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AUD spring 2020 CI > Week 7.2 Pediatric Candidacy > Flashcards

Week 7.2 Pediatric Candidacy Flashcards

1
Q

when did the FDA 1st approve CI’s for children

A

june 1990

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2
Q

AB audiometric threshold requirements for children

A

severe to profound bilateral sensorineural hearing loss (>70 dB HL)

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3
Q

AB auditory skills and speech recognition in younger children

A

<4 years of age: failure to reah developmentally appropriate auditory milestones (such as spontaneous response to name in quiet or to environmental sounds) measured using the infant-toddler meaningful auditory integration scale or meaningful auditory integration scale; or <20% correct on a simple open-set word recognition test (multisyllabic lexical neighborhood test (MLNT)) administered using monitored live voice (70 dB SPL)

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4
Q

AB auditory skills and speech recognition in older children

A

> 4 years of age: <12% on a difficult open-set word recognition (phonetically balanced kindergarten test) or <30% on an open-set sentences (hearing in noise test for children) administered using recorded materials in the sound field (70 dB SPL)

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5
Q

AB amplification requirements for children

A

use of appropriately fitted hearing aids for at least 6 months in children 2-17 years, or at least 3 months in children 12-23 months of age. The minimum duration of hearing aid use is waived in the presence of ossification concerns

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6
Q

cochlear audiometric threshold requirements in children

A
  • 12-23 months: bilateral profound SNHL

* 24 months-18yrs: bilateral severe-to-profound SNHL

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7
Q

Cochlear auditory skills and speech recognition in younger children

A

lack of progress in the development of simple auditory skills as quantified an a measure such as the Meaningful Auditory Integration Scale or the Early Speech Perception test

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8
Q

cochlear auditory skills and speech recognition in older children

A

= 30% correct on MLNT or lexical neighborhood test (LNT), depending on the child’s cognitive and linguistic skills

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9
Q

cochlear amplification requirements for children

A

use of appropriate amplification and participation in intensive aural habilitation over a 3 to 6 month period

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10
Q

med-el audiometric threshold requirements

A

profound bilateral SNHL with thresholds of 90 dB HL or greater at 1000 Hz

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11
Q

med-el auditory skills and speech recognition in younger children

A

lack of progress in the development of simple auditory skills in conjunction with appropriate amplification

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12
Q

med-el auditory skills and speech recognition in older children

A

<20% correct on the MLNT or LNT depending on cognitive ability and linguistic skills

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13
Q

Mel-el amplification requirements for children

A

use of appropriate amplification and participation in intensive aural habilitation over a 3 to 6 month perios
*radiologic evidence of cochlear ossification may justify a shorter trial with amplification

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14
Q

when can you use conditioned play audiometry

A

24-30 months up to 6 yrs

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15
Q

CI criteria for children (audiometric thresholds)

A
  • 12-24 months: bilateral profound SNHL
  • > 24 months
  • –cochlear= bilateral severe to profound SNHL
  • –AB and Mel-el= bilateral profound SNHL
  • can implant earlier then 12 months by decision of the CI team
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16
Q

different ways to assess hearing status of children

A
  • objective testing
  • –case history
  • –tymps
  • –acoustic reflex
  • –OAE
  • –ABR
  • –EcochG (will tell you pre synaptic or post synaptic lesion)
  • speech recognition testing
  • accurate diagnosis (VRA or play audiometry is really helpful to know what is really going on, this is preferable)
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17
Q

when to use evoked potential testing for candadicy for children

A
  • use on your itty bittys who cant give behavioral responses

* can also use to try and find the site of lesion

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18
Q

about what percent of children with HL have auditory neuropathy and what is the significance of this

A
  • about 9% of kids with HL have AN
  • this is important to know because it would affect the recommendations depending on type 1 or type 2
  • –type 2 is more of damage to the synapse of the IHC
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19
Q

hearing aids eval in CI candidate for children

A
  • testing conditions: the best-aided condition
  • HA verification process
  • –PMM or test box verification with pt specific real ear to coupler difference (RECD) corrections
  • –DSL m[i/o] should be used
  • –verify target at speech-input levels corresponsing to soft, average, and loud, such as 50, 60, and 70 dB SPL
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20
Q

speech recognition testing for children basic

materials and presentation level

A
  • speech testing material
  • –recorded is necessary for older children
  • –some children only respond to MLV, but really need to do recorded
  • —–use the multisyllabic lexical neighborhood test (MLNT) and monosyllabic lexical neighborhood test (LNT)- both are recorded
  • presentation level
  • –use 60 dB A
  • amplification trial period
  • –importance
  • –6 months
  • –shorter trial
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21
Q

speech recognition testing in younger children

A
  • mainly looking at auditory skills development via questionnaires
  • closed set tests are recommended for younger kiddos
  • –Nu-chips
  • –WIPI
  • –CRISP Jr
22
Q

