CSD 5400 REHABILITATION PROCEDURES FOR THE HARD OF HEARING Amplification Implantable Hearing Aids Cochlear Implants

At present, cochlear implantation is an option available to profoundly deaf children and adults whose hearing levels are 90 dB HL or worse Estimated at 1% of the deaf and hard-of- hearing population in the US About 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-Kids 1.Child must be between the ages of 18 mo and 17 yrs 2.The child must present with a profound bilateral SNHL 3.The child must demonstrate little or no benefit from appropriate binaural HAs 4.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 from the 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) components Electrodes, receiver stimulator, antenna, magnet External (worn) components Microphone, external transmitter, cords, speech processor (body worn or BTE)

Components to the Implant Incoming 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 processor Also FDA approved for adult users

Currently Available Systems The Clarion System manufactured by Advanced Bionics Corporation Also FDA approved for adult users

Currently Available Systems The Med El Combi 40+ manufactured by Med El Corporation Not FDA approved yet for adults Undergoing current clinical trials Approved for kids, though

Process of Implantation Stages of the implantation process include: Candidacy selection Surgery Implant Activation Habilitation

Candidacy Selection--kids Typically performed by a multi-disciplinary team of professionals that include Audiologist, 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 measures Typically no better than 20%

Cochlear Implant Activation Mapping Procedure that requires the user to respond to an electrical signal that’s delivered to each electrode individually Thresholds Electrical 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 levels Electrical 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 Implants Patient Management and Aural Rehabilitation Videos by Mary Jo Osberger Nancy Tye-Murray