Session Descriptions

This session provides an overview of the issues related to cochlear implant candidacy, surgical considerations, mapping of the cochlear implant devices and fitting procedures. What factors affect outcomes and what constitutes successful outcomes for cochlear implant use in children and adults will also be discussed.

Learning Outcomes
You will be able to:

• identify the considerations for candidacy for a cochlear implant
• describe the communication training for children versus adults with cochlear implants
• summarize the effect of the cochlear implant outcomes on language development in children

Baby Steps to Listening: Fun! Fun! Fun!
Sponsored by Special Interest Division 9, Hearing and Hearing Disorders in Childhood
Velvet Buehler, MA, CCC-SLP/A

This presentation outlines treatment components for typical children awaiting cochlear implantation and following activation who were implanted at 12 months of age. Emphasis is placed on laying the foundation for listening for the first year following activation. An overview of therapy goals, objectives, strategies, and activities used within treatment sessions for infants and toddlers is shared. Lesson plan ideas demonstrate fun ways to build auditory skills for beginning listeners.

Learning Outcomes
You will be able to:

• identify and describe components of treatment for infants awaiting implantation
• enumerate the factors to consider in laying the foundation for listening
• describe therapy strategies utilized prior to CI activation and after CI activation
• give examples of appropriate treatment objectives during the year following CI activation
• develop and implement fun lesson plans for children learning to listen with a CI

Cochlear Implants for Elderly Patients
Nancy Cambron, MS, CCC-A

This presentation is intended primarily for audiologists with little or no previous experience with cochlear implants who would like to know more about how cochlear implants can benefit elderly patients. The presenter discusses special issues that audiologists need to take into consideration when referring elderly patients for cochlear implants. Finally, case studies as well as research findings are presented to suggest programming and auditory rehabilitation strategies that are useful with this population.

Learning Outcomes
You will be able to:

• illustrate how cochlear implants can help elderly people
• specify unique considerations for referring elderly patients for CI evaluations
• determine strategies for cochlear implant programming and auditory rehabilitation with elderly patients

The Audiologist's Role in the Management of Cochlear Implants in the Classroom
Patricia M. Chute, EdD, CCC-A

This presentation outlines the role of the audiologist working in the school system to delineate his/her role in managing a child with a cochlear implant. The variety of functions this professional plays in ensuring that other school personnel are collaborating in the process is key. The responsibilities relative to the pre/post implant process, along with issues of classroom acoustics, mapping, and FM issues, are presented. Additionally, the role of the audiologist in rehabilitation, counseling, and advocacy are also outlined.

Learning Outcomes
You will be able to:

• differentiate the variety of roles that the audiologist plays when providing services for a child with a cochlear implant
• apply the responsibilities outlined in the process of implantation both pre- and post-operatively
• design a framework for working with children in the schools from the perspective of device maintenance, classroom acoustics, and rehabilitation

Music Perception, Enjoyment, and Participation of Pediatric CI Recipients
Kate Gfeller, PhD

This presentation includes research data on pediatric CI recipients for music perception and enjoyment; comparisons of hearing history and perceptual accuracy of pediatric and adult CI recipients; and implications for involvement in music-based activities such as lessons, ensembles, school music classes, and music listening. The evidence from research and clinical studies forms the basis for recommendations regarding educational accommodations, selection of meaningful music activities, and the uses of music in aural rehabilitation. The presentation emphasizes the impact of developmental issues and variability among CI recipients, and the importance of individualizing educational and clinical decisions.

Learning Outcomes
You will be able to:

• name structural parts of music that are best and worst transmitted through the cochlear implant
• describe how pediatric CI recipients differ from adult CI recipients in music perception and enjoyment
• describe types of music activities that are typically most and least successful for pediatric CI recipients
• list important accommodations for pediatric CI recipients in music classes
• describe uses of music in aural rehabilitation programs for preschool and school-aged children

Electric and Acoustic Stimulation (EAS) With Cochlear Implants: Past, Present, and Future
Sponsored by Special Interest Division 7, Aural Rehabilitation and Its Instrumentation
René Gifford, PhD, CCC-A

Electric and acoustic stimulation (EAS) is a hot topic in the area of cochlear implants. EAS, however, is still in the early stages of development with the first peer-reviewed paper appearing just nine years ago. This area has gone through a remarkable evolution, demonstrating that hearing aids and cochlear implants are merging technologies. This session covers the history of EAS, the present state of clinical trials, the unknown variables, hearing preservation with conventional cochlear implantation, and future applications of EAS—and their associated controversies.

