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CI Quiz 2

Terms in this set (74)

cochlear implant mapping
programming of speech processor

individualized

programmed to get max speech perception and understanding
what to assess at mapping appointments
(subjectively) how patient is doing with sound & speech discrimination

if equipment is working properly

if magnet & BTE incision site looks normal

(objectively) pt's performance in sound booth

re-measure electrode current levels and fine tune the map
what to ask about patient history during mapping appointment?
decrease in auditory reaction/alertness to sound?
decrease in vocalizations/vocal play?
"slushy" production of previously mastered speech sounds?
signs of physical discomfort?
refusal to wear processor?
complaints of difficulty with hearing?
SLP tx results - particular problem sounds?
volume comfort?
sound/voice quality?
difficulties with operating external equipment?
irritation of skin?
listening check
ling 6 sound test
sound clear?
distortion/static?
intermittent?
working volume control/program buttons?
telemetry
get & give info to internal device

bi-directional communication of data between programming hardware and implant via radio-frequency code

cannot be measured if coil isn't over implant or implant isn't working

1. impedance
2. ECAP
3. Electrode compliance
Impedance Telemetry
check of individual electrode function - how well electricity is flowing through electrode array

impedances are impacted by physical properties of electrode lead & the medium (fluid, tissue) surround the lead

can change over time - must be measured at each appointment

OK/WNL
OPEN
SHORT
open circuit on impedance telemetry
HIGH impedance (> 30 kohms)
electrode NOT in contact with body fluids
broken electrode lead
short circuit on impedance telemetry
LOW impedance (<700 ohms)
electrode lead in contact with another electrode
ECAP Telemetry
electrically evoked compound action potential

records neural activity within the cochlear in reaction to electrical stim from the implant

quick & non-invasive

objective measure of peripheral neural function

NRT, NRI, ANRT
how do ECAP telemetry work?
1. electrical pulses are delivered to stimulating electrode

2. neural activity is obtained by recording electrode

3. NRT software receives telemetry signal, averages it, and displays it on computer screen
why is ECAP telemetry used?
supplements behavioral measures

provides assurance of auditory nerve function

objective info for clinical management
- create entire map
- monitor peripheral responsiveness over time
- when behavioral rx are unreliable
- potential for improving speech understanding bc map is optimized without needing extensive pt feedback
compliance telemetry
determining if the electrode can fire effectively on this map with particular battery

max amount of current that can be delivered to an electrode - varies by electrode

Ohm's Law: Voltage = (current)*(resistance)

Max Current = Voltage / Resistance
electrode
physical contact on array in cochlea

# of electrodes = # electrical contacts on electrode array
charge-balanced, biphasic current pulse
electrical stim delivered to the nerve

safe for body

amplitude = intensity/loudness
width/duration = temporal cues

negative and positive phases equalize so no net charge
amplitude
loudness

amount of stim current
frequency/spectral info
place/site of stimulation

pitch

variable by cochlear duct length
temporal info
rate and pattern of stim

timing cues
map parameters
# of channels/sites of stim

stim mode

pulse width

speech coding strategy

stimulation rate

**infinite # of maps can be made with these parameters
stimulation mode
how electrodes are coupled to form channel
pulse width
how long stimulation stays on when pulse is presented
speech coding strategy
spectral vs temporal information

or both
stimulation rate
how fast each channel or whole array is pulsing per second
sweeping
1 stimulus presented on each channel to ensure loudness across array
balancing channels
ensures 2 neighboring channels are equal in loudness
Input Dynamic Range (IDR)
range of acoustic inputs mapped within electrical dynamic range (EDR)

default: 40-60 dB
electrical dynamic range (EDR)
difference between T & C levels - measured in current units
aided audiogram
confirms detection of soft sounds/tones

confirms threshold they can understand (SRT)

confirms % speech understood at conversational level
threshold (T) level
LOWEST current level that elicits a very soft, but consistent hearing sensation

