National Cochlear Implant Programme
Beaumont Hospital
&
Children’s University Hospital, Temple Street
Bilateral Cochlear Implants
Jennifer Robertson, Clinical Specialist SLT
May 2014
What are the Benefits of Bilateral
Cochlear Implants?
•
•
•
•
Sound localisation
Listening in noise
Ease of listening
Two processors mean reduced likelihood of
being without sound in case of breakdown
All resulting in optimum listening opportunities
for developing spoken language
A second cochlear implant will not:
• Restore normal hearing
• Resolve additional speech/language or
learning problems
What are likely challenges?
• Perception of sound with the second implant may be poorer
due to a longer duration of deafness in that ear
• The second implant may be distracting and unhelpful until the
individual becomes used to it which will take time and
perseverance
• Sound perception might be different from the first implant
• The risk of tinnitus and balance disturbances
• Residual hearing in the second ear will be damaged by having
an electrode array inserted
• The operation and its associated risks e.g. anaesthetic
Remember:
It takes time and practice to get used to the sound and gain good benefit
BY KIND PERMISSION OF MANCHESTER AUDITORY IMPLANT CENTRE
Which children may benefit from a second cochlear implant?
Red – indicators of little or no benefit
Long time since 1st CI surgery (greater than 8 years)
No hearing in second ear
No hearing aid use in second ear
Intermittent cochlear implant use
Sign language is the main mode of communication
No ability to process auditory information in the second ear
Poor attendance at appointments
Amber – indicators of possible benefit
Time since
CI surgery between 5-8 years
No or limited hearing or some residual low-frequency
hearing in second ear, but no consistent hearing aid use
Intermittent cochlear implant use and / or hearing aid use in
second ear
Sign language is the primary mode of communication
Limited ability to process sound in the second ear
1st
Green – indicators of significant benefit
Short time since 1st CI surgery (less than 5 years)
Consistent or committed cochlear implant user
Consistent hearing aid user in second ear if it provides
benefit.
Proven ability to process oral language
Regular attendance at appointments
Every child's case is
different and the
decision regarding the
benefit, if any, your
child is likely to receive
from a second implant
can only be made
following assessment
Who will receive a second cochlear implant first?
*All dates and ages from 18 December 2013*
• Group 1: Children who have had an implant for less than 4 years and are
under 5 years old. Within this group those who received their first
cochlear implant most recently will be assessed first.
• Group 2: Children who have had an implant for less than 4 years and are
older than 5 years. Within this group those who received their first
cochlear implant most recently will be assessed first.
• Group 3: Children who have had implant for more than 4 years but are
under 10 years old. Within this group those who received their first
cochlear implant most recently will be assessed first.
• Group 4: All the other children and teenagers under 18 on 1 December
2013. Within this group those who received their first cochlear implant
most recently will be assessed first.
NB: at any time a child may be prioritised on clinical need
Some Reasons for Prioritisation
Children with visual difficulties
If a child has a diagnosed visual condition and they are not
already in Group 1, they will be prioritised and approached
together with Group 1
Older teens
Teens who have just turned 16 through to 18 years of age at
start of bilateral sequential programme, will be contacted
with Group 1. All teenagers will be given an appointment with
clinical psychologist.
Questions??
• Is this the only opportunity to avail of a second CI?
• If currently the child is doing well with a contra
lateral hearing aid can a CI be considered later if the
hearing deteriorates?
• Will the child have an N6 processor for both ears?
• What model implant will be used?
• Can the child make the decision himself when he is
18?
• If the second CI is unsuccessful can it be removed?
What will happen next?
•
•
•
•
•
•
Each child will be called for a 1:1 appointment with
the team:
Medical review
Audiology review – PTA for unimplanted ear may be
required
Possible SLT review
Liaison between ICTOD & VTOD/school
Possible meeting with clinical psychologist, especially
for older children and teenagers
Team discussion with parents
Important Dates!
• Monday 21st July – first bilateral simultaneous
• Wednesday 23rd July – first bilateral sequential
Hope to implant approx 30 bilateral sequential
before the end of the year
It may take up to three years to complete the
bilateral roll out
This is going to take time!!
Funding for additional staffing has been secured
but staff are not in place yet
Please be patient!
There may be delays after surgery before ‘switch
on’ can take place
We are also very short of space
Thank for listening!