How Do I Know if the Cochlear Implant is Working?

1. How Do I Know if the Cochlear Implant is Working?

2. Gail S. Murray, Ph.D., CCC-A Associate Professor, CWRU Director, Audiology Services Clinical Director, Cochlear Implant Program UH Case Medical Center Rainbow Babies & Children’s Hospital August 5, 2009 Gail.murray@uhhospitals.org

3. Introduction • Cochlear Implant Manufacturers • Cochlear Americas (Nucleus) • Advanced Bionics (AB) • Also known as Clarion • Med-EL

4. Introduction • Each manufacturer supports multiple sound processor models. • Each manufacturer has “current” sound processor technology that is back-ward compatible with “older” implant technology. • Each sound processor requires slightly different troubleshooting procedures.

5. Troubleshooting made easy . . . Identical Main Modules Different Controllers

6. Recommendations for Schools • At least one person at school become familiar with the student’s sound processor. • Learn the model name of your student’s sound processor. • Learn the components or parts of the sound processor by name. • Practice preventative maintenance

7. Troubleshooting Toolbox • Be prepared to troubleshoot • Work with the parents & audiologist to have the following on hand: • Appropriate back-up batteries • Appropriate battery holder/rack • Monitor Headphones • Signal Check • Back-up transmitting cables • Lapel or Auxiliary Microphone

8. Nucleus Freedom Standard BTE Sound Processor • Sound Processing Module • Microphone(s) • Transmitting Coil/Cable Coil • Coil & Magnet • Controller • Batteries or Rechargeable Battery Module

9. Nucleus Freedom Body Worn Sound Processor • Sound Processing Module • Microphone(s) • Transmitting Cable/Coil • Coil & Magnet • Controller • Controller Shoe & Cable • Batteries or Rechargeable Battery Module

11. Nucleus Esprit 3G Sound Processor • Sound Processor • Microphone(s) • Transmitting Cable/Coil (missing in slide) • Coil & Magnet • (missing in slide) • Controls • Battery module

12. Advanced Bionics Harmony BTE Sound Processor and Components • Sound Processing Module & Controller • Microphone & Ear Hook • Transmitting Cable/ Coil • Coil & Magnet • Rechargeable Battery Module

13. Advanced Bionics Harmony BTE Sound Processor and Components There are two other models of BTE processors Auria Platinum/CII BTE

14. MED-EL Ear-level Speech Processors • Tempo+/OPUS 1 • Program/volume switches • Sensitivity dial • OPUS 2 • Switch free design • FineTuner™

15. MED-EL Tempo+ BTE Sound Processor • Sound Processing Module & Controller • Microphone(s) • Transmitting Coil & Magnet • Transmitting Cable • Ear Hook • Battery Module

16. MED-EL Opus BTE Sound Processor • Sound Processing Module & Microphone(s) • Coil & Magnet • Transmitting Cable • Earhook • Battery Module • Connecting piece

17. Basic Troubleshooting Concepts • Establish a two-way communication & notification method with the student’s parent. • Incorporate an action plan for daily equipment checks into the student’s IEP

18. Basic Troubleshooting Concepts • Establish reliable speech-base feedback tools to use for daily listening check. • Ling 6 sounds test (aa, oo, ee, sh, ss, mm) • Closed set spondees (baseball, airplane) • Closed set words (colors, familiar names) • Open set words/sentences (What did you eat for breakfast; Who drove you to school).

19. Ling 6 Sound Check

20. Cochlear Implant Accessories – to have on hand • Monitor Headphones • Lapel or Auxiliary Microphone • Signal Check or System Sensor • Battery Charging System • Earhooks (T-Mic, Direct Connect, etc) • Audio or Interface Cables • User Manual (CD)

21. Nucleus Freedom BTE Accessories • Monitor Headphone • Lapel or Auxiliary Microphone • Signal Check/System Sensor • Battery Charging System • Earhooks (T-Mic, Direct Connect, etc) • Audio or Interface Cables • User Manual (CD)

22. Sprint Body Worn Accessories • Monitor Headphone • Lapel or Auxiliary Microphone • Signal Check/System Sensor • Battery Charging System • Audio or Interface Cables • User Manual (CD)

