 1985 Advanced Bionics (HiResolution Bionic Ear system) - has the option of either an ear-level processor or body-worn processor - fastest processing speech in the industry MED-EL Corporation (MAESTRO Cochlear Implant System) - Australia - choice of either titanium or ceramic car implant, an ear-level processor, and a remote control - often the implant of choice for people who need multiple MRIs because it allows for low-level MRI

(INTERNAL COMPONENT) receiver stimulator

Decodes and analyzes data - delivers data to electrode array

Describe what is essentially happening with the two methods of mapping - NRT and NRI.

Electrical stimulation is sent through the implant and then measuring with the electrodes what's coming out from the auditory nerve

Regarding pediatric candidacy, what does the audiologic evaluation consist of?

Evaluation of degree of hearing loss Evaluation of speech perception Evaluation of hearing aid

Other candidacy criteria for CI

Family's desire to be part of hearing world High motivation & appropriate expectations (children need to be taught to use CI and make sense of the information, children need to be taken to appointments, etc.) Hearing aid use for at least 6 months Little success with hearing aids Age 12 months Commitment to spoken language Appropriate educational placement

Why is it much more difficult for people with CI to differentiate speech from noise?

For a person with normal hearing to function in noise, it's very important to have all 4,000 inner hair cells, those 4,000 channels to function to help the brain take the information and sort out what is speech and what's not speech and focus on the speech When you only have 26 channels, it's REALLY hard to sort out noise and speech *Sensitivity control on the processor is one way of controlling how much of those softer sounds the child is going to get

Who developed the first multi-channel cochlear implant?

Graham Clark (in Australia) *Cochlear Corporation is one of the largest cochlear implant companies in the world

When was the first cochlear implant implanted in an adult?

In 1972 at the House Ear Institute The House/3M device consisted of a single electrode implanted in the basal end of the cochlea with a ground electrode placed in the eustachian tube device was capable of providing patient with information on the presence or absence of sound, durational cues, and intensity cues

Why is the information that the child/adult is getting from the CI VERY POOR compared to the natural instrument?

In the cochlea, the inner hair cells are responsible for taking information and sending it through the nerves and up to the brain There are from 3500-4000 inner hair cells laid out within the cochlea The 26 electrodes offered by the CI is like have 4000 notes on a piano, and then cutting that down to 26 notes. The information that the child/adult is getting is VERY POOR compared to the natural instrument. Little information compared to what a normal child gets Children need training with CI, LOTS of stimulation, and focused therapy in order to learn how to use their CI

Visually Reinforced Audiometry (VRA)

Kids age 6 months - 18/24 months playing sounds through the implant, when child hears that or is stimulated by that, they would be rewarded visually with a light or image

What are some of the recipient outcome predictors for adults, regarding CI?

Length of auditory deprivation Pre-lingual vs. post-lingual Etiology (ossification, Mondini) Electrode insertion length Patient motivation Family support

(INTERNAL COMPONENT) magnet

Maintain connectivity with external hardware Piece implanted under the skin behind the ear Carve out a little bit of the skull to make room for this magnet, so it doesn't create a big bump implant square piece with the round piece above underneath the skin magnet is within the small round piece, antenna is around the outside of the small round piece

C levels, or _________________________prevent sounds in the environment from being _____________________.

Maximum Levels of Comfort uncomfortably loud

What are the two components of Candidacy Evaluations for CI?:

Medical evaluation Audiologic evaluation

CONTRAINDICATIONS (for CI)

Michel deformity (No cochlea) Small auditory canal syndrome (Absence of the cochlear nerve) Chronic middle ear disease (e.g., frequent ear infections can impact the implant because the cord that runs through the electrodes runs through the middle ear space) Bleeding disorders (e.g. hemophilia) Heart disease

What are the basic Map Parameters?

Minimum Levels of Audibility Maximum Levels of Comfort Programming Strategies

T levels, or _________________________ allow the recipient to hear the ____________ sounds of speech and the environment.

Minimum Levels of Audibility softest

Give examples of electrophysiologic measures we can use to estimate the levels when a child is an infant or unable to participate.

