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Cochlear Implant Program
A hearing aid is a device that amplifies sound. The amplified sound then travels down the ear canal, past the ear drum and middle ear bones, to the cochlea. A cochlear implant is an artificial hearing device, which transmits sound directly to the auditory nerve through electrical stimulation of the cochlea, bypassing the ear canal, ear drum, and middle ear bones. Neither hearing aids nor a cochlear implant can return a person with hearing loss to a state of normal hearing, but both provide children with better access to sound. For certain children with profound hearing loss, where benefit from hearing aids has been severely limited, a cochlear implant may provide vast improvement in the ability to listen and learn to communicate through spoken language. The ear is divided in three parts: the outer, middle, and inner ear. The part of the ear we see and the ear canal make up the external ear. The middle ear includes the ear drum (tympanic membrane) and three tiny bones (malleus, incus and stapes). The inner ear consists of the cochlea and the vestibule. When sound enters the ear canal, it vibrates the eardrum. This vibration then travels through the middle ear bones to the oval window, which is connected to the cochlea. The cochlea is a snail shaped tunnel filled with liquid and lined with “hair cells”. When the sound vibration hits the oval window, it vibrates the liquid inside the cochlea, which “stimulates” the hair cells. The hair cells then send an electrical signal to the auditory nerve which then carries the sound information to the brain.
WHO IS A COCHLEAR IMPLANT CANDIDATE? Generally speaking, anyone above 12 months of age, with severe-to-profound sensorineural hearing loss in both ears (70 decibels or greater), who have limited benefit from hearing aids is a candidate for a cochlear implant. Typically, a trial period with hearing aids of at least three-to-six months is necessary to determine if the patient has limited benefit. WHAT NEEDS TO BE DONE TO ASSESS IF MY CHILD IS A CANDIDATE? ü Audiological evaluation
ü Medical evaluation
ü Speech and language evaluation
ü Developmental and psychological evaluation
ü Educational evaluation
The medical evaluation is done on Thursday mornings, at the Hearing Clinic of Rady Children's Otolaryngology Department. All the other appointments are held at Rady Children's Audiology/Hearing Department. WHAT TO EXPECT FROM THE COCHLEAR IMPLANT The hearing potential from a cochlear implant depends on many factors, which are unique to the individual. Qualities that increase the likelihood of successful outcome include young age, short duration of deafness, good family support, intensive auditory habilitation and speech-language intervention, as well as normal cognitive development. On average, an infant or toddler who is implanted has a very good chance of developing enough spoken language to be able to be in a mainstreamed educational placement by Kindergarten. This is only with intensive auditory habilitation, speech-language intervention, and carry-over of language learning activities into the daily routines of the home. Despite being able to attend a regular Kindergarten classroom, many children may still need some assistance to be successful in school, such as an FM system coupled to their implant, preferential seating in the classroom, and captioning or note taking services. Children who are implanted over the age of four-to-five years face more challenges than younger children. To develop spoken language these children often need visual cues, such as speech reading or signed language, in addition to the auditory information the implant can provide. They may need a special classroom setting or additional supports at school for many years in order to be successful. There are some children for whom the cochlear implant may not be appropriate, and it may interfere with the child's acquisition of signed language. These tend to be older children who have very limited spoken language and rely on signed language completely for communication. Other developmental problems can make learning any language (spoken or signed) very difficult for a child. It is important to assess all aspects of the child’s development during the cochlear implant pre-evaluation process. ü PRE-OP
ü SURGERY TECHNIQUE
ü POST-OP
IMPORTANT:
IS MY CHILD GOING TO HEAR RIGHT AFTER SURGERY? WHAT HAPPENS NEXT? The implant is activated by the audiologist about one month after the surgery, when the surgical site has healed. After the first activation is when the real work starts. Here’s what needs to be done in order for your child to fully benefit from the cochlear implant: ü Audiology
ü Speech and Language
ü Education
RADY CHILDREN’S HOSPITAL OF SAN DIEGO COCHLEAR IMPLANT TEAM
Ayala Ben-Tall, Ph.D., is a psychologist who received her Ph.D. from the University of California, Santa Barbara in 1998. She has worked at the Rady Children’s Hospital Developmental Evaluation Clinic and has been on the Cochlear Implant Team since 2000. Daniela Carvalho, M.D. is our ENT surgeon. She did her ENT-Head and Neck surgery residency in Brazil and completed a pediatric otolaryngology fellowship at Rady Children’s Hospital-San Diego from 1999 to 2001. She was invited to join the pediatric ENT practice at Rady Children’s Hospital as the ear specialist. She is the director of the Hearing Program at Rady Children’s Hospital. She has published extensively in pediatric otolaryngology and has been invited to speak at meetings in the USA and other countries. Dr. Carvalho speaks five languages, including English, Spanish, Portuguese, French and German. Melanie Coll has worked as an