- standard audiometry
- count the beeps
- play, VRA, BOA
- neural rx
- estimate/clinical judgement
- % below C levels

too low = pt cannot perceive quiet sounds
too high = pt perceives constant background noise
comfortable/most comfortable (C/MC) level
LOUDEST level of electrical stim that's tolerable for each channel

- live speech
- loudness rating/balancing
- neural rx
- acoustic reflex
- pre-map audiogram
- clinical judgement

too low = pt perceives all sounds as too soft
too high = risk of over stim & short batter life
dynamic range
difference in current level between T & C
what can cause T and C levels to change?
increase in awareness of sound

physiological changes

health/sickness

medications

stress/tinnitus
common complaints post CI
*sound quality

- echo
- boomy/tinny
- my voice is too loud
- clarity isn't as good as expected
active listening
hearing is access to acoustic info, but listening requires attention & intention (EFFORT)

repair strategies
- determine general context of convo
- set up environment
- ask partner to rephrase not repeat
- speech is redundant - missing 1 word doesn't mean you should give up
- tell speaker to slow down and face forward

avoid maladaptive behaviors
- bluffing
- dropping out
- becoming passive
facial nerve stimulation post CI
find problem electrode and cap stim OR disable electrode

decrease Cs

decrease width/rate
tinnitus post CI
possible over stim - decrease overall amount

not necessarily caused by CI


counsel
post-op assessment
1. equipment check
2. audiological eval
3. subjective eval
4. medical eval
post-op equipment check
check status of sound processor and other equipment

listening check
post-op audiological eval
1. unaided hearing eval
- pure tone air/bone conduction
- implanted ear - residual hearing?
- non-implanted ear - hearing aid?
- monitor over time

2. CI alone

3. Bimodal/Bilateral

4. aided hearing eval
- soundfield testing with narrowband & warble tones
- 250-6,000 Hz
- 20-30 dB
- standard audiometry, CPA, VRA, BOA

5. speech testing
- repeat AzBio used to qualify for CI
- speech recognition threshold (SRT) or speech awareness threshold (SAT)
- word recognition (CNC, NU-6)
- sentence testing (quiet and noise)
audiological eval at home
not yet widely available

cochlear's remote check

threshold, speech in noise, questionnaires, pics of implant site

triage future appointments
post-op subjective eval
pt's experience and satisfaction with CI doesnt always match performance in sound booth

counseling

questionnaires
Cochlear Implant Quality of Life (CIQoL)
6 domains:
communication
entertainment
listening effort
emotional
environmental
social
Speech, Spatial and Qualities of Hearing Scale (SSQ)
49 items

hearing abilities

speech communication, spatial hearing, quality of sounds & speech
Abbreviated Profile of Hearing Aid Benefit (APHAB)
Measures the disability associated with hearing loss and the amount by which use of hearing aids reduces the disability

24 items

ease of communication, background noise, reverb, aversion to sound
questionnaires for peds
LittlEARS

Auditory Skills Checklist (ASC)
post-op medical eval
go back to surgeon 10 days to check incision site

discuss surgery related symtpoms
- dizziness
- taste disturbances
- pain

annual/biannual
factors affecting pt success
duration of deafness
-longer duration = worse outcomes
- >20 yrs
- changes in auditory system (loss of spiral ganglion) and auditory deprivation

hearing aid use
- consistent stim of nerve = avoid auditory deprivation

age of ID
- 1-3-6 rule
- early ID = early implant = early tx = better results

age of implantation
- earlier is better - critical period of language, aud dep

HL etiology
- genetic - if anatomy is good has good results
- aud nerve deficiency = decreased outcomes
- abnormal anatomy = complicated surgery
- auditory neuropathy - CIs help with open set sentences, but who knows what else
- meningitis - cochlear ossification
- sudden - good outcomes
- mode of comm - LSL is best
binaural hearing
well-established benefits of binaural amplification