NU-CHIPS

A

northwestern university children’s perception of speech

  • picture booklet with 4 pics per page (25% chance)
  • vocab level is 2.5-5 years
23
Q

WIPI

A

word identification picture intelligibility

  • picture booklet with 6 pictures per page (16.7% chance)
  • vocab level is 3-5 years
24
Q

CRISP Jr

A

children’s realistic intelligibility of speech perception (computer based)

  • 16 words that are body parts or names of objects
  • age group is 2.5-5 years
25
Q

FDA speech recognition testing in older children in order of developmentally appropriate progression

A
  • early speech perception (ESP) test
  • multisyllabic lexical neighborhood test (MLNT)
  • lexical neighborhood test (LNT)
  • phonetically balanced kindergarten (PBK) word recognition test
  • BabyBio sentences for children
  • CRISP (childrens realistic intelligibility of speech perception (computer based)
26
Q

ESP

A

early speech perception test

  • closed-set (36 words, 3 lists)
  • ages 2-6 years
27
Q

MLNT

A

multisyllabic lexical neighborhood test

  • open-set, 2 lists of 12 lexically easy and 2 lists of 12 hard mutisyllabic words (level 3-5 years)
  • words and phonemes correct
28
Q

LNT

A

lexical neighborhood test

*2 lists of 25 lexically easy and 2 lists of 25 hard monosyllabic words (level 3-5 years)

29
Q

PBK test

A

phonetically balance kindergarten word recognition test

  • minimum 4 years
  • ope-set, 50 words-phonemes and word correct
30
Q

BabyBio sentences for children

A
  • at least 5 years old

* 16 lists, each has 20 lists of 3-12 words

31
Q

CRISP

A

children’s realistic intelligibility of speech perception (computer based)

  • 25 spondees
  • age group is 4-7 years
32
Q

FDA labeled ped CI candidacy for speech for AB

A
  • young=<20% on MLNT

* older= <12% on open set (PBK) or <30% on HINT-C

33
Q

FDA labeled ped CI candidacy for speech for cochlear

A
  • young= lack of progress

* older=<30% on MLNT or LNT

34
Q

FDA labeled ped CI candidacy for speech for med-el

A
  • young= lack of progress

* older=<20% on MLNT or LNT

35
Q

evaluating progress of auditory skill for kids 0-3 years

A
  • looking to see auditory skills and progress during the HA trial
  • must be done via parental history and validated questionnaires:
  • –infant-toddler version of the Meaningful Auditory Integration Scale (IT-MAiS)
  • —–0-3 yrs
  • —–10 item parental interview
  • —–open-ended questions with scores ranging from 0 (never) to 4 (always)
  • –the LittlEars Questionnaire
  • —–0-24 months in normals (or up to 24 months following implantation)
  • —–35 yes/no questions
  • —–questions are hierarchical, so ceiling at 6 consecutive no answers
  • –the auditory skills checklist (ASC)
  • ——0-3 yrs
  • —–parental interview style with 35 items assessing detection, discrimination, identification, and comprehension
  • —–soreing 0= child does not have the skill; 1= child has skill developing; 2= child demonstrated the skill
  • –functioning after pediatric cochlear implantation (FAPCI) questionnaire
  • —–2-5 yrs
  • —–23 items does not require parental interview
  • —–provides baseline (pre-op)
  • –functional auditory performance indicators (FAPI)
  • —–assess sound awareness, meaningful sounds, auditory feedback,sound localization, discrimination, short-term auditory memory and linguistic auditory processing
  • —–scoring: emerging (0-35%); in process (36-79%); acquired (80-100%)
  • –3mo until all acquired
  • –early language milestone scale (ELM)
  • —–0-3 yrs
  • —–43 items designed to assess language development (expressive, receptive,a and visual language–parental interview
36
Q

evaluating progress of auditory skills for preschool to school-age children

A
  • common questionnaires
  • –the meaningful auditory integration scale (MAIS)
  • —–3-5 yrs
  • —–10 item parental interview style questionnaire
  • –the parents’ evaluation of aural/oral performance in children (PEACH)
  • —–3-7 yrs
  • —–13 items designed for parental completion
  • —–parent reflect on the child’s listening behavior over the previous week and assigns a numerical value ranging from 0 (never) to 4 (always)
37
Q

SLP’s role in CI

A
  • critical role in CI candidate selection

* at least SLP eval during candidacy selection process should take place during the HA trial (after verification)

