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Cochlear Implantation Process, Performance, and Culture
- 1. Alexandra D. Costlow, B.S.
- 15. CT Scan of Cochlea http://www.sciencedaily.com/releases /2008/04/080425151819.htm
- 17. MRI (at 3 tesla) of Cochlea http://www.vanderveer.org.nz/research/labs/mri.php
- 28. Neural Response Telemetry http://www.uzh.ch/orl/lea/nrt.jpg
Editor's Notes
- Realistically, there may have been a string of appointments that may have lead up to the patient attending the candidacy appointment. Ex: parent-teacher conference, IEP meeting/s, appointments with the audiologist and/or speech-language pathologist It is important to remember this because although this will be the start of the appointment process for the professional, this is likely not the beginning of the appointment process for the patient.
- Professionals who are familiar with the implantation process from start to finish may be better able to identify both risk factors and strengths for implantation Factors that affect performance- patient motivation, family support, *duration of deafness at age of implantation neural activity allows neuronal pathways to retain their potential to achieve meaningful integration of prosthetic inputs (Niparko, 2009). Factors that affect perceived benefit- realistic expectations
- Multimodal Processing Assessment is performed by an occupational therapist to identify subtle motor and/or sensory delays that may interfere with the child’s ability to integrate audition with other senses and into a social context. It is important to look at the big picture. Is implantation safe? Will this patient be a successful CI user? The BL: Look at patient as a whole– are the fit to be a successful CI user?
- In other words, the hearing assessment has moved away from being “all about the numbers” to being more holistic and functionally-based. Constraints of HA usage: anotia/microtia, no residual hearing, limited manual dexterity
- A child may have residual hearing, but he/she may not be able to functionally use the residual hearing.
- Prognostic value of knowing the etiology of the HL is only for ossification of the cochlea (due to meningitis, lues, and trauma) or changes in labyrinthine bone (osteogenesis imperfecta) (Niparko, 2009). Usher Syndrome- deafness of inner ear, gradual vision loss due to retinitis pigmentosa (degeneration of retinal cells), and balance difficulties. Caused by mutation of 1 of 10 genes. Neurofibromatosis II – (MISME = Multiple inherited schwannomas, meningiomas- on meninges, ependymomas- on ependyma, a soft tissue) is an inherited disease that causes the patient to develop these benign tumors, principaly on CN8. They also have eye problems.
- Waardenburg syndrome- is a group of inherited conditions characterizedby deafness and partial albinism (pale skin, hair, and eye color).Symptoms: Cleft lip (rare); Constipation; Deafness; Extremely pale
- Knutson, J.F., Johnson, A., & Murray, K.T. (2006) Social and emotional characteristics of adults seeking a cochlear implant and their spouses. British Journal of Health Psychology, 11 (2), 279-292.
- Psychological testing and Counseling go hand in hand
- Computerized Axial (Anatomical)- of or relating to the axial bones of the body, which are the skull, vertebral column, ribs, and sternum Tomography- Greek “tomos,” to cut or section
- Science Daily (2009). Low frequency hearing linked to shape of cochlea, from: http://www.sciencedaily.com/releases/2008/04/080425151819.htm
- From Van Der Veer Institutefor Parkinson’s and Brain Research (2007) Magnetic resonance Imaging at 3 tesla – The first in New England, from: http://www.vanderveer.org.nz/research/labs/mri.php
- Cochlear abnormalities- Mondini’s deformity (incomplete or lack of intrascalar septa); Cochlear aplasia (cochlea is a single cavity) Mastoid- stenoisis of the EAC
- Skin flap designs vary (C flap versus Inverted J flap) and are aided by a mock BTE processor and implant. Cochleostomy is anterior and inferior insertion to the round window
- http://www.youtube.com/watch?v=x7ltzA0B2X8&feature=related Skin flap measurement and incision Insertion of the transmitter
- http://www.youtube.com/watch?v=I0Z3eKNw2vc&feature=related Cue before 2:30 Drilling into round window, Insertion of the implant and threading of the electrode
- The first appointment is about 2 hours, and the patient will return the following day for a 1.5 – 2 hour appointment.
