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Cochlear Implant Technology: Revolutionizing Hearing Assistance

This article discusses the prevalence of hearing loss in Canada and the different types of hearing aids available. It also explores the benefits and limitations of cochlear implants and when they are recommended for adults and children with severe to profound hearing loss.

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Cochlear Implant Technology: Revolutionizing Hearing Assistance

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  1. Cochlear Implant Technology Presented to Carleton University By Bob Baillargeon,Thursday November 11th 2010

  2. Did you know that… • Hearing Loss is the 4th Most Prevalent Disability in Canada after Mobility, Pain and Agility. (Source: Statistics Canada, Participation and Activity Limitation Survey, 2001)‏ • 40% of Persons over the age of 65 Report a Significant Hearing Loss (Source: Statistics Canada (December 2002))‏ • Today’s Youth are also at Risk of Significant Hearing Loss • At 85 dB, you can listen to music for 8 hours with no damage. But for every 3 dB increase, cut that time in half. • 4 hours for 88 dB • 2 hours for 91 dB (subway, lawnmower)‏ • ½ hour for 97 dB (motorcycle)‏ • 15 minutes at 100 dB (school dance)‏ • for a concert which can be 110 dB and above… less than a minute! (Source: Ontario Association of Speech-Language Pathologists and Audiologists (2005))‏

  3. Who motivates the hearing impaired adult to seek help? • Self 30% • Spouse 25% • Physician 19% • Children 12% • Friend 10% • Other 4% Adam, 1999

  4. Anatomy of the Ear • Outer ear • Middle ear • Inner ear - cochlea Normal Inner Ear Damaged Ear Inner Hair Cells Outer

  5. Four primary styles of Hearing Aids • Completely In the Canal (CIC)‏ • In The Canal (ITC)‏ • In The Ear (ITE)‏ • Behind The Ear (BTE)‏

  6. Completely in the Canal (CIC)‏ • Fits deeper inear canal (custom made)‏ • Mild to moderate or sloping high-frequency hearing losses • Not usually for children • Advantage: • Smallest size (least visible)‏ • Disadvantages: • Small size can be difficult to handle • Small batteries are changed more often • Cannot be used with some accessories • Can be damaged by earwax & ear drainage

  7. In The Canal (ITC)‏ • Fits in ear canal (custom made)‏ • Mild to moderately-severe hearing loss • Not usually for children • Advantage: • Smaller size (barely visible)‏ • Disadvantages: • Small size can be difficult to handle • Cannot be used with some accessories • Can be damaged by earwax & ear drainage

  8. In The Ear (ITE)‏ • Fits completely in the outer ear (custom made). • Mild to severe hearing loss • Not usually for children • Advantages: • Small size • Can be used with add-on accessories • Disadvantages: • Small size can be difficult to handle • Can be damaged by earwax & ear drainage

  9. Behind The Ear (BTE)‏ • Fits behind the ear with custom earmold or slim tube in outer ear • Mild to profound hearing loss • Can be used by all ages • Advantages: • Durable • Larger size easier to handle & maintain • Separate earmold can be easily replaced • Easy to use with assistive listening devices • Disadvantage: • Larger size (highly visible)‏

  10. What all hearing aids have in common? • A battery • A microphone • An amplifier • Loudspeaker

  11. Cost of hearing aids • Some coverage offered: ADP(Assistive Device Program) in Ontario = $500/3 years/ear. • Patient still has to pay between $600 to $2500 per ear after ADP contribution. • The cost is the same for adults and children

  12. Facts about Hearing Aids • Hearing aids do not completely correct a hearing loss 100% • Hearing aids amplify all sounds • Hearing aids will help hearing in many situations • Benefits of hearing aids depend on several factors • Two hearing aids are better than one • Adjusting to hearing aid(s) is a long process

  13. Some simple communication strategies: • Face the hearing impaired person so lipreading is possible • Speak more slowly and distinctly, do not shout! • Rephrase instead of repeating • Write down a few key-words if necessary

  14. Other possible options Bone Anchored Hearing Aid Titanium fixture/external abutment/sound processor Typically for congenital atresia or chronic ear infections • Implantable Hearing Aid • Alternative to an acoustic hearing aid, for mild to severe sensorineural hearing loss • Cochlear Implant BAHA Vibrant Soundbridge

  15. What is a Cochlear Implant ? • Surgically implanted device. • Electrode Array and a Receiver-Stimulator • But it works only if used with: • External components: • Speech Processor, Headpiece & Battery • To work, it needs: • Programming with a computer • To work even more optimally: • Rehabilitation sessions necessary

  16. External components: Speech Processor, Headpiece & Battery

  17. What does it look like? Illustration from Advanced Bionics

  18. When to refer an Adult for a CI? • Bilateral severe to profound sensorineural hearing loss • Limited benefit from appropriate hearing aids i.e. poor speech recognition • Telephone use is difficult, limited or impossible • Patient relies heavily on speech reading or note writing to understand speech • Patient is distressed by the inability to communicate efficiently on a daily basis • No medical contraindications

