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Aural Rehab Lectures > 1.05 - Cochlear Implants > Flashcards

1.05 - Cochlear Implants Flashcards

0
Q

When was the first work on hearing implants stopped? Why?

A

1959

Funding issues

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1
Q

When was the first deaf person implanted? By whom? Where?

A

1957

Djourno & Eyries

France

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2
Q

Who was William House? When was his big year?

A

First person to be implanted with an early version of CI

1968

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3
Q

What was going on in the 1970s?

A

Work on stimulation of the human visual cortex

NIH supported auditory stimulation

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4
Q

When did the FDA approve cochlear implants?

A

1984

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5
Q

What are the three parts to a CI?

A

Internal Package

Speech Processor

Electrode Array

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6
Q

Where is the internal package found?

A

Under the skin, behind the ear

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7
Q

Where is the speech processor found? Where was it located in the past?

A

Behind the ear (like a BTE hearing aid) and connecting the the internal package via a magnet

Used to be a box unit

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8
Q

Where is the electrode array found?

A

In the cochlea

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9
Q

Does the electrode array go all the way to the cochlea’s apex? Why or why not?

A

No. It is too narrow and the electrodes don’t fit

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10
Q

What does a CI provide?

A

Functional hearing to individuals with severe-profound hearing loss

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11
Q

What are the three companies that make CIs?

A

Cochlear Corporation

MedEI Corporation

Advanced Biotics Corporation

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12
Q

Advance Biotics was recently sold to ______. They are currently working on ______.

A

Phonak

Combining HA & CI tech

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13
Q

What are the four parts of the CI internal receiver?

A

Magnet

Receiver coil

Electrodes

Electronic Platform (Computer Chip)

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14
Q

How are CIs implanted?

A

The internal device is place surgically underneath the skin behind the ear.

The electrical array is placed in the cochlea. This delivers electrical stimulation to the auditory nerve.

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15
Q

What does the CI receiver do?

A

Decodes the signal from the speech processor

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16
Q

What does the CI electrical array do?

A

Converts the code into electrical signal

This stimulates the nerve fibers and auditory nerve

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17
Q

Are all CIs programmed with the same software?

A

No. Each company used different software

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18
Q

Can you mix and match parts of CI designed by different companies?

A

No. You can’t even mix part by the same brand as they are connected with a recognition/locking code.

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19
Q

The CI electrode array is put in the cochlea’s ______.

A

Scala tympani

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20
Q

The CI electrode array is _____.

A

Tonotopic

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21
Q

What provides the frequency resolution for the CI?

A

The auditory nerve and the brain

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22
Q

How does a CI work?

5

A

Microphone captures sound

Signal is converted into digital code by the speech processor

This code is transmitted by an FM signal across the skin to the internal device

The computer chip decodes this signal and sends an electrical signal via the electrical array

The electrical array stimulates the nerve fibers and the auditory nerve delivers this information to the brain.

23
Q

What, in regards to the cochlea, do we assume with CIs?

A

The the root of the missing inner hair cells will pick up the signal

24
Q

What are the four external components in CIs?

A

Microphone

Speech Processor

Transmitter Coil

Magnet

25
Q

What powers the CI? Where is the power source located?

A

Batteries

Speech processor

26
Q

What is the name of the Advanced Biotics Speech Processor?

A

Harmony

27
Q

What is the name of the Cochlear Corp’s Speech Processor

A

Nucleus 5

28
Q

What is the name of MedEL’s speech processor?

A

Opus 2

29
Q

The common task of ALL cochlear implant systems is the convert the acoustic input signal into an ______ that yields _____ and allows for ______.

A

Electrical signal

Speech clarity

Speech recognition

30
Q

What is the magic number (age) for cochlear implantation?

A

7 years

31
Q

How is a CI different from a hearing aid?

3

A

Bypasses the outer and middle ear - needs no acoustic amplification

Bypasses damaged or missing hair cells

Stimulates auditory nerve directly!

32
Q

What is a CI MAP? How is it designed?

A

The CI programming that is written on the chip in the speech processor

Designed for the individuals particular ability and need

33
Q

When is the CI MAP usually done?

A

After surgery and healing time. Usually about 4 weeks

34
Q

What does the CI MAP do?

A

Tells the internal device how to deliver sound to the electrodes

35
Q

Are CI thresholds calculated in dB?

A

No. They are calculated in electrical current

36
Q

What is the first choice in designing a CI MAP?

A

Which speech coding strategy to implement

37
Q

What are the three parameters of sound processing used in CIs?

A

Frequency (the site of stimulation)

Amplitude (the amount of stimulus)

Time (Rate & pattern of stimulation)

38
Q

What does NRI stand for?

A

Neural Response Imaging/Telemetry

39
Q

What is NRI?

A

Electrically evoked responses on the electrodes

Used to confirm settings in babies and in adults who are poor reporters

40
Q

Which ear should be implanted?

A

This is a controversial issue

41
Q

Why do some people think it’s best to implant the better ear?

A

Better neurons should mean better performance

42
Q

Why do some people think it’s better to implant the poorer ear?

A

To save the better ear for new tech (improvements)

To maintain hearing aid use in the better ear

43
Q

Who gets to make the final decision on what ear to implant (assuming there is not physical reason that one ear is not a candidate)?

A

The patient

44
Q

What are the three similarities between the three CI companies?

A

Electrical stimulation

Internal & External components

Outcomes

45
Q

What are the four differences between the three CI companies?

A

Length of electrode array

Speech coding strategies

Number of channels

Stimulation rates

46
Q

Who could receive CIs in 1985?

4

A

Adults 18+

Postlinguistic HL

Profound SNHL

Open set speech understanding = 0%

47
Q

Who could receive CIs in 1990?

4

A

Adults and children over 2

Postlinguistic adults

Pre/Postlinguistic children

Profound SNHL

Open set speech scores = 0%

48
Q

What were the qualifications for adults to receive CIs in 1998?

(3)

A

Pre/Postlinguistic HL

Severe-Profound SNHL

Open set speech scores = 40% or less

49
Q

What were the qualifications for children to receive CIs in 1998?

(3)

A

18 months or older

Pre/Postlinguistic

Lack of auditory progress (less than 20% on pediatric word tests)

50
Q

What are the present qualifications for adults to receive CIs?

(3)

A

Pre/Postlinguistic HL

Bilateral Moderate to Profound SNHL

Open speech set scores = 60% or less in contralateral ear, 50% or less in implanted ear

51
Q

What are the present qualifications for children to receive CIs?

(7)

A

12 months or older (exception menigitis)

Pre/Postlinguistic HL

Bilateral Moderate to Profound SNHL is children older than 2

Bilateral Severe to Profound SNHL is children less than 2

Lack of auditory progress and speech development with amplification

No medical or radiologic contraindications

Appropriate family expectations

52
Q

What open set sentence test score does medicare require?

A

40% or less

53
Q

What are some expectations (not promises) for postlingual adults who receive CIs?

(4)

A

Good open set speech understanding

Good understanding in noise

Ability to use the phone

Ability to enjoy music

54
Q

What are indications for CI referral for pediatrics?

3

A

ASAP - Don’t wait!

Infants & children with severe to profound HL

Lack of progress with amplification

55
Q

What can affect CI success in congenitally deaf pediatric patients?

(4)

A

Pre-implant thresholds (both aided and unaided)

Age when amplification was initiated (length of HA use)

Amount of aural habilitation

Age at implantations

56
Q

What are expectations with pediatric CI patients?

A

Normal speech and language development

No need for special ed placement

Aural Rehab Lectures (8 decks)

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