Qualifying Exam Question – Class of Summer A, 2000

Dr. Alice Holmes – Cochlear Implants and Assistive Devices

Describe who should be part of a cochlear implant team and their roles in the determining if a patient is a candidate for a cochlear implant.  How does this differ with different groups of patients, i.e. Children, pre-lingual adults, post-lingual adults.

“The age, mode of communication, amplification history, and related medical and social issues of both the proposed candidate and the family will often determine which of the team members need to be involved in the initial evaluation.”₁

The team of professionals can consist of the following:

            * Audiologist             * Pediatrician                        Otolaryngologist                   Radiologist

                        * Speech Language Pathologist                           Educational Advisor

                        * Psychologist                                   Social Worker

Most of the above listed professionals are used in evaluation of a child. Those marked with an * can be modified for adult evaluations.

The audiologist should performed standard audiometric procedures as well as fit the patient, for a trial period, with suitable amplification.  The patient should receive appropriate habilitation/rehabilitation during this time.

Adult criteria: severe-to-profound sensorineural hearing loss bilaterally with

open-set sentence recognition scores less than or equal to 30%. 

Child criteria: profound sensorineural hearing loss bilaterally and minimal

speech perception under best aided conditions.

A Pediatrician/Primary Care physician can order all suitable medical tests that are deemed necessary to find out if the patient is physically suitable for surgery. 

Adult criteria: most anyone in good health unless there is poor anesthetic risk,

severe metnal retardation or psychiatric disorders, or organic brain syndromes.  Child criteria: otologically stable, no active middle ear disease,

The Otolaryngologist (surgeon) should explain all pertinent information regarding what the process is, pre-op instruction and post-op instructions.

The Radiologist performs any CT scans or MRIs that are ordered.  He/she should work very closely with the surgeon to coordinate the best surgical procedure for this particular patient. 

Adult criteria:  as long as there are no visible abnormalities that may impede or

compromise the surgery they are a candidate. 

Child criteria:  same as adults.

The Speech-Language pathologist performs standardized testing to access speech perception, language development, speech production etc.

A Psychologist is used to determine the psychological development of a child. 

Child criteria:  to insure that implantation is the proper intervention

An Educational Advisor can determine the child’s academic development, how he/she has gotten along so far, without the use of their hearing.  How they have been developing, academically, through the years.

A Social Worker is useful to ensure that the family is doing well with the hearing loss of the child, the adjustment to the idea that the child will eventually hear and the stress of the child’s surgery and therapy after that.

The parents, if the candidate is a child, should be well informed of all the testing, evaluation and surgical procedures.  They should be included in everything and their questions should be answered to the best of the professional’s abilities.  If the patient is an adult, the parents can be there as support.

Additionally:  One should remember that pre-lingually deafened adults have shown little improvement with cochlear implantation, however, they do have some satisfaction from the fact that they can at least hear some sounds.  Cochlear implants are very successful in post-lingually deafened adults with little speech perception, using hearing aids, due to the severity of their hearing loss.

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