National Cochlear Implant Programme Beaumont Hospital

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National Cochlear Implant ProgrammeBeaumont
Hospital Childrens University Hospital,
Temple Street

• Bilateral Cochlear Implants

Jennifer Robertson, Clinical Specialist SLT May
2014
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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

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

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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

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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

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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

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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.
•  

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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?

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What will happen next?

• Each child will be called for a 11 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

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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

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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

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• Thank for listening!