Wk8a - Clinical Aspects - Candidacy and Ax

Question 1

Considering the proportion of CI candidates compared to hearing aid candidates, which technology do you think has more invested into it and why?

Answer 1

Hearing aids - there is a higher number of candidates/potential buyers

Question 2

Why should we treat hearing loss?

Answer 2

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

Question 3

Name 3 goals of treating hearing loss

Answer 3

Acquiring/maintaining basic auditory functions

• sound detection
• sound discrimination
• sound localization
• emotion identification
• music appreciation

Question 4

What is prelinqual and postlingual deafness?

Answer 4

Deafness acquired before and after acquired language

Question 5

What is peri-lingual deafness?

Answer 5

Hearing loss that occurs during the process of acquiring language

Question 6

What does “total communication” refer to?

Answer 6

The use of any combination of signs, finger spelling, listening with amplification, lip-reading, facial expression, body language, reading and writing

Question 7

Name the main members of the CI team (including organizations)

Answer 7

CI candidate/parents
Family physician
CI team within the CI program
Ministry of health (financing)
CI manufacturers

Question 8

What are the 5 CI programs in Ontario?

Answer 8

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

Question 9

Which professionals make up the implant team?

Answer 9

Audiologists
ENT surgeons
Psychologist/psychometrist
Social worker
Child-Life specialist
Speech Language Pathologist
Auditory-verbal therapist

• this team assesses candidacy for each individual case

Question 10

Who are the 4 certified CI manufacturers in Canada?

Answer 10

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…)

Question 11

What is the role of the family doctor?

Answer 11

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

Question 12

What allows a pt to become a CI candidate?

Answer 12

• 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…)

Question 13

What are the audiological criteria for CI candidacy?

Answer 13

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

Question 14

Why don’t we just use threshold data for CI candidacy?

Answer 14

A person’s percentage does not accurately reflect the pt’s function or ability to cope with the HL

Question 15

Currently, in North America cochlear implantation is not approved earlier than ___ months of age

Answer 15

12 months/1 year of age

Question 16

What are the CI criteria for younger children?

Answer 16

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

Question 17

What are the CI criteria for older children?

Answer 17

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

Question 18

What are the CI criteria for adults (Sunnybrook)?

Answer 18

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

Question 19

How have CI candidacy requirements changed over the years?

Answer 19

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

Question 20

What change to candidacy occurred in 2019?

Answer 20

FDA approved Med-EL’s CI’s for single-sided deafness and asymmetric hearing loss

Question 21

Describe the general assessment process

Answer 21

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)

Question 22

Describe the typical pre-implant audiological assessment

Answer 22

• 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

Question 23

What are contraindications to CI’s?

Answer 23

• 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)