Learning Outcomes
You will be able to:

• identify candidates for EAS
• explain the history and evolution of EAS
• describe the outcomes for hearing preservation with conventional cochlear implantation
• recognize the confounding variables affecting EAS efficacy studies
• summarize the future applications and associated controversies surrounding EAS

Clinical Use of Evoked Potentials in Cochlear Implants
Michelle L. Hughes, PhD, CCC-A

This session summarizes a growing body of research that has examined the clinical utility of the electrically evoked compound action potential (ECAP) and electrically evoked stapedial reflex threshold (ESRT) for cochlear implant speech processor programming. This session focuses on: a basic review of how ECAP and ESRT are measured using commercially available equipment; challenges associated with making and interpreting these measures in a clinical setting; and what to do with the measures once they have been obtained.

Learning Outcomes
You will be able to:

• describe how to measure ECAP and ESRT in cochlear implant recipients using commercially available equipment
• identify ways to improve clinical interpretation of ECAP and/or ESRT measures
• describe how ECAP and ESRT can be used to assist with speech processor programming in CIs

Bilateral Cochlear Implants: Current Progress and Future Possibilities
Ruth Litovsky, PhD

This session introduces participants to the growing area of bilateral cochlear implants. We discuss the inclusion criteria and some of the reasons for the recent growth in number of persons receiving two implants. Appropriate methods for evaluation of children and adults who receive a second implant are discussed. Research outcomes that can be considered in a clinical realm are discussed, along with suggestions for implementation of some of these tests. We also go over the limitations that are often encountered by patients, and reasons for delaying providing a second cochlear implant to children and adults.

Learning Outcomes
You will be able to:

• discuss standard practice in the U.S., and to some extent abroad, with regard to bilateral cochlear implants, and benefits of listening with two ears vs. one
• apply information about measurable benefits to clinical settings
• analyze outcomes in own patients in order to predict performance under various amplification conditions, and choose appropriate tests for measuring bilateral benefits
• identify conditions under which a candidate for bilateral cochlear implants should be tested before providing the second implant, and during follow-up testing
• examine limitations posed by two cochlear implants compared with two typical (normal) ears, and how patients might not reach the same level of performance as their normal-hearing peers
• utilize tests introduced during this session

Infusing Audition Into Classroom Themes and Units
Sponsored by Special Interest Division 16, School-Based Issues
Mary Ellen Nevins, EdD

The individual service provider has a unique opportunity to assist in improving auditory performance outcomes by increasing academic learning time (ALT) in the therapy setting. This is accomplished largely through the development of challenging, yet attainable auditory goals in the context of familiar content material. When individual therapy time is devoted to authentic auditory activities that reinforce classroom listening there is greater likelihood that there will be generalization to other settings of the child's "personal best" demonstrated in therapy.

Learning Outcomes
You will be able to:

• describe linguistic and situational contexts in which auditory skill development can be provided
• describe the importance of including classroom content into therapy goals and activities
• develop auditory activities that integrate classroom content

Predictors of Outcome: Early Observations in Childhood Development After Cochlear Implantation
John K. Niparko, MD

The CDaCI project is a six-center, prospective study of cochlear implantation of U.S. children under the age of 5 years. The study probes child, family, school, and peer factors that influence children's progress in developing spoken language after cochlear implantation. We are interested in the effects of early-established trajectories in oral language on participants' psychological, social, and scholastic adjustment. Because the emergence of spoken language is likely based in success across developmental domains, the CDaCI attempts to relate variability in linguistic outcomes to environmental, social, interventional, and biological influences.

