Download PDF
J Am Acad Audiol 2018; 29(08): 722-733
DOI: 10.3766/jaaa.17011
Articles
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cochlear Implant Practice Patterns: The U.S. Trends with Pediatric Patients

Carly Hemmingson
*   Department of Communication Sciences and Disorders, University of South Dakota, Vermillion, SD
,
Jessica J. Messersmith
*   Department of Communication Sciences and Disorders, University of South Dakota, Vermillion, SD
› Author Affiliations
Further Information

Publication History

Publication Date:
29 May 2020 (online)

   Permissions and Reprints

Abstract

Background:

Many factors affect an individual’s outcomes with a cochlear implant (CI); however, quality of device programming and consistency of follow-up appointments have been shown to be crucial contributors. As audiologists’ CI caseloads increase, time constraints on appointments also increase, thus fueling the need for efficient and effective programming strategies. Currently, there are no standardized guidelines describing what methods should be used during programming, nor are there standardized schedules that delineate what procedures should be performed at specific appointment intervals. Without standardized programming guidelines, clinical practices may be variable and may not align with best practice research; thus, outcomes with a CI, particularly for pediatrics, may not be reflective of the actual potential available.

Purpose:

The purpose of this study was to identify the clinical practice patterns used by U.S. audiologists when programming and providing follow-up care to children who use CIs. This study aimed to determine the following: common programming approaches, provision intervals for these procedures, common validation assessments, typical follow-up care schedules, and source(s) of CI training. In addition, this study sought to evaluate if training and/or follow-up care differed between small and large CI centers.

Research Design:

A cross-sectional survey design was used.

Study Sample:

Target population included practicing audiologists working with pediatric CI users throughout the United States. Participation was voluntary, thus random selection could not be used. A total of 167 participants opened and began the online survey and 113 successfully completed the survey instrument (23.99% return rate).

Data Collection and Analysis:

Potential participants were identified using the “find a clinic” function on three CI manufacturers' websites. Potential participants were asked to complete an online survey seeking information about practices they employ in their clinical setting. Survey responses were analyzed for trends.

Results:

Overall, a common follow-up schedule was determined, which included an average of 6.8 appointments within the first year. Minor differences in training and programming practices between small and large CI centers emerged; however, no statistically significant results were noted. Results did reveal trends in the use of certain clinical practices. This was particularly evident in the limited use of objective measures.

Conclusions:

Overall, the findings support other recent studies that suggest the development of CI guidelines that may standardize programming and follow-up practices of CI audiologists. This could prove valuable for the continual improvement of CI outcomes, particularly in the pediatric population.

Key Words

cochlear implants - pediatric - practice patterns

Portions of this work were presented at Audiology Now! 2016. Held in Phoenix, AZ, April 13–16, 2016.


 

