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Mike's review Flashcards

1
Q

SPOT testing:

  1. Where are the electrodes placed?
  2. What are the settings for initial noise measurement?
  3. What are acceptable noise levels?
A
  1. ipsilateral mastoid on the implant side (red)
    contralateral mastoid (green)
    ground electrode on the forehead (black)
  2. 500,000 samples/second
    8 us acquisition rate
    50 dB gain
  3. +/- 0.05 V
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2
Q

SPOT testing:

  1. What are the settings for amplitude and pulse width growth test?
  2. What are the settings for ramp up?
A
  1. 500,000 sample/sec
    8 us duration
    20 dB gain
  2. 20,000 Samples/sec
    5,000 us duration
    20 dB gain
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3
Q
  1. What is the normal charge voltage range in capacitor testing?
  2. If the charge voltage is out of range, what can we say about the leakage current?
  3. What leakage values are expected?
A
  1. 1.0-3.5 V
  2. The leakage values may not be valid. They are only valid if the charge voltage is within range.
  3. 50 uA
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4
Q

What would be good settings for a noise program?

A music program?/

A

Noise:

  • narrow IDR to 45
  • decrease low frequency gain/increase high frequency gains
  • change filter to standard
  • decrease sensitivity to 5 dB
  • T-mic only mixing ratio

Music:

  • extend low frequency filters
  • increase IDR to 80 dB
  • flatten gains
  • disable AGC
  • use Fidelity 120 strategy
  • Aux input adjustment as needed
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5
Q

What are the disadvantages for ball electrodes?

What are the advantages to plate/planar electrodes?

A

Ball electrode:

  • electrical current is spread in all directions
  • increased chance of FNS
  • higher current requirements

Plate electrode:

  • all electrodes are directed towards the modiolus
  • better capability to direct current
  • more surface area which allow more charge without exceeding FDA limits
  • spread is minimized with silastic partitions
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6
Q

NRI

  1. How far away is the recording electrode from the stimulating?
  2. can you stimulate and record from the same electrode?
  3. What coupling is used with NRI? Where are the grounds?
A

SW defaults to 2 apical for recording electrodes.
Example: if stimulating on e6, then recording will be e4.

  1. No, the stimulus artifact is too large
  2. Monoploar coupling. The stimulating electrode is grounded in the case. Recording electrode is grounded in the ring band.
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7
Q

What can be done to reduce noise during NRI?

A

increase number of averages

use a different recording electrode

use a PSP

increase gain (be careful of amplifier saturation) .

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8
Q
  1. What does electrode conditioning do?
  2. When does conditioning stop?
  3. What is the stimulus for conditioning?
A
  1. Introduces stimulation to all electrode contacts to stabilize impedances prior to programming.
  2. stop running when impedance no longer changes by 10% or more.
    min: 3x
    max: 10x
  3. 256 uA current
    40 usec PW
    bipolar coupling
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9
Q
  1. What can influence an ECAP?
  2. What stimulus waveform is used in NRI testing?
  3. What is the stimulus rate?
A
  1. -number of nerve fibers
    - whether nerve are firing synchronously or not
    - nerve fiber location with respect to the measuring electrode
  2. -biphasic pulses with a PW of 32 usec. Long enough to produce a highly synchronous response, but shorter than the latency of the response.
  3. 30 Hz.
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10
Q

What are the advantages of the Hi-Focus electrode?

A

16 plate electrodes which point to the sprial ganglion

silastic partitions to direct current toward the nerve

slightly pre-curved

not ear specific

1.1 mm spacing between contacts

electrodes are labeled 1-16

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11
Q
  1. What is the latency of N1 and P2?

2. What is the amplitude response size of the ECAP?

A
  1. 0.2 to 0.5 us and just before 1 us

2. 20-1500 uV

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12
Q

What is APW?

A

automatic pulse width: automatically optimizes PW and rate during device fitting process to maintain the narrowest PW and fastest rate for a given M level.

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13
Q

What are the advantages of the CII/90K ICS over the C1?

A

83,0000 pulses/sec

16 high precision output circuits

Fidelity 120, HiRes, MPS, CIS strategies

NRI

backwards compatible

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14
Q
  1. When should a manual PW be used?

2. When increasing to a manual PW, where should you start?

A
  1. poor sound quality
    - inadequate growth of loudness due to FNS
    - reports of sound flutters/choppy sound
    - pt wants programs that are louder and louder
  2. start with doubling the PW
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15
Q

What happens if compliance is exceeded?