NRT - Neural Response Telemetry (Cochlear) Estimates the T levels *Sending electrical stimulation through the implant and then measuring with the electrodes what's coming out from the auditory nerve NRI - Neural Response Imaging (Advanced Bionics) Estimates the M Levels *Sending electrical stimulation through the implant and then measuring with the electrodes what's coming out from the auditory nerve eSRT - stapedial reflex threshold

The results of the Bilger Reports were sufficient enough to justify funding from the _____________ to investigate ____________________.

National Institute of Health how effective and safe cochlear implantation could be

Do cochlear implants restore normal hearing?

No Some individuals are provided with auditory awareness, detection of environmental sounds, and improvement of speechreading ablilities, while others are able to achieve open set speech production without visual cues

What is a good tool for sumarizing the evaluation process for children?

Nottingham Children's Implant Profile (NChIP)

(EXTERNAL COMPONENT) magnet

Only purpose is to locate and maintain connectivity between internal and external components

What were the significant findings of the Bilger Report?

Patients could not understand speech with implant alone Ability to lip-read improved (really, the ability to speech read) Quality of life improved Speech production improved (because they were able to get feedback about the way they were producing their own speech)

What does a "normal" tympanogram look like?

Peak is lined up with 0 indicating a normal tympanogram

Elaborate on why "no response" is usually the criteria for cochlear implants in regards to the OAE (Otoacoustic emissions).

Presence of OAE suggests normal functioning cochlea/ normal hearing If we suspect the child has a severe-profound hearing loss, we suspect that these hair cells are not working, and therefore cochlear implants would be appropriate *One exception to this is auditory neuropathy. Hair cells might be functioning the way they should but somehow the connection between the hair cells and auditory nerve,OR the ability of the auditory nerve to fire synchronously is not functioning well. Still a lot of debate on how to treat these children. In the case that the problem is synchronous firing of the auditory nerve, the CI would help because the implant would help improve synchronous firing

What you should know about the external device

Program Contains the individualized map Volume Modifies the C/M levels (upper limits of loudness comfort) Sensitivity Controls the softest level of sound allowed in the processor Controls the "size of your listening world" (e.g. to try to get rid of noise, some soft sounds are considered not important but some speech sounds may fall into this category where they are so soft that the implant processor is set to not catch this type of speech) Troubleshooting Microphone test (Ling 5 sound test) Lights on processor (Communicate function, low battery, microphone working, headpiece fallen off) Intact external equipment

(EXTERNAL COMPONENT) transmitter

Purpose is to deliver data to the internal receiver (antenna) via radio frequency Round piece sends signal across the skin down to the internal device • AKA - transmitter • AKA - headpiece • AKA - coil

Limitations / Precautions of Cochlear Implants

SIDE EFFECTS: Pain Infection Dizziness Facial paralysis Meningitis risk Electrostatic discharge ELECTROSTATIC DISCHARGE (programming could be effected if you are around static electricity) Sources of static electricity - Clothes: wools and synthetics (acrylic, nylon, polyester) - Nylon carpets, vinyl flooring, gymnastics mats, car upholstery, plastic - Plastic slides, plastic tubing, plastic covering - Computer TV screens: devices which actively create electrostatic discharge - Van Der Waal globes - found in science exhibits SWIMMING: Remove when swimming / showering, etc.

(AUDIOLOGIC EVALUATIONS) OAE Otoacoustic Emission

Sounds produced by the cochlea, usually in response to sound Presence of OAE suggests normal functioning cochlea/ normal hearing Must be absent to qualify for implantation device placed in ear, clicks are made, and then clinicians measure what comes back out o the ear

What are some factors that contribute the success of CI?

Status of the cochlea Appropriate mapping Consistent use of implant Child's potential Therapy Educational placement Parental involvement and carry-over

Regarding pediatric candidacy, what does the medical evaluation consist of?

Status of the cochlea General health of the patient

(INTERNAL COMPONENT) electrode array

Stimulate the auditory nerve fibers in the cochlea

Give examples of people who might be members of a transdisciplinary cochlear implant team

Surgeons Audiologists Other Physicians (pediatricians) Education Specialists Speech Language Pathologists Psychologists / Social Worker Clinical Coordinator

What are some of the performance expectations of children with CI that Jean Moog reported?

