The Yorkshire Auditory Implant Service Sequential Bilateral Cochlear Implantation in Children:
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The Yorkshire Auditory Implant ServiceSequential Bilateral Cochlear Implantation in
Children:
Assessment, Rehabilitation and Outcomes
Jane Martin, Catherine Totten, Catherine Killan and Prof. Chris Raine
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NICE Guidance January 2009National Institute for Health and Clinical Excellence
• ‘Simultaneous cochlear implantation is recommended as an option for the following groups of people with severe to profound deafness who do not receive adequate benefit from acoustic hearing aids:
• Children• Adults who are blind or who have other
disabilities that increase their reliance on auditory stimuli…’
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Sequential Implantation
• ‘Bilateral cochlear implantation carried out in separate operations is not recommended as an option for people with severe to profound deafness. However, people who had a unilateral implant before publication of this guidance, and who fall into one of the categories described for bilateral implantation….’ following assessment by the responsible clinician.
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YAIS Response
• Numbers of potential candidates
• General Newsletter
• Devised Sequential Cochlear Implant Profile (SCIP)
• Targeted letter
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AssessmentSEQUENTIAL COCHLEAR IMPLANT PROFILE (SCIP)
FactorsChronological age (current)Age at first implant (congenital)Otology (ear infection and scan results)Medical (fitness for GA)Hearing history of non-implanted earChild’s ability to participate in programmingConsistent unilateral c.i. use establishedDevelopment of functional spoken languageFamily commitment to long term supportEducational support
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Chronological Age
Assessment Factors No Concern Mild to Moderate Concern
Great Concern
Chronological Age
a) Plasticity of auditory system
< 3.5 years 4 – 7 years 8 years unless bimodal
b) Ability to adjust to 2nd implant
< 7 years 7 – 12 years > 12 years
Sequential Cochlear Implant Profile (SCIP) definitions
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Demographics of Implantees
• 78 children
• Age range at 1st CI: 1yr 2mths – 7yrs 9mths
• Age range at 2nd CI: 1yr 11mths – 15yrs
3mths
• Length of sequential use: 4 months – 7yrs
8mths
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Age at First and Second Implant
1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 13-14 14-15 15-160
5
10
15
20
25
30
Age at 1st CI
Age at 2nd CI
Age in years
Num
ber o
f Chi
ldre
n
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Interval Between the First and Second Implants
0-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-130
2
4
6
8
10
12
14
Time between implants in years
Num
ber o
f Ch
ildre
n
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Rehabilitation Support
Support and guidance offered to the child/teenager, the family and local professionals• Consistent use of both speech processors• Auditory training for second side (depending
on age and gap)• Expectations, motivation and commitment,
long term
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Outcomes-2nd Ear Cochlear Implant Use
n = 78
0-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 12-13 14-15 15-160
2
4
6
8
10
12
14
Non-usersPoor usersGood users
Age at 2nd Implant (years)
Num
ber o
f Chi
ldre
n
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CAP 6 months - 2nd ear
Level 3Level 4Level 5Level 6Level 7
L5 22%
Outcomes-Categories of Auditory Performance
CAP 12 months - 2nd ear
N = 45
N = 37
L3 7% L4
22%L649%
L7 3%
L413%
L519%
L665%
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• The Left-Right Discrimination Test
• The Toy Localisation Test
• The Toy Discrimination Test (Spatial Release from Masking for Speech)
• The BKB Sentence Test
ABC-York Crescent of Sound: Test Battery
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Two ears better than one in background noise
1st 2nd
Speech
Noise
1st 2nd
Speech
Noise
1st 2nd
Speech &Noise
2 years 4 years0
1
2
3
4
5
6
7
Bene
fit (d
ecib
els)
N = 14
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Left / Right Discrimination
6
10
Left / Right Discrimination at 2 years
unable to tell right from left
can tell right from left
16
Left / Right Discrimination at 4 years
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• Two non-users• Two thirds of children have achieved open-set
sentence understanding using the 2nd implant alone by 12 months
• Functional listening ability improves over time– Localisation ability– Listening in background noise
Summary of Outcomes
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Conclusions
• Flexible approach to rehabilitation support, particularly targeting 9-11 age group
• Recognition of long-term commitment and motivation is essential– Child– Parents
• Co-operation from local professionals
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Thank You