Arnold School - Cochlear Implant Program

USC SPEECH & HEARING RESEARCH CENTER APPOINTMENT POLICY

Your hearing and speech/language skills are very important to us and to give you the best services possible, we require that you come to all scheduled appointments.

We understand that there are numerous appointments before and after implantation and we will try our best to accommodate your schedule.

This process requires a deep commitment from the recipient and family and if for any reason, you feel that you cannot make that commitment, then a cochlear implant may not be appropriate.

We will support you and your family as much as we can but if you cannot come to appointments (no show for 3 appointments in one year or have excessive cancellations), unfortunately we will have to discontinue our services. However, we will be happy refer you to another CI center.

The Initial Hookup

This visit is 1 1/2 hours in length and has the following goals:

Fit the sound processor and headpiece
Create a "first-pass" map or program that is comfortable. Additional maps will also be created for the recipient to try prior to the next clinic visit.
Counsel family regarding device operation, troubleshooting, equipment care and maintenance Complete Product Registration and Warranty information

To achieve those goals:

The session will begin with measurements of the integrity of the internal device (impedances)
Depending on age and previous hearing experience, subjective or objective measurements will be used to create the maps
If Subjective Measurements are possible, individual channels will be stimulated and the thresholds for sound as well as comfortable loudness levels will be assessed if Objective Measurements are necessary, the implant software is used to measure the auditory nerve’s response to stimulation
The map is tested in live speech and if needed, further modifications are made for comfort and audibility An equipment orientation regarding the use, care and maintenance of the device is completed

Follow Up Appointments

Because of the adaptation of the auditory system, numerous mapping changes are necessary, especially at the beginning. The recipient will always require mappings for the lifetime of the cochlear implant. For these reasons, we have established the following schedule.

Initial fitting (3-4 weeks after surgery)
Once per week for the first month of hearing
1, 3, 6, or 12 month intervals as determined by the audiologist
Additional appointments as needed for problems or troubleshooting

AUDITORY-VERBAL THERAPY/AURAL REHABILITATION THERAPY

For both children and adults who have been without sound stimulation for any length of time, rehabilitation is absolutely critical for successfully using and understanding spoken language. Adults who acquire hearing loss after developing language often can learn to recognize the new speech sounds provided by the cochlear implant. Adult aural rehabilitation therapy helps to develop these new listening skills and support the recipient in their endeavor to understand speech in all types of listening environments.

However, for children who are born deaf, they often have little or no sound experience on which to draw. Without intensive rehabilitation such as Auditory-Verbal Therapy and appropriate educational support, they often fail to develop spoken language and gain little benefit from the implant. Thus, it is critical that children and their families receive intensive and consistent intervention from professionals who are specifically trained in developing listening and spoken language abilities in children with cochlear implants.

The primary function of the cochlear implant is to provide sound and spoken language information through hearing sensation and active listening. The cochlear implant and mappings provide the hearing sensation and therapy provides the tools for learning to listen.

Therapy is individualized and family members are actively involved in the therapy session in order to facilitate carryover of skills into other environments. A goal of therapy is for hearing and active listening to become an integral part of a recipient’s communication, recreation, socialization, education and work.

Many therapists provide services to improve communication skills of children with hearing impairment. Some therapists teach American Sign Language, while others use total communication, cued speech, or other techniques. Auditory- Verbal Therapy does not use sign language. Therapy is centered around meaningful, fun activities to maximize the child’s use of hearing as a primary sense for speaking and learning at school.

The University of South Carolina Speech &Hearing Research Center is equipped with skilled clinicians trained in the area of Auditory-Verbal Therapy as well as aural rehabilitation. Support groups for adult recipients and for families of children with cochlear implants are also available at the Center.

DEVICE WARRANTY

Cochlear Implant Manufacturers offer a 3-year warranty on the external sound processor, microphone and headpiece. Most cables are covered by the warranty, although some are not depending on the device configuration. Warranty policies go into effect from the day of initial activation. A one-time replacement for loss or accidental damage (beyond repair) is available during the user’s initial 3-year warranty period. Warranted items are replaced due to “normal wear and tear” only.

For coverage after the 3-year warranty expires, service contracts can be purchased from the manufacturer. To supplement this, or in place of this, loss and damage insurance policies are available through Ear Service Corporation (ESCO). Some families choose to cover the hardware through homeowner’s insurance policies as well. Proper care and storage will affect the durability of the external hardware. The better the hardware is cared for, the less chance of encountering problems. Insurance providers may pay for out of warranty repairs, but coverage varies. Cochlear implants are manmade medical electronics. Although the internal devices are designed to withstand long-term use, it is unlikely that they will last a lifetime. All manufacturers offer a 10-year warranty for the internal portion of the cochlear implant system. This policy goes into effect the day of surgery. Internal devices may fail due to electronic malfunction or due to a direct blow to the head. For this reason, we recommend parents carefully consider allowing their child to participate in “high risk” activities, such as contact sports or bicycling or rollerblading without a helmet.

Cochlear implant manufacturers track the life of their implants as a number called Cumulative Survival Rate (CSR). This percentage is tracked by the device model, number of recipients and years that it remains in use. This information is available to the general public upon request.

