CD 440 ch 3 cochlear implants

CI Insertion depths can range up to ...

30 mm

can programming schedule for children be modified to include more or fewer visits depending on the person's adaptation to the implant, auditory responsiveness, and ease of programming.??

yes

A normal-hearing person requires about (in relation to SNR loss)

+2 dB signal-to-noise ratio (speech louder than the background noise by 2 dB) to identify 50% of key words in sentences on the QuickSIN test.

how long is the CI surgery

1 to 3 hours done on outpatient basis

HOW DO CIs WORK???

1. sounds are picked up by microphone 2. signal is then "coded" by speech processor and turned into a special pattern of electrical pulses 3. these pulses are sent to the transmitter coil where they are then transmitted across the skin via FM radio waves to the internal receiver 4. the internal receiver sends electrical pulses to the electrodes in the cochlea 5. the auditory nerve picks up these electrical pulses and sends them to the brain. the brain recognizes these signals as sound

In _________ the first wearable implant was implanted in an adult at the House Ear Institute.

1972

currently there are how many componies approved by the FDA? what are they?

3 They are Cochlear, Advanced Bionics (swimming), and Med-El (MRI are feasible).

Many improvements came in the 1990s, demonstrating over ....

80% scores in open-set in auditory-only conditions.

criteria for children for cochlear implant? (for 24 months to 18 years old)

> 70 dB in 24 month-olds to 18-year-olds with limited benefit from traditional amplification.

what is Adaptation to sound stimulation that changes the measured T- and C-levels allowing the individual to tolerate higher levels.

Acclimatization to sound

examples of variables that affect success with the implant. ???

Age of onset (known factor) length of deafness (known factor) age of implantation length of implant use etiology of the hearing loss nerve survival (unknown) mode of communication cochlear implant technology, surgical issues audiologic re/habilitation methods, and motivation

what has been developed for individuals with neurofibromatosis who are deafened from bilateral VIII nerve tumors.

An auditory brainstem implant (ABI)

what is an integral part of the cochlear implant process?? It includes?

Audiologic re/habilitation including speech processor programming and training (With training, the cochlear implant can improve the quality of life for persons with severe-to-profound hearing loss)

Future Trendsin Cochlear Implants??

Both internal and external devices are becoming smaller. The introduction of behind-the-ear speech processors

The __________ is the ______________ for a long period of time.

C- level the loudest level that can be listened to comfortably

true or false: Some individuals within the deaf community have voiced that they do not resent anyone trying to "fix a Deaf child."

FALSE Some individuals within the deaf community have voiced that they resent anyone trying to "fix a Deaf child."

when should a second implant be considered?

If, after a trial period, the patient does not receive any benefit from the bimodal condition compared to the cochlear implant alone condition

who derives the greatest benefits from cochlear implantation?

Late deafened adults with oral communication skills and a recent memory for sound AND young children whose brains are very malleable

after CI fitting.. how do adults react? how do children react?

Most adults describe speech as sounding mechanical and cartoonlike. Children often react with tears. This is understandable, considering that they may have no concept of what sound and hearing are and may find the stimulation frightening. Often they are hearing their own voice, including their crying, for the first timeAs they are calmed down, they often realize that when they stopped crying, the stimulation stopped. This can be the first step to auditory awareness.

is everyone a candidate for cochlear implant??

NOOO Sometimes the HINT (hearing in noise test) is done as well. Candidacy differs with insurance companies.

what are objective techniques that can be used to estimate the dynamic ranges in young children or difficult-to-test patients.

Neural Response Telemetry (NRT), Neural Response Imaging (NRI), or Auditory Response Telemetry (ART)

what Allows the implant system to function as a miniature evoked potential system by sampling and recording action potentials generated by electrical stimulation.

Neural response telemetry (NRT):

cochlear implant team includes?

