10/31/2013 No disclosures Cochlear Implants: Where weve been, - - PDF document
10/31/2013 No disclosures Cochlear Implants: Where weve been, Where we are Colleen Polite, AuD Assistant Director Cochlear Implant Center Otolaryngology Head and Neck Surgery University of California, San Francisco November 1, 2013
Colleen Polite, AuD Assistant Director Cochlear Implant Center Otolaryngology Head and Neck Surgery University of California, San Francisco
November 1, 2013
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Poll: I work with CIs in my practice
Poll: How many CI candidates have you seen in ... Poll: How many patients have you referred for ...
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10 20 30 40 50 60 Saw None Saw 1‐4 Ref'd None Ref'd 1‐4
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Huart, 2009
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ENT-VSL-3.2 Increase the proportion of persons who are deaf or very hard of hearing and who have cochlear implants
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www.healthypeople.gov/2020
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Age: 18 yrs+ Hearing loss: bilateral profound post-lingual Speech recognition: 0% words or sentences with HAs Hearing aid use: 6 months
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Figure 2. Advances in technology and signal processing in cochlear implants have resulted in improved performance outcomes. Shown are group mean scores for CUNY and HINT sentences in quiet and CNC monosyllabic words from multiple sources: Skinner et al. (1994), Skinner et al. (1991);Pijl et al. (2009).
Huart, 2009
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Age: 18 yrs+ Hearing loss: bilateral MODERATE – PROFOUND, post-, peri- or pre-lingual Speech recognition: ≤50% on sentences in ear to be implanted and ≤60% best aided/contralateral ear
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Gifford, 2008
Minimum age: 2 yrs Hearing loss: profound Communication: 0% words or sentences with HAs Hearing aid use: 6 months
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Minimum age: 12 – 23 mos Hearing loss: <24 mos prof HL; ≥24 mos sev-prof Communication: 30-40% word or sentence scores Hearing aid use: 3-6 months
– Higher communication performance – Higher scores on all language measures
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Houston, et al. 2012
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Nicholas & Geers, 2007
– Children with poorer hearing pre-CI had lower language skills at 3.5 yrs – Accounted for almost 60% of variance in language performance
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Nicholas and Geers, 2006
experienced longer periods of hearing aid use before implantation.
hearing aid trials before implantation.
implantation may not always be the most beneficial course of action for young children who may be CI candidates.
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– Early referral for patients with progressive/fluctuating loss
cochlear malformations
– Managed intra-operatively – Has no significant effect on speech outcomes (Adunka, et al., 2012)
Word Recognition RE: 4% LE: 84% PTA RE: 72 dB HL LE: 105 dB HL
Drop in RE hrg 1 mo ago following head injury Increased tinnitus since drop in hrg
Aided Speech CNC AzBio-Q/+10 RE: 0% LE: 60% B: 50% 58% / 42%
Speech Perception 1 mo CNC AzBio-Q/+10 CI: 56% 75% / 32% Speech Perception 3 mos CNC AzBio-Q/+10/+5 CI: 74% 71%/57%/17% CI+ HA: 96% 100%/88%/73%
– Even with previous chemical or surgery treatment
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Lustig, et al., 2003
– EVAS – Meniere’s
– Implant poorer ear – Bimodal listeners
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– EVAS – Meniere’s
– Implant poorer ear – Bimodal listeners
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– refer for CI evaluation – CI may offer neural synchronization
– Comparable to SNHL in those without other medical/cognitive issues – ? Contraindicated in hypoplasia/aplasia of cochlear nerve – Counseling is key
– EVAS – Meniere’s
– Implant poorer ear – Bimodal listeners
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– EVAS – Meniere’s
– Implant poorer ear – Bimodal listeners
– Hybrid/EAS – Improved hearing in noise, music quality
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– Common cavity – Cochlear hypoplasia – Incomplete partition – SCC dysplasia – Enlarged Vestibular Aqueduct
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– Complete labyrinthine aplasia – Cochlear aplasia – Absent auditory nerve
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– What happens when there is no access to auditory information in the first year of life? – Cognitive mechanisms/language processes – Sensitive periods
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– Improved phonological skills – Superior speech understanding – Language skills growth rate similar to normal-hearing peers – Support non-verbal cognitive development (Coletti, 2011)
– Minimalized by experienced pediatric surgeons and anesthesiologists
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– Less difficulty hearing in noise – Some benefit for localization – Reduced tinnitus – ? Hearing quality – ? Binaural benefits
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