A
  • adequate loudness growth may not be achieved
  • appropriate amplitude information may not be conveyed
  • distortion may be introduced into the system
  • patients are at an increased risk for somatosensory symptoms (FNS)
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16
Q

When should an electrode be turned off?

A
  • impedance too high (open)
  • unresolved FNS or somatic response
  • inadequate growth of loudness
  • pitch confusion
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17
Q

When was the S-series introduced?

A

1997

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18
Q

When was the 1.2 souind processor introduced?

A

1996

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19
Q

When was the 5th generation Harmony HiRes Bionic ear system introduced?

IOW: When was Harmony released?

A

2006

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20
Q

What year was the 1.2 ICS approved for adults and peds?

A

Adults: August 1996
Peds: December 1997

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21
Q

When was the 4th generation HiResolution system introduced?

A

2003

90K ICS
HiRes strategy
Auria sound processor

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22
Q

When was the CII Bionic ear system introduced?

A

April 2001

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23
Q

When was the C1 electrode postioning system approved by the FDA?

A

Adults: August 2000
Peds: December 2000

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24
Q

When was the enhanced bipolar electrode used?

A

1997-2000

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25
Q

What are the advantages of HiResolution?

A
  • delivers 5x more resolution than any other sound processing strategy
  • flexible programming options to customize hearing needs
  • available to thousands of bionic ear recipients
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26
Q

Why is measuring M levels using tonal stimuli might not be as accurate as with speech?

A
  • differences in repetition rates
  • differences in degree of simultaneity
  • loudness summation
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27
Q

EFI

  1. what are the EFI parameters?
  2. What are the ranges for invalid and shorted electrodes?
  3. For a CII/90K result, the diagonal shows what information? What is the normed range?
  4. How do you find a shorted electrode?
A
  1. PW = 32 us Amplitude = 36 uA = 29 CU

2. > 0.5 to

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28
Q

What does SPOT not tell us?

A
  • the device is without a doubt working 100%
  • that there is a fine leak present
  • may miss intermittent transients
  • will not answer sound quality issue problems
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29
Q

What does SPOT tell us?

A
  • implant is obeying commands
  • pulses are symmetric and not reversed
  • the device is powering up normally
  • transient stimuli can be detected
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30
Q

What are the parts of the implant that BEIT checks?

What does BEIT tell us about those systems?

A

BEIT checks the stimulation and recording systems, lock, BT, FT, device ID

BEIT notifies us of open electrodes (not shorts)

BEIT tells us teh systems are obeying commands

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31
Q
  1. What does WNL BEIT tell us?

2. What are the limitations of BEIT testing?

A
  1. implant can maintain communication with sound processor
    - stimulus and PW growth is observed
    - impedance are WNL
    - FT and BT are reliable
  2. cannot run BEIT if no lock
    - not available for C1
    - may not detect intermittent issues
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32
Q

EFI C1

  1. How are open electrodes displayed in the test results?
  2. what is a normal value?
  3. How do you find a shorted electrode?
A
  1. Numbers in the diagonal gives information about open electrodes
  2. less then 1050 V
  3. if a value in the grey row is 70% of the diagonal, that electrode is shorted.
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33
Q

What is gain?

A

amplification or attenuation applied to the signal input at the output of a band-pass filter (+/- 10 dB)

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34
Q

What are the 4 earhook options for Auria and Harmony?

A

T-mic
standard earhook
iConnect
Direct Connect

**all come in 2 sizes

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35
Q

What porcessor can use ClearVoice?

A

Neptune
Naida
Harmony

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36
Q

SoudWave is used for programming which external and internal equipment?

A

CII and 90K recipients

C1 patients with a Harmony

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37
Q

In SW 2.0, what makes a program un-editable?

A
  • closing the pt. file
  • generating a report on the program
  • stimulating the program from the pt. record window
  • downloading the program into the processor
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38
Q
  1. What is the 90K CSR after 1 year?
  2. What is the CSR after 5 years?
  3. What is the Harmony monthly return rate?
  4. What is the PSP monthly return rate?
A
  1. 99.8%
  2. 98.6%
  3. < 1%
  4. 5.3 years
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39
Q

What is the average battery life with a PowerCel and PowerCel Plus?

A

PowerCel = 14 hours

PowerCel Plus = 24 hours

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40
Q
  1. Why do we use NRI?
  2. What are the 2 components to the ECAP?
  3. What does ECAP mean?
A
  1. to estimate psychophysical levels
    - to verify pts. levels
    - to assess the auditory nerve’s function
    - as a counseling tool
  2. N1 & P2
  3. electrically evoked compound action potential
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41
Q

The HiRes 90K ICS is capable of how many PPS?

