Becoming Familiar with Cochlear Implants

2. Becoming Familiar with Cochlear Implants Name Title

3. Sonova and Advanced Bionics Our Commitment to the Future of Hearing • Advanced Bionics • Most advanced cochlear implants • Cutting-edge technology • Sonova • Global market leader • Full spectrum of hearing solutions • Medical division

4. What you will learn today: • How the ear works • How to interpret the audiogram • Cochlear implant candidacy • Treatment options for hearing loss • Management of a child with a cochlear implant

5. The ear consists of four main parts: Brain Inner Ear Outer Ear Auditory Nerve Middle Ear

6. The Outer and Middle Ear Ear Drum Bones of the Middle Ear

7. The Inner Ear Brain Cochlea Auditory Nerve

8. Hearing Loss Brain Without functioning sensory cells in the cochlea, sound information cannot reach the brain for processing. Damaged Sensory Cells in Cochlea

9. What you will learn today: • How the ear works • How to interpret the audiogram • Cochlear implant candidacy • Treatment options for hearing loss • Management of a child with a cochlear implant

10. The Audiogram Audiogram: A graph that shows an individual’s type and degree of hearing loss.

11. Frequency Low Pitch to High Pitch Loudness Soft to Loud

12. Normal Hearing x o x o x o x o x o

13. x o x o o o o x x x x o Moderate- to-Severe Loss

14. o x x o x o x o o x Severe-to- Profound Loss

15. Types of Hearing Loss Sensorineural Conductive Mixed

16. < x o < x o < < < x o x o x o x o Sensorineural Hearing Loss

17. x o x o x o o x x o x o < < < < < Conductive Hearing Loss

18. x o x o x o o x x o x o Mixed Hearing loss < < < < <

19. What you will learn today: • How the ear works • How to interpret the audiogram • Cochlear implant candidacy • Candidacy guidelines • Steps to determine candidacy • Treatment options for hearing loss • Management of a child with a cochlear implant

20. Who is a Candidate for a Cochlear Implant? Range of hearing for a cochlear implant candidate.

21. 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 - 2 years) • Profound, bilateral sensorineural deafness (> 90 dB HL) • Little or no benefit from hearing aids • Children (2 years - 17 years) • Severe-to-profound, bilateral sensorineural deafness • Little or no benefit from hearing aids

22. Pediatric Cochlear Implant Candidacy • Audiologic Evaluation • Medical Evaluation • Speech Language Evaluation • Psychological Evaluation • Educational Evaluation

23. Teacher Psychologist Surgeon & Pediatrician Child SLP Caregivers Audiologist Team Approach

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

25. Medical Evaluation • Determine cause of hearing loss • Assess status of middle ear & cochlea • CT scan/MRI • Counseling • Hearing loss • The surgical procedure • Typically out-patient and performed by an otolaryngologist (ENT) or otologist (ear specialist) • Post-surgical considerations

26. Bilateral Cochlear Implants • Bilateral Implants • Industry trend • Simultaneous vs. sequential • Benefits: • Improved directionality • Improved listening in noise • Clarity of speech • Developmental

27. Speech & Language Evaluation • Areas assessed • Vocabulary - knowledge of single words • receptive • expressive • Language - word combinations, grammar • receptive • expressive • Articulation/Intelligibility • Reading skills

28. Developmental 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 child’s learning style • Assessment of any other underlying issues • Serves as a baseline evaluation

29. Educational Evaluation • Areas to consider: • Communication methodology • Support services • Speech/language and auditory skill development • Professional training

30. What you will learn today: • How the ear works • How to interpret the audiogram • Cochlear implant candidacy • Treatment options for hearing loss • Management of a child with a cochlear implant

31. Treatment Options for Hearing Loss Cochlear Implants Systems Hearing Aids

32. Treatment Options for Hearing Loss Hearing Aids Behind-the-Ear In-the-Canal In-the-Ear

33. How is a Cochlear Implant Different From a Hearing Aid?

34. How Does a Cochlear Implant Work? A Cochlear implant system consists of two main parts: Internal Implant External Equipment or

35. HiRes 90K™ AdvantageHigh-Performance Hearing

36. Unmatched Technology • Unlimited ways to deliver stimulation • 16 independent current sources • Low-profile design • Removable magnet • Industry’s highest case impact resistance- up to 6 Joules1,2 • Industry’s fastest stimulation rates • Reliability you can count on with 99.8% CSR at one year3 HiRes 90KTM Implant HiRes 90K™ AdvantageImplant • Holtkamp V. Cochlear Implants Under Impact Loading. Evaluation of Accident Scenarios. Determination of Load Limits, and Development of a Standardizable Test Procedure. Dissertation accepted by the Senate of Hannover Medical School, May 19, 2004. • Cochlear Nucleus CI512 Cochlear Implant Technical Specifications. N33741F 1ss1 Jun09. • Advanced Bionics Reliability Update. 2012.

37. Harmony™ Sound Processor

38. HiResolution™ Bionic Ear System • Engineered to be Reliable • Industry Standard Reliability • 99.8% CSR at 1 year³ for the current AB HiRes 90K Implant • Built to withstand rain, perspiration and moisture 3. Advanced Bionics Reliability Update. 2012.

39. The World’s First and Only Waterproof Sound Processor • Durable and Easy to Use • Ideal for All Ages and Lifestyles • Freestyle™ Design • Built Kid Tough™ • Stylish and Discreet

40. Neptune Battery Compartment Headpiece Neptune Features • Waterproof • Removable Controls • Powered by 1 AAA Battery • Cost Effective • Full day of use with a single disposable or rechargeable battery • Universal Headpiece (UHP) and AquaMic • Compatible with HiRes 90K™ and CII implant devices Cable

41. HiResolution™ SoundWhat do parents want for their child? • …to be able to hear like everyone else does • …to fit in • …to realize their potential • …to be successful in today’s world

42. 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 implant. • The implant delivers the sound to the electrodes. • The electrodes stimulate the hearing nerve. • The hearing nerve sends the signal to the brain where it is perceived as sound.

43. How Does a Cochlear Implant Work?

44. What you will learn today: • How the ear works • How to interpret the audiogram • Cochlear implant candidacy • Treatment options for hearing loss • Management of a child with a cochlear implant

45. Pediatric Management • Audiologic Management • Rehabilitation • Family Commitment • School Support

46. Audiologic Management • Goal is to assure access to sound adequate for auditory development • Programming or “mapping” of the cochlear implant system • Assessments at regular intervals to track auditory development • Age-appropriate techniques & materials

47. CI CI CI CI CI Audiologic Management

48. Rehabilitation is KEY

49. Parent Commitment

50. School Support • Understand what a cochlear implant is & equipment troubleshooting • Assist in the management of the device and child • Perform behavioral listening checks on a daily basis • Know where to find support and resource materials • Maintain communication between the student’s parents, teachers and cochlear implant center