CDO 431 AuD Rehab Implant Devices

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CDO 431 AuD Rehab Implant Devices
2013-09-18 13:45:58
Implant Devices

Implant Devices
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  1. Implantable Devices
    • Cochlear implants
    • Bone anchored hearing aid
    • Middle ear implants
    • Brainstem implants
    • Other devices
  2. Cochlear Implants
    • CIs offer an alternative for sound stimulation to individuals who receive limited benefit from hearing aids. Available for adults in 1972.
    • Moderate to profound SNHL*
    • Poor word recognition with hearing aids (40-50%) WR
    • Desire to be part of the hearing world
    • No medical contraindications
    • Highly motivated patient with appropriate expectations
    • some people in Deaf culture are not committed to auditory inout and therefore not the best candidate
    • test someone with best HAs for WR based on sentences
  3. Cochlear Implants
    • CIs became available to children in 1980:* Profound SNHL
    • Lack auditory development (3-6 month period) or ≥ 30% word recognition (for older children) w/ appropriate amplification
    • Enrolled in therapy program to enhance auditory development or educational program which includes auditory skills (for older children)
    • No medical contraindications
    • Highly motivated parents (or older child themselves) w/appropriate expectations
    • originally only for profound HL
    • in 1980 you had to be 24 months but now only need to be 12 months
  4. Bilateral implants are recommended
    typically 2 separate surgeries
  5. cochlear implants are electronic sound
    no longer acoustic
  6. if not bilateral then bimodal is recommended
    cochlear on one side + HA on other side
  7. 20 channel = 20 electrode = 20 frequencies
    • more electrodes turned on means more frequencies that you can hear
    • the sound will never be the same as it is to someone without hearing impairment because it is electrical not acoustic
    • eventually, if successful, people with cochlear implants will begin to interpret it as regular sound
  8. Internal Hardware
  9. Speech Processor
  10. The External Hardware
  11. The Team Approach
    • Careful evaluation by a team of professionals is needed to determine candidacy for cochlear implantation and to develop the appropriate treatment plans for these individuals.
    • Patients and parents
    • Audiologists
    • Physicians (surgeons)
    • Speech language pathologist
    • Teachers of the hearing impaired
    • Social workers
  12. The CI Audiology Evaluation
    • Pure tone hearing levels
    • Word recognition without hearing aids and with“appropriate hearing aids”. Test materials are sentences
    • Presentation level is typically 60 dB
    • FDA provides “guidelines”
    • Speech recognition tested using sentences (% correct)with appropriate hearing aids in each ear and with both ears.
    • Speech discrimination scores:
    • Medicare: 40% or poorer in the “best aided condition”
    • Other insurances: 50% or poorer in the ear to be implanted with no better than 60% in the other ear or binaurally
  13. The Team Approach
    • Audiologic re/habilitation is an integral part of the cochlear implant pre-evaluation and post surgery process.
    • SLPs and Audiologists* are the most likely providers ofAR services
  14. The CI Process
    • Candidacy established
    • Surgery (≈2 hours), most often out-patient
    • Initial stimulation/mapping “the hook-up” 6 weeks postsurgery(≈1.5 hrs.)
  15. Initial stimulation/mapping “the hook-up” 6 weeks post surgery(≈1.5 hrs.)
    • NRT or NRI (Neural response telemetry or imaging)
    • T levels (electrical thresholds)
    • C levels (maximum current level- comfort level)Follow-up mapping
    • Follow-up auditory training and therapy
  16. The CI Process
    • Reevaluate Ts and Cs, re-MAP
    • Review journals
    • Initial word recognition testing
    • Scales and inventories (children)
    • Sounds and noises (older children)
    • Words w/ pictures (older children)
    • Sentences and words (adults)
  17. LING Sounds
    • /m/ is a very low frequency sound and if your childcannot hear this sound they may not develop speechwith normal prosody (tune) and without vowel errors
    • /oo/ – [u] has low frequency information
    • /ee/ – [i] has some low frequency information andsome high frequency information
    • /ah/ – [a] is at the center of the speech range
    • /sh/ is in the moderately high frequency speech range
    • /s/ is in the very high frequency speech range
  18. Follow-up
    Weekly visits for one month post activation, monthly visits until 3 months old, every 3 months till 12 months, yearly or sooner after 12 months.