How many spectral bands?

A

83,000 PPS

120 spectral bands

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42
Q

What does initializing do?

A
  • assigns the process to a pt
  • makes the processor compatible with the version of SW you are running
  • removes pre-existing programs
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43
Q

What are are the advantages of the T-mic?

A
  • laces the mic at the opening of the ear for highly focused and more effortless hearing
  • user friendly wireless connectivity with telephone and other audio devices.
44
Q

How many electrodes are needed to enable Fidelity 120?

A

minimum of 3 electrode pairs

45
Q
  1. How many programs does a CII BTE have in SCLIN? How many in SW?
  2. How many programs does a Platinum BTE have in SCLIN? How many in SW?
A

CII BTE:
SCLIN: 2 programs and 1 dead spot
SW: 3 programs

Platinum BTE:
SCLIN: 3 programs and 1 dead spot
SW : 3 programs

46
Q

NRI

  1. How far apart should the starting and ending stimulation level points be?
  2. How many points are typical?
  3. What should be your increment size?
  4. What happens if you have too many points?
A
  1. 100-150 CU.
  2. 5-6 points
  3. 20-30 CU
  4. the greater the number of points, the smaller the increment step size will be. This can effect your tNRI value.
47
Q

In SCLIN, when should changing the minimum tank voltage be considered?

A
  • pt. takes HP off without turning off the processor first
  • lock is unstable
  • loud transients as the system is about to lose lock
  • if tank voltage is too high intermittencies can occur
  • may need to increase PF with increased to min. tank voltage
48
Q

In SCLIN, what can happen when the ICS tank voltage is too low?

A

if the tank voltage drops below a threshold, the ICS looses communication with the processor and no data is sent to the electrode array.

data errors, including amplitude coding errors, can occur when unstable voltages are reached.

errors can result in pops or OLS where the stimulation can exceed the set M levels.

49
Q

What is the repetition rate for an MPS program?

A

1625 Hz/channel

50
Q

Which C1 electrode has L8 location near M1?

What are the consequences of this?

A

Enhanced bipolar array

electrode 8 is turned off in SAS.

51
Q

What is IntelliLink?

A

reads the unique serial number directly from the implant and associates that number with a particular pt. program.

prevents accidental stimulation from a processor that attempts to communicate with the incorrect implant.

52
Q

What are the 4 outcomes of an impedance test?

What is the normal impedance range for CII/90K?

What change in impedance can impact sound quality?

A

vailld, open short, invalid
(green, yellow, purple, grey)

1 to 30 kilo-ohms

doubling to >10 Kilo ohms

53
Q

What are the medical contraindications of cochlear implantation?

A
  • absence of the cochlea
  • lesions of the auditory nerve or central auditory pathway
  • absence of the auditory nerve
54
Q

What com ports does SCLIN use?

55
Q

What processors have audio mixing abilities in SCLIN?

A

PSP, Platinum BTE, CII BTE

56
Q

Power control loop is only available for which processors?

A

1.2 and S-series

57
Q

What is power control loop?

A

the ICS sends power usage information (voltage) to the processor through back telemetry (BT)

the power control loop monitors thank voltage so it does not dip below the minimum ICS voltage

PCL re actively adjusts the PF based on tank voltage info from the ICS
(reacts to the effects that changes in the acoustic signal have on the tank voltage and changes the RF).

58
Q

Explain power control loop.

A

tank voltage is monitored periodically

if the TV > higher threshold for a period of 1 us, the RF level is dropped one level and the timer is restarted.

if TV < lower threshold for 10 us then the RF level is increased and the timer is restarted.

59
Q

What is the overall stimulation rate for SAS?

A

91,000 PPS

60
Q

What should the gains be adjusted?

A

if sound is described as tinny, high frequency sounds can be attenuated.

if sound is described as booming, how frequency sounds can be attenuated

61
Q

Ts are set by SCLIN at a default vales of ____ CUs for a C1 and CII ICS

62
Q

When should you disable a channel in SCLIN?

A

-if impedance is too high
-unresolved FNS
inadequate loudness growth
-pitch perception problems

63
Q

What is the current version of SCLIN?

What operating system does it run on?

A

SCLIN 20000 1.08

Windows XP. Not compatible with Windows Vista or Windows 7.

64
Q

What should T level be measured in a SAS programs?

