2. Becoming Familiar with Cochlear Implants Name Title

3. Advanced Bionics Most advanced cochlear implants Cutting-edge technology Sonova Global market leader Full spectrum of hearing solutions Medical division Sonova and Advanced Bionics Our Commitment to the Future of Hearing

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 Sensorineural Conductive Mixed

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

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

18. << < << xoxo 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 Psychologist SLP Audiologist Caregivers Surgeon & Pediatrician Teacher Child

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 Systems 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 system consists of two main parts: Internal Implant External Equipment How Does a Cochlear Implant Work? or

35. HiRes 90K Advantage High-Performance Hearing

36. Unlimited ways to deliver stimulation 16 independent current sources Low-profile design Removable magnet Industrys highest case impact resistance- up to 6 Joules 1,2 Industrys fastest stimulation rates Reliability you can count on with 99.8% CSR at one year 3 HiRes 90K Advantage Implant HiRes 90K TM Implant Unmatched Technology 1.Holtkamp V. Cochlear Implants Under Impact Loading. Evaluation of Accident Scenarios. Determination of Load Limits, and Development of a Standardizable Test Procedure. Dissertation accepted by the Senate of Hannover Medical School, May 19, 2004. 2.Cochlear Nucleus CI512 Cochlear Implant Technical Specifications. N33741F 1ss1 Jun09. 3.Advanced Bionics Reliability Update. 2012.

37. Harmony Sound Processor

38. HiResolution Bionic Ear System Engineered to be Reliable Industry Standard Reliability 99.8% CSR at 1 year³ for the current AB HiRes 90K Implant Built to withstand rain, perspiration and moisture 3. Advanced Bionics Reliability Update. 2012.

39. The Worlds First and Only Waterproof Sound Processor Freestyle Design Built Kid Tough Stylish and Discreet Durable and Easy to Use Ideal for All Ages and Lifestyles

40. Neptune Features Waterproof Removable Controls Powered by 1 AAA Battery Cost Effective Full day of use with a single disposable or rechargeable battery Universal Headpiece (UHP) and AquaMic Compatible with HiRes 90K and CII implant devices Neptune Battery Compartment Cable Headpiece

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

42. 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 implant. The implant delivers the sound to the electrodes. The electrodes stimulate the hearing nerve. The hearing nerve sends the signal to the brain where it is perceived as sound. How Does a Cochlear Implant Work?

44. 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

45. Audiologic Management Rehabilitation Family Commitment School Support Pediatric Management

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

47. Audiologic Management CI

48. Rehabilitation is KEY

49. Parent Commitment

50. 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 between the students parents, teachers and cochlear implant center

51. 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 important rehabilitation. Parent commitment and school support are necessary components to ensure a child s success with a cochlear implant.

52. Resources & Support: For Educators, Therapists, Recipients, and Families Online: Live chat Click on icon AdvancedBionics.com 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

53. Education and rehabilitation are keys to success with a cochlear implant. Visit Advanced Bionics online today at AdvancedBionics.com! AdvancedBionics.com