1. How Do I Know if the Cochlear Implant is Working?

2. Gail S. Murray, Ph.D., CCC-A Associate Professor, CWRU Director, Audiology Services Clinical Director, Cochlear Implant Program UH Case Medical Center Rainbow Babies & Children’s Hospital August 5, 2009 Gail.murray@uhhospitals.org

3. Introduction Cochlear Implant Manufacturers –Cochlear Americas (Nucleus) –Advanced Bionics (AB) Also known as Clarion –Med-EL

4. 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.

5. Identical Main Modules Different Controllers Troubleshooting made easy...

6. 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

7. 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

8. Sound Processor Components Sound Processing Module Microphone(s) Transmitting Coil/Cable Coil Coil & Magnet Controller (On the device or remote) Batteries or Rechargeable battery Module Fine Tuner

9. Nucleus Freedom Standard BTE Sound Processor Sound Processing Module Microphone(s) Transmitting Coil/Cable Coil Coil & Magnet Controller Batteries or Rechargeable Battery Module

10. 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

12. Nucleus Esprit 3G Sound Processor Sound Processor Microphone(s) Transmitting Cable/Coil (missing in slide) Coil & Magnet (missing in slide) Controls Battery module

13. Nucleus Sprint Body Worn Sound Processor Sound Processing Module & Controller Microphone(s) Short Transmitting Coil Coil & Magnet Long Transmitting Coil Batteries or Rechargeable Battery Module

14. Advanced Bionics Harmony BTE Sound Processor and Components Sound Processing Module & Controller Microphone & Ear Hook Transmitting Cable/ Coil Coil & Magnet Rechargeable Battery Module

15. There are two other models of BTE processors Auria Platinum/CII BTE Advanced Bionics Harmony BTE Sound Processor and Components

16. MED-EL Ear-level Speech Processors Tempo+/OPUS 1 –Program/volume switches –Sensitivity dial OPUS 2 –Switch free design –FineTuner™

17. MED-EL Tempo+ BTE Sound Processor Sound Processing Module & Controller Microphone(s) Transmitting Coil & Magnet Transmitting Cable Ear Hook Battery Module

18. MED-EL Opus BTE Sound Processor Sound Processing Module & Microphone(s) Coil & Magnet Transmitting Cable Earhook Battery Module Connecting piece

19. 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

20. 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).

21. Ling 6 Sound Check

22. 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)

23. 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)

24. Sprint Body Worn Accessories Monitor Headphone Lapel or Auxiliary Microphone Signal Check/System Sensor Battery Charging System Audio or Interface Cables User Manual (CD)

25. Freedom Sound Processor Help Messages

26. 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

27. Freedom Sound Processor Help 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

28. Freedom Sound Processor Help Messages H5 = MAP corrupt –Try alternate program –Contact student’s cochlear implant center H6 = RF interference –Contact student’s cochlear implant center

29. Harmony Sound Processor Help Messages

30. 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

31. 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.

32. LED Indicator in MED-EL Processors Processor status Program errors Low battery Flashing patterns can be deactivated by the CI audiologist

33. MED-EL TEMPO+/OPUS 1

34. 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

35. Basic Troubleshooting Concepts Check for power –Processor turned on & in proper program –Check for visible signal light or LCD display –Replace batteries

36. Power Options Ask parents to provide disposable battery pack option

37. Basic Troubleshooting Concepts Check for visible defects –Frayed cables –Cracked casing or controller –Loose connections Cables, component parts, batteries

38. 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.

39. 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:

40. Basic Troubleshooting Concepts Advanced Bionics

42. Microphone Check

43. 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

44. 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).

45. Don’t forget about the internal device When all else fails – refer the student back to the implant center &/or surgeon

46. 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.

47. 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

48. Help on the Web... http://www.cochlearamericas.com/PDFs/T eachersGuide.Chpt6.pdfhttp://www.cochlearamericas.com/PDFs/T eachersGuide.Chpt6.pdf http://www.bionicear.com/tfs_ –Interactive Troubleshooting guide on-line http://www.medel.com/ENG/INT/60_Conta ct_and_support/020_download_center.asp

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