A

obtain a baseline measure to monitor any physiologic changes that may occuer over time

to set the vol control, although Ts are not used in the program, they are used in setting the range for the VC.

65
Q

In SCLIN, what processors have extended low frequencies set during initialization?

A

S-series

1.2 processor

66
Q

What is the rep. rate for a CIS program in SCLIN?

A

813 Hz/ channel

67
Q

SCLIN is used for the programming of what internal and external equipment

A

All C1 (1.0 and 1.2) and CII patients using 1.2, S-series, Platinum BTE, CII BTE, and PSP

68
Q

In SCLIN, what is the acceptable impedance range for a C1 electrodes?

What is shown when impedance is out of this range?

A

5-150 kohms

if 150 kohms, SCLIN will display electrode as open (yellow)

a true open for a C1 will have a reading of 999.9 kohms

69
Q

C1 standard and enchanced bipolar electrodes use what coupling by default?

70
Q

C1 HiFocus electrodes use what coupling by default?

71
Q
  1. C1 standard and enhanced bipolar electrodes have what type of electrode arrangement?
  2. what does a HiFocus have (for CII/90K)?
A
  1. 1-8 medial and lateral electrodes

2. 1-16 electrodes in a row

72
Q

What are the RF carrier frequencies?

A

Forward telemetry 49 mHz

back telemetry 10.7 mHz

73
Q

With the magnet removed, what is the safe range for an MRI with a 90K?

A

0.3-1.5 Tesla

74
Q

What is PoEM and what are the advantages?

A

power estimator

  • improves lock stability across environments
  • accounts for changes in pt. flap thickness that naturally occurs over time
  • operates over various hardware configurations allowing programs to be interchangeable between processors
  • any change in hardware does not require a clinic visit to optimize RF
75
Q

What is APW II?

What is a significant change in impedance?

A

provides more compliance headroom so that sound quality is less likely to be affected by fluctuating impedances

more than doubling of impedance to value > 10 kohms

76
Q

What are the adult FDA guidelines for CI candidacy?

A
  • severe to profound SNHL with PTA > 70 dB in both ears
  • limited benefit from HAs
  • sentence score <50% in the implanted ear
  • healthy adult over the age of 18
  • postlingual onset of deafness (after 6 years of age)
77
Q

By age 3, how many words does a child need to hear each day to develop language needed for success in school?

78
Q

What are the pediatric FDA guidelines for CI candidacy?

A

12 months to 17 years old

profound SNHL in both ears (PTA > 90 dB)

trial with appropriately fit HAs for approximately 6 months (trial waived if x-ray shows ossification)

little to no benefit from HAs
4 years: < 30% on sentence test.

79
Q

What is AutoSound?

A

adapts to the pt’s changing environments

automatically capture the widest range of sounds

optimizes hearing without requiring processor adjustments (hands-free convenience).

80
Q

What is constant charge?

A
  • used in SW
  • constant charge accounts for both amplitude and PW
  • constant charge is calculated by pulse amplitude and pulse width
  • changes in PW do not require remeasuring Ms because the charge area is held constant
81
Q

When does APW increase PW?

A
  • merge compliance voltage of electrodes with 3-6th highest voltage is greater than 8 volts
  • average voltage of all enabled electrodes are greater than 7 volts
  • average maximum current level of the 3-6th highest current is greater than 1400 micro amps
82
Q

When would you manually decrease the T settings from 10%?

When would you increase them?

A

decrease if pt hears a background humming

increase them if pt reports soft sounds are inaudible

83
Q
  1. What is compliance?
  2. What is the maximum voltage of a CII/90K?
  3. C1?
A
  1. Compliance is the voltage required by the circuit to deliver a specific amount of current through a resisitive load (impedance)
  2. 8 volts.
  3. 7 volts.
84
Q

!. What does sensitivity do?

  1. What could happen if sensitivity is too high or low?
A
  1. provides additional gain or attenuation to the input signal (+/- 10 dB)

impacts where the acoustic input is mapped within the pt’s electrical range

  1. could push an acoustic input below stimulus threshold or into compression
85
Q

When should you increase the IDR?

When should it be decreased?

A

increase: pt. reports soft sounds care inaudible or when pt wants a music program
decrease: pt has difficulties hearing in situations where there is low background noise and when pt. hears noise from the T-coil.

86
Q

What would be the current for a CII device if the impednace was 8 kohms?

10kohms?

3 kohms?

What would be the CUs in SW?

A

8 kohms = 1000 uA =130 CU

10 kohms = 800 uA = 104 CU

3 kohms = 2670 uA = 347 CU

87
Q

What are 5 benefits of the Harmony over the Auria?

