1. Michael Scott, Au.D., CCC-A Cochlear Implant Program Coordinator, CCHMC President, NOCCCI

2. All questions will be honored and answered at the end of today’s proceedings. Please write your question/s on a provided note card.

3. What is a Cochlear Implant? Having a Great School Year…

4. Goals: 1. Review hearing loss 2. Provide a basic understanding of how a cochlear implant works 3. Compare hearing aids & Cochlear implants 4. List the current candidacy criteria

5. Why are we all here today? Because hearing loss has the potential to negatively impact ANY of our students at ANY time. A quick review to explain how…

6. Access to Sound without access to the entire “speech banana”, a child would be miss out on vital parts of speech…

8. For example: To the right, is a hearing loss that may be considered for a cochlear implant:

9. For example: The blue region is the range of sounds heard by this child That means that they do not hear: /f/, /s/, /h/, /th/, among others

10. Why an implant? C ochlear implants provide children with severe to profound hearing losses with access to sound. Don’t hearing aids do this?

11. Hearing aids vs. Implants - hearing aids have their limitations -even with the best hearing aid, a child may not hear high pitches

12. Access to Sound -A cochlear implant can provide access to the entire speech banana without the limitations of hearing aid output levels and without feedback. - An implant is much more complicated than a hearing aid.

13. How a Cochlear Implant differs from a Hearing Aid Hearing aids amplify the signal, which passes through the auditory system and utilizes surviving hair cells to carry the signal to the auditory nerve. No matter how loud a signal the hearing aid produces, some profoundly hearing-impaired ear cannot process the information due to the damaged hair cells. With a cochlear implant, the electrode array bypasses damaged hair cells in the cochlea to directly stimulate the surviving auditory nerve fibers.

14. Access to Sound R ather than just making sounds louder, cochlear implants send sound directly to the child’s hearing nerve, electrically.

15. Hearing Aids vs. Implants Hearing aid –Microphone –Battery –Circuitry –Speaker –Earmold –Sounds made louder Cochlear Implant –Microphone –Battery –Circuitry –Transmitting Coil –Sounds delivered electrically

16. Access to Sound R ather than just making sounds louder, cochlear implants send sound directly to the child’s hearing nerve, electrically.

17. Processor Anatomy 1. Circuitry 2. Power source 3. Program/volume/ sensitivity controls 4. Microphone 5. Cable 6. Transmitting coil with magnet

18. Processor Anatomy 1. Circuitry 2. Power source 3. Program/volume/ sensitivity controls 4. Microphone 5. Cable 6. Transmitting coil with magnet

19. Processor Anatomy 1. earhook 2. microphone 3. circuitry 4. program selector button 5. display 6. battery compartment 7. cable 8. coil with magnet Photo courteous of Cochlear Americas

20. Implant 1. Magnet 2. Receiving Coil 3. Circuitry 4. Electrode array

21. Implant Silicone/ceramic casing Electronics Electrode array Ground electrode Magnet NO POWER SOURCE Photos courtesy of Advanced Bionics

22. Access to Sound Therefore, without the speech processor (outside part)….

23. Demo http://www.youtube.com/watch?v=S mNpP2fr57A&feature=player_embe ddedhttp://www.youtube.com/watch?v=S mNpP2fr57A&feature=player_embe dded

24. Demo 1. sound is picked up by the processor 3. the surgically implanted receiver accepts the signal and transmits it down the electrical array http://www.nidcd.nih.gov/health/hearing/ear_coch_img.htm 2. After the sound is changed to electrical energy, it is transmitted across the skin via the transmitting coil 4. The electrical array stimulates the hearing nerve, which sends the signal directly to the brain

25. Manufacturers

26. WHO CAN GET A COCHLEAR IMPLANT? FDA Criteria Severe/Profound sensorineural hearing loss in both ears 12 months to 17 years of age (in the case of meningitis with ossification, implantation can be done earlier) Receive little to no benefit from appropriately fit hearing aids No medical/surgical contraindications Motivated and supportive caretakers, as well as appropriate expectations (parents and child, when appropriate) Failure to reach developmentally appropriate auditory milestones Less than or equal to 20% correct on a open-set word recognition test OR less than or equal to 30% on an open-set sentence test (HINT for Children).

27. Pediatric Candidacy: Take-home message 12 months or older Severe to Profound sensorineural hearing loss in both ears Delayed auditory skill development No medical contraindications

28. The Cochlear Implant Team Coordinator/ Cochlear Implant Audiologist Administrative Assistant Aural Rehabilitation Audiologist Speech/Language Pathologist Surgeon Social Worker Developmental Pediatrician Representative from school Candidate & family

29. Cochlear Implant Evaluation Protocol Audiologic evaluations showing no benefit from consistent hearing aid usage over at least a 3-6 month period Cochlear Implant Consultation Aural Rehabilitation evaluation (independent of or in conjunction with Speech Pathology) Speech/language evaluation (independent of or in conjunction with Aural Rehabilitation)

30. Cochlear Implant Evaluation Protocol Evaluation of family support systems and counseling regarding the psychosocial impact of obtaining a cochlear implant Pre-surgical counseling and evaluation Coordination and consultation with child’s school placement

31. Resources Cochlear Implant Awareness Foundation: http://www.ciafonline.org/index.htmlhttp://www.ciafonline.org/index.html American Speech and Hearing Association: http://www.asha.org/default.htmhttp://www.asha.org/default.htm Natural Communication, Inc.: http://www.nciohio.com/http://www.nciohio.com/ Auditory Options Project: http://www.auditoryoptions.org/http://www.auditoryoptions.org/ Listen-Up: http://listen-up.org/http://listen-up.org/ Let Them Hear Foundation: www.letthemhear.orgwww.letthemhear.org NOCCCI: http://groups.yahoo.com/group/NOCCCIhttp://groups.yahoo.com/group/NOCCCI AG Bell Association: www.agbell.orgwww.agbell.org Manufacturers: Advanced Bionics: www.bionicear.comwww.bionicear.com Cochlear Americas: www.cochlearamericas.comwww.cochlearamericas.com MedEl: www.MedEl.comwww.MedEl.com