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How Do I Know if the Cochlear Implant is Working?. Gail S. Murray, Ph.D., CCC-A Associate Professor, CWRU Director, Audiology Services Clinical Director, Cochlear Implant Program UH Case Medical Center Rainbow Babies & Children’s Hospital August 5, 2009 Gail.murray@uhhospitals.org.

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How Do I Know if the Cochlear Implant is Working?

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How Do I Know if the Cochlear Implant is Working?


Gail S. Murray, Ph.D., CCC-A

Associate Professor, CWRU

Director, Audiology Services

Clinical Director, Cochlear Implant Program

UH Case Medical Center

Rainbow Babies & Children’s Hospital

August 5, 2009

Gail.murray@uhhospitals.org


Introduction

  • Cochlear Implant Manufacturers

    • Cochlear Americas (Nucleus)

    • Advanced Bionics (AB)

      • Also known as Clarion

    • Med-EL


Introduction

  • Each manufacturer supports multiple sound processor models.

  • Each manufacturer has “current” sound processor technology that is back-ward compatible with “older” implant technology.

  • Each sound processor requires slightly different troubleshooting procedures.


Troubleshooting made easy . . .

Identical Main Modules

Different Controllers


Recommendations for Schools

  • At least one person at school become familiar with the student’s sound processor.

  • Learn the model name of your student’s sound processor.

  • Learn the components or parts of the sound processor by name.

  • Practice preventative maintenance


Troubleshooting Toolbox

  • Be prepared to troubleshoot

  • Work with the parents & audiologist to have the following on hand:

    • Appropriate back-up batteries

    • Appropriate battery holder/rack

    • Monitor Headphones

    • Signal Check

    • Back-up transmitting cables

    • Lapel or Auxiliary Microphone


Nucleus Freedom Standard BTE Sound Processor

  • Sound Processing Module

  • Microphone(s)

  • Transmitting Coil/Cable Coil

  • Coil & Magnet

  • Controller

  • Batteries or Rechargeable Battery Module


Nucleus Freedom Body Worn Sound Processor

  • Sound Processing Module

  • Microphone(s)

  • Transmitting Cable/Coil

  • Coil & Magnet

  • Controller

  • Controller Shoe & Cable

  • Batteries or Rechargeable Battery Module


Nucleus Esprit 3G Sound Processor

  • Sound Processor

  • Microphone(s)

  • Transmitting Cable/Coil (missing in slide)

  • Coil & Magnet

  • (missing in slide)

  • Controls

  • Battery module


Advanced Bionics Harmony BTE Sound Processor and Components

  • Sound Processing Module & Controller

  • Microphone & Ear Hook

  • Transmitting Cable/ Coil

  • Coil & Magnet

  • Rechargeable Battery Module


Advanced Bionics Harmony BTE Sound Processor and Components

There are two other models of BTE processors

Auria

Platinum/CII BTE


MED-EL Ear-level Speech Processors

  • Tempo+/OPUS 1

    • Program/volume switches

    • Sensitivity dial

  • OPUS 2

    • Switch free design

    • FineTuner™


MED-EL Tempo+ BTE Sound Processor

  • Sound Processing Module & Controller

  • Microphone(s)

  • Transmitting Coil & Magnet

  • Transmitting Cable

  • Ear Hook

  • Battery Module


MED-EL Opus BTE Sound Processor

  • Sound Processing Module & Microphone(s)

  • Coil & Magnet

  • Transmitting Cable

  • Earhook

  • Battery Module

  • Connecting piece


Basic Troubleshooting Concepts

  • Establish a two-way communication & notification method with the student’s parent.

  • Incorporate an action plan for daily equipment checks into the student’s IEP


Basic Troubleshooting Concepts

  • Establish reliable speech-base feedback tools to use for daily listening check.

    • Ling 6 sounds test (aa, oo, ee, sh, ss, mm)

    • Closed set spondees (baseball, airplane)

    • Closed set words (colors, familiar names)

    • Open set words/sentences (What did you eat for breakfast; Who drove you to school).


Ling 6 Sound Check


Cochlear Implant Accessories – to have on hand

  • Monitor Headphones

  • Lapel or Auxiliary Microphone

  • Signal Check or System Sensor

  • Battery Charging System

  • Earhooks (T-Mic, Direct Connect, etc)

  • Audio or Interface Cables

  • User Manual (CD)


Nucleus Freedom BTE Accessories

  • Monitor Headphone

  • Lapel or Auxiliary Microphone

  • Signal Check/System Sensor

  • Battery Charging System

  • Earhooks (T-Mic, Direct Connect, etc)

  • Audio or Interface Cables

  • User Manual (CD)