38
Q

social worker and physiologist involvement in CI candidate selection

A
  • often helpful for families struggling with the diagnosis
  • help to determine family dynamics and level of dedication to the recommended post-op therapy schedule
  • social workers can provide counseling and support in financial options
39
Q

medical and surgical issues with ped CI candidacy

A
  • medical team ensures that candidates are current on recommended immunizations
  • a pre-op medical eval anesthesia) and other medical specialties as needed
  • imaging: CT and MRI
40
Q

vestibular considerations for ped CI candidacy

A
  • vestib impairment is the single most common associated feature of SNHL
  • –many pts with HL experience dizziness and/or imbalance
  • balance system: detection and integration from the visual, proprioceptive, and vestib system
  • –vestib system is at the biggest risk during cochlear implantation
  • 5 vestibular end organs within each ear:
  • –3 SSC that detect and encode angular accelerations
  • —–info detected here triggers the vestibulo-ocular reflex, leading to maintenance of stable vision during movement
  • —–2 remaining= otolith (utricle and saccule)- linear movements such as gravity and head tilts
  • ———important for postural stability through vestibulo-colic and vestibulo-spinal reflexes
  • ———important for gross motor skill development (learning to sit, stand, and walk)
41
Q

vestibular function and HL

A
  • 72% of children and adults with significant SNHL have some level of vestib dysfunction-type depends on underlying inner ear pathology
  • –for cases evaled for CI, up to 50% have SCC abnormalities, and up to 44% have abnormal otolith function
  • genetic:
  • –Usher syndrome (Type I)
  • –pendred syndrome
  • –waardensburg syndrome
  • –cogan syndrome
  • –brachio-oto-renal syndrome
  • –CHARGE
  • –connexin 26
  • –inner ear malformations
  • –enlarged vestibular aqueduct
  • –charcot-marie-tooth disease
  • Acquired:
  • –prematurity
  • –anoxia
  • –fetal alcohol syndrome
  • –meningitis
  • –CMV
  • –ototoxicity
  • –aging
  • –menieres
  • –labyrinthitis
  • –autoimmune inner ear disease
  • –trauma
42
Q

pediatric vestibular considerations

A
  • children with severe to profound HL are likely to demonstrate additional vestibular impairment
  • children with congenital SNHL demonstrate semicircular canal (41%) and otolith (42%) dysfunction
  • vestibular function in children is commonly overloooked. but congenital and early-onset vestib dysfunction may lead to significant delays in motor skill development
  • developmental milestones (upper limit)
  • –response to tilt (>36 months)-should right within seconds
  • –head control- 4 months
  • –sitting unsupported-9 months
  • –walk 18 months
  • motor function (standing on one leg)
  • –2.5 yrs= 1 sec
  • –3 yrs= 2 sec
  • –4 yrs=5 sec
  • –>/= 5 yrs= 8 sec (eyes open), 4 sec (eyes closed)
43
Q

when to refer kid for vestib eval

A
  • delayed motor development
  • delayed walking
  • loss of postural control= falls
  • episodes where pallor/vomiting
  • investigating etiology of HL +/- balance symptoms
44
Q

barriers to ped CI

A
  • lack of pt awareness
  • finances
  • –SEC
  • –insurance
  • lack of professional knowledge
  • lack of referrals
45
Q

infants under 12 months and CI

A
  • FDA candidacy is 12 months
  • no greater anesthetic risks for infants <12 months
  • surgical issues:
  • –intraoperative blood loss
  • –facial nerve damage
  • –skull thickness
  • –fixation of the internal device
  • –thin skin flap
  • –skull growth causing migration
46
Q

SSD and amplification options

A
  • CROS
  • osseointegrated bone conduction hearing device
  • remote mic system
  • CI
  • –improve speech in quiet and noise
  • –better spatial hearing
  • –tinnitus suppression in unilateral hearing loss
47
Q

SSD in peds

A
  • cochlear nerve deficiency: as many as 50% of children with SSD have cochlear nerve deficiency- CRUCIAL to get an MRI
  • –likely to reject CI
  • CMV-most common environmental cause of genetic HL
  • –some children with SSD due to CMV will make limited progress with implant due to cognitive/neural deficits associated with CMV
  • bacterial meningitis-if ossification has occurred, unlikely that a CI will be possible
  • enlarged vestibular aqueduct- relatively common cause of SSD; highly successful with Ci if duration of deafness prior to implantation is short
48
Q

SSD in adults

A
  • menieres
  • -CI with simultaneous labyrinthectomy (if vertigo) is generally successful
  • more successful if implanted after a short period of deafness (shorter the better)
  • adults should be highly motivated to be implanted
49
Q

children with global developmental delay and CI

A
  • no professional consensus on whether children with compromised cognition/severe global developmental delay should be implanted
  • difficulty in obtaining reliable behavioral estimated of hearing
  • expectations need to be managed with counseling
50
Q

neurofibromatosis Type 2

and CI

A
  • autosomal dominant disorder
  • outcomes from cochlear implantation is variable but generally better than patients with an ABI
  • patient counseling
  • ***i think this really meant they do better with ABI

AUD spring 2020 CI (16 decks)

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