Cochlear ImplantsCochlear ImplantsAmerican Sign Language

Children & Cochlear ImplantsChildren & Cochlear Implants Psychological Evaluation of Psychological Evaluation of

Implant CandidatesImplant Candidates

James H. Johnson, Ph.D., ABPP

Department of Clinical and Health Psychology

University of Florida

Functioning of the Normal EarFunctioning 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 EarFunctioning 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 EarFunctioning 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?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 How do Cochlear Implants Work?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?How do Cochlear Implants Work? The electronic impulses

from the processor are sent to a coil or transmitter (half-dollar 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?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 ImplantA Fitted Cochlear Implant

The Implant ProcessThe 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 ProcessThe 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 EverythingTraining is Everything

Typical Indications for ImplantsTypical 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 Family Agreement and DisagreementsDisagreements

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 ExpectationsAssessing 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”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?