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Introduction to Amplification and Aural Rehabilitation > Implantable devices > Flashcards

Implantable devices Flashcards

1
Q

When are implantable devices typically considered?

A

When hearing aids do not offer adequate auditory benefit and all other options are explored

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2
Q

What is the audiologist’s role with implantable hearing devices?

A
  1. Carry out the hearing assessment
  2. Fit hearing aids optimally and know when to stop trying
  3. Provide adequate advice
  4. Onward referral at the right time and not too late
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3
Q

What is the role of a hearing implant audiologist?

A
  1. Candidacy assessment: do all of the audiological assessments again in order to cross-check previous results, make sure the referral is appropriate
  2. IHD programming and troubleshooting
  3. IHD fine tuning
  4. Multidisciplinary team member
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4
Q

Why are multidisciplinary teams important for hearing implant patients and who are the members of this team?

A

-Multidisciplinary teams make sure that there is a consensus on the management of the patient and that all of their other difficulties are taken into consideration
-Other aspects of their life must be appropriate for surgery
-Audiologists, speech and language therapists, ENTs and psychologists form part of the multidisciplinary team

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5
Q

What is the most common assessment route for IHDs?

A
  1. Audiological assessment (case history, PTA, tymps, OAEs, ABR)
  2. HA trial (if applicable)
  3. SALT assessment (counselling and discussion of options)
  4. MRI/CT (to ensure the patient can be implanted)
  5. MDT discussion (decision to treat/ not treat)
  6. Consent for surgery
  7. Activation (2-4 weeks post op)
  8. Rehabilitation (depending on patient background)
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6
Q

What are the four types of implantable hearing devices?

A
  1. Bone conduction implants (BCI): sometimes referred to as BAHA (Bone Anchored Hearing Aids)
  2. Middle ear implants (MEIs)
  3. Cochlear implants (CIs)
  4. Auditory brainstem implants (ABIs)
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7
Q

Describe how bone conduction implants (BCIs) work

A

-Bypass the outer/ middle ear and transmit sound to the cochlea
-Function as a bone conductor
-Placed on mastoid region

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8
Q

Who are the ideal candidates for BCIs?

A

Children with glue ear problems and people with microtia

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9
Q

What is the age at which BCIs are considered?

A

5+ because the skull is not fully formed until then

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10
Q

Who are BCIs contraindicated for?

A

-People with bone disease
-People who are sensitive/ allergic to the materials used
-People with psychological, emotional or psychological disorders that would interfere with surgery or the ability to allow suitable rehabilitation
-Caution for those with radiotherapy in the implant area

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11
Q

What kind of hearing loss is ideal for BCIs?

A

-Conductive/ mixed hearing loss
-Ideally BC thresholds should be better than 55 dB
-Single sided deafness
-Concept of ‘dominant cochlea’ picking up stimulation from mastoid vibration
-Overcoming the air-bone gap
-Ideally BC thresholds should be between 0-45 dB from 0.5 kHz to 2 kHz

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12
Q

Describe percutaneous BCIs

A

-Small titanium implant is surgically placed in the bone behind the ear
-An abutment is attached to the implant and protrudes through the skin
-The sound processor connects to the abutment

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13
Q

What are the advantages and disadvantages of percutaneous BCIs?

A

Advantages: Provides better hearing outcomes, MRI compatible
Disadvantages: risk of complications at the abutment site so the patient has to ensure adequate hygiene, may not be aesthetically acceptable

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14
Q

Describe transcutaneous BCIs

A

-Transmits sound through the skin via internal and external magnets
-A small implant and internal magnet are surgically placed in the bone behind the ear
-An external magnet is attached to the sound processor
-The sound processor converts sounds to vibrations and transmits these to the implant via the magnet

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15
Q

What are the advantages and disadvantages of transcutaneous BCIs?

A

Advantages: No abutment, less risk of complications and infections
Disadvantages: May not be MRI compatible, less powerful hearing outcomes as the transmission is lost through the skin

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16
Q

Describe how middle ear implants (MEIs) work

A

-MEIs work by inducing direct movement of the ossicular chain, causing amplification of the vibrating ossicles
-The implant is attached to the middle ear bones/ the membrane window at the cochlea
-They can also be used in sensorineural hearing loss where hearing aids cannot be used

17
Q

Who are middle ear implants primarily used for?

A

-Conductive/ mixed hearing loss
-Moderate to severe sensorineural hearing loss
-Inability to maintain percutaneous BCI

18
Q

Why may hearing aids not be sufficient in severe to profound sensorineural hearing loss?