  19. Follow-up Therapy adults:
    • Auditory training
    • Computer based programs such as “Sound and Beyond”
    • SLP therapy for speech
  20. Follow-up Therapy children:
    • Encourage a rich auditory environment
    • Encourage “listening"
    • Coordinate school (and home) based services
  21. Cochlear Implant Controversy
    • Deaf culture often opposes cochlear implantation especially in children. This opposition has softened over the years. The National Association of the Deaf (NAD)
    • “Deaf and hard of hearing children and adults are not handicapped or second-class citizens in need of being “fixed” with cochlear implants”
    • “An implant is not a “cure” and an implanted individual is still deaf”
    • “Cochlear implants destroy what remaining hearing an individual may have, precluding the use of hearing aids in the future”
  22. Cochlear Implant Controversy
    “The NAD strongly urges physicians, audiologists, and allied professionals to refer parents to qualified experts in deafness and to other appropriate resources so that parents can make fully informed decisions – that is,decisions that incorporate far more than just the medical surgical.Such decisions involve language preferences and usage, educational placement and training opportunities,psychological and social development, and the use of technological devices and aids.”
  23. Bone Anchored Hearing Device
    • Received FDA approval to treat conductive and mixed hearing loss in 1996
    • Received FDA approval to treat unilateral sensorineural hearing loss in 2002.
  24. BAHA
    BAHA candidates:
    • People with chronic ear infections
    • People with conductive HL who can not wear traditional hearing aids.
    • congenital external auditory canal atresia
    • single sided deafness who cannot benefit from conventional hearing aids.
    • The system is surgically implanted and allows sound to be conducted through the bone rather than via the middle ear - a process known as direct bone conduction
  25. The BAHA consists of three parts
    • Titanium implant
    • External abutment
    • Sound processor
  26. BAHA - How does it work
  27. BAHA Hardware
  28. BAHA
  29. Middle Ear Implants
    • Middle ear implants use mechanical energy to stimulate the structures of the inner ear. They are an alternative to hearing aids
    • Implanted since 1996, the Vibrant Soundbridge Middle Ear Implant System from MED-EL is the most successful middle ear implant on the market today
  30. MEI Candidates
    • Mild to severe sensorineural, conductive and/or mixed hearing losses
    • Cannot tolerate foreign bodies in the ear canal for medical reasons (chronic ear canal inflammations or ear canal eczemas)
    • Require a free ear canal for personal or professional reasons (musicians, singers or physicians) who wish to hear harmonics free and undistorted by the occlusion effect
  31. MEI
  32. Auditory Brainstem Implant
    • Developed for those deafened by neurofibromatosis(bilateral VIII CN tumors)
    • Placed on the cochlear nucleus in the brainstemoften at the time of tumor removal
  33. ABI
    • Patients with the ABI can detect and discriminate sounds based on their temporal and amplitude properties. This auditory information improves their face-to-face communication by about 30% by supplementing speech reading.
    • Most NF2 ABI recipients cannot identify words or sentences only with the sound from the ABI. A few patients have more than 20% word understanding.
  34. ABI Hardware
  35. Other (Non-Surgical Devices)
    • Sound Bite: Dental Appliance (bone conduction)
    •   Single sided deafness or conductive HL
    • Lyric: Long term daily wear hearing aid
    •   Mild to moderately-severe hearing loss
    •   120 days, replacement
  36. Implantable Devices Review
    • Cochlear implants
    • Bone anchored hearing aids
    • Middle ear implants
    • Brainstem implants
    • Other devices