Otolaryngologist: Surgery and medical decisions Audiologist: Determines audiologic candidacy and programs the processor Speech Language Pathologist Teachers of the hearing impaired Social Workers Parents

what can corrupt stored programs or, in rare cases, cause damage to the internal unit when the external device is being worn

Static electricity

what info should be given after CI

Suggestions on wearing the units using clips, belts, or harnesses should be given. Accessories should be explained and demonstrated. Warnings on the dangers of electrostatic discharge (ESD) should be given, as well as any other safety factors. Warranty and loss and damage insurance information should be covered.

The speech processor is then programmed or "mapped" using one of the several encoding strategies so that the electrical current delivered to the implant will be within this measured dynamic range between ....

T- and C-levels.

_______________ is the ____________ that produces an auditory sensation by the patient 100 percent of the time.

T-level or minimum stimulation level softest electrical current

disadvantages of bilateral cochlear implant?

The cost of bilateral implantation will be $60,000 to $80,000 greater than with a unilateral cochlear implant. Surgical risks are also increased. In addition, one must consider the possibility that some future device may be developed that could only be used in an ear that had never had an implant

WHAT HAPPENS NEXT after receiver stimulator and the electrode array is inserted in mastoid bone

The electrode array is then threaded through the mastoid and the middle ear cavity and then inserted in the scala tympani of the cochlea through the round window

what must the patient and family be able to do with CI?

They must know how to place the processor and coil on the head, change batteries, manipulate the controls, and troubleshoot the unit.

why is there a waiting period after CI surgery

This waiting period allows for healing of the incision area prior to placing the magnet on the sensitive surface where the external transmitter is placed.

can patients with a corner audiogram receive some benefit from a hearing aid in the opposite ear to supplement what they are receiving from the cochlear implant.

YESSS

The Deaf community defines Deafness with ...

a capital "D" as a culture rather than a disability. *It is characterized by having its own language, American Sign Language (ASL). *

the speech processor in CI consists of?

a microphone, speech processor, and transmitter coil

Cochlear implants offer ...

an alternative for sound stimulation to individuals who receive limited benefits from traditional amplification

how can the audiologist check the internal device prior to programming the system.

bc Electrode voltages and impedances can be measured when current is supplied through the system.

criteria for children for cochlear implant? (for 12-24 month old)

bilaterally profound sensorineural hearing loss > 90 dB in 12 to 24-month-olds

if any sounds were uncomfortably loud it is indicating that

c levels set too high

why would using hearing aid in opposite ear as cochlear implant be good?

can help with localization and improved hearing in noise provides prosody information can even help patients with corner audiogram

bimodal stimulation aka

cochlear implant in one ear plus hearing aid in the other

for an ABI the implant is placed on the ....

cochlear nucleus of the brainstem during the surgery to remove the tumor.

advantages of bilateral cochlear implant ??

demonstrated improved localization abilities and improved speech understanding in noise

cochlear implant consists of ??

ear level speech processor (microphone, speech processor, transmitter coil), internal receiver, implanted electrodes, auditory nerves

the processor in CI is either...

either body worn or at the ear, similar to a BTE hearing aid.

what is when the cochlear implant electrode array is placed only in the basal portion of the cochlea and programmed for high-frequency sounds

electric-acoustic stimulation

In order to create the program, or MAP, for the speech processor, the audiologist must determine the ....

electrical dynamic range for each electrode used.

The programming system delivers an electrical current through the cochlear implant system to each electrode in order to obtain the __________ and _______________ of current that is comfortably loud measures

electrical threshold maximal level

true or false: patient performance does not vary greatly among cochlear implant users.

false , patient performance varies greatly among cochlear implant users. *Many users are able to achieve open-set speech recognition even in the presence of background noise, whereas some patients receive only improvement in their speechreading abilities and awareness of environmental sounds.

true or false: A coordinated effort on the part of all professionals and parents isn't very important in developing and implementing the treatment plans.

false A coordinated effort on the part of all professionals and parents is very important in developing and implementing the treatment plans.

true or false: Research in vestibular and tinnitus rehabilitation does not promise hope to the many individuals suffering from vertigo and tinnitus.

