Guest Lectures
Dr. Ahmad gave a lecture on surgeries...
What percent of pediatric patients that need implants actually recieve them?
36%!
When would you increase the pulse width?
When the C/M levels cannot be adjusted any higher but the pt. still needs more volume.
Which manufacturer must you set the T levels for?
Cochlear
What is the SNR level for AzBio in noise?
5-10
The Bonebridge is approved by the FDA for people __ years and older
12
What are 3 barriers to care that may prevent a child from recieving a cochlear implant?
1) Living in a rural area
2) Parent education
3) Medicaid insurance
What should be the dynamic range of users with Cochlear CIs?
19-40 CL (clinical units)
Which manufacturer allows you to change the number of maxima?
Cochlear because they use the n-of-m strategy
What are some commonly utilized speech perception tests for pediatric patients?
Speech perception testing PMSTB (Pediatric Minimum Speech Test Battery)
• 60 dBA presentation level for conversational
speech AND
• 50 dBA presentation level for soft speech for
borderline cases
Yes
If score 0% after 10 stimulus items, may
discontinue and record a score of 0%.
Optional
C4. SPEECH P ERCEPTION T ESTS
• Test in aided condition only, no visual cues.
• Must administer both a word and a sentence test.
• All presentations at 60dB SPL
• Administer a more difficult test when scores are >50%.
• Use recorded stimuli when possible.
• Test each ear individually and both ears together if case is borderline or hearing is asymmetric.
• Considerations: use your clinical judgement and your knowledge of the patient to determine
whether to start with the harder tests (open-set) or start with the easier tests (closed-set).
Open-Set Tests: Common Phrases Test, The Hearing In Noise Test (HINT)-C, The Lexical Neighborhood Test, the Multisyllabic Lexical Neighborhood Test Phonetically Balanced Kindergarten (PB-K) Test
Closed-Set Tests: Early Speech Perception Test Low Verbal Version, Early Speech Perception Standard Version, Ling Six Sound Test
What is the candidacy for someone to be implanted with a bone conduction hearing device?
>30 dB conductive loss
Ms. Turoff gave us a lecture on interpretation in the hospital... How did she define Total Communication?
Total Communication method (originally conceived as using
any language or modality best-suited to the child; now often
employs simultaneous communication – spoken language
and signs simultaneously. Often uses a form of S.E.E. -
Signing/Seeing Exact English or English- ordered signs.)
Front-end: Includes C/T levels (upper and lower stimulation levels), rate, maxima, pulse width etc.
Back-end: Things that are manipulated: Noise reduction, directionality -- after the signal becomes electric and is now being processed by the actual processor. Things that do not manipulate the MAP essentially
With respect to Telemetry...which manufacturer refers to their method as ART? (Auditory Response Telemetry)
MED-EL
What is the candidacy for EAS systems?
WRS: <60% in implanted ear; <80% in contralateral ear
If a patient has a CHL/MHL with a bone conduction threshold PTA less than 55 dB
No age requirement
Motivated to proceed with a non-surgical hearing solution
What should we recommend?
BAHA
Ponto
Dr. Tribble gave us a lecture on Connectivity with Implants... what were the big 3 factors that she named as listening obstacles?
1) Reverberation
2) Distance
3) Background noise
If a pt. is experiencing facial twitching near their eye, this means that we should adjust...
The C/M levels
Cochlear uses peak picking coding strategies...
Name 4 types of strategies that use this method
SPEAK
ACE
MP3000
N-of-M
What are some contraindications of cochlear implanatation?
For MED-EL... if the pt. is intolerant to the materials used in the implant (silicone, titanium, iridium)
Absence of cochlear development
Unstable psychological state
Unrealistic expectations
Anatomic abnormalities
Name 3 types of passive non-surgical bone conduction devices
1) Softband
2) SoundArc
3) ADHEAR (MED-EL)
What are 2 advantages and 2 disadvantages of remote microphones?
Advantages: Discreet/less parts, versatile, some can work with Roger systems, high performance, cost effective
Disadvantages: Debates about school use, shorter warranties for repairs, may not work for all bimodal users, easy to lose
If the patient says sounds are still too soft...what should be do?
Increase the C levels/pulse width etc
AB and MED-EL use envelope coding strategies
Name a few types
CIS
CIS+
HDCIS
HiRES (Optima S/P for AB)
In the case of SSD, what is the criteria for MED-EL?
More than or equal to 90 dB HL of hearing loss
Less than 5% correct on CNC words in quiet
1 month trial of BCHD
What is the difference between passive and active?
Passive: Mechanical amplification travels through the skin
Active: Mechanical amplification is transferred directly to the bone