Wk8a - Clinical Aspects - Candidacy and Ax Flashcards
Considering the proportion of CI candidates compared to hearing aid candidates, which technology do you think has more invested into it and why?
Hearing aids - there is a higher number of candidates/potential buyers
Why should we treat hearing loss?
To protect our auditory pathways
- neural plasticity means we need to use it or lose it
- loss can occur through neural degeneration and recruitment to other sensory systems
Name 3 goals of treating hearing loss
Acquiring/maintaining basic auditory functions
- sound detection
- sound discrimination
- sound localization
- emotion identification
- music appreciation
What is prelinqual and postlingual deafness?
Deafness acquired before and after acquired language
What is peri-lingual deafness?
Hearing loss that occurs during the process of acquiring language
What does “total communication” refer to?
The use of any combination of signs, finger spelling, listening with amplification, lip-reading, facial expression, body language, reading and writing
Name the main members of the CI team (including organizations)
CI candidate/parents Family physician CI team within the CI program Ministry of health (financing) CI manufacturers
What are the 5 CI programs in Ontario?
Pediatric:
- Children’s Hospital of Eastern Ontario
- Hospital for Sick Children
- London Health Sciences Centre
Adults:
- Sunnybrook Health Sciences Centre
- Ottawa Civic Hospital
- London Health Sciences Centre
Which professionals make up the implant team?
Audiologists ENT surgeons Psychologist/psychometrist Social worker Child-Life specialist Speech Language Pathologist Auditory-verbal therapist
- this team assesses candidacy for each individual case
Who are the 4 certified CI manufacturers in Canada?
Advanced Bionics (US; owed by Sonova (phonak, unitron…))
Cochlear Americas (Australia)
Med-EL Corp (Austria)
Oticon Medical (France; owned by William Demant (Oticon, Bernafon, Interacoustics, GSI…)
What is the role of the family doctor?
Patients need a referral to be a CI candidate (required by physician)
- early referrals are paramount to pt outcomes
- initial contact of the centre can often be made by others
What allows a pt to become a CI candidate?
- pt has tried HAs and does not receive benefit
- pt’s HL is so profound that appropriate fit of HAs is not possible
- pt has no medical or psycho-social contraindications (e.g anaesthesia, surgery, nothing that will limit benefit…)
What are the audiological criteria for CI candidacy?
Thresholds (PTA of 500 Hz, 1 and 2 kHz)
Speech perception scores (scores of 30% or worse on either the MLNT or Lexical Neighbourhood Test for children)
**Both criteria need to be met
Why don’t we just use threshold data for CI candidacy?
A person’s percentage does not accurately reflect the pt’s function or ability to cope with the HL
Currently, in North America cochlear implantation is not approved earlier than ___ months of age
12 months/1 year of age
What are the CI criteria for younger children?
12-24 months of age
- profound bilateral SNHL
- limited benefit from HAs (little ears, IT-MAIS)
- no medical contraindications
- spoken language as a primary mode of communication
- educational placement with strong auditory component
- realistic expectations by family (parents should not expect normal hearing or overnight results)
- strong motivation and family support
What are the CI criteria for older children?
25 months - 17 years 11 months
- severe to profound (70+ dB HL) bilateral SNHL
- open set speech perception score of less than or equal to 30% (MLNT or LNT dependant on child’s age)
- all other criteria are the same as the 12-24 month age range
What are the CI criteria for adults (Sunnybrook)?
18 years old or older
- moderate to severe/profound bilateral SNHL
- limited benefit from optimally fitted amplification (AzBio <50% in the CI ear and = 60% in opposite ear or binaurally)
- post-lingually deafened, or pre-lingually deafened but are oral communicators
- all other criteria same as older children
How have CI candidacy requirements changed over the years?
1985 - adults, poslingual, profound SNHL, 0% speech scores
1990 - adults and children, added pre and post-lingual children, profound SNHL, 0% speech scores
1998/2000 - added severe category, 50% or less HINT
What change to candidacy occurred in 2019?
FDA approved Med-EL’s CI’s for single-sided deafness and asymmetric hearing loss
Describe the general assessment process
Patient/Family/Professional Inquiry
- > Questionnaire/Info Package
- > Information Session
- > Audiological Evaluation (possible HA trial period)
- > medical evaluation
- > speech and language ax (possible aud/verbal therapy
- > psychological eval
- > social work eval
- > CI team meeting (assess candidacy)
- > either approved (surgery and f/u) or declined (annual f/u)
Describe the typical pre-implant audiological assessment
- ABR - objective estimate and ax of AN (if not already done through IHP)
- behaviour audiology ax (each ear)
- ME measurements
- OAEs (hair cell health, if not done by IHP)
- amplification ax and verification (if pt already has HAs)
- HA fitting (if not already fit) - as part of candidacy, children undergo 6 month trial emphasizing development of aud/oral skills
- speech perception testing (aided and unaided)
- function auditory performance and communication (HHI, AHIP…)
- varies in length (age, health, etc)
- requires significant collaboration b/w professional
What are contraindications to CI’s?
- lack of AN (narrow meatus on imaging, ABR results)
- mastoid cavity - relative contraindication only (depends on skill of surgeon)
- lack of commitment or social support
- unrealistic expectations
- severe malformations of inner ear (most mild and moderate malformations can be implanted)
- general health (cannot withstand general anaesthesia)
