Cochlear Implants

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Cochlear Implants

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

3. 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.

4. 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.

5. 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.

6. 1985-Today.. 1985 FDA approved implant for post-lingual adults 1990 FDA approved implant for children Nucleus 22 Implants

7. 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

8. 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

9. Cochlear Implant Surgery

10. 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.

11. 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.

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

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

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

15. SPrint Processor

16. Sprint Processor

17. 3G Processor

18. 3G Processor

19. 3G Processor

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

21. Freedom BTE

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

23. Platinum Body Processor

24. Auria BTE

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

26. 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

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

28. FM Compatibility with 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

29. 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!!

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