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

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Cochlear implants l.jpg

Cochlear Implants

Kirsten Marconi, B.A.

The Northeast Ohio Au.D. Consortium

Stark County ESCDecember 2, 2005


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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.


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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.


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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.


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1985-Today..

  • 1985

    • FDA approved implant for post-lingual adults

  • 1990

    • FDA approved implant for children

      • Nucleus 22 Implants


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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


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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



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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.


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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.


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Cochlear Implants:Manufacturers & Products

Cochlear Corporation

Advanced Bionics

Med-El


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Cochlear Corporation

  • Implant: Nucleus 22

    • Processors:

      • Spectra

      • ESPrit22

      • ESPrit 3G


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Cochlear Corporation

  • Implant: Nucleus 24

    • Processors:

      • SPrint

      • ESPrit 3G







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Freedom System

  • Implant:

    • Nucleus Freedom with Contour Electrode

  • Processors:

    • BTE & Body worn Configurations



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Advanced Bionics

  • Implants:

    • C II

    • HiRes 90K

  • Processors:

    • S-Series

    • Platinum Body

    • Platinum BTE

    • Auria BTE


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Platinum Body Processor

  • 3 Buttons: * Off/On * Volume Control * Sensitivity Control



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Med-El

  • Implants:

    • Combi 40 +

    • Pulsar CI 100

  • Processors:

    • Tempo Body

    • Tempo BTE


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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


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FM: Fitting

Consult the Phonak Fitting Guide

Determine which system you are using

Step-by-step guide to fit the system


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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


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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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