Bilateral Cochlear Implants

1. National Cochlear Implant ProgrammeBeaumont Hospital & Children’s University Hospital, Temple Street Bilateral Cochlear Implants Jennifer Robertson, Clinical Specialist SLT May 2014

2. What are the Benefits of Bilateral Cochlear Implants? • Sound localisation • Listening in noise • Ease of listening • Two processors mean reduced likelihood of being without sound in case of breakdown All resulting in optimum listening opportunities for developing spoken language

3. A second cochlear implant will not: • Restore normal hearing • Resolve additional speech/language or learning problems

4. What are likely challenges? • Perception of sound with the second implant may be poorer due to a longer duration of deafness in that ear • The second implant may be distracting and unhelpful until the individual becomes used to it which will take time and perseverance • Sound perception might be different from the first implant • The risk of tinnitus and balance disturbances • Residual hearing in the second ear will be damaged by having an electrode array inserted • The operation and its associated risks e.g. anaesthetic Remember: It takes time and practice to get used to the sound and gain good benefit

5. BY KIND PERMISSION OF MANCHESTER AUDITORY IMPLANT CENTRE Which children may benefit from a second cochlear implant? • Red – indicators of little or no benefit • Long time since 1st CI surgery (greater than 8 years) • No hearing in second ear • No hearing aid use in second ear • Intermittent cochlear implant use • Sign language is the main mode of communication • No ability to process auditory information in the second ear • Poor attendance at appointments • Amber – indicators of possible benefit • Time since 1st CI surgery between 5-8 years • No or limited hearing or some residual low-frequency hearing in second ear, but no consistent hearing aid use • Intermittent cochlear implant use and / or hearing aid use in second ear • Sign language is the primary mode of communication • Limited ability to process sound in the second ear Every child's case is different and the decision regarding the benefit, if any, your child is likely to receive from a second implant can only be made following assessment • Green – indicators of significant benefit • Short time since 1st CI surgery (less than 5 years) • Consistent or committed cochlear implant user • Consistent hearing aid user in second ear if it provides benefit. • Proven ability to process oral language • Regular attendance at appointments

6. Who will receive a second cochlear implant first?*All dates and ages from 18 December 2013* • Group 1:Children who have had an implant for less than 4 years and are under 5 years old. Within this group those who received their first cochlear implant most recently will be assessed first. • Group 2: Children who have had an implant for less than 4 years and are older than 5 years. Within this group those who received their first cochlear implant most recently will be assessed first. • Group 3: Children who have had implant for more than 4 years but are under 10 years old. Within this group those who received their first cochlear implant most recently will be assessed first. • Group 4: All the other children and teenagers under 18 on 1 December 2013. Within this group those who received their first cochlear implant most recently will be assessed first. NB: at any time a child may be prioritised on clinical need

7. Some Reasons for Prioritisation Children with visual difficulties If a child has a diagnosed visual condition and they are not already in Group 1, they will be prioritised and approached together with Group 1 Older teens Teens who have just turned 16 through to 18 years of age at start of bilateral sequential programme, will be contacted with Group 1. All teenagers will be given an appointment with clinical psychologist.

8. Questions?? • Is this the only opportunity to avail of a second CI? • If currently the child is doing well with a contra lateral hearing aid can a CI be considered later if the hearing deteriorates? • Will the child have an N6 processor for both ears? • What model implant will be used? • Can the child make the decision himself when he is 18? • If the second CI is unsuccessful can it be removed?

9. What will happen next? Each child will be called for a 1:1 appointment with the team: • Medical review • Audiology review – PTA for unimplanted ear may be required • Possible SLT review • Liaison between ICTOD & VTOD/school • Possible meeting with clinical psychologist, especially for older children and teenagers • Team discussion with parents

10. Important Dates! • Monday 21st July – first bilateral simultaneous • Wednesday 23rd July – first bilateral sequential Hope to implant approx 30 bilateral sequential before the end of the year It may take up to three years to complete the bilateral roll out

11. This is going to take time!! Funding for additional staffing has been secured but staff are not in place yet Please be patient! There may be delays after surgery before ‘switch on’ can take place We are also very short of space

12. Thank for listening!