Fundamental Practices of Programming

Question 1

What is the goal of pre-implant counseling?

Answer 1

To establish a relatively conservative and realistic expectation with the implant and review typical performance at activation while still convincing the candidate that cochlear implantation is in his or her best interests
Strike a balance between conservative outlook and understanding the value of cochlear implantation
To discuss the schedule of audiological, medical, and rehabilitative appointments before and after cochlear implantation, preparing families for associated time and financial commitments
To familiarize patient/ family with the implant hardware
To provide written materials to the patient/family
Implant manufacturers provide written materials covering implantation details, accessible on their website

Question 2

Is establishing realistic expectations one of the most important objectives prior to activation?

Answer 2

Yes
Unfortunately, no matter how thoroughly expectations are discussed, patients and families often are discouraged with performance during the first few days of even weeks of use

Question 3

What are some reasons for patient dissatisfaction with initial cochlear implant use?

Answer 3

The signal from a CI is much different from that of a hearing aid
A period of acclimatization is required for the auditory system to adjust to the new signal
Little or no exposure to sound prior to implantation in most young children have; consequently, a period of auditory-focused speech language therapy normally is required before conversational spoken language skills emerge

Question 4

What is the CI fitting procedure?

Answer 4

Review surgical report
Physical examination
Selecting a signal coding strategy
Streamlined vs comprehensive programming
Measuring stimulation levels
Adjustments to special parameters

Question 5

Is it standard practice for the surgeon to request a post-op x-ray?

Answer 5

Yes, to confirm electrode placement
Audiologist needs to confirm with the cochlear implant surgeon about any intracochlear electrode contacts that are not favorably or fully inserted into the cochlea
Surgeon should inform the programming audiologist of any other pertinent details that may influence programming

Question 6

What should be included in the physical examination on the day of activation?

Answer 6

Perform otoscopy on both ears
Examine skin flap for signs of irritation or infection
Any remarkable observations should be approached cautiously, with the CI surgeon alerted if necessary
Prior to every programming session, visualize the site on which the transmitting coil rests to ensure that the magnet strength is not excessive
Reduce magnet strength, if pronounced indentation and/or discoloration are present

Question 7

How do you determine appropriate magnet strength?

Answer 7

A subjective skill that the clinician may need to perfect over time
It is important to select a magnet strength that is sufficient to prevent the transmitting coil from repeatedly falling off of the recipient’s head
It is more important that the magnet strength is not too great because excessive adherence of the coil may compromise circulation to the skin underneath the coil

Question 8

What can result from prolonged excessive magnet strength?

Answer 8

Skin necrosis under the coil
Potentially leading to skin flap breakdown and requiring reimplantation.
Older children and adults: will typically complain of a headache or a dull discomfort if the coil magnet strength is too strong
Young children may not be able to verbalize any discomfort, posing a greater concern