Unfortunately, this is seldom the case.
While children with cochlear implants hear significantly better than they were able to hear with hearing aids, they are not hearing optimally. Testing speech perception in a quiet test room may make it appear that a child is hearing well, but it will not provide good information about how the child hears outside of the test situation. By testing in competing noise and at soft conversational levels, the audiologist can more closely demonstrate how a child will function in everyday situations. If word recognition deteriorates in those conditions, an FM system should be recommended.
Unfortunately, coupling cochlear implants and FM systems is significantly more complicated than coupling hearing aids and FM systems. Previously, a series of challenges compromised the widespread use of FM systems with cochlear implants. These included the need to have a special patch cord between the body-worn processor and the FM system, the potential for radio frequency interference between the two devices, and the sheer bulk of the equipment on small children. As speech processors substantially decreased in size and ear-level devices became available, the coupling process and ability to wear the systems together became more user-friendly.
Although children with cochlear implants can now use FM systems more readily, they should not be fit with FM systems until they have some experience with their implants. This is especially important in very young children for whom there are minimal responses observed during the early cochlear implant stages. Once the clinician is confident in the responses of the child with the implant alone, the FM system can easily be attached to the unit. However, both devices must be monitored carefully during their use. It is important for teachers and therapists who see the child daily to be aware of any changes that might indicate that either system is not working appropriately. As always, providing in-service training to teachers in mainstream settings is crucial to the proper use of both devices.
Currently, two types of FM systems are commonly used in the classroom: a desktop speaker FM unit and an FM receiver that inputs directly into the speech processor. Within the past year, two manufacturers introduced FM receivers that input directly into the speech processor: the AVR Sonovation LogiCom Ci FM system and the Phonak MicroLink FM system. While a system that provides a direct input into the speech processor offers a more consistent signal, the desktop system is recommended when the child’s auditory responses are not well developed and the child may not be able to report a malfunction.
As the school year begins, clinicians serving children with cochlear implants need to be aware of the use of FM amplification in the child’s school. FM systems have become more prevalent in education and are used not only for children with hearing loss, but also for those with auditory processing disorders and learning disabilities. Clinicians must be certain that each classroom is on a different frequency and make arrangements for children using FM systems who share activity areas such as a gym or computer centers.
Additional responsibilities for school-based clinicians working with children with cochlear implants include arranging for a daily check of the FM receiver and processor using a functional listening evaluation. General educators are often not aware of the importance of maintaining and repairing FM equipment, so a procedure for sending in broken equipment must be established at the beginning of the school year. Checking with the manufacturer regarding warranties and service contracts will expedite the repair.
Since the presence of noise in a classroom can impede learning, children who use cochlear implants or hearing aids must have access to technology that will assist them in maximizing the use of their device. The FM system is just one method of supporting children with hearing loss in the classroom to enhance their listening abilities.
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Jane Madell
is director of the Hearing and Learning Center at Beth Israel Hospital in New York City. Contact her by email at
jmadell@bethisraelny.org
.
Patricia M. Chute
is an associate professor at Mercy College in New York. Contact her by email at
pchute@mercy.edu
.
Rebecca Kooper
is an educational audiologist for Nassau BOCES Hearing Services in Levittown, NY. Contact her by email at
ReKoop1213@aol.com
.