2 ears > 1

binaural squelch
binaural summation
localization
why use bimodal systems?
1. 2 ears > 1
2. better access to low freq info (HA)
3. improved speech perception in quiet & noise
4. better music appreciation
5. easy connectivity
6. improved quality of life
better-ear-effect
ear with better SNR used for speech recognition

SNR improvements more than 10 dB in normal hearing
binaural squelch
speech understanding in noise

increase understanding by using additional input from ear with least favorable SNR to decrease distraction of noise

SNR improvement more than 5 dB in normal hearing
binaural summation
central auditory process that allows a signal to be perceived as louder when listening with two ears compared to one
localization
the ability to tell the direction from which sound comes without seeing the actual source of the sound
effect of educational outcomes of mild unilateral untreated hearing loss
22-35% of kids with mild or unilateral HL fail 1 or more grades

impact on psychological well-being
suprasegmental info
voice pitch cues

tonal languages and stress
segmental info
voice onset time

voiced vs voiceless sounds
low frequency speech
voice fundamentals of speaker
high frequency speech
manner and place of articulation in consonants
better music appreciation in bimodal
chord discrimination and timbre perception were tested

improved emotional perception
improved quality of life with bimodal
increase in sound perception, activity, self-esteem, social interactions
problems with bimodal fitting
loudness mismatch: dynamic range of acoustic (HA) & electrical (CI) hearing differ

solution: audiology adjusts volume until 2 devices sound merge (loudness balancing)
- binaural advantage for localization
- binaural advantage for speech perception in noise
current bimodal technology
1. AB Naida CI + Phonak Naida Link HA

2. Cochlear Nucleus 7 CI + ReSound LiNX 3D 7 HA

3. Med-El has no HA partnership
single-sided deafness
pt with significant hearing loss in only 1 ear

with CI...
- improvements in localization and speech understanding in noise
- increased QoL
- progress is slower than traditional CI user
- AB Naida CI + Link CROS
Contralateral Routing of Signal - transmit sound from non-implanted ear to CI
electro-acoustic stimulation (EAS)

hybrid device
HA + CI in 1 device

best of both worlds

allows pt to take advantage of residual low freq hearing and provide an overall more natural sound quality
timing for 2nd CI
less than a year

speech perception ability in 1st CI is a better predictor than timing of 2nd CI

critical period: 12-13 years
wireless streamers vs FMs
soundfield receivers didn't improve speech recognition in noise

direct audio input showed significantly greater improvements in speech recognition than traditional or desktop soundfield receivers
parts of a sound processor
1. sound processor
2. batteries
3. microphone
4. body cables/ BTE cables
5. cable, coil, and magnet
speech processor controls/optoins
1. program selection
2. volume
3. microphone sensitivity
4. telecoil on/off
5. aux input on/off
6. battery connection
speech processor models
Coclear: Nucleus 6, 7 ; Kanso 1, 2

AB: Naida Marvel, Harmony BTE, Neptune

Med-El: Sonnet 2, Rondo 3
speech processor batteries
rechargable: 12-18 hours

disposable: 2-3 days
battery suitability depends on...
skin flap thickness
environmental conditions
listening conditions
speech coding strategies/pt map
stim rates
recipient power level
use of accessories
what to have on hand for trouble shooting
mic tester
charged/new batteries
new cables
new coil
new speciality earhooks
remote control
apps
steps to CI check
1. visual inspection
2. check settings
3. battery
4. microphone
5. behavioral check
6. signal check / sensor or LED display

need to be checked everyday
if any part isn't working, hearing will be different
use working CI to trouble shoot
mixing ratio
Relative strength of signals from processor and streaming device

parameters can be changed in programming software

FMs are 1:1

adults have higher ratios 3 (stream):1 (environment)
CI maintenance and precautions
water/moisture
- use dry box and aqua accessory

magnet in environment

medical procedures

head protection (sports)
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