Pediatric CI Fitting Flashcards
(34 cards)
Does a physical evaluation need to be done on the day of activation?
Yes
The audiologist needs to inspect the incision site for signs of irritation or infection and perform otoscopy bilaterally
The audiologist also needs to inspect the area above the internal device to ensure it is stabilized on the desired location
If any thing remarkable is observed, the clinician should proceed with caution and alert the CI surgeon
Also prior to every programming session, the audiologist needs to visualize the site on which the transmitting coil rests to ensure that the magnet strength is not excessive
If pronounced indentation and/or discoloration are present, the magnet strength should be reduced
Do families often assume that CIs will restore “normal” hearing?
Yes, however, Cis require therapy, adaptation, and time to yield functional outcomes
Professionals must set realistic expectations before CI activation to avoid frustration or loss of trust.
Important points to communicate:
Cochlear implants are not the same as LASIK — outcomes are gradual, not immediate
CIs provide access to sound, not a restoration of normal auditory function
Spoken language may take months or longer to develop post-implantation
Do families need counseling prior to implantation?
Yes
Families need clear, compassionate counseling before activation to ease anxiety and set realistic expectations
To prepare families of pediatric recipients and put them at ease, audiologists need to discuss all of the potential responses following activation
What are the three ways a child might respond at the first activation?
Positive response - child may smile, vocalize, or seem pleased; this is encouraging, but not all children respond this way initially
Neutral or no observable reaction - this can concern families, but is often normal and not a sign of failure; audiology tools (eCAP, NRI, ART, NRT) can be used to reassure families that the implant is working
Upset or distressed response - the child may cry, remove the device, or seek comfort; often due to sudden exposure to a new sensory input; acceptable as long as the sound is not physically uncomfortable
What is eyes open ears on?
Counseling technique for families regarding full-time CI use and intensive therapy focused on the development of auditory and spoken language abilities
No gradual wear time - must be full time and immediate
A “gradual wear schedule” is not appropriate for young children with congenital hearing loss
Early auditory input is a neurodevelopmental emergency — the brain requires consistent sound exposure to develop speech and language pathways
Missing input during this critical period can cause irreversible delays in auditory and spoken language development
Should the clinician assist the family in ensuring that sufficient habilitative therapy is in place to support the child’s development after implantation?
Yes
Is it the clinicians responsibility to adequately educate the family about the different factors that influence the outcomes children achieve with their cochlear implants?
Yes
Numerous studies have shown that optimal cochlear implant outcomes are dependent on the family’s commitment to full-time implant use and audition-based therapy (Ching & Dillon, 2013; Ching et al., 2013; Moog & Geers, 2003)
Children need to hear ~46 million words by age 4 to support strong vocabulary growth (Hart & Risley, 1995)
Inconsistent hearing tech use = fewer words heard = greater risk of language delay
Studies (Sharma et al., Buckley & Tobey, Ching & Dillon) confirm the urgency of early, full-time input
Does the clinician need to set the stage for success on activation day and all subsequent programming sessions?
Yes
The use of appropriate décor and furniture: this step is especially important for young children
This action ensures optimal placement and seating for behavioral testing and successful reinforcement with toys, distracters, snacks, and other items needed to facilitate cooperation during the session
Babies and young toddlers may be seated in a highchair during programming
A child-sized picnic table is also an option for children who are able to sit still and is suitable for conditioning games, coloring books, play dough, and so forth, used during pediatric programming sessions
Is there often a test assistant?
Yes
Most clinics assign an audiologist to program the device and a second professional—often another audiologist or a speech-language pathologist—to assist with testing
One person alone cannot effectively manage programming, child behavior, and cooperation during long sessions
A dedicated test assistant helps ensure accurate results and a smoother experience for the child
What is the role of the test assistant in pediatric programming?
Facilitating a conditioned response from the child
Keeping the child engaged and focused
Ensuring the transmitting coil remains on the head
Managing the child’s behavior and comfort
Assisting with objective measures (e.g., electrically evoked stapedial reflex threshold)
Observing and confirming the child’s responses to auditory stimuli
Does a child’s CI need to be carefully and appropriately programmed?
Yes
There are a number of different techniques used to set stimulation levels for pediatric CI recipients
For children, should you stick with default parameters and focus on stimulation levels?
Yes
Use the manufacturer-recommended signal coding strategy as a first step
If audiologic assessment, and more importantly, speech and language development are unfavorable, then a reasonable approach is to try an alternative signal coding strategy or stimulation rate
However, clinicians should primarily focus on establishing the most appropriate stimulation levels for a child rather than switching signal coding strategies or adjusting other mapping parameters
Does learning to listen with a CI take time?
