As part of the cochlear implant process, a pre-implant evaluation is necessary to determine whether an individual is a candidate for a cochlear implant. Ideally, a cochlear implant candidate is someone who is likely to obtain more benefit from an implant than from traditional amplification (hearing aids). In addition, it is important to ensure that potential recipients and their families are well informed regarding all aspects of cochlear implantation. The evaluation process typically involves consultation with various professionals and comprehensive testing in order to fully determine the individual’s level of communicative function. The following appointments may be included in this process:
Cochlear Implant Orientation
The purpose of the orientation is to provide the child and the family with information regarding the cochlear implant and the implant process. Topics discussed typically include:
How cochlear implants work
- Available devices and the differences between them
- Surgery and follow-up procedures
- Expectations for a young child/adult who receives an implant
- Need for on-going special services following implantation
During the audiological evaluation, an audiologist will measure the potential recipient’s hearing levels with and without hearing aids. Testing can involve active participation (traditional hearing testing) and/or the use of special machines (otoacoustic emissions, tympanometry). Typically, the audiologist will also evaluate the individual’s understanding of speech both with and without the use of hearing aids. In a young child, the audiologist will evaluate the child's meaningful listening skills. Based on the test results, the audiologist may recommend a trial with a different set of hearing aids (e.g., high power hearing aids or frequency compression aids).
Because of the proximity of the hearing and balance (vestibular) organs within the inner ear, vestibular testing will typically be conducted to look at the health of the candidaate's balance system.
At this evaluation, the ear surgeon will discuss issues regarding the medical and surgical aspects of cochlear implantation. In addition, the physician will obtain information about the candidate's medical and hearing health history, conduct an ear examination, and review available x-rays and test results to determine whether the child can safely undergo the surgical procedure and whether there are any medical or structural problems that could prevent successful insertion or use of a cochlear implant.
This is a special type of x-ray that is used to provide the ear surgeon with information regarding the status of the cochlea and may indicate which ear would be better to implant. The physician is interested in whether the cochlea and auditory nerve canal have a normal shape and whether there is bony growth that can potentially compromise insertion of the cochlear implant electrode array (e.g., in cases where the child has had meningitis).
Speech/Language Evaluation (For Children)
A speech/language pathologist conducts an evaluation that looks at the child’s overall communication abilities, including receptive and expressive language, functional auditory skills and speech production as well as the child’s potential for growth in these areas. Parent questionnaires are usually used to gather information if the child is very young. Standardized tests administered in the child’s primary mode of communication are used with older children. The results of this evaluation are used to determine the child’s areas of strength, to identify ways to help the child further develop communication skills, and to serve as a baseline from which to compare subsequent performance.
Functional Communication Assessment (For Adults)
A speech/language pathologist will assess the impact of the candidate's hearing difficulties on communication and quality of life. A test is also administered to screen for any cognitive issues that could affect outcomes. A plan for listening therapy services after the cochlear implant is in place will be discussed.
The purpose for discussing expectations is to determine if a candidate/family has a good understanding of the benefits and limitations of a cochlear implant device. The following topics may be discussed with the child and/or family:
- What factors led to an interest in cochlear implants?
- How have the individual and family adjusted emotionally to the hearing loss?
- Are there socialization issues that are of concern?
- Has the individual's hearing loss affected school or job performance?
- What are the family's expectations for the individual's performance with the cochlear implant?
- Are expectations realistic? Has the family talked with other implant users?
- How supportive are the immediate and extended family members to the idea of an implant?
- How committed will the family be to follow-up visits or therapy?
- What type of educational support services are available?
- What does the individual or family know about the Deaf Culture's view regarding cochlear implants?
- What information is needed about assistive devices in addition to the cochlear implant?
- What information is needed about support groups and individual counseling?
Additional evaluations may be recommended on a case-by-case basis. These may include appointments with a neurologist, psychologist, geneticist, eye specialist, occupational therapist, physical therapist and/or social worker.
The comprehensive candidacy evaluation may require several visits to the center. For candidates who must travel long distances to reach Boys Town National Research Hospital, lodging is available at nearby hotels or at the Ronald McDonald House.
Once all team members have evaluated the individual, the team will discuss the findings as a group and a representative will communicate the decision to the individual or family. If the individual is a candidate, pre-operative appointments and surgery will be scheduled following insurance pre-approval. If the individual is not a candidate, subsequent care or referrals will be provided, and/or a follow-up visit may be scheduled.