A 
16 bit A/D converter
multi-color LED
internal T-coil
longer battery life 
access to Fidelity 120 and CV
88
Q

What are the components to intensity input?

What determines intensity?

A

T-mic
16 bit/96 dB front end processing
AutoSound
wide IDR (up to 80 dB)

89
Q

What is IDR?

What is the patient benefit?

A
  • defines how much captured sound is delivered by the system
  • access to more sound information for better hearing at softer presentation levels.
  • incidental learning, awareness of environment, responding to important sounds and selective listening
  • fewer processor adjustments
90
Q

What are the Harmony advantages?

A

HiResolution and Fidelity 120
AutoSound
T-mic

91
Q

What are the Neptune audible alarms?

A

beeps once/sec = loss of lock

Beeps rapidly = wrong implant

beeps once/5 sec = low battery

2 beeps/3 sec = battery is depleted

continuous beep = error condition (not programmable)

92
Q

What does the LED colors indicate on the PSP, Harmony, Neptune?

A

orange: battery status
flashes: battery charge
steady: low battery
2x blinks: change battery

green: response to sound: blinking
solid: open program slot

red: no lock (1 blink/sec)
     wrong implant (rapid blinking)
     processor error (solid red)
93
Q

What are the Neptune power options?

What are the average battery life for each?

A

disposable AA lithium battery
avg 20 hrs
range 11-30 hrs

Disposable AAA Alkaline battery
avg 12 hours
range 6-21 hours

rechargeable NiHM AAA battery
avg 13 hours
range 8-21 hours

94
Q

What are the pros and cons of first NRI vs tNRI?

A 
First NRI:
\+ alternative if the I/O function cannot be calculated
- impacted by noise floor
- impacted by step size
- impacted by scale
- impacted by clinician expertise

tNRI:
\+ faster and easier to measure
\+less contaminated by noise floor
\+less subjective among clinicians
- too few data points can give inaccurate regression line
95
Q

What are the PW options in SCLIN?

A

75 us
150 us
225 us
300 us

96
Q

5 points of/when using interpolation.

A
  1. only SCLIN available in measurements screen, not the program screen
  2. only available in monopolar coupling
  3. uses measured T & M values to estimate the levels of the remaining channels
  4. requires at least one M level to be measured
  5. enables rapid initial fitting and prevents pt fatigue
97
Q

What is “headroom” in SCLIN programming?

A

upper third of the first 3 ranges. Headroom is provided for increasing the amplitude using the VC. There is no headroom in the 4th range.

98
Q

In SCLIN, how does the device power up?

A

system first attempts to attain lock at the RF start up level. once lock is established, the RF is gradually decreased to the set RF level.

When this set level is reached, power control starts with 1.2 and S-series processors.

PSP and BTE do not require power cell level to optimize battery life. The static RF is set.

99
Q

What does configuring do in SCLIN?

A

optimize RF for each program on the sound processor

measures final impedances

sets audio alarms

downloads programs to processor

100
Q

what are the file extentions for SCLIN and SW?

A

SCLIN pt. file: .pat
SCLIN database file: .bkp

SW pt. file: .xml
SW database file: .bak

101
Q

In SCLIN, C1 electrodes shows a CU range of 0-20000.

How does CII scale this range?

A

scaled into 4 sub-ranges:

1st 0-250/ 1 CU increments
2nd 0-500/2 CU increments
3rd 0-1000/4 CU increments
4th 0-2000/8 CU increments

102
Q

In SCLIN programming of CII, what are the cross over levels of each range?

A

1st-2nd 170 CU
2nd-3rd 340 CU
3rd-4th 680 CU

103
Q

What is the advanced programming mode in SCLIN?

A

a tonal stimuli can be generated on a channel by channel basis to remeasure M & T levels in the program window (PSP, PBTE, CII BTE)

not available with S- series. Changes to M & T levels must be made in the measurement window

104
Q

What are the 3 primary device fitting objections?

A
  1. measure the Pt’s psycho-physical response to electrical stimuli as delivered through the CI
  2. determine the most beneficial speech coding strategy
  3. provide to most effective settings for the selected speech coding strategy.
105
Q

What are 3 device fitting objective?

A

prevent pt. fatigue

optimize pt long term outcomes

optimizes reimbursement

106
Q

What are the configured RF issues with SCLIN?

A

BTEs should be manually configured.

adjust lock normally with 1.2 and S-series processors

RF typically 0 with PSP and CII ISC.

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