  • REFERENCES

  • Advanced Bionics 2011 SoundWave 2.1: Quick Reference Cards. Retrieved from http://www.advancedbionics.com/content/dam/ab/Global/en_ce/documents/professional/AB_SoundWave_2.1_Quick_Reference_Cards.pdf . Accessed February 4, 2014
  • Advanced Bionics 2015 Find a Clinic [Interactive Map of Cochlear Implant Clinics Registered with Advanced Bionics]. Retrieved from https://www.advancedbionics.com/content/advancedbionics/au/en/home/about-cochlear-implants/find-a-clinic.html . Accessed August 22, 2017
  • American Academy of Audiology 2013 Cochlear Implants in Children. Retrieved from http://www.audiology.org/resources/documentlibrary/pages/cochlearchildren.aspx . Accessed March 9, 2015
  • American Speech-Language-Hearing Association 2003 Technical Report: Cochlear Implants. Retrieved from http://www.asha.org/policy/TR2004-00041/ . Accessed September 25, 2014
  • Bradham T., Snell G., Haynes D.. 2009; Current practices in pediatric cochlear implantation. Perspect Hear Hear Disord Child 19: 32-42
    Google Scholar
  • Caner G, Olgun L, Gültekin G, Balaban M. 2007; Optimizing fitting in children using objective measures such as neural response imaging and electrically evoked stapedius reflex threshold. Otology and Neurotology 28 (05) 637-640
    CrossrefPubMedGoogle Scholar
  • Carver C. 2007; Cochlear implant mapping: what every CI user and candidate should know. Hearing Loss Magazine 28 (04) 10-13
    Google Scholar
  • Chang DT, Ko AB, Murray GS, Arnold JE, Megerian CA. 2010; Lack of financial barriers to pediatric cochlear implantation: impact of socioeconomic status on access and outcomes. Arch Otolaryngol Head Neck Surg 136 (07) 648-657
    CrossrefPubMedGoogle Scholar
  • Cochlear Ltd 2010 Clinical Guidance Document. Retrieved from http://cochlear-cee-training.org/wordpress/wp-content/uploads/2011/12/231495_ISS3_EN_CSS_Clinical_Guidance_Document.pdf . Accessed February 4, 2014
  • Cochlear Ltd 2014 Custom Sound 4.1 Software User Guide. Retrieved from http://www.cochlear.com/wps/wcm/connect/0e264406-f2fd-4a69-b37e7c5919d01351/en_product_css_4.1_sp3_userguide_540440_1.01_june2014_1.05mb.pdf?MOD=AJPERES&CACHEID=0e264406-f2fd-4a69-b37e-7c5919d01351 . Accessed February 4, 2014
  • Cochlear Ltd 2015 Contact a Hearing Specialist [Interactive Map of Cochlear Implant Clinics Registered with Cochlear Ltd.]. Retrieved from http://www.cochlear.com/wps/wcm/connect/us/home/take-the-next-step/contact-a-hearing-specialist . Accessed August 22, 2017
  • Dawson PW, Skok M, Clark GM. 1997; The effect of loudness imbalance between electrodes in cochlear implant users. Ear Hear 18 (02) 156-165
    CrossrefPubMedGoogle Scholar
  • Eisenberg LS. 2010 Measuring auditory performance of Pediatric cochlear implant users: what can be learned for children who use hearing instruments? Presentation at the Meeting of the International Pediatric Conference “A Sound Foundation through Early Amplification,” Chicago, IL
  • Fadda S. 2011; Psychological aspects when counseling families who have children with cochlear implants. J Matern Fetal Neonatal Med 24 (Suppl 1) 104-106
    PubMedGoogle Scholar
  • Fryauf-Bertschy H, Tyler RS, Kelsay DM, Gantz BJ. 1992; Performance over time of congenitally deaf and postlingually deafened children using a multichannel cochlear implant. J Speech Hear Res 35 (04) 913-920
    CrossrefPubMedGoogle Scholar
  • Geers A, Moog J. 1989; Factors predictive of the development of literacy in profoundly hearing impaired adolescents. Volta Review 91: 69-85
    Google Scholar
  • Geers AE, Nicholas JG, Moog JS. 2007; Estimating the influence of cochlear implantation on language development in children. Audiol Med 5 (04) 262-273
    CrossrefPubMedGoogle Scholar
  • Gordon KA, Papsin BC, Harrison RV. 2004; Toward a battery of behavioral and objective measures to achieve optimal cochlear implant stimulation levels in children. Ear Hear 25 (05) 447-463
    PubMedGoogle Scholar
  • Gross A. 2003 Fitting Techniques for the Pediatric Cochlear Implant Patient. Retrieved from http://www.audiologyonline.com/articles/fitting-techniques-for-pediatric-cochlear-1128 . Accessed March 13, 2014
