Download SESSION 2 (11 January 2008): COCHLEAR IMPLANT BASICS

UNIVERSITY OF BRITISH COLUMBIA
SCHOOL OF AUDIOLOGY AND SPEECH SCIENCES
COCHLEAR IMPLANTS:
TOPICAL SEMINAR
INTRODUCTION AND COURSE SYLLABUS
9 January – 22 February 2008
COURSE INSTRUCTOR:
Sipke Pijl Ph.D.
Director, Department of Audiology
St. Paul’s Hospital
1081 Burrard Street,
Vancouver, BC V6Z 1Y6
Phone: (604) 682-2344 Ext. 62514
Fax:
(604) 806-8447
E-mail: <[email protected]>
UNIVERSITY OF BRITISH COLUMBIA
SCHOOL OF AUDIOLOGY AND SPEECH SCIENCES
COCHLEAR IMPLANTS: A TOPICAL SEMINAR
INTRODUCTION
9 January – 22 February 2008
GENERAL COURSE OBJECTIVES
This course is intended to give an overview of cochlear implants and related technology for clinical
audiologists. The course reviews issues such as cochlear implant candidacy criteria, cochlear implant
design, surgery, habilitative and rehabilitative issues and strategies.
SPECIFIC COURSE OBJECTIVES:
To provide students with a general knowledge of
 The history, purpose, and application of cochlear implants
 The basic functioning of cochlear implants
 The issues surrounding candidacy for a cochlear implant
 A characterization of the physiological response of the auditory system to electrical stimulation
 The test batteries used in the determination of cochlear implant candidacy
 The test batteries used to assess performance with a cochlear implant
 Assistive technology for deaf and hard-of-hearing persons
COURSE REQUIREMENTS:
The Cochlear Implant Topical Seminar consists of 14 sessions (at St. Paul’s Hospital Department of
Audiology). Most of the sessions will be in a lecture format, but a portion of some of the sessions will be
devoted to lab (and demonstration) type of activities. Reading assignments are your responsibility. You
will be asked to prepare one written assignment which will consist of either:
 Two case studies (approximately 1500 words each) on two separate cochlear implant recipients.
In these case studies, factual information is expected to be accurate, but you will be graded
primarily on your overall impressions and your thoughtful discussion of the relevant issues raised
in the section below (under “Case Presentations”). If there is sufficient time, you may be asked to
present these case studies in class.
 Or a paper (1500-2000 words):
 Comparing coding strategies for cochlear implants, and describing the reasons for their
success
 Describing why cochlear implants have not been very successful in conveying musical
information other than rhythm
 To convince a Ministry of Health official to provide additional funding so that pediatric and
adult patients (if they so wish) can be implanted bilaterally
 Discussing some of the ethical questions surrounding pediatric cochlear implantation
 Justifying the cost of cochlear implantation for older adults
 Comparing the long-term survival rates of devices made by the 3 major cochlear implant
manufacturers
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


Describing, for a potential implant recipient, the differences between Nucleus, MedEl and
Advanced Bionics devices
Discussing differences between adult and pediatric cochlear implant programs
On a cochlear implant- related topic of your choice (check with course instructor first). The
above are merely suggestions.
CASE PRESENTATIONS
Outline:
1.
2.
3.
4.
5.
Chronological Summary (brief summary of patient’s hearing history)
Background (age at onset, duration of deafness, age at implantation, hearing & hearing aid history)
Cochlear Implant Candidacy
Cochlear Implant Results
Impressions
Length: No more than 1500 words each, typewritten, double-spaced.
For the purposes of this assignment, the impact of deafness and cochlear implantation on the CI recipient
are more important than precise historical details about audiometric or speech perception data.
Some questions to consider, in interviewing CI recipients:
 How did progressive (or sudden) deafness affect this patient? Family? Friends?

How did this patient cope with the absence of useful hearing?

What was this person’s quality of life, during unaidable deafness? Was this patient’s quality of life
improved, as a result of cochlear implantation? If so, how?

What were the social, educational, psychological & emotional consequences of unaidable deafness,
for this patient?

How has the sound of the cochlear implant compared to the sound of the patient’s hearing aid?

Which ear was implanted, and why? Could equivalent results have been obtained through
implantation of the other ear?

How has the cochlear implant improved this person’s quality of life? The lives of family/friends?

What was the time line, for this implant recipient’s adjustment to the sound of a cochlear implant?

What remain the major limitations of the CI, for this person? Some suggestions:

explore the ability of the person to use the phone for interactive conversation (not just
with family/friends, but for making “business” calls to complete strangers who are not
aware of the less-than-perfect hearing)

explore the ability of the person to listen to the radio or TV (with or without closedcaptioning)

explore the ability of the recipient to enjoy music (music that was familiar to the person,
prior to the onset of deafness; or, the ability to enjoy “new” music” or music not
previously heard)
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
explore the ability of the recipient to function in various noise backgrounds or multiple
speakers (e.g., at dinner table, or at conventions or other gatherings)

What are the factors that have made the implant a successful (or failed) intervention, for this
person? What factors are limiting further achievement?