false New advances in these areas have helped many patients resume active and productive lives

true or false: Obtaining the t-levels in children is a challenging task, with the audiologist often relying totally on behavioral observation.

false Obtaining the C-levels in children is a challenging task, with the audiologist often relying totally on behavioral observation.

true or false: Obviously, T- and C-levels are much easier to obtain on adults and older children with prelingual hearing loss.

false Obviously, T- and C-levels are much easier to obtain on adults and older children with postlingual hearing loss.

true or false: Parents don't need to be shown how to check the system prior to putting it on the child. Spare cords or cables should be supplied.

false Parents need to be shown how to check the system prior to putting it on the child. Spare cords or cables should be supplied.

true or false: Research has indicated that the hearing aid, even in cases with profound hearing loss, can not provide the patients with prosody information that can be provided by current generation implants.

false Research has indicated that the hearing aid, even in cases with profound hearing loss, can provide the patients with prosody information that cannot be provided by current generation implants.

ABI Results are similar to early _________ and show promise to those who have not been able to benefit from cochlear implants because they lack functioning VIII nerves.

generation multi-electrode implants

Otologic-medical evaluations done by a physician include ....

include MRIs or CT scans to determine if patient is implantable

With adults and older children the pre-training may include....

include speechreading therapy and training in the use of communication strategies for communication breakdowns.

criteria for cochlear implant for adults??

is < 50% speech recognition in the ear to be implanted when listening at normal levels to sentences on the HINT test in the best aided conditions. The opposite ear must have < 60%.

the placement of the receiver stimulator and the insertion of the electrode array goes in the...

mastoid bone

during cochlear implant surgery the surgeon makes an incision behind the ear and drills a small area in the ...

mastoid bone for the placement of the receiver stimulator and the insertion of the electrode array.

in order for someone to get cochlear implant there should be no _____, _______ or ________

medical contraindications, VII nerve absence or active middle ear infections.

can higher pitches be amplified on hearing aids?? low pitches??

no yes

Prosody or suprasegmental information includes rhythm, stress, and intonation that can help in understanding in ...

noise, music appreciation, and hearing emotion in speech.

in 1980's Many people were able to achieve ________ understanding

open-set speech multi-electrode devices bringing more but still limited frequency cues.

The amount and length of therapy with the cochlear implant depend on the....

patient

the microphone does what??

picks up the sound wave, converts it into an electrical signal, and sends it to the speech processor.

cochlear implants is device made for patients with ...

profound (sometimes only severe) sensorineural hearing loss

in order to be considered for candidacy for cochlear implant you must....

prove little or no benefit from traditional hearing aids

Techniques for testing the T-levels in young children are similar to testing ....

pure tone hearing thresholds, ranging from observational testing to conditioned play audiometry.

NRT, NRI, and ART offer a means of testing the compound action potential of the nerve using two of the electrodes in the array as _______ and two as ____________

recording electrodes stimulating electrodes. *No additional equipment is necessary. From these measures, T- and C-levels can be estimated.

what is mapping?? (in terms of cochlear implant)

rigorous rehabilitation to program and adjust to device 4-6 weeks after surgery

risks of electric-acoustic stimulation

risk losing residual acoustic hearing

The House/3M device consisted of a ______ how many patients received device and when ???

single electrode placed in the basal end of the cochlea. Over a 1000 persons received this device, in 1980 it became available for children over the age of 2 years.

Programming follow-ups for adult patients with postlingual hearing loss usually consist of approximately ...

six visits in the first two months of use, then at three months, six months, and annually thereafter

what codes the information using a device-specific strategy and sends it to the external transmitter coil

speech processor

formal evaluations for cochlear implant should include..

standard audiometric unaided test batteries, Otoacoustic emissions, aided speech perception testing and aided speechreading evaluations.

