This document discusses various aspects of caring for children who use cochlear implants, including candidacy criteria, the activation process, monitoring requirements, and considerations for the non-implanted ear. Key points covered include FDA approval age minimums, tests used in evaluation and programming, the benefits of bilateral implantation or bimodal stimulation, and periodic audiological assessments of implant function and speech perception.

1. Care of Children Who Use a
Cochlear Implant

2. Overview

3. Overview

4. Overview

5. Overview

6. Overview
● T levels – thresholds levels
– Measured behaviorally or generated in software
● M or C levels – comfort levels
– Measured behaviorally or estimated by
electrical compound action potential or
electrical stapedial reflex threshold
● Range between T level and M/C level between 40 to
60 dB

7. Overview
● T levels – thresholds levels
– Measured behaviorally or generated in software
● M or C levels – comfort levels
– Measured behaviorally or estimated by
electrical compound action potential or
electrical stapedial reflex threshold
● Range between T level and M/C level between 40 to
60 dB

8. Overview
● T levels – thresholds levels
– Measured behaviorally or generated in software
● M or C levels – comfort levels
– Measured behaviorally or estimated by
electrical compound action potential or
electrical stapedial reflex threshold
● Range between T level and M/C level between 40 to
60 dB

9. Overview
● T levels – thresholds levels
– Measured behaviorally or generated in software
● M or C levels – comfort levels
– Measured behaviorally or estimated by
electrical compound action potential or
electrical stapedial reflex threshold
● Range between T level and M/C level between 40 to
60 dB

10. Overview
● T levels – thresholds levels
– Measured behaviorally or generated in software
● M or C levels – comfort levels
– Measured behaviorally or estimated by
electrical compound action potential or
electrical stapedial reflex threshold
● Range between T level and M/C level between 40 to
60 dB

11. Candidacy
● FDA approval for Cochlear Implants is device-
specific (slight differences between manufacturers)
● Minimum age approved by FDA = 12 months
for children with bilateral, profound hearing
loss and 24 months for severe hearing loss
(bilateral or better ear)
● Implanting under 12 months for special cases
but increased risk

12. Candidacy
● FDA approval for Cochlear Implants is device-
specific (slight differences between manufacturers)
● Minimum age approved by FDA = 12 months
for children with bilateral, profound hearing
loss and 24 months for severe hearing loss
(bilateral or better ear)
● Implanting under 12 months for special cases
but increased risk

13. Candidacy
● FDA approval for Cochlear Implants is device-
specific (slight differences between manufacturers)
● Minimum age approved by FDA = 12 months
for children with bilateral, profound hearing
loss and 24 months for severe hearing loss
(bilateral or better ear)
● Implanting under 12 months for special cases
but increased risk

14. Candidacy
● Audiologist assesses word recognition with
either questionnaires (e.g., IT-MAIS, MAIS) or
speech audiometry (MLNT, LNT, HINT-Q).
● Speech-language evaluation
● Developmental evaluation
● Otological/Radiological evaluation

15. Candidacy
● Audiologist assesses word recognition with
either questionnaires (e.g., IT-MAIS, MAIS) or
speech audiometry (MLNT, LNT, HINT-Q).
● Speech-language evaluation
● Developmental evaluation
● Otological/Radiological evaluation

16. Candidacy
● Audiologist assesses word recognition with
either questionnaires (e.g., IT-MAIS, MAIS) or
speech audiometry (MLNT, LNT, HINT-Q).
● Speech-language evaluation
● Developmental evaluation
● Otological/Radiological evaluation

17. Candidacy
● Audiologist assesses word recognition with
either questionnaires (e.g., IT-MAIS, MAIS) or
speech audiometry (MLNT, LNT, HINT-Q).
● Speech-language evaluation
● Developmental evaluation
● Otological/Radiological evaluation

18. Intraoperative Testing
● Impedance telemetry to detect short or
open circuits
– Short circuit = impedance too low
– Open circuit = impedance to high
● Measure the electrically-evoked
compound action potential (a.k.a., NRT,
NRI, or ART)

19. Intraoperative Testing
● Impedance telemetry to detect short or
open circuits
– Short circuit = impedance too low
– Open circuit = impedance to high
● Measure the electrically-evoked
compound action potential (a.k.a., NRT,
NRI, or ART)

20. Intraoperative Testing
● Impedance telemetry to detect short or
open circuits
– Short circuit = impedance too low
– Open circuit = impedance to high
● Measure the electrically-evoked
compound action potential (a.k.a., NRT,
NRI, or ART)

21. Intraoperative Testing

22. Activation of CI
●
Activation is 1 to 4 weeks post­surgery
●
Familiarization prior to activation (toys, books)

23. Activation of CI
●
Activation is 1 to 4 weeks post­surgery
● Familiarization prior to activation (toys, books)
●
At activation/programming, audiometry may be
performed (depending on age)
●
Electrically­evoked compound action potentials may also
be performed in the office during programming
– Better than in operating room (less electrical
interference)
– But exposes child to loudness discomfort

24. Activation of CI
●
Activation is 1 to 4 weeks post­surgery
● Familiarization prior to activation (toys, books)
●
At activation/programming, audiometry may be
performed (depending on age)
●
Electrically­evoked compound action potentials may also
be performed in the office during programming
– Better than in operating room (less electrical
interference)
– But exposes child to loudness discomfort

25. The Other Ear
● Contralateral stimulation is often beneficial (hearing aid or
cochlear implant) --- bimodal hearing
● Bilateral implants (re: unilateral implant) eliminates the
head shadow effect and provides superior sound
localization, detection of soft sounds, speech perception
in noise.

26. The Other Ear
● Contralateral stimulation is often beneficial (hearing aid or
cochlear implant) --- bimodal hearing
● Bilateral implants (re: unilateral implant) eliminates the
head shadow effect and provides superior sound
localization, detection of soft sounds, speech perception
in noise.

27. The Other Ear
●
Contralateral stimulation is often beneficial (hearing aid
or cochlear implant) ­­­ bimodal hearing
●
Bilateral implants (re: unilateral implant) eliminates the
head shadow effect and provides superior sound
localization, detection of soft sounds, speech perception in
noise.

28. Monitoring
●
Unaided audiogram every 12 months
●
Aided audiogram every 6 months
●
Aided thresholds should typically be between 20
to 30 dB HL (pulsed tones in soundfield)
●
Questionnaires to track progress
●
Aided speech perception testing (closed vs open
set)

29. Monitoring
●
Unaided audiogram every 12 months
●
Aided audiogram every 6 months
●
Aided thresholds should typically be between 20
to 30 dB HL (pulsed tones in soundfield)
●
Questionnaires to track progress
●
Aided speech perception testing (closed vs open
set)

30. Monitoring
●
Unaided audiogram every 12 months
●
Aided audiogram every 6 months
●
Aided thresholds should typically be between 20
to 30 dB HL (pulsed tones in soundfield)
●
Questionnaires to track progress
●
Aided speech perception testing (closed vs open
set)

31. Monitoring
●
Unaided audiogram every 12 months
●
Aided audiogram every 6 months
●
Aided thresholds should typically be between 20
to 30 dB HL (pulsed tones in soundfield)
●
Questionnaires to track progress
●
Aided speech perception testing (closed vs open
set)