Cochlear Implant Candidacy Flashcards
What is the importance of prevalence?
- To provide education to health care providers, third-party players, and policy maker
- To ultimately improve access to care
Why is the number of implant recipients so low?
- Shortages in number of professionals
- Reimbursement rates are insufficient to meet actual costs of service delivery
- Disparities in implantation rate based on ethnicity and SES
Describe audiologic CI evaluation for adults.
- Regular audio within last 6 months
- HA check, EA
- Aided SF detection (warble tones or NBN; test AD, AS, AU)
- Aided sentence recognition (CID Everyday Sentences or HINT or AZ Bio; presented at 55-65 dB HL)
- Aided CNC words (not standard, but can be another data point for post-op comparison)
What are FDA guidelines for adult conventional CIs?
-18 years+
-Moderate to profound HL bilaterally
-Limited benefit from amplification:
<50% aided sentence performance for implanted ear
<60% aided sentence performance for better ear
What are Medicare guidelines for adult conventional CIs?
->70 dB hearing loss OR moderate to profound HL
<40% open-set speech recognition (recorded material, no visual cues)
-Provides full payment for first procedure
What are the conventional CI candidacy criteria for children?
- Young children (1-2): profound HL AU
- Children (2-17): severe to profound HL AU
- Lack of progress in developing auditory skills (bilateral amplification and intense rehab for 3-6 months; <30% on open-set speech measures in best aided condition)
What is the candidacy criteria for the hybrid implant?
- Implanted ear: 10-60% CNC words, 75+ dB HL PTA @ 2, 3, 4 kHz
- Not implanted ear: <80% CNC words; >60 dB HL PTA @ 2, 3, 4 kHz
- Post-op thresholds <85 dB HL (otherwise acoustic component will not help)
Compare EAS vs. Hybrid.
- EAS: conventional implant array but with acoustic external component
- Hybrid: short electrode array (~1 turn)
What is included in the otologic consult?
- Etiology
- Medical contraindications to implantation
- Imaging
- Genetic testing/counseling
- Discuss risks/benefits of surgery
What are some medical contraindications to implantation?
- Deafness due to nVIII or central auditory pathway lesions
- Active ME infections
- Complete ossification of cochlea
- Other complicated comorbidities? (i.e., epilepsy)
What is included in the general health consult?
- General health (fitness for anesthesia/follow-up)
- Ophthalmology
- Psychological/social
What are potential benefits of a CI?
- Environmental sound awareness
- Speech recognition
- Benefit to lipreading/communication
- Speech and language development
- Reduction of tinnitus
- Enjoyment of music
- Educational achievements
- Improved employment prospects
- Changes to quality of life
- Psychosocial well-being
What external factors impact success with a CI?
- Electrode design and insertion
- Speech processing strategy
- Quality and quantity of auditory input
What internal factors impact success with a CI?
- Age of HL onset
- Duration of deafness
- Hearing aid history/performance
- Age of implantation
- Educational environment
- Motivation/family support
- Attention/rehab (both pre and post)
- Cognition
What factors can predict success in pediatrics?
- NVIQ is most important child factor
- Device factors: more benefits with larger number of active electrodes in implant
- Most important factor in better speech outcomes was educational setting emphasizing oral-aural communication
- Long term implant use (w/ early implantation)
What holds children back from early implantation?
- Progressive HL
- Management for other medical issues
What are the 2 biggest factors for predicting success with a CI?
1) Duration of deafness
- Predicts ~25% of overall range of outcomes
2) Speech discrimination ability
- Predicts ~17% of overall range of outcomes
What are some considerations for outcome measures?
- Objective vs. subjective
- Open-set vs. closed-set
- Recorded vs. MLV
- Presentation level
- Use of competing noise
- Multimodality
What is the MAIS?
- 10 questions completed in interview format
- Score of 0-4 (never to always)
- Hierarchy of behaviors: attachment to sensory aid, simple auditory detection, recognition of speech, comprehension of speech
- Want to look at change from pre- to post-implantation
What are some pediatric closed-set speech perception measures?
- Early Speech Perception (ESP) Test: 12 pictures, easy words
- WIPI: 6 pictures, harder words
- Pediatric Speech Intelligibility (PSI) Test: 5 pictures, sentences
What are some pediatric open-set speech perception measures?
- Mr. Potato Head
- Lexical Neighborhood Test
- PBK
What are some considerations for presentation level during the candidacy assessment?
- Standard is 60 dB HL to represent “normal conversational speech” (but actually louder)
- Current clinical practice often includes background noise (no mention of presentation environment in guidelines)
- Soundfield responses better correlated with performance at 50 or 60 dB SPL than 70 dB SPL
- Test-retest reliability is better for 50 dB SPL in quiet than 60 dB SPL in noise
What should be considered for determining candidacy?
- Moderate to profound HL
- No medical contraindications
- POOR SPEECH UNDERSTANDING
- At least 1;0
- HISTORY OF HA USE
- Lack of benefit
- Support
- Duration of deafness
- Consistent, committed HA use
- Communication modality
- Educational setting
What vaccines are recommended to reduce changes of post-op meningitis?
- Prevnar13
- Pneumovax23