Learning Outcomes
You will be able to:

• discuss the indications for early cochlear implantation and considerations for bilateral intervention
• identify the potential risks of cochlear implantation and the observed benefits for early cochlear implantation, both unilateral and bilateral
• discuss the environmental, demographic, family, and child variables that influence communication outcomes with early cochlear implantation

Clinical Red Flags for Slow Progress in Children with Cochlear Implants
Amy McConkey Robbins, MS, CCC-SLP

This session describes the Red Flags procedure (Robbins, 2005) for use by SLPs and audiologists. The Red Flags Matrix contains auditory milestones based upon published data that allow clinicians to monitor children's progress in the first year of cochlear implant use. This tool enables us to identify children whose listening progress is slower than expected and to intervene using a variety of techniques (One- or Two-Flag responses). The rationale for such a system is that identifying and treating delays early gives us the best chance of closing a gap between chronological and language age.

Learning Outcomes
You will be able to:

• complete the Red Flags Matrix on a student with a cochlear implant
• list the areas of auditory weaknesses shown by a given student
• outline changes in instruction to address a student's delays
• write learning goals aimed at increasing the time course of auditory learning in a student with a cochlear implant

Cortical Development and Reorganization in Children With Cochlear Implants
Anu Sharma, PhD, CCC-A

We are investigating the deterioration, development, plasticity, and re-organization of the human central auditory pathways in normal hearing children and in deaf children who regain hearing after being fitted with cochlear implants. Our measures of central auditory maturation include cortical auditory evoked potentials (CAEP), high density electroencephalography (EEG), magnetoencephalography (MEG), and behavioral measures. We discuss the results of using these and other brain imaging measures in humans, and in animal models of deafness.

Learning Outcomes
You will be able to:

• explain the basic aspects of central auditory development and plasticity in human and animal models
• describe aspects of cortical plasticity and re-organization in hearing impaired children
• discuss the latest techniques in clinical application of cortical auditory evoked potentials (CAEP) in clinical populations

Cochlear Implants in Patients With Auditory Neuropathy/Dyssynchrony
Jeffrey L. Simmons, MA, CCC-A

Auditory neuropathy/auditory dyssynchrony (AN-AD) is a category of hearing disorder characterized by test findings that indicate impaired function of the auditory nerve coincident with normal or near-normal outer hair cell activity in the cochlea. Based on early research involving the disorder, it was assumed that patients with AN/AD would not be successful with cochlear implants. Experience since that time has shown that cochlear implantation can, in fact, be an effective intervention in at least some individuals with AN/AD. This session reviews reports in the literature describing a variety of outcomes seen in cochlear implant recipients who have been diagnosed with this hearing disorder. Discussion includes speech-language findings as well as objective measurements, such as electrically evoked compound action potentials (ECAP) and electrically evoked auditory brainstem response (EABR). Suggested considerations involving a protocol for cochlear implants in this particular patient population are offered.

Learning Outcomes
You will be able to:

• describe the characteristic audiological findings seen in a patient with auditory neuropathy/dyssynchrony through the use of a comprehensive test battery
• describe speech and language findings reported in the literature for pediatric patients with auditory/neuropathy/dyssynchrony who have received cochlear implants
• discuss the reasons why cochlear implantation is as beneficial in some cases involving auditory neuropathy/dyssynchrony as it is in patients with sensorineural hearing loss
• describe instances in which a patient with a diagnosis of auditory neuropathy would not be considered a candidate for cochlear implant, or in which limited benefit might be the outcome

The Relationship Between Hearing, Speaking, Language, and Reading
Linda J. Spencer, PhD, CCC-SLP

This session reviews studies investigating the relationship between listening, language, and literacy skills in pediatric cochlear implant users. Findings are applied to clinical practice. Early speech perception and production skills after four years of listening experience predict reading achievement after 90 months cochlear implant experience. This finding provides a framework for setting therapeutic goals that target capitalizing in the early years, using the early access to sound to build better phonological processing skills (which are likely contributors to eventual reading success). Practical ideas for integrating speech-language-listening and literacy work are included.

Learning Outcomes
You will be able to:

• explain how the concepts of phonology, phonologic processing, and phonics relate to and contrast one another in the context of children with hearing loss
• describe the relationships between auditory processing and comprehension, language, cognitive processes, and literacy
• demonstrate ways to assess and extend the skill development of the early reader and apply these skills in practical settings with children who are hard of hearing