Wk8c-Clinical Aspects-Odds

Question 1

What does the Ministry of Health (through OHIP) cover regarding CIs?

Answer 1

• the cost of the pre- and post-implant appointments
• the surgical costs
• the initial equipment kit

Question 2

What type of initial warranty do manufacturers generally have on CIs?

Answer 2

• 3-5 years (Med-EL is 5 years and includes cords but not batteries)
• Advanced Bionics and Cochlear Americas exclude the cords and batteries
• one time loss and damage policy

Question 3

What types of costs can patient’s and families expect?

Answer 3

• extended warranty ($600-700)
• ADP will assist with purchase of new device after 3 years if equipment breaks and is not under warranty, which covers 75% of the cost (max $5444), or up to $7258.67 if through ACSD/ODSP
• trade-in for upgrade costs typically around $2000-3000
• upgrade without trade-in costs around $3000-4000

Question 4

We can give all patients hearing in the normal to mild HL range (provided there are no medical complications), but we don’t know is what?

Answer 4

We don’t know how well each person will be able to use the sound from the implant to understand speech
-> can never guarantee how well someone will do with a CI

Question 5

A CI can give a representation of frequency and amplitude to the AN, but how is a CI different from a cochlea?

Answer 5

• only up to 22 channels vs 30,000 ganglion cells
• electrical range much smaller (10-20 dB vs 100 dB)
• > squeezing rich info (speech) into narrow bottleneck

Question 6

The number of neurons needed for speech comprehension is probably at least ____ - ____ with some in high frequency areas, but speech comprehension has been observed with some CIs where only 3,000 (__%) of surviving neuronal population

Answer 6

5000-10,000

10%

Question 7

What are some of the factors that play a role in CI success?

Answer 7

• amount of residual hearing
• age of identification of HL and beginning of intervention
• duration of hearing loss
• access to sound prior to implantation
• status of cochlea and AN
• degree of involvement in post-implantation rehab
• rehab approaches
• family involvement
• other medical, social, emotional and cognitive variables
• electrode insertion, activation and dynamic range
• “magic” factor

Question 8

How do we determine which ear is implanted (e.g. better or worse)?

Answer 8

• traditionally the better hearing ear
• most recently deafened
• worst vestibular function
• previous surgery (e.g. mastoidectomy) may make us choose the other ear
• pt preference (often most important factor)
• useful hearing aid use in one ear
• this is when we anticipate a monaural implantation

Question 9

Name 2 emerging trends in CIs

Answer 9

• newer speech processing strategies combining spectral and temporal info (e.g. ACE, Hi Res)
• closer to modiolus, current steering
• apical stimulation
• less current spread, more localized excitation
• younger implantation age (6 months/1 year)
• broader indications (single sided deafness, dizzy patients)
• smaller package (Totally Implantable system)

Question 10

Why must we refer Meningitis early?

Answer 10

• ossification of cochlea makes implantation difficult/impossible

Question 11

Are malformations always a contraindication?

Answer 11

No - depends on extent

Question 12

Is a Rehab program always needed? What should the focus be on?

Answer 12

Yes

Oral communication

Question 13

What are some of the controversies with CIs?

Answer 13

• are CI’s deaf culture genocide?
• how old is too old?
• how does life expectancy (e.g presence of another disease) factor into candidacy?
• Is total communication recommended/useful?
• should we implant with severe malformations of the cochlea?
• what is the best approach with marginal candidates (deaf/blind) who will have difficulties with AVT?
• who gets 2 CI’s and who doesn’t?