  • Haskins J. 1949. A phonetically balanced test of speech discrimination for children (unpublished master's thesis). Evanston, IL: Northwestern University;
    Google Scholar
  • Hedley-Williams AJ, Sladen DP, Tharpe A. 2003; Programming, care, and troubleshooting of cochlear implants for children. Top Lang Disord 23 (01) 46-56
    CrossrefGoogle Scholar
  • Hodges AV, Balkany TJ, Ruth RA, Lambert PR, Dolan-Ash S, Schloffman JJ. 1997; Electrical middle ear muscle reflex: use in cochlear implant programming. Otolaryngol Head Neck Surg 117 3 Pt 1 255-261
    CrossrefPubMedGoogle Scholar
  • Holt RF, Svirsky MA. 2008; An exploratory look at pediatric cochlear implantation: Is earliest always best?. Ear Hear 29 (04) 492-511
    CrossrefPubMedGoogle Scholar
  • Hughes ML, Stille LJ. 2008; Psychophysical versus physiological spatial forward masking and the relation to speech perception in cochlear implants. Ear Hear 29 (03) 435-452
    CrossrefPubMedGoogle Scholar
  • Javel E, Viemeister NF. 2000; Stochastic properties of cat auditory nerve responses to electric and acoustic stimuli and application to intensity discrimination. J Acoust Soc Am 107 (02) 908-921
    CrossrefPubMedGoogle Scholar
  • Kiang NY, Moxon EC. 1972; Physiological considerations in artificial stimulation of the inner ear. Ann Otol Rhinol Laryngol 81 (05) 714-730
    CrossrefPubMedGoogle Scholar
  • Kirk KI, Miyamoto RT, Lento CL, Ying E, O’Neill T, Fears B. 2002; Effects of age at implantation in young children. Ann Otol Rhinol Laryngol Suppl 189: 69-73
    PubMedGoogle Scholar
  • Kirk KI, Miyamoto RT, Ying EA, Perdew AE, Zuganelis H. 2000; Cochlear implantation in young children: effect of age at implantation and mode of communication. Volta Review 102 (04) 127-144
    Google Scholar
  • Ling D. 1976. Speech and the Hearing-Impaired Child: Theory and Practice. Washington, DC: Alexander Graham Bell Association for the Deaf;
    Google Scholar
  • Ling D. 1989. Foundations of Spoken Language for the Hearing-Impaired Child. Washington, DC: Alexander Graham Bell Association for the Deaf;
    Google Scholar
  • Locke B, Keiser-Clark D. 2001 PsychData. Retrieved from URL. https://www.psychdata.com/default.asp . Accessed April 3, 2014
  • MED-EL 2012 Maestro System Software. Retrieved from http://www.medel.com/products-software-maestro/ . Accessed December 22, 2014
  • MED-EL 2013 Find a Clinic [Interactive Map of Cochlear Implant Clinics Registered with MED-EL]. Retrieved from http://www.medel.com/us/clinic-finder/ . Accessed December 22, 2014
  • MED-EL. (2015). Quick Fitting Guide for Opus 2, Rondo & Sonnet with Maestro 6.0. Innsbruck, Austria: MED-EL. Print.
  • Mertes J, Chinnici J. 2006 Cochlear Implants- Considerations in Programming for the Pediatric Population. Retrieved from http://www.audiologyonline.com/articles/cochlear-implants-considerations-in programming-1011
  • Messersmith JJ, Lockie J. . (2015, April) Evaluation of streamlined programming measures in children with cochlear implants. Poster presented at the annual meeting of the American Academy of Audiology, San Antonio, TX.
  • Minimum Speech Test Battery (MSTB) 2011 Minimum Speech Test Battery for Adult Cochlear Implant Users 2011: Version 1.0. Retrieved from http://www.auditorypotential.com/MSTBfiles/MSTBManual2011-06-20%20.pdf . Accessed March 11, 2014
  • Moodie S, Rall E, Eiten L, Lindley G, Gordey D, Davidson L, Bagatto M, Scollie S. 2016; Pediatric audiology in North America: current clinical practice and how it relates to the american academy of audiology pediatric amplification guideline. J Am Acad Audiol 27 (03) 166-187
    Article in Thieme ConnectPubMedGoogle Scholar
  • Moore JA, Teagle HF. 2002; An introduction to cochlear implant technology, activation, and programming. Lang Speech Hear Serv Sch 33 (03) 153-161
    CrossrefPubMedGoogle Scholar
  • National Institute on Deafness and Other Communication Disorders, National Institutes of Health 2013 Cochlear Implants (NIH Publication No. 11-4798). Retrieved from https://www.nidcd.nih.gov/health/hearing/pages/coch.aspx . Accessed August 22, 2017
  • National Institutes of Health 2013 Cochlear Implants. Retrieved from http://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=83 . Accessed March 9, 2015
