Download pre-operative hearing implant candidate worksheet

COCHLEAR™ NUCLEUS® 6 SOUND PROCESSOR WITH HYBRID HEARING
PRE-OPERATIVE HEARING IMPLANT CANDIDATE WORKSHEET
2 SPEECH PERCEPTION – AIDED SOUNDFIELD
1 CANDIDACY CRITERIA – AUDIOGRAM
Frequency [Hz]
125
250
500 750 1000 1500 2000 3000 4000 6000 8000
CNC Word Score @ 60 dBA
Left________ Right________
Az Bio Sentence Score
10
Hearing Threshold (dB HL)
20
OR
Cochlear
Hybrid®
Hearing Zone
30
40
Quiet (60 dBA)
Left________ Right________ Bilateral________
Noise (65 dBA) @ ________ SNR
Left________ Right________ Bilateral________
50
2a Hybrid L Electrode Candidate (Based on Audiogram)
60
Is aided CNC Word score in one ear ≥ 10% & ≤ 60%
 Yes  No
70
80
Is aided CNC word score in other ear ≤ 80%
and a PTA (2,3,4 kHz) ≥ 60 dB HL
 Yes  No
90
100
Yes to both — Hybrid implant candidate of poorer hearing ear
If No — Not a hybrid implant candidate, monitor
performance and re-evaluate annually
110
120
Hybrid L Electrode Candidate*
Cochlear Implant Electrode Candidate*
2a Cochlear Implant Electrode Candidate (Based on Audiogram)
Are audiometric thresholds within the hearing implant
range (shaded purple and yellow areas) for both ears?
 Yes, a candidate for a hearing implant
 No, not a candidate for a hearing implant
Is Az Bio Sentence score in one ear ≤ 50%
 Yes  No
Audiometric thresholds for the poorer ear are within:
 Hybrid L Implant Range (Purple)
 Cochlear Implant Range (Yellow)
Yes to both — Cochlear implant candidate
If No — If audiometric thresholds between 125Hz-500 Hz
are < 60 dB HL, evaluate for Hybrid Implant using CNC
words (see above). All others, consider re-evaluation with
new hearing aids and monitor performance
Proceed to speech perception testing based on selection.
4 HEARING IMPLANT RECOMMENDATION
3 SATISFACTION WITH HEARING AIDS
Very
Satisfied
Satisfied
Neutral
Dissatisfied
Using Telephone
Noise Environments
Quiet Environments
1:1 Conversations
Small Groups
(3-5 people)
Large Groups
(5+ people)
Listening at a distance
(lectures, church, etc)
If overall satisfaction is neutral to very dissatisfied
proceed with hearing implant.
Is Az Bio Sentence score in the best aided condition ≤ 60%
 Yes  No
Very
Dissatisfied
Recommended Ear to Implant
 Left  Right
Recommended Implant Electrode type
 Hybrid L Electrode  Cochlear Implant Electrode
Counseling Considerations
 Duration of Overall Hearing Loss
 Hearing History and Etiology
 Age
Maximizing Two Ears
 Potential for combined hearing
 Potential for bimodal hearing
 Potential for bilateral cochlear implants
*Refer to package insert for FDA approved indication
COCHLEAR™ NUCLEUS® 6 SOUND PROCESSOR WITH HYBRID™ HEARING
POST-OPERATIVE HYBRID HEARING WORKSHEET
1 MEASURE
2 DOMES & MOLDS
Choose the length of the acoustic component for the ear
to be implanted using the R or L template. Use the top of
the ear canal as a reference. If the measurement is between
two lengths, pick the longer length.
The initial Hybrid Hearing Kit comes with Power Domes
(8mm,10mm, 12mm) or a Plus Domes (one size) for initial
fitting. Indicate your selection on the order form.
Dome (Pack of 10) – Select Appropriate Size:
 8mm  10mm  12mm  PLUS
A custom earmold can provide greater comfort and gain
for recipients. These earmolds come in in different styles,
materials and choice of skin tones. With an ear impression,
these molds can be ordered from your preferred supplier.
Based on measurement, check the
ear and length for the acoustic component
 Left  Right —  1  2  3  4  5
3 POST-OP AUDIOGRAM
People with post-implant thresholds < 85 dB HL
between 250-1500 Hz are candidates for Hybrid Hearing
Hybrid Hearing — Acoustic low frequency hearing
(with or without amplification) and a hearing implant
for high frequencies in the same ear
For recipients with post-op thresholds in the hybrid range,
proceed with fitting Hybrid Hearing.
Frequency [Hz]
125
250
500 750 1000 1500 2000 3000 4000 6000 8000
10
Hearing Threshold (dB HL)
20
4 MAXIMIZING HEARING IN BOTH EARS
Combined Hearing — Using Hybrid Hearing in
one ear and acoustic hearing in the opposite ear
(with or without amplification)
40
Bimodal Hearing — A hearing implant in
one ear and acoustic hearing in the other ear
(with or without amplification)
50
Bilateral CI — A cochlear implant in each ear
30
60
70
80
90
100
110
120
Hybrid Hearing Mode
Cochlear Implant Mode
PLEASE REFER TO THE DESK REFERENCE
FOR THE COCHLEAR HYBRID HEARING
SOLUTION AS REQUIRED
www.Cochlear.com/US
Cochlear Americas
13059 East Peakview Avenue
Centennial, CO 80111 USA
Tel:
1 303 790 9010
Fax: 1 303 792 9025
Toll Free: 1 800 523 5798
©2014 Cochlear Limited. All rights reserved. Hear Now. And Always and other
trademarks and registered trademarks are the property of Cochlear Limited.
Cochlear Canada Inc.
2500-120 Adelaide Street West
Toronto, ON M5H 1T1 Canada
FUN1946 ISS2 MAR14
Tel:
Fax: 1 416 972 5082
416 972 5083