- Standard check checks impedances of contacts of the cochlea to evaluate communication between the internal and external devices (like EA for a HA) Impedance change? Can be caused by ossification of the cochlea Impedance too low? Increase current flow to increase intensity of signal *Level of Comfort and not UCL ** 100% detection
- Tele = remote, metry = measure At the Cochlear Corporation lecture, we talked about how telemetry determines how much current is necessary for stimulation, how to spread the current, how long the pulses should be, the rate of stimulation, the pulse width, etc…
- The implanted electrodes deliver stimulus to the auditory nerve, which then elicits a neural response NRT takes about 5 minutes to complete
- http://www.youtube.com/watch?v=YFBUNJtT39Y&feature=related Pt: “I can’t hear it, but I can feel it” Hears echo of own voice Pt: “Sounds like I’m on helium” – like a chipmunk, robot, duck Pt: “I’m hearing noise, but I just can’t make it out” – muffled and echo-ey Aud: “It’s not making you feel dizzy or nauseous or anything?” Aud adjusts intensity Aud took off the extended filter, which allows for more low frequency emphasis, but it made this pt. hear an echo Aud: None of these decisions are set in stone Aud: Three ways to map: 1. Activate all electrodes at once and use live voice, 2, Activate 4 electrodes as a time and use bursts of sounds to make adjustments, 3. NRI= Stimulate the implant and measure response from the nerve NRI=Neural Response Imaging (telemetry) Fidelity 120 = sound processing option used in difficult listening environments like in a restaurant or on the phone Aud: This is why we set several electrodes and interpolate in between them
- For children, follow-up appointments will be necessary more often.
- Carver, C.L. (2007) Cochlear implant mapping: What every CI user and candidate should know.
- New Listeners will learn that the hum of the refrigerator is normal and can be ignored whereas a siren is a warning signal.
- BOTH: Identification of alerting sounds Ex: Audiologist plays fire alarm, child identifies that it is a signal to leave the school Ex: Audiologist plays horn, adult recognizes that it is a warning signal for driving
- Ching, T.Y., Incerti, P., & Hill, M. (2004). Binaural benefits for adults who use hearing aids and cochlear implants in opposite ear. Ear and hearing, 25 (1), 9-21. Diotic- Diotic is the same as binaural, and means hearing one, two, or more, sound sources with two ears, and then making sense of where that/those sound(s) are coming from. Dichotic- Dichotic, on the other hand, refers to the artificially generated state of hearing a different sound with each ear, as when messages are presented through earphones (Trimble, 1931).
- Litovsky, R.Y., Parkinson, A., Arcaroli, J., Peters, R., Lake, J., Johnstone, P, & Gonquiang, Y. (2004). Bilateral cochlear implants in adults and children. Archives of otolaryngology head and neck surgery, 130 (5), 648-655. Results for bilateral CIs are less robust for children
- Tyler, R.S., Gantz, B.J., Rubenstein, J.T., Wilson, B.S., Parkinson, A.J., Wolaver, A., Preece, J.P., Witt, S., & Lowder, M.W. (2002). Three-month results with bilateral cochlear implants. Ear and hearing, 23 (1), 80S-89S.
- Litovsky, R.Y., Johnstone, P.M., & Godar, S.P. (2006). Benefits of bilateral cochlear implants and/or hearing aids in children . International Journal of Audiology, 45 (S1), 78-91.
- Ching, T.Y.C., Psarros, C., Hill, M., Dillon, H.,& Incerti, P. (2001). Should children who use cochlear implants wear hearing aids in the opposite ear? Ear and hearing, 22 (5), 365-380.
- Deaf culture has a distinct pattern of social organization
- In the US, there is a strong legal foundation that establishes parental authority as paramount Cis fail to foster language in children born deaf- Lane, and Bahan (1998) found that mean scores overstate speech perception ablity, children born deaf score close to zero, and high-scorers may derive benefit more from rehabilitation than from the CI itself BUT, this research evaluates only early CI research, only examined very stringent auditory-only testing conditions, used children with an average age of implantation that was over 5, and the children had limited CI use. Socio-cultural genocide because it is “… A general intent to commit genocide can be established, in the absence of a specific intent, from proof of reasonable forseeability” (Lane & Bahan, 1998). Lane, H, & Bahan, B. (1998). Ethics of cochlear implantation in young children: A review and reply from a Deaf-World perspective. Otolaryngology and Head Neck Surgery, 119 , 297-313.