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CI > Candidacy > Flashcards

Candidacy Flashcards

1
Q

Adult candidacy-FDA

A

-Moderate to profound HL bilateral
-limited benefit from amplification
—-<50% aided sentence performance for implanted ear
——<60% aided sentence for better ear

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2
Q

Adult candidacy-Medicare

A

->70dB HL or moderate to profound HL
-<40% speech rec (use to be 30%)
—tape recorded speech testing
-provides full pay, ENT for first procedure (and now possibly the second )

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3
Q

Child Candidacy

A

-young children (12mons-2yrs)
—-profound HL bilaterally
-2-17yrs
—-severe to profound HLs bilaterally

Lack of progress in developing auditory skills
—bilaterally amp and intense rehab for 3-6mons
—30% or less on open set speech measures in best aided condition.

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4
Q

Pediatric assessment

A 
Temps and OAES
ABR (<3yrs)
Subjective measures (IT Mais)
Speech testing
-hint
-CNC lists
-CID Sentences
-ESP low verbal testing
-AzBio pediatric lists
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5
Q

Candidacy requirements

A
  • Psychologically stable and motivated
  • Support system
  • Compliance (time off, attendance, f/u)
  • Medical contraindications
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6
Q

Pre op vs post op

A

Pre:

  • Who to implant
  • Baseline performance
  • Expectations

Post:

  • Evaluate progress
  • Evaluate device efficacy.
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7
Q

Which ear to implant

A 
Better ear
Poorer ear
-more favored approach 
-->30 years of aud. deprivation--> implant better ear
-bimodal listening

Some recs to implant more recently deafened ear
Little clinical diff in performance

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8
Q

-Other steps involved in the candidacy process

A
  1. Audiologic evaluation
  2. Otologic consultation
  3. Imaging
  4. General health consults
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9
Q

Role of otologic counslt

A

Determine etiology of hearing loss and identify contraindications to implantation

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10
Q

Etiologies that are not contraindications alone

A

-Meningitis
-Usher’s syndrome (vision decline and involves diff systems)– bilat. CIs
-Cochlear otosclerosis
-Temporal bone fracture
(Last two may cause CN7 stimulation; solution= diff. internal device)

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11
Q

Medical contraindications

A
  • Deafness due to CN8 or central auditory pathway lesions
  • active middle ear infections
  • complete ossification of cochlea
  • absence of cochlear development
  • complicated comorbidities (i.e. seizure disorder)
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12
Q

Role of Imaging/Otologic consult

A 
High res CT scan to identify
-IAC
-labyrinth
-Mastoid (internal receiver location)
Genetic testing/counseling referral
Discuss risks/benefits of surgery (temp. ex below)
-Dizziness
-infection
-facial nerve damange/compromise
-change in taste
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13
Q

General Health Consults

A 
General Health
-ability to endure general anesthesia 
-readiness for f/u care
Ophthalmology
Psychological/social (formal vs informal)
-depression
-social introversion
-suspiciousness
-social anxiety
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14
Q

Hybrid Candidacy

A

Implanted ear:

  • 10-60% CNC words
  • PTA @2,3, 4 kHz>/= 75 dB HL

Non-implanted ear:

  • = 80% CC words
  • PTA >/=60 dB HL

Post op thresholds: = 85 dB HL

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15
Q

Hybrid Contraindications

A 
Duration of HL >/= 30 Yrs
Fluctuating HL (HL is going to decline anyway)
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16
Q

Predictors of performance w/ CI

A
  • Cognition- ability to extract and process info from incoming stimulus (Knutson et al., 1991)
  • Auditory foundation:
  • -Duration of deafness (predicts ~25% of overall range of outcomes)
  • -Speech discrim ability (predicts ~17%)
17
Q

Predictors of performance of CI- Pedatrics

A
  • Nonverbal IQ
  • Constant NVIQ, earlier age of implantation
  • oral-aural education setting

Greers et al. (2002 and 2008)

18
Q

Candidacy for really old adults

A
  • Performance in older adults improved w/ CI (Friedland et al. 2010) and were satisfied with CI (Orabi et al. 2005)
  • anatomical— survival of neural portions of the auditory system
19
Q

Outcome Measures

A

Objective vs subjective (COSI and HHI)
Open set (HINT) vs Closed set (colors, states, etc.)
Recorded speech vs MLV (easier)
Presentation level
Use of competeing noise
(ceiling effects; fixed vs adaptive SNR)
Multimodality (audio only vs audio visual-easier)

20
Q

Pediatric outcome measures - questionnaires

A

-CID Speech perception categories
7 labels (0-6) that can be used to categorize speech perception skills from no detection (0) to open set word rec (6)
-(I)MAIS =(Infant) Meaningful Auditory Integration Scale: 10 question completed in interview format
-Hierarchy of behaviors (always to never 0-4 scale)
-Categories of Auditory Performance (CAP)

21
Q

Pediatric Testing measures

A

Closed-set perception:
-Early Speech Perception test (like WIPI, but easier words)
-WIPI
Pediatric speech intelligibility (PSI) test

Open-set perception:

  • Mr. Potato Head
  • Lexical neighborhood test
  • Phonetically Balanced Kindergarten (PBK) words
22
Q

Presentation level

A
  • 60 dB is standard=”normal convo level”

- Current clinical practice includes BN (no mention of presentation environment in guidelines)

23
Q

Determining candidacy (overview)

A
  • Moderate to profound HL
  • no medical contraindications
  • poor speech understanding
  • at least 12 months of age
  • History of good HA use with lack of benefit (consistent use)
  • Motivation
  • Support
  • Duration of deafness
  • Communication mode
  • Educational setting

CI (4 decks)

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