2. Becoming Familiar with Cochlear Implants Name Title Becoming Familiar_V3_Dec2008

3. Advanced Bionics Founded by Alfred E. Mann with a vision to fully restore hearing for severe to profoundly deaf individuals Led by Jeff Greiner who has been the companys operational leader since its founding providing experience and expertise in implantable medical products Only American cochlear implant company based in Sylmar, CA More than 500 employees around the globe

4. What you will learn today: How the ear works How to interpret the audiogram Cochlear Implant Candidacy Treatment Options for Hearing Loss Management of a child with a cochlear implant

5. Outer Ear Middle Ear Inner Ear Auditory Nerve Brain The ear consists of four main parts:

6. Ear Drum Bones of the Middle Ear The Outer and Middle Ear

7. Cochlea Auditory Nerve Brain The Inner Ear

8. Without functioning sensory cells in the cochlea, sound information cannot reach the brain for processing. Damaged Sensory Cells in Cochlea Hearing Loss Brain

9. What you will learn today: How the ear works How to interpret the audiogram Cochlear Implant Candidacy Treatment Options for Hearing Loss Management of a child with a cochlear implant

10. Audiogram: A graph that shows an individuals type and degree of hearing loss. The Audiogram

11. Loudness Soft to Loud Frequency Low Pitch to High Pitch

12. xooxxooxxo Normal Hearing

13. xo ox o x o x o x ox Moderate to Severe Loss

14. x o ox oxoxo x Severe to Profound Loss

15. Types of Hearing Loss 1. Sensorineural 2. Conductive 3. Mixed

16. xo < x o < xo o o x x xo < << Sensorineural Hearing Loss

17. <<<< < xoxo x o ooxx xo Conductive Hearing Loss

18. << < << xox o x o ooxx xo Mixed Hearing loss

19. What you will learn today: How the ear works How to interpret the audiogram Cochlear Implant Candidacy Candidacy Guidelines Steps to determine candidacy Treatment Options for Hearing Loss Management of a child with a cochlear implant

20. Who is a Candidate for a Cochlear Implant? Range of hearing for a cochlear implant candidate.

21. Adults (18 years+) Severe to Profound, bilateral sensorineural hearing loss Less than 50% speech recognition with hearing aids on open-set sentence recognition Children (12 months - 2 years) Profound, bilateral sensorineural deafness (> 90 dB HL) Little or no benefit from hearing aids Children (2 years - 17 years) Severe to Profound, bilateral sensorineural deafness Little or no benefit from hearing aids Who is a Candidate for a Cochlear Implant?

22. Audiologic Evaluation Medical Evaluation Speech Language Evaluation Psychological Evaluation Educational Evaluation Pediatric Cochlear Implant Candidacy

23. Team Approach

24. Audiological Evaluation Determine the type and degree of hearing loss Air & bone conduction thresholds for each ear ABR & OAEs Assess the childs current amplification system Aided sound field testing Aided speech perception testing Counseling Address realistic expectations Device selection Post-operative follow-up

25. Medical Evaluation Determine cause of hearing loss Assess status of middle ear & cochlea CT scan/MRI Counseling Hearing loss The surgical procedure Typically out-patient and performed by an otolaryngologist (ENT) or otologist (ear specialist) Post surgical considerations

26. Bilateral Implants Industry trend Simultaneous vs. Sequential Benefits: Improved directionality Improved listening in noise Clarity of speech Developmental Bilateral Cochlear Implants

27. Speech & Language Evaluation Areas assessed Vocabulary - knowledge of single words receptive expressive Language - word combinations, grammar receptive expressive Articulation/Intelligibility Reading skills

28. Developmental Evaluation Assessment of non verbal & verbal IQ Verbal IQ assessed when appropriate Counseling for family Impact of hearing loss on the family unit Assessment of childs learning style Assessment of any other underlying issues Serves as a baseline evaluation

29. Educational Evaluation Areas to consider: Communication Methodology Support services Speech/language and auditory skill development Professional training

30. What you will learn today: How the ear works How to interpret the audiogram Cochlear Implant Candidacy Treatment Options for Hearing Loss Management of a child with a cochlear implant

31. Cochlear Implants Treatment Options for Hearing Loss Hearing Aids

32. Behind-the-ear In-the-Ear In-the-Canal Treatment Options for Hearing Loss Hearing Aids

33. How is a Cochlear Implant Different From a Hearing Aid? Hearing AidCochlear Implant Acoustically amplify sound. Convert sound into electrical signals. Rely on the responsiveness of healthy inner ear sensory cells. Bypass the inner ear sensory cells and stimulate the hearing nerve directly.

34. A Cochlear Implant consists of two main parts: Internal Equipment External Equipment How Does a Cochlear Implant Work? or

35. Electrode Array 3 turn gold wire coil Internal Electronics Removable Magnet Internal Equipment HiRes 90K

36. Harmony® HiResolution® Bionic Ear System Engineered to be Reliable Industry Standard Reliability 99.1% CSR at 2 ½ years for the current Harmony Bionic Ear System Built to withstand rain, perspiration, and moisture Speech processor return rate is 1.5% (all returns including moisture)

37. Harmony® Sound Processor

38. …to be able to hear like everyone else does …to fit in …to realize their potential …to be successful listening in todays world HiResolution® Sound What do parents want for their child?

39. Sound waves enter through the microphone. The sound processor converts the sound into a distinctive digital code. The electrically coded signal is transmitted across the skin through the headpiece to the internal portion of the device. The internal device delivers the sound to the electrodes. The electrodes stimulate the hearing nerve. The hearing nerve sends the signal to the brain for processing. How Does a Cochlear Implant Work?

41. What you will learn today: How the ear works How to interpret the audiogram Cochlear Implant Candidacy Treatment Options for Hearing Loss Management of a child with a cochlear implant

42. Audiologic Management Rehabilitation Family Commitment School Support Pediatric Management

43. Audiologic Management Goal is to assure access to sound adequate for auditory development Programming or mapping of the cochlear implant device Assessments at regular intervals to track auditory development Age appropriate techniques & materials

44. Audiologic Management CI

45. Rehabilitation is KEY A cochlear implant is NOT a cure

46. Parent Commitment

47. School Support Understand what a cochlear implant is & equipment troubleshooting Assist in the management of the device and child Perform behavioral listening checks on a daily basis Know where to find support and resource materials Maintain communication b/w the students parents, teachers and cochlear implant center

48. Summary Cochlear implants are an effective treatment for severe to profound sensorineural hearing loss. A multi-disciplinary approach is necessary when determining cochlear implant candidacy in children. Post-operative management of a child with a cochlear implant consists of programming of the sound processor and intensive rehabilitation. Parent commitment and school support are necessary components to ensure a childs success with a cochlear implant.

49. Resources & Support: For Educators, Therapists, Recipients, and Families Online: Online chat Click on icon www.BionicEar.com www.HearingJourney.com Customer Care: Speak with an Audiologist at 1-877-829-0026 Monday through Friday, 5 am to 5 pm PST Ask questions via Email: ToolsForSchools@AdvancedBionics.com ListeningRoom@AdvancedBionics.com Hear@advancedbionics.com

50. Education and rehabilitation are the keys to success with a cochlear implant. Visit Advanced Bionics online today at www.BionicEar.com! www.BionicEar.com