Current implants have the capability of testing the integrity of the internal device by using a technique called ....

telemetry

what sends the information through the skin via FM radio waves to an internal receiver.

the coil

SNR Loss is defined as....

the dB increase in signal-to-noise ratio required by a hearing-impaired person to understand speech in noise, compared to someone with normal hearing. *similar to definition of pure tone hearing loss*

The initial fitting and programming of the headset and speech processor of cochlear implant is called...

the hook up it usually takes 1 1/2 - 2 hours

what sends the information to the implanted electrodes that stimulate the available auditory nerve fibers.

the internal receiver

what is c level?

the loudest level that can be listened to comfortably for a long period of time.

WHAT HAPPENS NEXT AFTER T- and C-levels are established and the MAP is created

the microphone is then activated so that the patient is able to hear speech and sounds in the environment.

what is SNR loss??

the patient's performance in noise compared to normal-hearing persons' performance in noise. THE DIFFERENCE IN PERFORMANCE IS THEN SNR LOSS

what is t level ?

the softest sound that produces an auditory sensation by the patient 100 percent of the time.

what has a magnet that adheres to the head over the skin where the receiver stimulator is placed??

transmiter coil

true or false: Studies have shown that the shorter the length of severe-to-profound hearing loss and better the pre-implant discrimination score, the better the prognosis for benefit from the cochlear implant.

true

true or false: Auditory training methods such as speech tracking are extremely helpful in both treatment and monitoring progress with the device

true

true or false: Bilateral cochlear implantation is becoming more common worldwide and has also shown significant improvement in localization and hearing in noise in adults.

true

true or false: in relation to bilateral cochlear implant the importance of keeping one child's ear open for future options needs to be considered.

true

true or false: It is important that the implant team members be able to help parents make informed decisions taking into consideration Deaf culture issues.

true

true or false: Patients with balance problems or complaining of tinnitus no longer must be told there are no successful treatment plans available.

true

true or false: Using a team approach with two audiologists is very helpful when programming or mapping the cochlear implants of young children.

true

true or false: With children, audiologists will often evaluate only a limited number of electrodes spaced throughout the electrode array during the initial hook-up and either estimate the levels for the other electrodes or only include the tested electrodes in the initial program.

true

true or false: the newest cochlear implants are very small

true

true or false: Over the past 15 years, the National Association of the Deaf (NAD) has softened its criticisms of cochlear implants

true

true or false: Recent studies have shown that some of the benefits of binaural hearing such as localization and improved hearing in noise can be accomplished using bimodal hearing when the patient wears a hearing aid in the ear opposite the cochlear implant .

true

true or false: during the hook up the audiologist must program the speech processor using a specific manufacturer-designed diagnostic program.

true

true or false: A multidisciplinary team is necessary for a successful cochlear implant program.

true The Team leaders are the Otolaryngologist and Audiologist

After surgical placement of the internal receiver/stimulator and the electrode array, the patient must wait approximately _____ before ______

two to three weeks before the external head-set and speech processor can be fitted.

info on follow up programing and therapy

usually performed within one week after initial hook up Review of the patient diary and experiences with the implant are helpful in determining if the programs provided sufficient power for sound awareness and detection or if any sounds were uncomfortably loud During this visit, the T- and C-values are reevaluated, and new MAPs are placed in the processor.

For young children, the programming schedule suggested is ...

weekly visits for two months, then at six months, nine months, and every six months thereafter.

are Various therapy materials available to the clinician through each of the implant manufacturers??

yes

is More research is needed to determine the best way to afford bilateral listening to the cochlear implant user. ??

yes

is The cochlear implant surgery is completed under general anesthesia

yes

should Patients, parents, and significant others need to be made aware of the many variables that can affect performance.???

yes

will the implant team may suggest that the patient go through some pretraining before cochlear implant?

yes

do some Deaf people still oppose implantation?

yes despite all the evidence that demonstrate that children implanted at a young age received significant speech perception bene

will all cochlear implant patients regardless of age benefit from an audiologic therapy plan based on their needs.???

yess

has the scope of audilogic rehabilitation increased dramatically in past two decades?

yesss

should the patient and family be instructed one the daily care and maintenance of the system. ??

yessss

should parents remove the device when their child plays on plastic slides or on other static-generating materials??

yesssss bc static electricity corrupts stored program