Sprint Body Worn Accessories

  • Monitor Headphone

  • Lapel or Auxiliary Microphone

  • Signal Check/System Sensor

  • Battery Charging System

  • Audio or Interface Cables

  • User Manual (CD)


Freedom Sound ProcessorHelp Messages


Freedom Sound ProcessorHelp Messages

  • H1 = Battery flat

    • Check for proper battery insertion

    • Change batteries; change battery holder

  • H2 = Battery low

    • Change batteries

  • H3 = Coil error

    • Check for proper coil insertion & placement

    • Check for cable damage

    • Change coil


Freedom Sound ProcessorHelp Messages

  • H4 = Sound/stimulation error

    • Turn processor “Off”, “On”

    • Check/change microphone protector cover

    • Check/change coil

    • Check sensitivity & volume settings > 0

    • Use the lapel microphone to sound processor check microphone

    • Contact parent &/or student’s cochlear implant center


Freedom Sound ProcessorHelp Messages

  • H5 = MAP corrupt

    • Try alternate program

    • Contact student’s cochlear implant center

  • H6 = RF interference

    • Contact student’s cochlear implant center


Harmony Sound ProcessorHelp Messages


Harmony BTE 3 Color Help Messages

  • Red:

    • A communication error with implant

    • Processor/ear is mismatched

    • Headpiece off or loss of communication

  • Green:

    • Microphone is working

    • Program slot is empty

  • Orange:

    • Battery is low

    • Battery needs to be changed/dead

    • Battery charge status


MED-EL: Verifying normal equipment function

  • The red LED will illuminate 4-5 seconds when the processor is first activated (brief flashes for Opus 2)

  • This uploads the map, & performs a diagnostic check.

  • LED light continues to blink only when communicating a problem.


LED Indicator in MED-EL Processors

  • Processor status

  • Program errors

  • Low battery

  • Flashing patterns can be deactivated by the CI audiologist


MED-EL TEMPO+/OPUS 1


FineTuner Tips

  • Not needed during the day unless:

    • Child has need of the telecoil feature

    • Child needs to make a program or volume change

  • If processor batteries are changed, it reverts to the same settings previously in use

    • One exception: Telecoil on reverts to mic on


Basic Troubleshooting Concepts

  • Check for power

    • Processor turned on & in proper program

    • Check for visible signal light or LCD display

    • Replace batteries


Power Options

Ask parents to provide disposable battery pack option


Basic Troubleshooting Concepts

  • Check for visible defects

    • Frayed cables

    • Cracked casing or controller

    • Loose connections

      • Cables, component parts, batteries


Basic Troubleshooting Concepts

  • Check Transmitting Coil & Cables – Steps:

    1. Confirm that cable(s) is plugged in correctly.

    2. Hold the signal check over the transmitting coil when power is on.


Basic Troubleshooting Concepts

  • Check Transmitting Coil & Cables – Steps:

    3. Red light should illuminate.

    4. Replace transmitting coil one at a time; apply signal check after each component change.

    5. Check microphone if no transmission.

    MED-EL signal check: Nucleus:


Basic Troubleshooting ConceptsAdvanced Bionics


Basic Troubleshooting ConceptsAdvanced Bionics


Microphone Check


Basic Troubleshooting Concepts

  • Microphone Check Steps:

    • Turn off sound processor

    • Attach monitor headphones

    • Turn sound processor on

    • Perform listening check

      • Use Ling sounds & running speech

      • Own voice should be clear & static free

      • Move cables around & listen for static or intermittency

    • Apply Aux mic & compare sound


Use of Auxiliary Microphone

  • When the student’s headset or sound processor microphone produces no sound or sound of poor quality, the Aux/Lapel microphone may be used until a replacement microphone is available

  • Attach the lapel mic outside the student’s shirt, near the chin, and away from objects that may produce sound interference (e.g. jewelry).


Don’t forget about the internal device

  • When all else fails – refer the student back to the implant center &/or surgeon


Other Learning Tools

  • Join the hands-on demonstration at today’s Break-Out Sessions.

  • Accompany your student to the CI Center for a mapping session.

  • Attend the Greater Cleveland Cochlear Implant Support Group Meetings – 3 per year.


Help by Phone . . .

  • Cochlear Americas 800-523-5798

  • Advanced Bionics 800-678-2575

  • MED-EL 888-633-3524

    Ask for Customer Service, or for the “Audiologist on call”

  • The student’s Cochlear Implant Audiologist


Help on the Web . . .

  • http://www.cochlearamericas.com/PDFs/TeachersGuide.Chpt6.pdf

  • http://www.bionicear.com/tfs_

    • Interactive Troubleshooting guide on-line

  • http://www.medel.com/ENG/INT/60_Contact_and_support/020_download_center.asp


All questions will be honored and answered at the end of the morning proceedings. Please write your questions on a provided note card.


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