What has been the role of plasticity of the auditory CNS to adapt to the sound of electrical
stimulation?

Failure of the internal device is an ever-present possibility for an implant recipient. How do you
think this person would cope with such an event? Would this person opt to be reimplanted?

What have you, as a professional about to enter the field, learned from this particular individual?

What did you find remarkable or unique, about this particular individual?
EVALUATION AND GRADING PROCEDURES:


Clinical Competencies and Case Presentations:
Final Examination:
TOTAL: 100%
40%
60%
REQUIRED MATERIALS:
TEXT: COCHLEAR IMPLANTS by Susan Waltzman & Roland J. Thomas: Thieme Medical
Publishing Inc., 2nd Edition (2006)
Additional readings from: COCHLEAR IMPLANTS: AUDITORY PROSTHESES AND
ELECTRIC HEARING. Fan-Gang Zeng, A.N. Popper and R. Fay (Eds.). Springer Handbook of
Auditory Research (2004). Springer-Verlag, NewYork
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UNIVERSITY OF BRITISH COLUMBIA
SCHOOL OF AUDIOLOGY AND SPEECH SCIENCES
TOPICAL SEMINAR: COCHLEAR IMPLANTS
COURSE OUTLINE & READING LIST
9 January – 22 February 2008
TEXT: COCHLEAR IMPLANTS by Susan Waltzman & Roland J. Thomas: Thieme Medical
Publishing Inc., 2nd Edition (2006)
Additional selected readings from: COCHLEAR IMPLANTS: AUDITORY PROSTHESES AND
ELECTRIC HEARING. Fan-Gang Zeng, A.N. Popper and R. Fay (Eds.). Springer Handbook of Auditory
Research. Springer-Verlag, NewYork (2004)
SESSION 1 (9 January 2008): CONSEQUENCES OF DEAFNESS AND ELECTRICAL
STIMULATION
Text:
Chapter 3: pp. 25-39 (Consequences of Deafness and Electrical Stimulation)
See also: P.A. Leake & S.J. Rebscher: Anatomical Considerations and Long-Term Effects of
Electrical Stimulation. Chapter 4 (pp. 101-148) in Cochlear Implants: Auditory Prostheses and
Electric Hearing. Fan-Gang Zeng, A.N. Popper and R. Fay (Eds.). Springer Handbook of Auditory
Research (2004). Springer-Verlag, NewYork
See also: R. Hartmann & A. Krall: Central Responses to Electrical Stimulation. Chapter 6 (pp.
213-286) in Cochlear Implants: Auditory Prostheses and Electric Hearing. Fan-Gang Zeng, A.N.
Popper and R. Fay (Eds.). Springer Handbook of Auditory Research (2004). Springer-Verlag,
NewYork
SESSION 2 (11 January 2008): COCHLEAR IMPLANT BASICS
A discussion of past & presently available devices including Nucleus, Clarion, and Med-El.
Lecture will cover essentials of electrode designs, receiver/stimulator packages, and external
components.
Text:
Chapter 9: pp. 110-125 (Cochlear Implant Electrode History, Choices, and Insertion
Techniques)`
SESSION 3 (16 January 2008): PSYCHOPHYSICS I (Threshold & Loudness)
A discussion of the various parameters affecting hearing thresholds, loudness, and pitch, with
electrical stimulation of the auditory system. The Waltzman & Roland text has little or no
discussion of these issues.
Required reading: C.M. McKay: Psychophysics and Electrical Stimulation. Chapter 7 (pp. 286333) in Cochlear Implants: Auditory Prostheses and Electric Hearing. Fan-Gang Zeng, A.N.
Popper and R. Fay (Eds.). Springer Handbook of Auditory Research (2004). Springer-Verlag,
NewYork
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SESSION 4 (18 January 2008): PSYCHOPHYSICS II (Pitch, Timbre, Gap Detection)
Please note: The Waltzman & Roland text has little or no information about this area.
Required reading: C.M. McKay: Psychophysics and Electrical Stimulation. Chapter 7 (pp. 286333) in Cochlear Implants: Auditory Prostheses and Electric Hearing. Fan-Gang Zeng, A.N.
Popper and R. Fay (Eds.). Springer Handbook of Auditory Research (2004). Springer-Verlag,
NewYork
SESSION 5 (23 January 2008): SIGNAL PROCESSING STRATEGIES (F0F2, F0F1F2, SAS MPeak
ACE, SPEAK, CIS)
A discussion of the ways in which the acoustic signal is processed and presented to the electricallystimulated ear.
Text:
Chapter 4:
pp. 40-47 (Sound Processors in Cochlear Implants)
See also: B.S. Wilson: Engineering Design of Cochlear Implants. Chapter 2 (pp. 14-52) in
Cochlear Implants: Auditory Prostheses and Electric Hearing. Fan-Gang Zeng, A.N. Popper and
R. Fay (Eds.). Springer Handbook of Auditory Research (2004). Springer-Verlag, NewYork
