csd 5400 rehabilitation procedures for the hard of hearing amplification implantable hearing aids...
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CSD 5400REHABILITATION
PROCEDURES FOR THE HARD OF HEARING
AmplificationImplantable Hearing Aids
Cochlear Implants
Cochlear Implants
At present, cochlear implantation is an option available to profoundly deaf children and adults whose hearing levels are 90 dB HL or worseEstimated at 1% of the deaf and hard-of-
hearing population in the USAbout 1 million users
Children vs Adults
By and large, the differences in the candidacy and types of implants FDA approved between these two groups are small
For the most part, the requirements for an adult user are less restrictive
We’ll limit our discussion to children
Audiological Candidacy-Kids1. Child must be between the ages of 18
mo and 17 yrs2. The child must present with a profound
bilateral SNHL3. The child must demonstrate little or no
benefit from appropriate binaural HAs4. The child must participate in a 3-6 mo
hearing aid trial (can include vibrotactile HAs) if there has been no previous aided experience
Opposition fromthe Deaf Community
Deaf Community leaders have long opposed the implantation of children
School for the Deaf enrollment figures in the US over the past 20 years have dropped more than 50%Deaf Community views cochlear implants a
threat to their existence and a major reason for enrollment trends in these state centers of deaf culture
Parents need to be aware of the impact of cochlear implants within medical, educational, social and political contexts
Components to the Implant
Internal (implanted) componentsElectrodes, receiver
stimulator, antenna, magnet
External (worn) componentsMicrophone, external
transmitter, cords, speech processor (body worn or BTE)
Components to the ImplantIncoming sound detected by
the microphone and transmitted through a cord to the speech processor
Processed signal is forwarded through a cord to the external transmitter placed over the internal receiver via internal and external magnets
Signal reaches the internal receiver via FM transmission and then delivered to the electrodes
Currently Available Systems
Nucleus 22 and 24 System manufactured by Cochlear Corporation
Here is their latest generation Nucleus 24 Sprint and ESPrit, which has an ear-level signal processorAlso FDA approved for
adult users
Currently Available Systems
The Clarion System manufactured by Advanced Bionics CorporationAlso FDA approved
for adult users
Currently Available Systems
The Med El Combi 40+ manufactured by Med El CorporationNot FDA approved
yet for adultsUndergoing current
clinical trials
Approved for kids, though
Process of Implantation
Stages of the implantation process include:Candidacy selectionSurgeryImplant ActivationHabilitation
Candidacy Selection--kids
Typically performed by a multi-disciplinary team of professionals that includeAudiologist, SLP, surgeon, teacher of the deaf and
sometimes a psychologist and social worker
Adequate trial (3-6 mo) with conventional forms of amplification is mandatory
Need to demonstrate a maximum level of auditory speech perception using standardized assessment measuresTypically no better than 20%
Cochlear Implant Activation
MappingProcedure that requires the user to respond to
an electrical signal that’s delivered to each electrode individually
ThresholdsElectrical pulses are delivered to a designated
electrode at a particular current level and the lowest level the listener consistently identifies sound sensation is the T-level
Comfort levelsElectrical pulses are delivered to a designated
electrode at a particular current level and the highest level the listener finds comfortable is the C-level
Current Trends
Current Issues with Cochlear ImplantsPatient Management and Aural
RehabilitationVideos by
Mary Jo OsbergerNancy Tye-Murray