Becoming familiar_rev2_Aug06

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Becoming familiar_rev2_Aug06
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What You Will Learn Today

• How the ear works
• How to interpret the audiogram
• Treatment Options for Hearing Loss
• Cochlear Implant Candidacy
• Management of a child with a cochlear implant

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How the Ear Works

• The ear consists of four main parts

Brian
Inner Ear
Outer Ear
Auditory Nerve
Middle Ear
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How the Ear Works
Outer and Middle Ear
Bones of the Middle Ear
Ear Drum
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How the Ear Works
Cochlea
Brain
Cochlea
Auditory Nerve
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What You Will Learn Today

• How the ear works
• How to interpret the audiogram
• Treatment options for hearing loss
• Cochlear Implant Candidacy
• Management of a child with a cochlear implant

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The Audiogram

• Audiogram A graph that shows an individuals type
  and degree of hearing loss.

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The Audiogram
Frequency Low Pitch to High Pitch
Loudness Soft to Loud
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The Audiogram
Normal Hearing
Mild Loss
Moderate Loss
Moderate Severe Loss
Severe Loss
Profound Loss
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The Audiogram
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The Audiogram
Three Types of Hearing Loss Sensorineural Conducti
ve Mixed
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The Audiogram
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The Audiogram
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The Audiogram
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Hearing Loss
Brain
Without functioning hair cells sound information
cannot reach the brain for processing.
Damaged Hair Cells in Cochlea
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What You Will Learn Today

• How the ear works
• How to interpret the audiogram
• Treatment Options for Hearing Loss
• Cochlear Implant Candidacy
• Management of a child with a cochlear implant

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Treatment Options for Hearing Loss

• Cochlear Implants

• Hearing Aids

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Treatment Options for Hearing Loss
Hearing Aids
Behind-the-ear
In-the-Canal
In-the-Ear
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How is a Cochlear Implant Different From a
Hearing Aid?

• Hearing Aidsacoustically amplify speech.
• Cochlear Implantsconvert speech information
  into electrical signals.
• Hearing Aidsrely on the responsiveness of
  healthy, inner ear sensory cells.
• Cochlear Implantsbypass the inner ear sensory
  cells and stimulate the hearing nerve directly.

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How Does a Cochlear Implant Work?
A Cochlear Implant consists of two main
parts Internal Equipment External
Equipment
or
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Internal Equipment HiRes 90K
Internal Electronics
Electrode Array
3 turn gold wire coil
Removable Magnet
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External Equipment For a Cochlear Implant
Sound Processors
Battery Supply
Headpiece
Microphone
Cable
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How Does a Cochlear Implant Work?

• Sound waves enter through the microphone.
• The sound processor converts the sound into a
  distinctive digital code.
• The electrically coded signal is transmitted
  across the skin through the headpiece to the
  internal portion of the device.
• The internal device delivers the sound to the
  electrodes.
• The electrodes stimulate the hearing nerve.
• The hearing nerve sends the signal to the brain
  for processing.

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What You Will Learn Today

• How the ear works
• How to interpret the audiogram
• Treatment Options for Hearing Loss
• Cochlear Implant Candidacy
• Current Candidacy Guidelines
• Steps to determine candidacy
• Management of a child with a cochlear implant

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Who is a Candidate for a Cochlear Implant?
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Who is a Candidate for a Cochlear Implant?
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Who is a Candidate for a Cochlear Implant?
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Who is a Candidate for a Cochlear Implant?

• Adults (18 years)
• Severe to Profound, bilateral sensorineural
  hearing loss
• Less than 50 speech recognition with hearing
  aids on open-set sentence recognition
• Children (12 months -17 years)
• Profound, bilateral sensorineural deafness
• (gt 90 dB HL)
• Little or no benefit from hearing aids

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Steps to Determine Pediatric Cochlear Implant
Candidacy

• Audiologic Evaluation
• Medical Evaluation
• Speech Language Evaluation
• Psychological Evaluation
• Educational Evaluation

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Team Approach
Teacher(s) of the Deaf
ENT Surgeon Pediatrician
Parents
Child
Speech and Language Therapist(s)
Psychologist Social Work
Audiologist
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• Audiological Evaluation

• Determine the type and degree of hearing loss
• Air bone conduction thresholds for each ear
• ABR OAEs
• Assess the childs current amplification system
• Aided sound field testing
• Aided speech perception testing
• Counseling
• Address realistic expectations
• Device selection
• Post-operative follow-up

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Medical Evaluation

• Determine cause of hearing loss (if appropriate)
• Assess status of middle ear cochlea
• CT scan/MRI
• Counseling
• Hearing loss
• Surgical procedure
• Surgery is usually out-patient
• Average time is 2.5 hours
• Typical incision is small
• Post surgical considerations
• Determination of ear to implant

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Speech Language Evaluation

• Areas assessed
• Vocabulary - knowledge of single words
• receptive
• expressive
• Language - word combinations, grammar
• receptive
• expressive
• Articulation/Intelligibility
• Reading skills
• Provides baseline information

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Psychological Evaluation

• Assessment of non verbal verbal IQ
• Verbal IQ assessed when appropriate
• Counseling for family
• Impact of hearing loss on the family unit
• Assessment of childs learning style
• Assessment of any other underlying issues
• Serves as a baseline evaluation

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Educational Evaluation

• Areas to consider
• Communication Methodology
• Support services
• Speech/language and auditory skill development
• Professional training

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What You Will Learn Today

• How the ear works
• How to interpret the audiogram
• Treatment options for hearing loss
• Cochlear Implant Candidacy
• Management of a cochlear implant

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Management of a Child with a Cochlear Implant

• Audiologic management
• Rehabilitation
• Parent commitment
• School Support

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Audiologic Management
Initial Stimulation or Hook Up
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Audiologic ManagementInitial Stimulation

• External equipment placed on child
• The sound processor is programmed
• Speech is introduced through the sound processor
• Informal assessment of childs initial responses
  to sound
• Counseling
• Care maintenance of equipment
• Follow up appointments
• Importance of therapy auditory integration

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Audiologic Management Programming consists of

• T levelelectrical current necessary to just
  detect the presence of sound.
• M Levelelectrical current necessary to hear the
  incoming sound as loud but comfortable.
• Sound Coding StrategyMethodology or formula
  used to transcribe acoustic sound into an
  electrical code.

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Audiologic Management

• Mapping very young children
• Clinical Experience
• Objective Measures

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Audiologic Management

• Follow Up Mapping

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Rehabilitation

• Rehabilitation is KEY
• A cochlear implant is NOT a cure for hearing
  loss.

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Parent Commitment
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School Support

• Support should include the following
• Understand what a cochlear implant is, how it
  functions and how to complete equipment
  troubleshooting
• Assist in the management of the device and child
• Perform behavioral listening checks to make sure
  the child is hearing on a daily basis
• Know where to find support and resource
  materials.
• Openly communicate with the students parents and
  cochlear implant center.

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Summary

• Cochlear implants are an effective treatment
  option for children and adults with a severe to
  profound sensorineural hearing loss.
• A multi-disciplinary approach is necessary when
  determining cochlear implant candidacy.
• Post-operative management of a child with a
  cochlear implant consists of programming of the
  sound processor and intensive rehabilitation.
• Parent commitment and school support are
  necessary components to ensure a childs success
  with a cochlear implant.