Cochlear Implant Protocols

Question 1

FDA Guidelines 12-23 months

Answer 1

• Profound bilateral sensorineural hearing loss
• No progress in auditory skill development with HAs and intervention
• Limited benefit is defined as lack of progress in the development of simple auditory skills in conjunction with appropriate amplification and participation in intensive aural habilitation over a 3- to 6-month period.
• No medical contraindications
• High motivation and appropriate expectations from family

Question 2

FDA Guidelines 25 months to 17 years

Answer 2

• Severe-to-profound sensorineural hearing loss in both ears
• Lack of progress in the development of auditory skills
• No medical contraindications
• High motivation and appropriate expectations (both child and family)
• Pre- or post-linguistic onset of hearing loss

Question 3

Implant Candidacy Trends

Answer 3

• implant at younger ages, especially if medical condition can interfere
• implant with more hearing, like unilateral HL or high frequency HL

Question 4

Limited Benefit from hearing aids

Answer 4

• fit with appropriate ones
• have child wear them with strategies to keep on
• 3 month trial period
• track responses & outcomes (assessment, functional listening benefit)

Question 5

Cochlear implant follow-up schedule (EHDI)

Answer 5

• Initial stimulation (IS) approximately 1-5 weeks after surgery (turn implant on)
• 2 weeks post IS
• 1 month post IS
• 3 months post IS (dependent on need)
• 6 months post IS
• 9 months post IS (dependent on need)
• 1 year post IS
• Semiannual visits thereafter

Question 6

why would two ears be better?

Answer 6

• Spatial hearing: Being able to locate sound sources in one’s environment
• Speech understanding in noise: Being able to segregate speech sounds from background speech and noise competitors
• Listen with less effort: Fatigue and learning
• Improved music appreciation

Question 7

Binaural Cues

Answer 7

• Interaural timing differences: diff in timing for when sound reaches ear; medial superior olive
• Intreraural level differences: diff in intensity of sound when reaches ear; lateral superior olive

Question 8

barriers to bilateral implantation

Answer 8

• Money
• Time, stress, AR that goes on - can’t handle another
• Surgery is scary - did one, do I want to risk a second
• Place of acceptance
• Some hesitant - cochlea gone - may want to preserve hearing in one ear & wait for developments