Cochlear Implant Selection Considerations

1
Cochlear Implant Selection Considerations

• CHILDREN'S HEARING FOUNDATION
• Sharon Bruna (B.Sp. Path. Dip AUD. MAudSA)
• Paediatric Audiologist

2
Philosophy

• to ensure potential benefits from the device and
  procedure

3
Hearing loss

• Severe to profound or profound hearing loss
  bilaterally
• Hearing thresholds gt 90 dBHL for 1000 Hz and
  above in the better ear
• Establishment of better/worse ear

4
Hearing loss

• CHILDREN If age and language appropriate,
  evaluation of speech perception abilities in the
  optimal aided condition using vowel imitation
  tasks, and or closed and open set speech test
  materials. ADULTS Open set discrimination of
  less than 40 in either ear using sentence test
  materials in the optimal aided condition

5
Hearing profile

• History of hearing loss including
• congenital or postlinguistic onset
• age at onset
• progressive or sudden loss
• duration of profound deafness
• etiology

6
Current communication mode

• ADULTS
• Candidates must use speech as primary
  communication mode.
• Prelingually deafened adults must have
  demonstrated use of residual hearing

7
Current communication mode

• CHILDREN
• An adequate period of diagnostic auditory therapy
  to indicate minimal or no benefit from optimal
  amplification.
• In cases of profound hearing loss as a result of
  meningitis, assessment for implantation is
  recommended immediately due to the risk of
  cochlea calcification
• Commitment to use of amplification if some
  benefit provided

8
Medical Considerations

• Evaluation of CT scans and MRI if indicated to
  check for full array insertion potential
• Elimination of retrocochlear or central pathology
  as cause of hearing loss
• Evaluation of middle and outer ear problems
• Evaluation of general health and fitness for
  surgery

9
Medical Considerations

• CHILDREN
• Global developmental assessment to indicate other
  potential barriers to speech and language
  development
• ADULTS
• Evaluation of promontory stimulation responses
  particularly pitch discrimination and gap
  detection
• Evaluation of psychosocial or neuropsychological
  problems and other handicaps

10
Habilitation Support

• CHILDREN Availability of regular long term
  support to the child from parents and educational
  system for habilitation
• ADULTS Availability of a suitable habilitation
  program and potential family and social support
  during rehabilitation.

11
Informed Consent

• CHILDREN
• Evaluation of parent's realistic expectations of
  outcomes from use of the device
• awareness of potential problems which may arise
  as a result of the surgical procedure and use of
  the device
• ADULTS
• Evaluation of patients expectations and awareness
  of potential problems
• Awareness of and commitment to the necessity of
  a habilitation program.

12
General considerations

• Priority 12 months to 6 years
• Government approved hospital
• Preference should be given to those candidates
  who according to the selection considerations
  have the potential to achieve the most
  significant benefits from the device

13
Case study Poor CI Candidate

• congenitally deaf teenager
• 14 years profound deafness
• profound to total bilateral sensorineural hearing
  loss.
• limited aided access to speech spectrum
• inconsistent HA user
• primarily relies on lipreading and signing
• attends deaf school
• little spoken language
• parents want child to develop intelligible speech

14
Case Study Good CI candidate

• congenitally deaf 12 month old infant
• confirmed profound sensorineural hearing loss
  bilaterally
• optimal amplification fitted at 3 months of age /
  full time HA user
• Aided access to low frequency speech spectrum
  only
• parents demonstrate commitment to using an
  auditory verbal therapy program in the home to
  develop listening and spoken language as primary
  communication mode
• parents aware of potential risks versus benefits
  from CI
• parents committed to long term habilitation
  emphasizing audition
• parents aim to send child to mainstream school
  with as close to age appropriate speech and
  language as possible