INITIAL STIMULATION AND ORIENTATION INFORMATION

ACCESSORIES TO FIT YOUR LIFESTYLE

A wide range of accessories can help you capture sounds more easily. Sometimes the cochlear implant sound processor is not enough in all listening situations. Difficult to hear environments such as the classroom, car, movies, phone, television, groups, restaurants, meetings, and parties all have their own unique listening challenges. Accessories and plug-ins are available from the manufacturer and other hearing instrument companies to make speech more attainable.

TELEPHONE OPTIONS

Many cochlear implant recipients enjoy using the telephone. Those who can understand speech without visual cues tend to have greater success. Recipients who used the telephone prior to their severe hearing loss with practice are often able to use the telephone with their cochlear implant.

CI recipients use the telephone in many ways. Some use the microphone of the speech processor and simply hold up the phone to their processor.

Some recipients use the speaker-phone feature on their cell or home phone and some use a text phone or video relay phone service.

A telecoil is built in to speech processors and recipients can take advantage of the numerous ways to utilize this technol-ogy. A telecoil is like an invisible assistive listening system delivering sound by magnetic induction. Cell phones are rated for microphone and telecoil compatibility (United States Federal Communications Commission). Phones rated M3 or M4 meet or surpass the standard for micro-phone compatibility, with M4 being the best. Phones rated T3 or T4 meet or surpass the standard for telecoil compati-bility, with T4 being the best. The telecoil in the phone will connect with the telecoil in the speech processor when acti-vated allowing direct communication between the two de-vices.

Bluetooth technology can be paired for telephone use. It is a short-range com-munications system intended to replace the cables connecting electronic devices. Most Bluetooth enabled phones support the Headset (HSP) and Handsfree (HFP) profiles for connecting the phones to headsets or car kits. Cochlear implant recipients can choose Bluetooth devices such as neckloops, silhouettes, or personal FM systems that are designed to work with the telecoil. Bluetooth devices are also available with a 3.5mm headphone jack that allows con-nection of Personal Audio Cable, headphones, audio silhou-ettes, etc.

Still, other recipients use a cable or telephone adapter. Cellu-lar patch cords provide a direct connection between the cell phone and the speech processor. They connect to the cell phone and speech processor using a "Y" configuration. One leg of the “Y” plugs into the cell phone's headset jack; the other connects to the processor and the cable’s built-in microphone can be attached to clothing.

The best advice when purchasing a new phone is simply to try it out. Some fea-tures to look for when purchasing a new phone include a volume control, Caller ID, integrated answering machine, and a high-quality speaker phone.

FM Systems

What Is the Purpose of an FM System?
Even if a cochlear implant speech processor is properly adjusted to the recipient’s personal hearing thresholds and comfortable listening levels, it may not be enough to optimize speech

understanding in all listening situations.

The speech processor is limited when in background noise as the microphone picks up and amplifies all sounds including background noise as well as the speech signal of the person talking. For children, the classroom is very noisy environment and these factors can affect learning. For adults, situations such as restaurants, in the car, or in a large meeting can be difficult.

The signal to noise ratio is recommended to be +15 dB or greater. However, in a typical classroom or other noisy situations the signal to noise ratio is much less. An FM system increases the signal to noise ratio within the classroom or noisy situation to give better access of the talker to the listener.

A transmitter/microphone picks up the voice of the talker and sends that signal wirelessly via radio waves to a receiver coupled to a soundfield speaker or coupled directly to the cochlear implant speech processor. Regardless of the distance between talker and listener, the signal is delivered directly to the FM receiver at a constant intensity level and the proximity of the talker's outh to the microphone ensures that his/her voice is delivered to the listener at a level that is significantly louder than the level of any background noise.

Personal FM receivers are worn on the body and attached directly to the child's sound processor
by means of a special FM adapter cable or a wireless connection. Sound field FM Systems transmit the talker's voice to one or more loudspeakers positioned near the listener, no direct coupling is necessary to the sound processor. The wireless talker-worn transmitter/microphone is identical for both personal and sound field FMs.

Bilateral Cochlear Implants

Views on bilateral cochlear implantation have changed significantly in the recent past. Whereas families and clinicians once thought it was best to save the non-implanted ear for improvements in future technology, this is no long the case.

There are at least three specific expected benefits of being a bilateral cochlear implant user. When properly fit, worn all waking hours, and therapy is utilized to develop auditions skills with the new implant, a bilateral cochlear implant recipient could expect the following:

Due to the increasing number of families interested in bilateral CI, the implant team asks that bilateral cochlear implantation be explored after at least 6-months of implant use with the first device. This allows for greater flexibility in planning for surgeries receiving their first implant as well as being able to accommodate the ever-increasing number of those waiting for a second device.

Bimodal hearing is when someone uses a cochlear implant in one ear and a hearing aid in the other ear. Some recipients still have some measurable hearing in their non-implanted ears. For these individuals, it may be possible to achieve greater benefit by listening with a hearing aid and an implant than with one implant alone. The reason for this is that the residual hearing, although not good enough on its own, can provide additional information not available through a cochlear implant. These recipients may gain benefits such as better speech perception, music appreciation, and pitch perception.

Post-Implant for Recipients