Wk8b-Clinical Aspects-Surgery and Rehab

Question 1

What are the two traditional approaches to electrode insertion? Which is less traumatic?

Answer 1

The traditional approach (cochleostomy) in which a hole was drilled in the cochlea anterior/inferior to round window (allows for stiffer electrodes)

The more modern round window approach in which the electrode is inserted through the round window

The round window approach is less traumatic, and possible b/c modern electrodes are smaller and more flexible (and can get around the 90 degree turn after the round window)

Question 2

How long does unilateral or bilateral CI operation take?

Answer 2

2-3 hrs (unilateral)

4-5 hrs (bilateral)

Question 3

What is the next step after CI surgery?

Answer 3

1-wk post-op check for healing

Question 4

How long is the healing time after CI surgery?

Answer 4

4 weeks

Question 5

What is MAPping?

Answer 5

The term for programming the speech processor of the CI to the specifications and needs of its user

• maps are programs that help optimize CI user’s access to sounds by adjusting the inputs to the electrodes on the array
• CI processor is connected to audiologist’s computer and T and C/M levels are set based on responses
• stimulation rate/programming strategy may also be changed
• duration of appointment varies
• accessory kit and troubleshooting inservice will also be provided at end of appoint

Question 6

After the initial MAPping appointment, pt’s generally want ____ (more/less) stimulation. Reprogramming typically happens at what 4 intervals?

Answer 6

More

1 week, 2 week, 1 month, and 3 months post-activation

Question 7

Research shows that CI users typically need __ to __ months to fully adjust to electric hearing, which is why speech perception testing is not done until ___ months after activation

Answer 7

3-6 months
6 months (re-programming and speech perception testing done at 6 months, 12, months, 18 months, and 2, 3, 4, 5, 7, and 10 years post-op)
*visits may occur more frequently

Question 8

What other post-activation follow-ups are sometimes needed and what are the challenges

Answer 8

Auditory-verbal therapy (AVT) once/week for an hour

• AVTs may be difficult to find, especially in rural areas, meaning extra travel
• time consuming and costly

Question 9

Is the CI alone enough to develop speech and language?

Answer 9

No - it is an amplification tool to access information paramount to the development of speech and language, but alone, it is not enough

Question 10

What does the SAC position paper say are rehabilitation goals for CI users?

Answer 10

• to process sound in order to understand spoken language
• to recognize and interpret environmental sounds
• to derive pleasure from listening (e.g. music)
• to develop spoken language

Question 11

What is the preferred first step in the rehab process? What other options are there?

Answer 11

AVT

- must continually monitor and recognize when things like ASL should be employed

Question 12

Besides emphasizing oral communication in rehab programs, what other information does SAC think we should make families aware of?

Answer 12

The position and concerns of the Deaf community regarding the right to access both spoken and signed languages
- encourage professionals to exercise caution when suggesting exclusion of certain languages

Question 13

What is the importance of binaural input?

Answer 13

• generally accepted that 2 ears are better than 1
• binaural summation
• reduced effort to decode speech
• localization
• spatial release of masking (improved SIN)
• elimination of head shadow and increased ability to hear from both ears

Question 14

Currently, ___(bi/uni)-lateral implantation is the standard of care for children who are candidates for CI’s in both ears.

Answer 14

Bilateral

• both ears must meet criteria for this to occur
• parents must consent to implantation of both ears