Cochlear Implants

1. Cochlear Implants Kirsten Marconi, B.A. The Northeast Ohio Au.D. Consortium Stark County ESCDecember 2, 2005

2. 4 years later… • William House & James Doyle • Worked together to come up with a way to electrically stimulate the auditory nerve endings in the cochlea. • Implanted several adult deaf volunteers in 1961 with single channel devices. • One of the volunteers received a multi-channel implant. • This implant “stimulated the cochlear at 5 different positions along its length, each sensitive to a different range of frequencies. • Purpose was to try to provide some speech discrimination. • Did not see any true benefit of the multi-channel versus the single channel implant, so he decided to focus on the single channel. • Eventually, due to problems with the insulation materials, the implants were unsuccessful and had to be removed.

3. 1969-1970 • William House teamed up with Jack Urban • Implanted 3 adults with multi-channel devices. • Insulation material had been perfected in the 60’s for use with heart pacemakers. • These implants were somewhat more successful. • Sensation of sound was sustained • House & Urban still focused on developing single channel implants. • Others in the United States, France & Australia were working on multi-channel devices.

4. Professor Graeme Clark • Motivated to develop a “bionic ear” largely because of his experiences with his father’s deafness. • Mid 60’s - Left a thriving surgical practice to try to develop a way to electrically stimulate the auditory nerve. • Ultimate goal: “speech understanding” • 1978- Implanted his first 3 patients. • Difficulty obtaining funding for his research. • Opposition: • 1. From physiologists who said that given the structure of the cochlea, it could not be done. As the effectiveness of implants became more apparent, this opposition lessened. • 2. From ENTs who felt the implant would damage the cochlea. This also diminished over time.

5. 1985-Today.. • 1985 • FDA approved implant for post-lingual adults • 1990 • FDA approved implant for children • Nucleus 22 Implants

6. Cochlear Implant Surgery • Usually runs about 2 hours • Under general anesthetic • The hair may or may not be shaved • Incision is made • A bed is drilled in the mastoid bone • Where they place the implant • Secured

7. Cochlear Implant Surgery • An opening is made into the cochlea • The electrode array is placed into the cochlea • The electrode array is secured in place • Packed with muscle • Impedances are checked by implant audiologist • Initial activation usually occurs around 4 weeks post-surgery • May be sooner

8. Cochlear Implant Surgery

9. Cochlear Implants • Sound is received from the microphone. • The sound is analyzed and digitized into coded signals by the internal circuit of the speech processor. • The coded signals are sent to the transmitter coil (the external portion that sticks onto the head). • The transmitter coil sends the coded signals across the skin to the implant where they are converted into electrical signals. • The electrical signals are sent to the electrode array to stimulate the hearing nerve fibers of the cochlea. • The stimulated auditory nerve fibers send the signals to the brain where they are recognized as sounds producing a hearing sensation.

10. Who’s eligible? • Currently: • Adults: severe to profound sensorineural hearing loss in both ears • Children (below age 2): a profound sensorineural hearing loss in both ears • Age 12 months or older  • Receive little or no benefit from hearing aids  • Adults: <50% open-set sentences • Children: <30% (MLNT, LNT) –or- lack of auditory progress • 6 month trial with hearing aids • No medical contraindications   • High motivation and appropriate expectations  • * Access to education and rehabilitation follow-up.

11. Cochlear Implants:Manufacturers & Products Cochlear Corporation Advanced Bionics Med-El

12. Cochlear Corporation • Implant: Nucleus 22 • Processors: • Spectra • ESPrit22 • ESPrit 3G

13. Cochlear Corporation • Implant: Nucleus 24 • Processors: • SPrint • ESPrit 3G

14. SPrint Processor

15. Sprint Processor

16. 3G Processor

17. 3G Processor

18. 3G Processor

19. Freedom System • Implant: • Nucleus Freedom with Contour Electrode • Processors: • BTE & Body worn Configurations

20. Freedom BTE

21. Advanced Bionics • Implants: • C II • HiRes 90K • Processors: • S-Series • Platinum Body • Platinum BTE • Auria BTE

22. Platinum Body Processor • 3 Buttons: * Off/On * Volume Control * Sensitivity Control

23. Auria BTE

24. Med-El • Implants: • Combi 40 + • Pulsar CI 100 • Processors: • Tempo Body • Tempo BTE

25. Tempo BTE • Can be worn 5 different ways • 1. Baby BTE • 2. Children’s Battery Pack • 3. Angled Battery Pack • 4. Straight Battery Pack • 5. Remote Battery Pack • 3 Programs • 1, 2 & 3 • 3 Volume Settings • X, Y & Z • X- usually the softest, Z- the loudest

26. FM: Fitting Consult the Phonak Fitting Guide Determine which system you are using Step-by-step guide to fit the system

27. FM Compatibilitywith Cochlear Implants • MicroLink is compatible with... • All implants • All generations • All maunfacturers • Depending on which generation you are working with, there may or may not be additional cables needed to fit the FM. • Compatibility guide • http://www.phonak.com/professional/productsp/fm/mlx.htm

28. Troubleshooting Things you will need to troubleshoot: Product Guide from Manufacturer Monitoring Earphones & Wand/Signal Check Phonak FM Guide MapCheck or Ling 6 Recording Form A good relationship with the implant audiologist!!