Transcript Children and Cochlear Implants

Cochlear Implants
American Sign Language
Children & Cochlear Implants
Psychological Evaluation of Implant
Candidates
James H. Johnson, Ph.D., ABPP
Department of Clinical and Health Psychology
University of Florida
Functioning of the Normal Ear

The ear has three
sections; the Outer Ear,
the Middle Ear and the
Inner Ear.
 Sound is transmitted as
sound waves from the
environment.
 These are gathered by
the outer ear and sent
down the ear canal to the
eardrum.
Functioning of the Normal Ear

Sound waves cause the
eardrum to vibrate which
sets the three tiny bones
in the middle ear into
motion.
 These are the Hammer
the Anvil and the
Stirrup.
 The motion of these
bones cause fluid in the
inner ear or cochlea to
move.
Functioning of the Normal Ear

Movement of the fluid in
the inner ear causes the
hair cells in the cochlea
to move.
 The hair cells transform
this movement into
electrical impulses.
 These electrical impulses
are transmitted to the
auditory nerve and to the
brain where they are
interpreted as sound.
What is a Cochlear Implant?

A cochlear implant is an electronic device, that
bypasses the damaged hair cells of the cochlea
and stimulates the auditory nerve directly.
 It can provide the child with useful “hearing”
and improved communication abilities in the
implant user.
 It is a safe, reliable, and an effective treatment
for profound hearing loss in children (and
adults).
How do Cochlear Implants
Work?

Cochlear implants detect
sounds via an ear level
microphone that sends
these sounds to a wearable
sound processor.
 The processor converts
these sounds to tiny digital
impulses that provide
hearing sensations to the
user.
 Some of the newest sound
processors are small
enough to fit behind a
person's ear.
How do Cochlear Implants Work?

The electronic impulses
from the processor are sent
to a coil or transmitter (halfdollar sized) worn
externally behind the ear
over the implant.
 The coil sends an FM signal
to the implant receiver,
located under the scalp.
 The implant then sends
these sound impulses to a
number of tiny electrodes
within the cochlea (inner
ear).
How do Cochlear Implants Work?

These signals contain
information about the
frequency and loudness
of speech and other
sounds.
 The responses to these
signals are then sent via
the auditory nerve to the
brain where they are
interpreted as sound.
A Fitted Cochlear Implant
The Implant Process
Implant surgery – general anesthesia
 Recovery/Healing – 4 – 5 weeks
 Activation, Fitting, and Mapping –






the child wears the processor
the processor is also attached to a computer
the clinic computer generates signals at carefully
controlled levels
the child is asked to indicate:
- the quietest signal heard (threshold level)
- the loudest comfortable signal heard (comfort
level)
these two levels are assessed for all the electrodes
in the cochlea (20 – 30 in all).
The Implant Process
– Using this information a speech processor
program is created which allocates sounds
between these two levels.
– The program mapping sets sounds so they are
loud enough to hear but not so loud as to be
uncomfortable.
– The program is fine-tuned during following clinic
sessions.
– This may occur a number of times during the
first year.

Auditory Training
 Speech and Language Training
Training is Everything
Typical Indications for Implants

Severe to profound sensorineural hearing loss
with poor speech recognition.
 Minimal or no benefit from the use of hearing aids
 Medically able to tolerate cochlear implant
surgery.
 Realistic understanding of the risks, benefits and
limitations of implantation
 Failure to develop good oral language skills
despite consistent hearing aid use and intensive
rehabilitative efforts
 A home and educational environment where oral
expression is encouraged and supported
Family Agreement and
Disagreements

Do parent and child agree on the
desirability of the implant?
 Do both parents agree on the
desirability of an implant?
 Are both willing to be active
participants in the implant
process?
 Do other close family members
support the idea of an implant?
Assessing Expectations

Do parents and child (if old enough) convey an
understanding that children vary in response to
implants?
 Is there understanding that degree of success depends
on parent and child being active participants in the
process (e.g., auditory training, speech/language
therapy, etc)?
 Do they understand that the child may not “hear” the
same way as a non-hearing impaired individual?
 Is there implied acceptance of outcomes that may not
involve;
– the development of functional speech
– a full understanding of speech without speechreading?
“The Sound and the Fury”

Now we are going to watch a documentary
called The Sound and the Fury that follows
a few families’ decisions on whether to get
a cochlear implant or not.
 This documentary gives us great insight into
Deaf culture.
 As you watch, consider the question:
– Should deaf babies receive cochlear
implants?