12/30/2013 This Week’s Learning Objectives You will be able to … Describe the information that needs to be 1 understood before cochlear implantation should be considered Describe ways to address family assumptions 2 about cochlear implant outcomes Describe the work needed to develop auditory 3 skills and benchmarks for performance Aural Hab: Describe red flags identifying issues with the 4 Child cochlear implant Karen L. Anderson, PhD Supporting Success for Children with 5 Describe issues with other implantable devices Hearing Loss 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 2 Audiometric CI Candidacy 4 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com Children’s Implant Profile: Areas of Etiology Profile of CI Candidates Consideration Before Implantation • 15-44% have SNHL of unknown cause • 40-50% genetic etiology • Must undergo 3-6 month hearing aid trials The audiologic evaluation is used to identify current aural performance and to GUIDE AURAL REHABILITATION after implantation. 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 5 1
12/30/2013 Complications of CI Expanding Candidacy • Complications occur in 10% of pediatric cases Implantation <12 months! • Complications breakdown: • Speech perception testing at 9 years post-CI – scoring between 76-100% • 50% infection in wound or OME • Implanted between 24-36 months = 20% • 20% hemotoma or sematoma (blood in tissues) • Implanted between 12-23 months = 38% • 10% CSF fistulas • Implanted prior to 12 months = 100% (superior • 20% device failure speech understanding!) • Also: • R/E language skills growth similar to typically hearing • Receptive language growth exceeding CI at any subsequent age and commensurate with age peers. 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 7 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 8 Invisible Barriers Future of Cochlear Implants As technology is refined, • Any abnormal auditory system, even with the • there will be less audiological follow-up needed to provide best technology will appropriate care for cochlear implant patients. • development of remote and/or self programming techniques, some • Not restore normal hearing levels (-10 to +10 dB) of which are currently being used in pilot programs. • • Have greater speech perception, As the age of implantation decreases, less speech-language services will be required due to being able to take advantage of discrimination, speech processing and natural language development. decreased comprehension in • The educating of children with hearing loss will also change. • will probably be a shift in the future that the SLPs and DHH • NOISE teachers will need to focus more on the “other disabilities ” rather • REVERBERATION than the hearing loss. • Furthermore, with reimbursement for services continuing to • DISTANCE decline, more innovative practice patterns will be needed for cochlear implant centers to remain open for services. http://div9perspectives.asha.org/content/19/1/32.full.pdf+html Current Practices in Pediatric Cochlear Implantation, Tamala S. Bradham, Geneine Snell, and David Haynes 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 9 10 Make It Yours Parents are interested in CI because... Patient 1 - Bo : age 8 months, deaf in right ear, mild sloping • 95% of children with hearing loss are born to to severe high frequency loss in left ear. Standard hearing families with no history of childhood HL aids since 6 weeks. Good family support. • They want the hearing loss to ‘go away’ Patient 2 - Sidney : age 3 years, same HL, inconsistent family • They want ‘the best’ for their child support, limited language, behavior issues • At adulthood they want their child to be… 2015 : What could communication abilities be like? highly educated, employable, marriable, etc. What are the hearing device options you would consider for • If their child is implanted, then he will be these children? ‘normal’ and they won’t have to do anything 2025 : Considering the trends, what may be different about ‘extra’ hearing device options? • ‘Like glasses only for ears’ How could the role of the audiologist be different? 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 11 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 12 2
12/30/2013 Listen for Intent • I just read about cochlear • Is there a concern about auditory response implants on the internet… and language learning with the hearing aids? • It sounds like implants are much • Is the child’s hearing loss changing? better than hearing aids. • Is this a family who has been involved and • Kids can talk just like other kids empowered through early intervention and is when they get cochlear implants. seeking information? • He has this hearing loss and the • Is this a family who has been inconsistent teachers are saying he isn’t and is seeking an ‘easier answer’ to the hard learning (you know there are work of early intervention? cognitive delay issues). If he uses • Is this a multicultural family concerned about implants learning should be their child’s future as a (marriageable) adult? better, right? • Etc. 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 13 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 14 The Olympic Skater The Power of the Analogy Babies brains are designed to learn words, language and • Hearing loss is invisible eventually reading. All they have to do is be exposed to • “Language” is not speech. Babies with hearing loss need help to learn this. Lets think about an analogy…. inherently understood • Everyone in your family for generations has been a talented (other than i.e. “Spanish”) skater. You believe that your child could go to the Olympics! • Predicting language and • You buy her skates. Will that be enough? learning delays because • You bring her to the ice rink and she puts on her skates once of this invisible barrier is a month. Will that do it? often not really ‘heard’ • You hire a coach with a really good reputation for training • Analogies can get good skaters, but she misses a lot of the lessons. effectively across the • She doesn’t have other people to skate with regularly or to ‘domino consequences’ of consistently model and encourage her to use new skills. hearing loss For a child with hearing loss, getting the device is the easy part! 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 15 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 16 The Olympic Listener/Talker/Learner Make It Yours Babies brains are designed to learn words, language and eventually reading. All they have to do is be exposed to • Think of another analogy that would get across speech. Babies with hearing loss need help to learn this. Lets • the ‘domino effect’ of not addressing the hearing loss in think about an analogy…. a timely way, or • Everyone in your family for generations has been a talented • Why a CI isn’t a ‘quick fix’ to the hearing world talker. You want your child to get a good education. • You get her hearing aids or a CI. Will that be enough? • Be creative! There are many types of families • The hearing devices are puts on once a month. Will that do it? A couple of hours a day? All waking hours a day! (interests, age, ethnicity, family goals for child, • You have an early intervention teacher with a really good etc). One analogy isn’t enough. reputation for working with families of children with hearing loss. YOU are people who will teach your baby to listen! • Language is learned through overhearing and interaction!. For a child with hearing loss, getting the device is the easy part! 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 17 2014 (c) Supporting Success for Children with Hearing Loss http://webcasts.successforkidswithhearingloss.com 18 3
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