  • Nilsson M, Soli SD, Sullivan JA. 1994; Development of the hearing in noise test for the measurement of speech reception thresholds in quiet and in noise. J Acoust Soc Am 95 (02) 1085-1099
    CrossrefPubMedGoogle Scholar
  • Nilsson MJ, Soli SD, Gelnett DJ. 1996. Development of the Sharing in Noise Test for Children (HINT-C). Los Angeles, CA: House Ear Institute;
    Google Scholar
  • Peterson GE, Lehiste I. 1962; Revised CNC lists for auditory tests. J Speech Hear Disord 27: 62-70
    CrossrefPubMedGoogle Scholar
  • Plant K, Law M, Whitford L, Knight M, Tari S, Leigh J, Pedley K, Nel E. 2005; Evaluation of streamlined programming procedures for the Nucleus cochlear implant with the contour electrode array. Ear Hear 26 (06) 651-668
    CrossrefPubMedGoogle Scholar
  • Raosoft, Inc 2004 Sample Size Calculator. Retrieved from http://www.raosoft.com/samplesize.html . Accessed February 5, 2015
  • Sarant JZ, Blamey PJ, Dowell RC, Clark GM, Gibson WP. 2001; Variation in speech perception scores among children with cochlear implants. Ear Hear 22 (01) 18-28
    CrossrefPubMedGoogle Scholar
  • Shapiro WH, Bradham TS. 2012; Cochlear implant programming. Otolaryngol Clin North Am 45 (01) 111-127
    CrossrefPubMedGoogle Scholar
  • Sharma A., Dorman M., Spahr A.. 2002; A sensitive period for the development of the central auditory system in children with cochlear implants: implications for age of implantation. Ear Hear 23 (06) 532-539
    CrossrefPubMedGoogle Scholar
  • Spahr AJ, Dorman MF, Litvak LM, Van Wie S, Gifford RH, Loizou PC, Loiselle LM, Oakes T, Cook S. 2012; Development and validation of the AzBio sentence lists. Ear Hear 33 (01) 112-117
    PubMedGoogle Scholar
  • Spahr AJ, Dorman MF, Litvak LM, Cook SJ, Loiselle LM, DeJong MD, Hedley-Williams A, Sunderhaus LS, Hayes CA, Gifford RH. 2014; Development and validation of the pediatric AzBio sentence lists. Ear Hear 35 (04) 418-422 Advance online publication 10.1097/AUD.0000000000000031
    CrossrefPubMedGoogle Scholar
  • Spivak LG, Chute PM, Popp AL, Parisier SC. 1994; Programming the cochlear implant based on electrical acoustic reflex thresholds: patient performance. Laryngoscope 104 (10) 1225-1230
    PubMedGoogle Scholar
  • Stephan K, Welzl-Müller K. 2000; Post-operative stapedius reflex tests with simultaneous loudness scaling in patients supplied with cochlear implants. Audiology 39 (01) 13-18
    CrossrefPubMedGoogle Scholar
  • Uhler K, Gifford RH. 2014; Current trends in pediatric cochlear implant candidate selection and postoperative follow-up. Am J Audiol 23 (03) 309-325
    CrossrefPubMedGoogle Scholar
  • Uhler K, Warner-Czyz A, Gifford R. Working Group 2017; Pediatric minimum speech test battery. J Am Acad Audiol 28 (03) 232-247
    Article in Thieme ConnectPubMedGoogle Scholar
  • U.S. Census Bureau 2011 [Graphic Map Illustration] Census Bureau Regions and Division with State FIPS Codes. Retrieved from https://www.census.gov/geo/maps-data/maps/pdfs/reference/us_regdiv.pdf . Accessed November 17, 2016
  • Vaerenberg B, Smits C, De Ceulaer G, Zir E, Harman S, Jaspers N, Tam Y, Dillon M, Wesarg T, Martin-Bonniot D, Gärtner L, Cozma S, Kosaner J, Prentiss S, Sasidharan P, Briaire JJ, Bradley J, Debruyne J, Hollow R, Patadia R, Mens L, Veekmans K, Greisiger R, Harboun-Cohen E, Borel S, Tavora-Vieira D, Mancini P, Cullington H, Ng AH, Walkowiak A, Shapiro WH, Govaerts PJ. 2014; Cochlear implant programming: a global survey on the state of the art. Scientific World Journal 2014: 501738
    PubMedGoogle Scholar
  • Waltzman SB. 2006; Cochlear implants: current status. Expert Rev Med Devices 3 (05) 647-655
    CrossrefPubMedGoogle Scholar
  • Waltzman SB, Roland Jr JT, Cohen NL. 2002; Delayed implantation in congenitally deaf children and adults. Otol Neurotol 23 (03) 333-340
    CrossrefPubMedGoogle Scholar
  • Wolfe J, Schafer EC. 2010. Programming Cochlear Implants: A Volume in the Core Clinical Concepts in Audiology Series. San Diego, CA: Plural Publishing;
    Google Scholar
  • Zwolan TA, Stach CJ. 2009. Programming cochlear implant systems. In: Eisernberg LS. Clinical Management of Children with Cochlear Implants. San Diego, CA: Plural Publishing; 113-131
    Google Scholar