1. HEIDI L. LERVIK, MA, CRC DEAF/HARD OF HEARING COMMUNITY OF PRACTICE JULY 27, 2016 Cochlear Implants 101: What you need to know

2. Three Implant Companies/Contact Information Cochlear Americas: http://www.cochlear.com/http://www.cochlear.com/ Advanced Bionics: http://www.advancedbionics.com/ http://www.advancedbionics.com/ MED-EL: http://www.medel.com/us/http://www.medel.com/us/

3. What is a Cochlear Implant? Consists of two parts:  Internal device  surgically implanted  External sound processor

4. 1967 World’s First Speech Processor

5. Circuit Board Design - 1970’s Today Paving the Way for Future Technology

6. An internal implant placed just under the skin, behind the ear An external sound processor that sits behind the ear Cochlear Implant Basics Two main components:

7. Hearing aids amplify sound using the natural auditory pathway. How Hearing Aids Work

8. Cochlea

9. Cochlear Implants Can… Bypass damaged hair cells in the inner ear Stimulate the hearing nerve directly

10. Where is it implanted?

11. Cross Section of the Cochlea

12. How a CI Works 1.Sound Processor Captures sound from the environment Processes sound into digital information Transmits to the implant 2.Implant Converts transmitted information into electrical signals Delivers signals to the electrode array for stimulating the hearing nerve 3.Hearing Nerve Transmits the signal which will be perceived by the brain as sound

13. Who is a candidate? Children >12 months of age with profound hearing loss who are not making auditory progress with appropriately fit amplification Adults with moderate to profound hearing loss who do not receive significant benefit from amplification Important to note: patients can have a significant amount of residual hearing and STILL be a candidate

14. Cochlear Implant Candidacy Cont. Candidacy has changed over the years…continues to evolve with new technology and surgical techniques Important that they go to a Cochlear Implant Clinic Team (surgeon, audiologist, speech language pathologist, psychologist, social worker)

16. Predicting success Adult considerations: Onset of deafness Duration of deafness Mode of communication Commitment/motivation to getting a cochlear implant Pediatric considerations: Age of the child at implantation Aural (re)habilitation Family commitment

17. Contraindications Deafness due to lesions of the acoustic nerve or central auditory pathway Active middle ear infection Absence of cochlear development Tympanic membrane perforations in the presence of active middle ear disease Nucleus™ Cochlear Implant System Physician’s Package Insert

18. Other considerations Psychological contraindications Medical contraindications to surgery Unrealistic expectations Disabilities that limit participation in (re)habilitation

19. What to Expect: The Surgery About two hours duration Requires general anesthesia Incision made behind ear Bed made in bone for implant Electrode array gently inserted into cochlea Day surgery or one night stay in hospital

20. What Happens After Surgery? Each patient is different, their surgeon will discuss with them possible limitations such as lifting and work restrictions or even flying Time and Patience Aural Rehabilitation….Practice, Practice, Practice

21. > Average word recognition scores with early generation cochlear implants were less than 20% 1 > We talked about “environmental awareness” > Sentence recognition scores exceed 80% in quiet (HINT scores) 2 > Today, we talk in terms of music appreciation and mainstream education Did You Know? 30 years agoToday 1 Krueger, B. et al. Performance Groups in Adult Cochlear Implant Users: Speech Perception Results From 1984 Until Today. Otology & Neurotology: June 2008 - Volume 29 - Issue 4 – p. 509-12. 2 The Nucleus Freedom® Cochlear Implant System: Adult post market surveillance trials results.

22. Using both Ears….

23. Maximizing the bimodal condition: Cochlear Americas and Resound Advanced Bionics and Phonak

24. Cochlear Americas and Resound Nucleus 6 (CP910) Resound Enzo

25. Wireless Compatibility Cochlear ™ Nucleus ® 6 & ReSound

26. Cochlear Americas Wireless Portfolio Remotes True Wireless Telecoil FM Technology

27. Advanced Bionics and Phonak Naida CI Q90 Naida Link

28. Advanced Bionics and Phonak Wireless Options: Phonak ComPilot Phonak TVLink Phonak EasyCall Roger Pen Roger 17 Receiver Phonak RemoteMic Nadia™ Link Ultra Power Nadia™ Link Receiver-in-the Canal Roger Clip-On Mic Phonak DECT Phone

29. Advanced Bionics and Phonak Wireless Options: Roger Pen

30. Advanced Bionics and Phonak Wireless Options Continued ComPilot TV Link ii

31. Advanced Bionics and Phonak Remote Mic Phonak EasyCall Phonak DECT Phone

32. MED-EL

33. Cochlear Implant Support Free support Apps for all three companies for trouble shooting and basic support Find a Clinic Customer Support Recipient Supports Groups Financial Services On line Community Forums Aural Rehabilitation Programs

34. Questions?