  19. Children Candidacy • Severe to profound sensorineural hearing loss in both ears • Lack of benefit from hearing aids and therapy • No medical contraindications • High motivation and appropriate expectations for child and family • Placement in educational program that emphasizes auditory skills • 12 months and up; may be indicated earlier for special cases

  20. Other considerations • Age • Duration of deafness • Language • Mode of Communication • Other handicaps • Motivation

  21. How is a Cochlear Implant Different from a Hearing Aid? • Hearing Aids: • acoustically amplify sound • rely on the responsiveness of surviving hair cells • Cochlear Implants: • bypass damaged hair cells Convert the acoustic input signal into electrical impulses to stimulate the auditory nerve fibers in the cochlea. The resulting electrical sound information is sent through the auditory system to the brain for interpretation.

  22. How does it work? • Sound Processor • captures sound from the environment • processes sound into digital information • transmits to the implant. 2. Implant • converts transmitted information into electrical signals • delivers signals to the electrodes for stimulating the hearing nerve. 3. Hearing Nerve • carries the sound information to the brain, where it is interpreted.

  23. Evaluation Process • Audiological • Medical • Psychological & Social Worker (children)‏ • Auditory-Verbal Therapy (children)‏ • Speech Language Pathology (for adults, when required)‏

  24. Audiological Assessment • Diagnostic testing: • Audiogram • Tympanometry & Acoustic Reflexes • Auditory Brainstem Response • Otoacoustic Emissions • Speech perception tests with appropriate amplification • Counseling re: types of implants & expectations

  25. Medical Assessment • Otologic history & examination • General medical health • Pneumococcal meningitis vaccine: Pneumovax • Diagnostic Imaging • Computed Tomography (CAT) • Magnetic Resonance Imaging(MRI)* • Electronystagmography ENG(Adult only)‏ Electronystagmography (ENG) is a diagnostic test to record involuntary movements of the eye caused by a condition known as nystagmus. It can also be used to diagnose the cause of vertigo, dizziness or balance dysfunction by testing the vestibular system.

  26. Surgery Risks and/or Adverse Effects • Facial nerve injury (less than 1/300 to 1/500)‏ • Small possibility of infection • The small amount of hearing in the operated ear will be lost. • Some discomfort or numbness around the implanted ear after the surgery • Temporary dizziness, tinnitus or taste disturbance • MRI precautions after surgery

  27. Surgery • Inpatient procedure • Requires general anesthesia • Duration ~ 3-4 hours

  28. Behind-The-Ear/Device Marking Template The Behind-the-Ear/Device Marking Template is used to allow adequate clearance between the pinna, the speech processor and the headpiece. From Advanced Bionics

  29. Device Coil Gauge After placing the Device Coil Gauge, an outline is drawn around the template. From Advanced Bionics

  30. Incision Line Note: The surgeon will determine the length of the incision line. A conventional postauricular-scalp incision approximately 5.0-6.0cm in length for children may be used. The incision may be longer in adults if the scalp needs to be thinned. From Advanced Bionics

  31. Recess Marking Template The Recess Marking Template is used to determine the location of the recess bed and channel for the electrode lead. From Advanced Bionics

  32. Mastoidectomy-Facial Recess Approach After completion of a mastoidectomy-facial recess approach, the implant-receiver well/recess bed and electrode lead channel are drilled. Suture tie-down holes to stabilize the implant are placed. A standard cochleostomy is used. From Advanced Bionics

  33. Electrode Insertion The insertion tool is used to insert the electrode array in the usual fashion. The Insertion Tube is placed just inside the cochlea toward the basal turn of the scala tympani, with the insertion tube slot directed toward the modiolar (or inner) wall. From Advanced Bionics

  34. Closure The skin incision is closed in layers. From Advanced Bionics

  35. Electrode Array Placement Within the Cochlea Illustration courtesy of Cochlear Corporation

  36. Audiological testing in the OR • Impedance check on all electrodes • Neural response testing to help estimate required levels

  37. X-Ray to confirm position of internal device Courtesy of Cochlear Corporation

  38. After the surgery • Initial stimulation: 4-6 weeks post surgery • Adjustments made regularly based on feedback from patients, parents, therapists and educators • Rehabilitation to meet specific patient needs • Regular follow-up appointments

  39. Positive psychological & social benefits • Increase in: • Self-esteem • Independence • Social integration • Vocational prospect • Decline in: -Loneliness -Depression -Social isolation

  40. Negative psychological & social impacts • Concerns about the maintenance and/or malfunctioning of the Cochlear Implant • Difficulty in background noise • Unreasonable expectations of aural-only benefit on the part of the implant user or their family and friends

  41. Potential Benefits • Better speech understanding compared to a hearing aid • Awareness and responsiveness to environmental sounds • Less dependence on family members for day to day living • Reconnection with the world of sound • Facilitation of communication with family and loved ones • Ability to talk on the phone • Better appreciation of music

  42. Advanced Bionics 28515 Westinghouse Place Valencia, CA 91355

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