Yes, it’s a gradual process and it’s not immediate
Initial activation focuses on comfort and audibility across speech frequencies
Early cochlear implant programs are often conservative and may need gradual adjustments over time
Some recipients tolerate an ideal amount of stimulation within days, while others need several weeks to reach ideal levels
Parents may expect immediate understanding, but speech and environmental sounds may not be meaningful at first for newly implanted children.
Activation day = “hearing birthday” – the start of auditory access
Development of speech understanding and spoken language depends on consistent exposure to intelligible speech
How can you determine threshold levels in children?
Using age-appropriate behavioral audiometry techniques
Behavioral observation audiometry (BOA)
Visual reinforcement audiometry (VRA)
Conditioned play audiometry (CPA)
Standard audiometry
What are some techniques for setting the T-levels in young children?
The same ascending/descending method used for adults is also appropriate for young children
Larger step sizes can help when working with children who have limited attention spans
Interpolation is used to estimate T levels on unmeasured channels (measurement in a few electrodes and then fills in for the others)
T levels are likely above true thresholds, therefore, a slight decrease in the T levels maybe needed to account for suprathreshold responses; these adjusted level become the T levels
T levels in children appear to increase rather significantly through the first few months of implant use and stabilize by 3 months to 1-year post implantation; therefore, children should be seen frequently for mapping during the first few months of CI use
How do you confirm adequate T-levels and audibility across the speech frequency range?
Ling Six Sounds
Detection of all six sounds indicated that the child has access to the full range of speech sounds
How do you optimize SF detection thresholds?
Target thresholds for warble tones in soundfield:
Ideally: 20–25 dB HL; thresholds that are better than 15 dB HL likely indicate that stimulation for low-level sounds is too high
Acceptable upper limit: 30 dB HL
High frequencies (2000–4000 Hz) require extra attention:
Should be ≤ 25 dB HL due to low-level phonemes in this range
Low frequencies (250–500 Hz) may tolerate thresholds closer to 30 dB HL because low-frequency phonemes are more intense
How should you think about t-levels?
Volume control for quiet sounds
Should clinicians be attentive for signs of insufficient access to low-level sounds?
Yes
If caregivers report the child does not consistently respond to soft sounds, T levels may need to be increased
If sound-field detection thresholds are elevated, T levels should be increased to provide better access to low-level sounds
Should the clinician rule out microphone issues before adjusting t-levels?
Yes
Slightly malfunctioning microphones typically cause greater elevation for high-frequency sounds
More significant faults may cause elevated sound-field thresholds across the frequency range
If the sound processor contains microphone covers to protect against moisture and debris, then the clinician should ensure that the covers are clean and free of obstruction and debris (common culprit of elevated SF thresholds)
What are the different strategies available to estimate upper stimulation levels?
Psychophysical loudness scaling for single channel - requires feedback from patient
Global adjustment in live speech - global adjustment from t-level, flat map, flat map with fine tuning (used in infants and young children)
Estimation from objective measures
What is psychophysical loudness scaling?
Used primarily with older children (typically 8–9 years and up) and adults to determine upper stimulation levels
The clinician presents pulsed electrical signals to individual electrode(s), increasing loudness gradually
Recipients respond by selecting a loudness level from a visual chart
Procedure is repeated across multiple electrodes to determine frequency-specific levels
Advantages: These measures help identify if a child is struggling to access sounds in a specific frequency range or finds a certain channel aversive
Limitation: Requires consistent reliable responses, making them less appropriate for young children
What are global adjustments in live speech mode?
Clinicians increase upper-stimulation levels globally in live speech
Increasing all channels simultaneously, allowing the recipient to listen and provide feedback in real time
Has the advantage of being fairly quick and simple
A potential limitation is the fact that the stimulation and loudness levels at each individual channel may not be optimized
Programming begins by measuring minimal electrical detection levels and then upper-stimulation levels are globally increased from the t-level profile using live speech mode
Start well below where you think t-levels are present c and t-levels simultaneously and then present live speech and look for a reaction; when you get reaction, mark t-levels and continue shifting c-levels
Clinicians observe the child’s behavior for signs of discomfort or overstimulation (e.g., facial changes, flinching, withdrawing from sound).
If the child shows signs of distress, programming should be immediately stopped and levels adjusted to ensure comfort
What is flat map?
Start with flat stimulation levels (T + C), initially inaudible to the child
Stimulation levels are all the same for every electrode
In live speech mode, gradually increase stimulation in small steps while the child listens to speech or environmental sounds (e.g., “ba, ba, ba”; “hi, Johnny!”)
Identify the level where the child first responds to sound—this is used to set T Levels.
Continue increasing upper-stimulation levels while observing the child’s responses to sounds until desired loudness is achieved
Think of this as a starting point for the map, every visit and as they get older their map is refined