audiologist since August 2005, when she joined Rady Children's Audiology team. Melanie has special skills in pediatric testing and hearing aid fitting. She has experience using American Sign Language and working with the culturally Deaf population. Her clinical fellowship year was spent at the Children's National Medical Center in Washington, DC. Other areas of interest are Cochlear Implants. Catherine Dabasinskas has worked at Rady Children's since 2001. She specializes in working with children with hearing loss, cochlear implants, multiple disabilities, autism and dyspraxia. Valerie Dorfman joined Rady Children's Hospital in March 2008. Prior to working in the hospital's outpatient setting, she worked in several public schools and outpatient hospital settings in Massachusetts. Valerie received her Master of Science in Speech Language Pathology at Boston University. She is a native Spanish speaker and specializes in providing therapy in Spanish. Her interests include working with children with hearing loss, cochlear implants, cleft lip and palate, speech and language impairments, apraxia of speech, and Autism Spectrum Disorders. Jennifer Foss has worked at Rady Children's Hospital since June 2006. Jennifer has experience working with a variety of children and adults with communication disorders, including those with speech and language delays, apraxia of speech, autism spectrum disorders, cleft palate, cochlear implants, acquired traumatic brain injuries, voice, and stuttering. Shani Goldgrub joined the Audiology team at Rady Children's in 2007, when she completed her clinical doctorate degree in Audiology. Shani completed her clinical externship at Providence Speech and Hearing Center in Orange, California, where she gained experience in pediatric Audiology, hearing aids and auditory evoked potentials. Additionally, she has special interest in cochlear implants. Having been raised in Mexico, Shani is fluent in Spanish. Eleanor Kalter became a speech-language pathologist in 1984 and joined Rady Children's in 1989. Eleanor has special talents in bilingual/bicultural therapy and consultation on related issues. Her extensive background includes working in Spanish and French as well as with other multicultural populations. Eleanor also has expertise in treating children with cleft palate and craniofacial anomalies, having served as speech pathologist on the Rady Children's Craniofacial team for over 10 years. Alyson Mellish, Au.D. has been an audiologist since 2002 and has worked at Rady Children's since July 2004. She specializes in the areas of pediatric diagnostic Audiology, hearing aid dispensing, and cochlear implant evaluations and rehabilitation. Dr. Mellish also serves as the Cochlear Implant Team Educational Liaison, collaborating between the clinic and the classroom. Alyssa Needleman, Ph.D., leads the Audiology Department at Rady Children's Hospital San Diego, providing day to day leadership to the department and developing systems that ensure quality patient care outcomes and fiscal management. She earned her doctorate at the University of Texas at Dallas, with her area of expertise in speech perception in individuals with hearing loss. She is certified as an audiologist with the American Speech-Language-Hearing Association, is a Fellow of the American Academy of Audiology, and has worked in all aspects of the audiological community since 1991, including hospital, corporate and university settings, as well as running her own private practice. Jackie Rand, Hearing Aid Program Coordinator, has worked in the health care field for 30 years in a variety of different areas, including Health Education in the private sector as Program Coordinator of a Health Prevention program for employees. She also worked for Sharp Healthcare for 19 of those 30 years in Physical Rehabilitation, Marketing and Volunteer Services. Jackie came to Rady Children’s hospital in March of 2005 as Hearing Aid Program Coordinator and since that time has done a wonderful job working with the Cochlear Implant team. Her goal is to provide the best possible service for our patients and families and to ensure that any equipment necessary is made available to them. Brooke Stulz joined Rady Children's Hospital in September 2005. Prior to working in the hospital's outpatient/inpatient setting, she was a school speech therapist in the U.S. Virgin Islands School District. Brooke specializes in early intervention, early childhood language, apraxia, articulation, and Autism Spectrum Disorders. Rada West, Ph.D. has been a licensed clinical psychologist since 2006 and has worked at Rady Children's Hospital Developmental Evaluation Clinic since 2005, specializing in neuropsychological and developmental evaluations of young children with developmental disabilities, Autism, learning disabilities and children who are preparing to receive a cochlear implant. She has been a part of the Cochlear Implant Team since 2007. She is bilingual in English and Russian. James Kim Wilkes, Ph.D. has been a psychologist since 1990. He has worked at Rady Children's since 1988 and specializes in the areas of developmental assessments of infants, preschoolers, children in foster care, and children preparing to receive cochlear implants. He received his doctorate in psychology at the California School of Professional Psychology, San Diego in 1987.
CONTACT US If you have any questions or would like to make an appointment, please call 858-966-5838 or 858-495-7767 (TTY).
© Children's Specialists, Division of Otolaryngology 3030 Children’s Way, Suite 402 San Diego, CA 92123 |
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The cochlear implant consists of several parts:
CSSD Division of Otolaryngology