1. Do I need an Implant Now? Or Wait? Things to Consider.
Ann-Marie Hennessey, M.A.
Massachusetts Eye and Ear Infirmary

2. Audiograms of CI candidates
CNC 8% right 24% left
CNC 8% right 32% left

3. Audiograms of CI candidates
CNC 0% right 6% left
CNC 0% right 0% left

4. Audiograms of CI candidates
Single side deafness

5. Speech performance testing
Speech performance with earphones and hearing aid is a factor.

6. TESTS CNC MINIMAL PAIRS WIPI NU6 CID GAPS NU-CHIPS ESP TAPS HINT-C BKB
NOISE-VOICE
NU-CHIPS
MLNT
HINTQ
CNC
ESP
4 CHOICE
MPS
TAPS
HINT-C
COMMON PHRASES
W22
WIPI
BKB
PLS-4
EXPRESSIVE VOCABULARY
SPINE
SPAC
NU6
CID
GAPS
RITLC
PPVT
ENVIRONMENTAL SOUNDS
AAPS
SOUNDFIELD
MINIMAL PAIRS
BBCS
PBK
CAP
ORAL AND WRITTEN LANGUAGE SCALES
VRA
TTC
HINT
LNT
CUNY LIPREADING
KABC-NV

7. WHAT WE HEAR! DETECT IS IT SPEECH OR IS IT NOISE?
Easiest
DETECT
IS IT SPEECH OR IS IT NOISE?
RECOGNIZE PATTERN OF SPEECH?
UNDERSTANDING FAMILIAR PHRASES
WITH VISUAL CUES
WITHOUT VISUAL CUES
UNDERSTANDING SINGLE WORDS (without visual cues and without context)
UNDERSTANDING SINGLE PHONEMES
Hardest

8. Tests for Adults Single-syllable words - CNC (Nu6) –
Sentences CID / HINT
Closed-set Multi-syllable words - 4-Choice Spondee
Auditory + Visual - Lipreading Sentences
Familiar sound recognition - Environmental Sounds
Recognize speech- Noise/Voice
Detection- Thresholds

9. Predictors of benefit from CI
Normal or better hearing in the past
Length of deafness
Consistent use of amplification
Non predictors
Etiology of loss
Configuration of hearing loss

10. Most Current tests
CNC consonant vowel consonant at most comfortable level.
Scores below 50% suggest a CI would be helpful.

11. TELEPHONE USE
If you are using a Caption Phone regularly, this suggest you are not hearing well without looking at the speaker’s face.

12. CONSULT TO SURGERY CI requires a hearing test
Testing with appropriate hearing aid
MRI to check cochlea
Select which device, color, accessories
Request insurance coverage
Schedule surgery date

13. What’s the surgery like?
It is now day surgery
The incision is small cut where the hair line is behind the ear
Most patients go home the same day or the morning after

14. Recovery Some pts report some dizziness but no pain
Return in 2 -3 weeks for activation

15. ACTIVATION
Electrodes are simulated and 4-5 successively louder programs are created. The pt will listen to the program 1 for 2 days then move on to 2 and so on.
Return in one week Performance testing will be completed and additional program such as measuring the soft sounds will be completed
Listening exercises are suggested. There are many on line at the manufacture's websites.

16. HOW WELL AM I DOING? Everyone asks Subjective How does it sound?
Is it easier to talk to people?
Am I recognizing sounds around me?
Is life better with or without the implant?
Answers may vary depending upon situation.

17. Performance measures
Monosyllable testing over time

18. Which ear? Factors for choosing an ear
An ear that has not been stimulated (HA use) for many years will take longer to acclimate. Performance may be relegated to environmental sounds only.
This can be a tough decision.

19. Congenitally deaf adults
Consistent use of amplification
Oral skills versus manual/visual communicator
CI provides sound awareness
Speech understanding does not significantly improve

20. 30 year male right implant at age 16 R ear 1998
L at age
Communicates ASL,Cued speech, speech reading
Performance each ear
R implant L ear hearing

21. Young Children Implant as soon as possible?
Advantage of early language learning through listening
Most children can mainstream into local school with educational support

22. Why wait? Wait for better/newer technology
Wait for medical cure such as stem cell replacement?
Wait until the child is old enough to decide for him/herself

23. Wait for New Technology?
The design of the electrode has not changed as much as the external devices and power management
The key to success is language learning early
External equipment can be upgraded to new models

24. Performance with Early Technology
Performance with earlier technology is equal to performance with later technology when implantation is at 2 years old or younger.

25. TESTS FOR CHILDREN Ling sounds /ah/ /ee/ /oo/ detection discrimination
Early Speech Perception
Closed set test
pattern recognition
spondee discrimination
monosyllable discrimination
Word Intelligibility by Picture Identification
Closed set
Monosyllable discrimination

26. Born in 1997
Implanted in 1999 L ear
Implanted in 2009 R ear

27. Born in 2003
Implanted R 2004
Implanted L 2008

28. When should I get an implant for the other side?
Test of unimplanted ear annually
Same factors can be applied to second ear.
Greatest benefit is hearing in noise
Downside may be loss of any natural hearing

29. Rapid progressive hearing loss
Equal performance
Implanted 5 years apart

30. Progressive loss
Implanted 14 years apart

31. Progressive hearing loss
Implanted 2 ½ years apart
Equal performance

32. Patient implanted in 1985 early technology
Patient implanted in 1985 early technology. He had no measurable hearing prior to implantation.
Right ear chosen because he wore an aid on that side only.
Performance with 1st implant 62%
Performance with 2nd implant 2%
He has discontinued use of 2nd implant

33. Hz
dBHL