Candidacy Flashcards
Adult candidacy-FDA
-Moderate to profound HL bilateral
-limited benefit from amplification
—-<50% aided sentence performance for implanted ear
——<60% aided sentence for better ear
Adult candidacy-Medicare
->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 )
Child Candidacy
-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.
Pediatric assessment
Temps and OAES ABR (<3yrs) Subjective measures (IT Mais) Speech testing -hint -CNC lists -CID Sentences -ESP low verbal testing -AzBio pediatric lists
Candidacy requirements
- Psychologically stable and motivated
- Support system
- Compliance (time off, attendance, f/u)
- Medical contraindications
Pre op vs post op
Pre:
- Who to implant
- Baseline performance
- Expectations
Post:
- Evaluate progress
- Evaluate device efficacy.
Which ear to implant
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
-Other steps involved in the candidacy process
- Audiologic evaluation
- Otologic consultation
- Imaging
- General health consults
Role of otologic counslt
Determine etiology of hearing loss and identify contraindications to implantation
Etiologies that are not contraindications alone
-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)
Medical contraindications
- 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)
Role of Imaging/Otologic consult
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
General Health Consults
General Health -ability to endure general anesthesia -readiness for f/u care Ophthalmology Psychological/social (formal vs informal) -depression -social introversion -suspiciousness -social anxiety
Hybrid Candidacy
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
Hybrid Contraindications
Duration of HL >/= 30 Yrs Fluctuating HL (HL is going to decline anyway)
Predictors of performance w/ CI
- 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%)
Predictors of performance of CI- Pedatrics
- Nonverbal IQ
- Constant NVIQ, earlier age of implantation
- oral-aural education setting
Greers et al. (2002 and 2008)
Candidacy for really old adults
- 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
Outcome Measures
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)
Pediatric outcome measures - questionnaires
-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)
Pediatric Testing measures
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
Presentation level
- 60 dB is standard=”normal convo level”
- Current clinical practice includes BN (no mention of presentation environment in guidelines)
Determining candidacy (overview)
- 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