SESSION 6 (25 January 2008): COCHLEAR IMPLANT SURGERY:
8:00 – 9:00 a.m. Guest Lecture: Dr. B.D. Westerberg
Text:
Text:
Chapter 9:
pp. 110-125 (Cochlear Implant Electrode History, Choices, and
Insertion Techniques)
Chapter 10:
pp. 126-132 (Complications of Cochlear Implant Surgery)
See also: J.K. Niparko: Cochlear Implants: Clinical Applications. Section 3 (pp. 70-73) of Chapter
3 in Cochlear Implants: Auditory Prostheses and Electric Hearing. Fan-Gang Zeng, A.N. Popper
and R. Fay (Eds.). Springer Handbook of Auditory Research (2004). Springer-Verlag, NewYork
9:00 – 11:00 a.m.: SIGNAL PROCESSING STRATEGIES
A discussion of the ways in which the acoustic signal is processed and presented to the electricallystimulated ear.
SESSION 7 (30 January 2008): DEVICE FITTING
A discussion of device activation, mapping (the translation of frequency and amplitude parameters
of sound into electrical stimulation parameters).
Text:
Chapter 11
pp. 133-145 (Device Programming)
Additional recommended reading: R.V. Shannon et al: Speech Perception with Cochlear Implants.
Chapter 8 (pp. 334-376) in Cochlear Implants: Auditory Prostheses and Electric Hearing. FanGang Zeng, A.N. Popper and R. Fay (Eds.). Springer Handbook of Auditory Research (2004).
Springer-Verlag, NewYork
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SESSION 8 (1 February 2008): AURAL REHABILITATION
A discussion of auditory rehabilitation issues & practices for cochlear implant recipients
SESSION 9 (6 February 2008): PEDIATRIC ISSUES IN COCHLEAR IMPLANTATION
Guest Lecturer: Todd Mitchell, Children’s & Women’s Hospital Cochlear Implant Program
Text:
Text:
Chapter 12:
Implants)
Chapter 13:
Implants)
pp. 146-152 (Speech Perception in Children with Cochlear
pp. 153-166 (Language Development in Children with Cochlear
SESSION 10 (8 February 2008): ELECTRICAL VS ACOUSTICAL STIMULATION OF THE EAR
A discussion of how neural response properties differ between acoustic and electrical stimulation
of the ear.
See also: P.J. Abbas & C.A. Miller: Biophysics and Physiology. Chapter 5 (pp. 149-212) in
Cochlear Implants: Auditory Prostheses and Electric Hearing. Fan-Gang Zeng, A.N. Popper and
R. Fay (Eds.). Springer Handbook of Auditory Research (2004). Springer-Verlag, NewYork
SESSION 11 (13 February 2008): EVALUATION OF POTENTIAL CANDIDATES and EAR
SELECTION;
A discussion of how candidacy for cochlear implantation is determined.
Text: Chapter 6:
Text: Chapter 17
Cochlear Implants)
pp. 57-68 (Selection of Cochlear Implant Candidates)
pp. 193-204 (Speech Perception by Adults with Multichannel
See also: J.K. Niparko: Cochlear Implants: Clinical Applications. Chapter 3 (pp. 53-100) in
Cochlear Implants: Auditory Prostheses and Electric Hearing. Fan-Gang Zeng, A.N. Popper and
R. Fay (Eds.). Springer Handbook of Auditory Research (2004). Springer-Verlag, NewYork
SESSION 12 (15 February 2008): OBJECTIVE MEASURES WITH COCHLEAR IMPLANTS
(ECAP, eABR, eMLR)
A discussion of impedance telemetry, neural response telemetry (eCAP measurement), other
electrically-evoked auditory potentials, and Averaged Electrode Voltages (AEV’s)
Text:
Chapter 8:
pp. 96-109 (Electrophysiology and Device Telemetry)
See also: P.J. Abbas & C.A. Miller: Biophysics and Physiology. Chapter 5 (pp. 149-212) in
Cochlear Implants: Auditory Prostheses and Electric Hearing. Fan-Gang Zeng, A.N. Popper and
R. Fay (Eds.). Springer Handbook of Auditory Research (2004). Springer-Verlag, NewYork
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SESSION 13 (20 February 2008): AUDITORY BRAINSTEM IMPLANTS and ELECTROACOUSTIC STIMULATION
Text:
Chapter 20
pp. 222-229 (Auditory Brainstem Implants)
Text:
Chapter 19:
pp. 214-221 (Acoustical and Electrical Speech Processing)
Additional recommended reading: R.V. Shannon et al: Speech Perception with Cochlear Implants.
Sections 7 & 8 (pp. 366-370) in Chapter 8 in Cochlear Implants: Auditory Prostheses and Electric
Hearing. Fan-Gang Zeng, A.N. Popper and R. Fay (Eds.). Springer Handbook of Auditory
Research (2004). Springer-Verlag, NewYork
SESSION 14 (22 February 2008): EXAMINATION
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