A

-Hair cells are severely malfunctioning or large numbers are missing
-The conversion of movement caused by sound into neural signals is weakened
-The auditory nerve is under-stimulated
-Loss of audibility and clarity of speech sounds
-Hearing aids may not be able to provide sufficient amplification

19
Q

Describe how a cochlear implant (CI) works

A

-By-passes the damaged cochlea and stimulates the functioning auditory nerve directly

20
Q

What are the two components of the cochlear implant?

A
  1. Internal component: Magnet, electronics or implant package, electrode array
  2. External component: Speech processor, battery, coil and coil cable, magnet
21
Q

What are the risks of cochlear implant surgery?

A

-Anaesthetic
-Partial insertion of the device
-Facial weakness
-Loss of residual hearing
-Infection
-Bruising/ pain/ numbness
-Dizziness
-Taste disturbance
-Tinnitus
-Implant failure
-Implanting a bigger magnet may thin out the skin on the patient’s head

22
Q

According to NICE guidelines, in which circumstances is a unilateral cochlear implantation the recommendation?

A

Patients with bilateral severe to profound deafness (PTA thresholds 80 dB or greater at 2 or more frequencies 500-4000Hz) who do not benefit from hearing aids

23
Q

How is hearing aid benefit assessed prior to referral for cochlear implantation?

A

-For adults: a phoneme score of 50% or greater on the AB word test presented at 70 dBA
-For children: speech, language and listening skills appropriate to age, developmental stage and cognitive ability

24
Q

According to NICE guidelines, in which circumstances is a bilateral cochlear implantation the recommendation?

A

-The same criteria as unilateral
-However the patient must either be a child or an adult who is blind or has other disabilities which increase reliance of auditory stimuli as a primary sensory mechanism

25
Q

What is electric acoustic stimulation (EAS)

A

-Cochlear implant is only inserted partially
-In high frequency sensorineural hearing loss only the basal part of the cochlea is implanted as this part codes for the higher frequencies
-The speech processor will contain a cochlear implant and a HA component
-Lower frequencies are amplified via the HA component
-Can be switched to a cochlear implant if the patient ends up losing the lower frequencies progressively

26
Q

What are the CI goals for paediatric patients?

A

-Primary goal is promoting appropriate speech and language development
-CIs for those with congenital severe to profound hearing loss is advised as soon as possible

27
Q
  1. Implantation after the age of ___ years can result in poor progress
  2. Children who receive a CI before the age of ___ tend to follow the normal development trajectory
A
  1. 5 years
  2. 3 years
28
Q

What are the CI goals for adult patients?

A

-Increased awareness of environmental sounds
-Improved speech perception in quiet
-Decreased overall listening effort
-Less reliance on lip-reading or need for additional cues such as subtitles

29
Q

What are some of the variables affecting outcomes post CI?

A

-Duration of deafness and age of onset of HL
-Pre/post lingual deafness and communication mode
-Aetiology
-Degree of hearing loss
-General medical
-Patient/ family commitment to rehabilitation

30
Q

Hearing aids provide ___ hearing
Cochlear implants provide ____ hearing

A
  1. Acoustic
  2. Electrical
31
Q

What are the possible remaining challenges following cochlear implantation?

A
  1. Speech in noise perception
  2. Using the telephone (particularly with unfamiliar speakers)
  3. Following speech in a group setting
  4. Music appreciation
32
Q

Who are auditory brainstem implants (ABIs) suitable for?

A

Patients who lack/ have a significantly damaged cochlea (which cannot be implanted) or auditory nerve

33
Q

What are the two components of the ABI?

A
  1. Internal component: electrode array (placed on the cochlear nucleus) and receiver stimulator (behind the ear, under the skin)
  2. External component: speech processor, battery, coil and coil cable
34
Q

What is the success rate of ABI?

A

7%

35
Q

What are the possible complications with ABI?

A

-Even with a good MRI it is difficult to know which part of the brainstem is coding for the auditory part
-Sometimes when the device is stimulated it codes for other parts and induces a variety of symptoms

36
Q

What affects ABI outcomes?

A

-Electrode array placement/ number of active electrodes
-Candidate’s hearing and medical history
-Additional needs (cognitive ability)
-Commitment to rehabilitation

37
Q

How long can ABI rehabilitation take for things to become normal in the best case scenario?

A

Up to 1 year

Introduction to Amplification and Aural Rehabilitation (9 decks)

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