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CSD 5400 REHABILITATION PROCEDURES FOR THE HARD OF HEARING. Amplification Implantable Hearing Aids Cochlear Implants. Cochlear Implants. At present, cochlear implantation is an option available to profoundly deaf children and adults whose hearing levels are 90 dB HL or worse

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CSD 5400REHABILITATION PROCEDURES FOR THE HARD OF HEARING

Amplification

Implantable Hearing Aids

Cochlear Implants


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Cochlear Implants

At present, cochlear implantation is an option available to profoundly deaf children and adults whose hearing levels are 90 dB HL or worse

Estimated at 1% of the deaf and hard-of-hearing population in the US

About 1 million users


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Children vs Adults

By and large, the differences in the candidacy and types of implants FDA approved between these two groups are small

For the most part, the requirements for an adult user are less restrictive

We’ll limit our discussion to children


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Audiological Candidacy-Kids

  • Child must be between the ages of 18 mo and 17 yrs

  • The child must present with a profound bilateral SNHL

  • The child must demonstrate little or no benefit from appropriate binaural HAs

  • The child must participate in a 3-6 mo hearing aid trial (can include vibrotactile HAs) if there has been no previous aided experience


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Opposition fromthe Deaf Community

Deaf Community leaders have long opposed the implantation of children

School for the Deaf enrollment figures in the US over the past 20 years have dropped more than 50%

Deaf Community views cochlear implants a threat to their existence and a major reason for enrollment trends in these state centers of deaf culture

Parents need to be aware of the impact of cochlear implants within medical, educational, social and political contexts


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Components to the Implant

Internal (implanted) components

Electrodes, receiver stimulator, antenna, magnet

External (worn) components

Microphone, external transmitter, cords, speech processor (body worn or BTE)


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Components to the Implant

Incoming sound detected by the microphone and transmitted through a cord to the speech processor

Processed signal is forwarded through a cord to the external transmitter placed over the internal receiver via internal and external magnets

Signal reaches the internal receiver via FM transmission and then delivered to the electrodes


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Currently Available Systems

Nucleus 22 and 24 System manufactured by Cochlear Corporation

Here is their latest generation Nucleus 24 Sprint and ESPrit, which has an ear-level signal processor

Also FDA approved for adult users


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Currently Available Systems

The Clarion System manufactured by Advanced Bionics Corporation

Also FDA approved for adult users


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Currently Available Systems

The Med El Combi 40+ manufactured by Med El Corporation

Not FDA approved yet for adults

Undergoing current clinical trials

Approved for kids, though


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Process of Implantation

Stages of the implantation process include:

Candidacy selection

Surgery

Implant Activation

Habilitation


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Candidacy Selection--kids

Typically performed by a multi-disciplinary team of professionals that include

Audiologist, SLP, surgeon, teacher of the deaf and sometimes a psychologist and social worker

Adequate trial (3-6 mo) with conventional forms of amplification is mandatory

Need to demonstrate a maximum level of auditory speech perception using standardized assessment measures

Typically no better than 20%


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Cochlear Implant Activation

Mapping

Procedure that requires the user to respond to an electrical signal that’s delivered to each electrode individually

Thresholds

Electrical pulses are delivered to a designated electrode at a particular current level and the lowest level the listener consistently identifies sound sensation is the T-level

Comfort levels

Electrical pulses are delivered to a designated electrode at a particular current level and the highest level the listener finds comfortable is the C-level


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Current Trends

Current Issues with Cochlear Implants

Patient Management and Aural Rehabilitation

Videos by

Mary Jo Osberger

Nancy Tye-Murray


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