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HAs vs. CIs

HAs acoustically amplify sound, relying on the responsiveness of the surviving hair cells.

CIs bypass absent or damaged hair cells and stimulate the nerve directly.


A Team Decision

Candidate in the center

- family/caregivers
- surgeon
- audiologist
- therapists (SLP, social worker)
- psychologist
- educational liaison
- teachers


Pediatrics Process

- Pre-operative Assessment
- surgery
- initial stimulation
- programming considerations
- follow-up routine


Goals of Pre-Operative Assessment

- determine if patient meets FDA candidacy criteria for AB
- assess non-audiologic factors influencing candidacy
- select ear to implant (or bilateral)
- counsel on potential benefits
- begin to set realistic expectations (UNDER-PROMISE and OVER-DELIVER)
- build positive rapport with patient and family
- provide resources for further info/education


FDA Criterion for pediatric AB CI

- 12 months - 17 yrs
- Profound bilateral SNHL (PTA > or = 90 dB HL)
- trial with appropriately fit HAs (can be waived)
- Little or no benefit from appropriately fit HAs
= Children or = 4: score of = 12% on difficult open-set word recognition test or = 30% on an open-set sentence test


Defining Benefit

What does benefit and success mean to the patient

- environmental sound awareness
- talking on phone
- ordering fast food meal
- ability to easily connect with family and friends
- being mainstreamed in school
- ability to hear parent say "I love you"


Pediatric Audiological Assessment

- ECochG/Otoacoustic Emissions
- Tympanometry
- Behavioral audiometry
- Speech Perception Testing


Pediatric Speech Perception Tools

0-24 mos:
- parent questionnaires (i.e., IT-MAIS)

2-4 yrs (Live Voice Presentation)
- Questionnaires, Closed and Open sets

5+ yrs (Taped presentation)
- Questionnaire, closed and open sets


Pediatric CI Surgery

Requires general anesthesia
Procedure takes ~1-2 hrs
Typically done as outpatient procedure
patients typically recover quickly with advanced in implant technology and surgical techniques


Intra-Operative Testing

- typically completed by audiologists from CI center
- some surgeons complete this
- typically consist of:
= conditioning electrodes
= impedance measures
= NRI (recommend 4 electrodes: 3, 7, 11, 15)


Preparing for Initial Stim

- limit # of ppl in programming room
- prepare caregivers on what to expect
- utilize NRI
- charge batteries


CI Pediatric Challenges

- limited language
- limited experience with auditory input
- limited attention span
- behavioral and compliance issues
- distraction (extended family, teacher, therapist, etc.)


Pediatric Initial Stim

select strategy
-start with 1 strategy and give at least a few months-6 of use with a particular speech processing strategy
- provide a CONSISTENT signal in which to develop auditory skills and language

perform objective measures

establish M-Levels
- utilize objective measures to assist in setting; however, behavioral responses always 'trump' objective measures

set program parameters

verifying audibility


Pediatric Typical Initial Responses

- looking at parent, audiologist, or computer
- seeking reassurance
- touching implant site
- slight body reflexes
- change in play activity
- surprise, pleasure, concern, bewilderment
- sometimes no behavioral response exhibited



Signs that sound may be too loud

- more active/aggressive play
- tension behaviors- twisting toys, fingers
- body tensing
- getting hot/red in face
- eye blinking
- distress, tears
- CH removes HP +/- SP



Setting Volume Control Range

- Goal- set VC to provide comfortable, consistent stimulation
- Young CH: restrict VC (-20 to 20)
- Very Young CH: restrict VC (-20 to 20 or 'off' 0 to 0)


Benefit may be influenced by:

- duration of HL
- age at time of fitting with amplification +/- implantation
- amount of HL or residual hearing
- etiology
- age at implantation
- mode of communication
- inconsistent function/use of CI
- presence of multiple handicapping conditions

- optimal fitting/programming of device(s)
- family support and follow-up
- (re)habilitation/therapy


Indications that re-programming/troubleshooting is needed

- decrease in speech perception ability
- decrease in speech production skills
- sudden resistance to wear
- concern reported for progress
- lack of expected progress over a period of time
- constant fiddling with device


Adult FDA Candidacy for AB CI

- bilateral severe-profound SNHL (PTA >/= 70 dB)
- Limited benefit from HAs: sentence score = 50% in ear to be implanted
- Healthy adult over 18 yrs
- Postlingual onset of deafness (after age 6 yrs)


Medical ContraIndications

- absence of cochlea or auditory nerve
- lesions of auditory nerve or central auditory pathway
- not healthy enough for anesthesia required for CI surgery
- active external or middle ear infection (needs to be eliminated before surgery)


Adult Speech Perception Testing

- auditory only (listening)
- Audio-visual
- Visual only

Type of Set: open and closed

Materials: sentences, words, consonant identification in vowel context (VCV)


Minimum Test Battery for Adult

- 2 Lists HINT sentences in quiet
- 2 Lists HINT sentences in noise
- 1 List CNC Monosyllabic words


Adult Initial Experiences

- initial reactions wil vary among adult users
- increased sound input may be overwhelming at first
- although initially speech may sound distorted or squeaky, most users report that this perception soon disappears with consistent use
- during 1st 3 months of implant use, post-lingual CI users demonstrate significant increases in speech perception


Adult Revised MSTB (Minimal speech test battery)

Recommended protocol post-implant

- 1 20-sentence list of AzBio sentences in quiet
- 1 20-sentence list of AzBio sentences in noise
- 1 50-word list of CNC words
- 1 16-sentence list-pair (8 sentences per list) of BKB-SIN pre-operativley; 1 20-sentence list-pair (10 sentences per list) of BKB-SIN post-operatively