Test: Open Set Speech Understanding Results:Range from 36% to 100% Test: Speech Intelligibility Results: All scored 90% or better Test: Language & Reading Results: 65% within average range Test:Reading Results: 70% within average range

Which CI system has the fastest processing speech in the industry?

The HiResolution Bionic Ear system (Advanced Bionics)

Why is one of the criteria for cochlear implants typically the ABSENCE of acoustic relfexes?

The absence of the acoustic reflex means that no matter how loud you make the sound, the brain stem isn't going to perceive it due to the hearing loss

Regarding possible side effects from surgery, why might there be issues with nerve damage?

The auditory nerve, vestibular nerve, and facial nerve all run through the same hole in the skull, right at the level of the inner ear Any electrical stimulation to this are could potentially stimulate any of those three branches of the nerve

What should we keep in mind in regards to programming strategies?

The human cochlea consists of thousands of nerves that process speech and sound A cochlear implant is only stimulating a fraction of those nerves A cochlear implant stimulates quite a few nerves and cross communication can occur between 2 adjacent electrodes Strategies are still evolving to come up with the best way to stimulate the nerves. One drawback is that we only have 26 electrodes. Another drawback is that the electrodes themselves don't match up with individual nerve fibers.

Elaborate on how the instructor personally feels about the role of sign language among children with CI.

The instructor personally feels that using sign language is not a bad idea because you can get language into the child must easier with sign language. We can control children's environments to some extent and teach them that in some environments they are expected to use their implants, whereas other environments they are expected to use sign language *Similar to a bilingual child * No good evidence to support instructor's theory or the "oralist" theory

What are minimum levels of audibility?

The lowest level of electrical stimulation required at each electrode to provide audibility Called T levels by all implant companies Cochlear recommends measuring them while Advanced Bionics and MedEl do not recommend measuring them T levels allow the recipient to hear the softest sounds of speech and the environment

What are maximum levels of comfort?

The maximum electrical stimulation level of sound that the recipient can comfortably tolerate at any given time Called "C" levels by Cochlear and "M" levels by Advanced Bionics and MedEl C= comfort level M = most comfortable level C levels prevent sounds in the environment from being uncomfortably loud

(AUDIOLOGIC EVALUATION) Immittance Testing

Typically consists of a Tympnogram and testing the Acoutic Reflex *Normal tympanogram and absent reflexes are criteria for candidacy *Testing done to see if the middle ear is healthy

How do we determine if the Map is right?

User should be able to hear ≤ 30 dB HL User should be able to detect/repeat all Ling sounds /ah/ /oo/ ee/ /sh/ /s/ /m/ User should be able to hear to at least 30 feet (Carol Flexer) Expect user to be able to over hear (incidental listening) User should be able to tolerate loud sounds

(METHODS OF MAPPING) What are some objective measures used to measure T levels?

Visually Reinforced Audiometry (VRA) Kids age 6 months - 18/24 months Conditioned Play Audiometry (CPA) Kids age 24/36 months-5/6 years Counting Conditioned Play Kids age 36 months, up Counting Kids age 6-8 to adults

What are some of the drawbacks of CI?

We only have 26 electrodes Electrodes themselves don't match up with individual nerve fibers so you can't control what nerve fibers each electrode is going to stimulate

What's the difference between "open set" and closed set"?

closed set - you known the choices, e.g. "repeat the digits" open set - the set could be anything, e.g. "repeat these words" (it could be ANY word!)

