1. Cochlear implants

2. City Lit Relates to: Assignment 2b Cochlear implants deadline 6 th July 2015.

3. City Lit Statistics There are over 250,000 users world wide Approx 12,000 users in the UK. (source: Hearing Link) The majority of profoundly deaf children in the UK have an implant. About 350 children per year are born deaf enough to be considered for an implant. About 100 more children per year become deaf early in life and may need an implant, giving an annual recurrent demand of 450 per year. In addition to those already implanted, about 7,500 adults are audiologically suitable for an implant. The annual recurrent demand is conservatively estimated to be 1200, being 450 children and 750 adults. ( source: The Ear Foundation)

4. City Lit What is a cochlear implant? Consists of a surgical implant and an external speech processor. It provides a sense of sound for those who receive no or limited benefit from conventional hearing aids - it does not cure deafness but is a prosthetic substitute which directly stimulates the cochlear nerve endings.

5. City Lit How a cochlear implant works External External speech processor captures the sound and converts to digital signals Processor sends digital signals through skin via transmitter coil to internal implant Internal Implant converts signals to electrical energy and sends to electrode array in cochlea The electrodes stimulate the cochlea’s hearing nerve fibres, bypassing damaged cochlea Signals sent to the brain are interpreted as sound

6. City Lit A = speech processor B = transmitter coil C = implant (receiver) and electrode array D = remote http://www.youtube.com/watch?v=jZhHabWYYrk&feature=related

7. City Lit Manufacturers Advanced Bionics MedEl Nucleus Neurelec - binaural implant All cochlear implant systems have the same broad characteristics and design principles. Variations arise in styling, accessories and battery type. Particular differences exist in electrode design and speech processing strategies which encode the external sound frequency details into digital signals.

8. City Lit Neurelec https://www.youtube.com/watch?v=pCiehL GmNPA

9. City Lit Who is eligible for a cochlear implant? National Institute for Health and Clinical Excellence (NICE) guidelines One ear - severe to profound deafness, with no benefits from hearing aids Both ears – severe to profound deafness, with no benefits from hearing aids 1. children 2. deaf blind adults 3. sudden deafness through meningitis

10. City Lit Referral Guidelines for Adults

11. City Lit How is ‘severe to profound’ defined for a CI? Severe to profound hearing loss is defined as hearing only sounds that are louder than 90 dB HL at frequencies of 2 and 4 kHz without hearing aids. Lipreading random sentences – if score is too high, then may be refused. Some clinicians have called for the audiological criteria and speech testing methods to be modified to closer resemble the hearing challenges faced in everyday life. Plus greater consideration of the social and emotional impact of the hearing loss and its significance for those at work.

12. City Lit Assessment Adults will have an assessment by a multidisciplinary team Tests and questionnaires cover the person’s hearing history, cause of hearing loss, amount of residual hearing, speech recognition ability, health status, and family commitment to aural habilitation/rehabilitation. Audiological Medical Hearing therapy

13. City Lit Ideal candidates having severe to profound sensorineural hearing impairment in both ears with a functioning auditory nerve showing little benefit from the latest model of high powered hearing aids good speech, language, and communication skills having no medical reason to avoid surgery living in or desiring to live in the "hearing world" realistic expectations about outcomes support of family and friends

14. City Lit Surgery an incision behind the ear being treated in order to gain access into the middle ear and cochlea surrounding area behind the ear will be shaved to facilitate this and this will quickly regrow operation lasts about three hours and typically people spend one night in hospital operation is delicate and intricate rather than dangerous because no vital organs are disturbed.

15. City Lit Switch-on Up to six weeks after the operation, the person will return to the implant centre for ‘Switch On’. Audiologist will fit the external speech processor and connect it to the computer used to adjust the settings on the device. When switched on, the speech processor sends signals to the electrodes in the cochlea for the first time. The audiologist will spend time 'tuning' it to help the person start to 'hear'. Conversation may sound quite different from what is remembered. It is often described as mechanical or tinny.

16. City Lit http://youtu.be/uZoKylVtptk - includes some surgeryhttp://youtu.be/uZoKylVtptk http://www.hearinglink.org/cochlear-implants/switch-onhttp://www.hearinglink.org/cochlear-implants/switch-on just switch on

17. City Lit Initial Tuning and Rehabilitation Weekly mapping sessions with audiologist Weekly rehab sessions with speech therapist or hearing therapist Rehab focussed on developing listening / auditory training use of device and accessories psychosocial adjustment home / web based training Music, phone, TV

18. City Lit Some different profiles In your groups, consider the following profiles: 1. The post-lingually deafened adult implanted aged 50 2. The young child born deaf implanted aged 1 3. The teenager implanted aged 15 Discuss: What could be the benefits of a CI? What factors would significantly affect outcomes? What could be the issues for the individual?

19. City Lit Different profiles – factors to consider 1. The post-lingually deafened adult implanted aged 50 Length of time between onset of deafness and implantation Degree of hearing loss Lipreading ability (suddenly deafened may not have skills yet) Expectations and perseverance Expectations of family

20. City Lit 2. The young child born deaf implanted aged 1 Degree of hearing loss Prior use of amplification during language development Parental expectations Language development Schooling – support Schooling – language – total communication? Oral? BSL?

21. City Lit 3.The teenager implanted aged 15 Degree of hearing loss Parental expectations Own expectations Own decision? Parents’ decision? Deaf peers - reaction/attitude Deaf or hearing world? Both? Oral/BSL? Prior use of amplification during language development

22. City Lit Cultural factors Why do some people in the Deaf community object to cochlear implants? They feel hearing people are trying to cure deafness They feel they put the emphasis on using speech rather than BSL Long-term result could be the demise of BSL Parents are making decisions for their children which will be irreversible

23. City Lit Organisations NCIUA – National Cochlear Implant Users Association CICS - Cochlear Implant Child Support Group NICE – National Institute for Health and Clinical Excellence BCIG – British Cochlear Implant Group NADP – National Association of Deafened People The Ear Foundation http://www.earfoundation.org.ukhttp://www.earfoundation.org.uk