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Programming Cochlear Implants

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March 2010

Programming Cochlear Implants

Jace Wolfe, PhD, Erin Schafer, PhD

Details

160 pages, Color Illustrations (2 Color), Softcover, 8.5 x 11"
ISBN10: 1-59756-372-2
ISBN13: 978-1-59756-372-7

$45.00

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About this Title
Table of Contents
About the Authors
Related Titles

Overview

Cochlear implants offer substantial benefit for children and adults with severe to profound hearing loss. However, for recipients to realize their full potential with the device, it must be carefully programmed. Programming Cochlear Implants, a volume in the Core Clinical Concepts in Audiology Series, offers practical guidance for clinicians who program or plan to program cochlear implants, introducing the basics of cochlear implant programming and continuing through advanced programming techniques. Manufacturer-specific information is provided, and case studies are presented to illustrate cochlear implant programming fundamentals and strategies. Specific topics covered include: basics of cochlear implant terminology and programming, clinical protocols for cochlear implant management, programming considerations for bilateral cochlear implant recipients, troubleshooting during the programming process, device-specific programming techniques, basic use of objective measures to set cochlear implant programs, use of FM and assistive listening devices with cochlear implants, and management of the difficult-to-program recipient. This book serves as a practical guide for clinicians who are providing services to cochlear implant users and also as a teaching tool for graduate-level students.

Audience

Primary Subject: Audiology / Amplification
Audience Level: Professional/Textbook - 90 Days

Basic Components of a Cochlear Implant
- Internal Stimulator/Electrode Array
  - Electronics of Internal Stimulator
  - Physical Design of Internal Stimulator
  - Electrode Array Design
  - Intracochlear vs. Extracochlear Electrodes
- External Equipment
  - Sound Processor
  - Cable/Coil/Radio Frequency (RF)
  - Bidirectional Telemetry/Lock
  - Power Source
Basic Terminology of Cochlear Implant Programming
- Stimulation Levels
  - T Levels/Upper Stimulation Levels (C/M/MCL)
- Electrode Coupling
  - Monopolar vs. Bipolar vs. Common Ground
- Electrode Impedance: short vs. open
- Channel vs. Electrode
- Mode of stimulation: Pulsatile vs. Analog/Sequential vs. Simultaneous
- Pulse Width vs. Current Amplitude
- Stimulation Rate
- Input Dynamic Range (IDR)
- Microphone Sensitivity
- Volume Control Setting
- Mixing Ratio
- Gains
- Sound Coding Strategy
  - CIS vs. n-of-m strategies (ACE) vs. Hi Res vs. FSP
- Frequency Allocation
Basic Principles of Programming
- Preparing the Patient
  - Children and Families
  - Adults
- Selecting a Signal Coding Strategy
- Streamlined vs. Comprehensive Mapping
- Measuring Stimulation Levels: T Levels and Upper Stimulation Levels
  - Children
    - T Levels: BOA vs. VRA vs. CPA
    - Upper Stimulation Levels
      - Psychophysical Loudness Scaling
      - Psychophysical Loudness Scaling
      - Going Live: Live Speech Mapping Electrically Evoked Stapedius Reflex Threshold (ESRT)
  - Adults
    - T Levels: Audiometric Threshold vs. “Count the Beeps” vs. Psychophysical Scaling
    - Upper Stimulation Levels
      - Loudness Scaling
      - Live Speech Mapping
      - ESRT
- Special Measures
  - Loudness Balancing
  - Confirmation of Tonotopic Organization
  - Electrode Sweeping to Confirm Sound Quality
- Selection of Special Parameters
  - Stimulation Rate
  - Pulse Width
  - Channel Gain
  - Frequency Allocation
  - IDR
  - Maxima
Manufacturer-Specific Programming Considerations
- Advanced Bionics
  - To Measure or Predict T levels
  - Setting M levels with Speech Bursts vs. Tone Bursts vs. Global Live Speech Adjustment
  - HiResS vs. HiResP vs. HiRes 120
  - IDR and Dual Action Automatic Gain Control (AGC)
  - Effect of Microphone Sensitivity and Volume Control
  - Mixing Ratio
  - Stimulation Rate
  - Power Economy Mode
  - Effect of Channel Gain Adjustment on CIS/HiRes-type Strategies
- Cochlear Corporation
  - Selection of Sound Coding Strategy
  - Setting T Levels
  - Selecting Stimulation Rate/Pulse Width/Maxima
  - Frequency Allocation
  - Effect of Channel Gain Adjustment on ACE Strategies
  - Adjusting Electrode Coupling Mode/Double Channel Mapping
  - Selecting IDR (T-SPL and C-SPL)
  - Effect of Microphone Sensitivity and Volume Control
  - Effect of Input Pre-Processing and How to Choose
- Med-EL
  - Selection of Signal Coding Strategy
  - Measuring vs. Estimating T Levels
  - Selecting Stimulation Rate
  - Channel Gain
  - IDR
  - Map-law
Clinical Considerations: Putting All of the Pieces Together
- Mapping Schedule
  - Children
  - Adults
- This Is How We Do It
  - Acquiring Critical Information from CI Surgeon
    - Anatomy of Cochlea and/or Auditory Nerve (CT scan/MRI)
    - Post-Operative X-ray
    - Surgical Complications
    - Examining Physical Status of Ear and Incision Site
  - Creating Maps on Activation Day and Forward
    - Impedance Measurement
    - Determining Magnet Strength
    - Determining Stimulation Levels
    - Setting Programs
    - Objective Measures and Impact on Programming
      - Electrode Impedance
      - Electrically Evoked Compound Action Potential (ECAP)
      - ESRT
    - Counseling of Patients and Families
    - Interaction/Communication with Family and Other Professionals
    - Follow-up Schedule
  - Considerations for Bilateral Cochlear Implants
Troubleshooting Patient Complaints and Complications
- Poor Progress in Speech Understanding
- Poor Sound Quality
- No Sound
- Intermittencies
- Facial Nerve Stimulation
- Red Flags
- Device Reliability
- Examination of External Equipment
- Populations Likely to Experience Poorer Outcomes
  - Cochlear Hypoplasia
  - CMV/Bacterial Meningitis
  - Autism
  - Advanced Elderly
  - Late-Implanted Children
  - Aplastic Auditory Nerve
  - Severe Mental Retardation
Hearing Assistance Technology (HAT) and Cochlear Implants
- HAT
  - Frequency Modulated (FM) Systems
  - Infrared Systems
  - Bluetooth
  - Remote Controls
  - Direct-Connect Cable Coupling
  - Interfacing with Personal Entertainment Devices
    - Cell Phones
    - Bluetooth
    - MP3 Players
    - Video Games
- Optimization of Cochlear Implant Parameters and HAT Settings
  - Mixing Ratios
  - IDR
  - Input Processing
  - FM Receiver Gain
Case Studies

About The Authors

Jace Wolfe, PhD

Jace Wolfe, Ph.D., is the Director of Audiology at the Hearts for Hearing Foundation. He also is an adjunct Assistant Professor in the Audiology Department at the University of Oklahoma Health Sciences Center.

Erin Schafer, PhD

Erin C. Schafer, Ph.D. is an Assistant Professor in the Department of Speech and Hearing Sciences at the University of North Texas, where she has held an academic appointment since August 2005. She teaches graduate courses in the areas of aural rehabilitation, pediatric habilitation, diagnostic audiology, and research methods, and she serves as an Educational Audiology consultant for local school districts.