Her areas of expertise include pediatric testing, auditory processing testing, and cochlear implant evaluations and programming. She is also currently supervising speech-pathology students at the Brooklyn College Speech and Hearing Clinic once a week.

  The questions presented here were provided by SWC members:

Question: Are there new criteria to have a CI procedure? What are the new criteria that must be met before someone becomes a CI candidate?

 

Answer: In recent years there have been several changes concerning requirements for cochlear implantation for both children and adults. While each hospital implant center may have their own candidacy requirements, the Food and Drug Administration (FDA) outlined general rules for candidacy in 2002. Regardless of individual differences among the cochlear implant centers, a team approach that involves the family and professionals from medical and educational settings (for children) is recommended.

The FDA lowered age requirement for children to 12 months of age. Minimum age requirement continued to be reduced due to limited surgical risks and complications, and improved CI benefit in younger children. There may be certain circumstances that would result in earlier implantation. For instance, if the cause of hearing is meningitis, the issue of ossification (bone build up in the cochlea) warrants earlier implantation.

The is no upper age limit for implantation, as long as the patient is in good general health, meaning there are no medical contraindications for surgery. I have a few patients who had been implanted in their 80s.

So, to give you a quick summary, for infants ages 12 months to two years: profound sensorineural hearing loss in both ears, no progress or benefit from conventional amplification (hearing aids), lack of progress in developing the auditory skills, enrollment in an educational program that provides appropriate speech and auditory therapy, high motivation and realistic expectations from the child's family, and no medical contraindications to surgery. For older children, ages 2-17, the requirements are generally the same, except the hearing loss can be severe to profound. Educational setting becomes a much more serious issue. I work in close contact with my patients' teachers, speech pathologists, and school audiologists.

For adults, severe to profound sensorineural hearing loss in both ears, no medical contraindications to surgery, ability to understand 50% or less on sentence recognition with the hearing aid without lip reading in the ear to be implanted, or < 60% in the non-implanted ear or bilaterally. Last, but not least, the adults considering cochlear implantation must have desire and motivation to succeed.

There are many other factors that need to be taken into account on an individual basis. That's why it is essential for members of the cochlear implant team to discuss each potential cochlear implant candidate and their pros and cons for implantation. In addition, while FDA regulations are generally followed, they are not legally binding, so exceptions can be made if they can be rationally justified. For further information on cochlear implant candidacy and general CI information, consult the websites of three CI manufacturers:

www.cochlear.com, www.advancedbionics.com, and www.medel.com

Question:  Is there real benefit to having two CIs?

Answer: In normal hearing listeners, using binaural hearing provides us with easier understanding in the presence of background noise, and correct localization of sounds. Research with hearing aid users demonstrated the same benefits.

While there have been enormous advances in speech processing technology in CIs, most cochlear implant recipients still complain about limited speech understanding in noisy environments. Recent studies have demonstrated that bilateral implants provide significant benefits to postlingually deafened adults when listening in noise, particularly when noise and speech come from different locations, benefits in localization of sound, and subjective reports of improvement in various everyday listening situations. Similar benefits have been observed with children. In fact, children seem to adapt more quickly to bilateral implants.

In addition, very often when selecting the implant ear preoperatively, it is difficult to predict which ear would result in better benefit from a CI. When doing bilateral implantation, chances of capturing that "better" ear are significantly higher. Bilateral implantation will capture the ear with the best monaural performance.

It should be noted that there are two types of bilateral CI procedures: sequential and simultaneous. If a patient goes through a CI surgery and gets both ears implanted it is called simultaneous bilateral implantation. If a patient had his/her right ear implanted five years ago, for example, and now decided to have his/her left ear implanted, it is sequential implantation, one after the other, not at the same time. Most of the longitudinal research available was conducted on sequentially implanted patients. However, research will be changing since simultaneous bilateral implants are becoming more of a "standard of care."

Question:  What are the disadvantages of having two CIs?

Answer: Most people who are concerned about bilateral implantation narrow it down to a single most important issue. What if there are further advances in technology and I won't be able to benefit from them since both of my ears are already implanted? There are different ways of looking at that issue. I personally think it is a reasonable concern. However, the benefits of binaural implantation outweigh the potential risks. Most improvements in technology can be implemented via software changes, and new software is often "backward compatible," meaning CI recipients of older models can benefit from software improvements.

Reimplantation for cochlear implant "failures" or faulty devices is a relatively simple and successful procedure, so it should be feasible to upgrade. Other potential disadvantages are that some CI users may not obtain significant advantage from using two devices or that the inconvenience of using two CIs may outweigh the benefits. However, those patients would still have the advantages of using the better monaural ear.

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