All CI operate using the basic principles. Explain.

consists of an externally worn headset connected to an ear-level or body-worn speech processor with a battery source AND a surgically implanted internal receiver stimulator attached to the electrode array that is placed in the cochlea

cochlear implant

device that electrically stimulates the auditory nerve of patients with severe-to-profound hearing loss NOT an amplifier that increases the level of the acoustic signal, but a surgically implanted device that bypasses the peripheral auditory system to directly stimulate the auditory nerve does NOT restore normal hearing

(EXTERNAL COMPONENT) sound processor

digitizes and analyzes incoming sounds takes information from microphone, turns it into a digital signal, analyzes the digital signal, chooses (based on what we program it to do) parts of the speech signal to turn into an electrical signal to send to the electrodes in the electrodes in the inner ear *analgous to amplifier in heraing aid

What mehod of mapping is good to use as an indication of when the brainstem feels a sound is loud?

eSRT - stapedial reflex threshold

William House was tied to the idea of a single __________.

electrode (or single channel) *He believed you do as well with a single channel cochlear implant as you could with a multi-channel cochlear implant

All cochlear implants consist of __________________ and __________________.

external components (microphone, sound processor, cords, external transmitter, power source, magnet) internal components (magnet, antenna, receiver stimulator, electrode array)

(EXTERNAL COMPONENT) microphone

gathers sound *directional microphone (consists of two parts, two arrows in diagram indicate the two microphones that are mixed to create a directional microphone)

(EXTERNAL COMPONENT) cords

goes from speech processor to the external device that carries the electrical information to the external transmitter

What information was the House/3M device able to provide the patient?

information on the presence or absence of sound, durational cues intensity cues *Even with this limited information, many individuals had improved speechreading abilities

What's the difference between lip reading and speech reading?

lip reading = visual input ONLY speech reading = visual and auditory input at the same time

open-set speech perception tests

listener has an unlimited number of response possibilities

closed-set speech perception tests

listener is given a choice of multile responses

Name the internal components of cochlear implants

magnet antenna receiver stimulator electrode array

Describe how single electrodes work

metallic device implanted under the skin wire one electrode on the end of the wire implanted into the cochlea or inner ear

Name the external components of cochlear implants

microphone sound processor cords external transmitter power source magnet

Immittance testsing is done to see if the ___________________ is healthy.

middle ear

What does the research tell us about single channel vs. multiple-channel cochlear implants?

multi-channel implants shows significant improvement compared to the single channel patients could understand without the aid of visual cues FDA APPROVED COMPANIES: -Nucleus device created by the Cochlear Corporation received FDA approval in 1985 -Advanced Bionics got FDA approval in 1995 - Med-EL got FDA approval in 1994 - Nuerelec was founded in 2006 in France but it has not been introduced to the American market

Who conducts medical evaluations?

neurootologist or ear nose and throat specialist who specializes in just ears general ENTs trained in cochlear implants more and more ear-nose-throat physicians are considering learning how to perform cochlear implants, due to the growing popularity

William House developed a device with ____________________ in which the electrical stimulation that came to the cochlea was either On/Off

one electrode *With this device, Robert Bilger was asked to look at the speech perception and cochlear implants by the U.S. government. A pivotal moment in cochelar impant history came about in the 1970s when the Bilger Report came out.

Who is on a cochlear implant team?

otolaryngologist (makes medical decision and performs surgery) audiologist (determines audiologic candidacy and programs the speech processor, develops audiologic rehabilitation plan)

In order to qualify for CI, a 12 month old child needs to present with ________________hearing loss and have little benefit from hearing aids.

profound

(EXTERNAL COMPONENT) power source

rechargeable or disposable batteries

To be a cochlear implant candidate, you have to have hearing loss in the ____________________ range.

severe - profound

What were the results of the multi-channel implant?

significant improvement, notably in open-set speech understanding without the aid of visual cues from the lips multiple electrodes allow for multiple areas of the inner ear to be stimulated

The audiologic guidelines (outlined in Table 3.1) are based on the performance of CI recipients as opposed to those with ____________________________.

similar hearing loss wearing hearing aids

eSRT

stapedial reflex threshold *Can give an indication of when the brainstem feels a sound is loud

3M/House single channel cochlear implant

still available today sold under the "All Hear" brand

What were the limitations of the single channel/single electrode device developed by William House?

there was no way of transmitting different frequency information through the electrode because of the way the cochlea is laid out (lower and lower frequency as you go up the cochlea) one electrode can only stimulate one area - it can't stimulate different frequencies