23. Freedom Sound ProcessorHelp Messages

24. Freedom Sound ProcessorHelp Messages • H1 = Battery flat • Check for proper battery insertion • Change batteries; change battery holder • H2 = Battery low • Change batteries • H3 = Coil error • Check for proper coil insertion & placement • Check for cable damage • Change coil

25. Freedom Sound ProcessorHelp Messages • H4 = Sound/stimulation error • Turn processor “Off”, “On” • Check/change microphone protector cover • Check/change coil • Check sensitivity & volume settings > 0 • Use the lapel microphone to sound processor check microphone • Contact parent &/or student’s cochlear implant center

26. Freedom Sound ProcessorHelp Messages • H5 = MAP corrupt • Try alternate program • Contact student’s cochlear implant center • H6 = RF interference • Contact student’s cochlear implant center

27. Harmony Sound ProcessorHelp Messages

28. Harmony BTE 3 Color Help Messages • Red: • A communication error with implant • Processor/ear is mismatched • Headpiece off or loss of communication • Green: • Microphone is working • Program slot is empty • Orange: • Battery is low • Battery needs to be changed/dead • Battery charge status

29. MED-EL: Verifying normal equipment function • The red LED will illuminate 4-5 seconds when the processor is first activated (brief flashes for Opus 2) • This uploads the map, & performs a diagnostic check. • LED light continues to blink only when communicating a problem.

30. LED Indicator in MED-EL Processors • Processor status • Program errors • Low battery • Flashing patterns can be deactivated by the CI audiologist

31. MED-EL TEMPO+/OPUS 1

32. FineTuner Tips • Not needed during the day unless: • Child has need of the telecoil feature • Child needs to make a program or volume change • If processor batteries are changed, it reverts to the same settings previously in use • One exception: Telecoil on reverts to mic on

33. Basic Troubleshooting Concepts • Check for power • Processor turned on & in proper program • Check for visible signal light or LCD display • Replace batteries

34. Power Options Ask parents to provide disposable battery pack option

35. Basic Troubleshooting Concepts • Check for visible defects • Frayed cables • Cracked casing or controller • Loose connections • Cables, component parts, batteries

36. Basic Troubleshooting Concepts • Check Transmitting Coil & Cables – Steps: 1. Confirm that cable(s) is plugged in correctly. 2. Hold the signal check over the transmitting coil when power is on.

37. Basic Troubleshooting Concepts • Check Transmitting Coil & Cables – Steps: 3. Red light should illuminate. 4. Replace transmitting coil one at a time; apply signal check after each component change. 5. Check microphone if no transmission. MED-EL signal check: Nucleus:

38. Basic Troubleshooting ConceptsAdvanced Bionics

39. Basic Troubleshooting ConceptsAdvanced Bionics

40. Microphone Check

41. Basic Troubleshooting Concepts • Microphone Check Steps: • Turn off sound processor • Attach monitor headphones • Turn sound processor on • Perform listening check • Use Ling sounds & running speech • Own voice should be clear & static free • Move cables around & listen for static or intermittency • Apply Aux mic & compare sound

42. Use of Auxiliary Microphone • When the student’s headset or sound processor microphone produces no sound or sound of poor quality, the Aux/Lapel microphone may be used until a replacement microphone is available • Attach the lapel mic outside the student’s shirt, near the chin, and away from objects that may produce sound interference (e.g. jewelry).

43. Don’t forget about the internal device • When all else fails – refer the student back to the implant center &/or surgeon

44. Other Learning Tools • Join the hands-on demonstration at today’s Break-Out Sessions. • Accompany your student to the CI Center for a mapping session. • Attend the Greater Cleveland Cochlear Implant Support Group Meetings – 3 per year.

45. Help by Phone . . . • Cochlear Americas 800-523-5798 • Advanced Bionics 800-678-2575 • MED-EL 888-633-3524 Ask for Customer Service, or for the “Audiologist on call” • The student’s Cochlear Implant Audiologist

46. Help on the Web . . . • http://www.cochlearamericas.com/PDFs/TeachersGuide.Chpt6.pdf • http://www.bionicear.com/tfs_ • Interactive Troubleshooting guide on-line • http://www.medel.com/ENG/INT/60_Contact_and_support/020_download_center.asp

47. All questions will be honored and answered at the end of the morning proceedings. Please write your questions on a provided note card.