Programming Cochlear Implants

Cochlear implants offer significant benefits for children and adults with severe to profound hearing loss; however, to realize these benefits, the device must be carefully and correctly programmed. With current information on cochlear implant technology, Programming Cochlear Implants, Third Edition, a volume in the Core Clinical Concepts in Audiology Series, is a valuable guide for clinicians providing services to cochlear implant users or as a teaching tool for graduate-level students

Programming Cochlear Implants, Third Edition introduces the basics of cochlear implant hardware and programming and continues through advanced programming techniques, with manufacturer-specific information and case studies. The text reviews clinical protocols for cochlear implant management; programming considerations for bilateral cochlear implant; troubleshooting during the programming process; device-specific programming techniques; use of objective measures to set cochlear implant programs; use of assistive listening devices with cochlear implants; and providing support to difficult-to-program users, such as infants, individuals with cognitive impairment, persons with disabilities, and so forth.

New to the Third Edition

• The latest hardware innovations in modern cochlear implant systems
• Advancements in software and programming approaches for cochlear implants
• New content on methods used to code sound intensity in cochlear implant systems
• Updates on the latest signal processing and input processing schemes and technologies used in cochlear implants 
• Expanded discussion of programming considerations related to electric-acoustic stimulation and bimodal use
• Recent developments in hearing assistive technologies used by cochlear implant recipients
• New and updated information on objective measures in cochlear implant programming

Contents

Preface
Introduction
Acknowledgments
Contributors

Chapter 1. Basic Components and Terminology of a Cochlear Implant
Jace Wolfe and Erin C. Schafer
Basic Operation of Cochlear Implants
Basic Components of Current Cochlear Implant Systems
Basic Terminology of Cochlear Implant Programming
    Parameters Affecting Signal Coding in the Intensity Domain
        Stimulation Levels
        Threshold of Stimulation
        Upper Stimulation Levels
        Current Amplitude and Pulse Width
        Mapping Acoustic Inputs Into the Electrical Dynamic Range
    Parameters Affecting Signal Coding in the Frequency Domain
        Electrode Contact Versus Channel
        Virtual Electrodes (Current Steering)
        Frequency Allocation
    Parameters Affecting Signal Coding in the Time Domain
        Stimulation Rate
Basic Cochlear Implant Terminology
    Electrode Coupling Strategy/Stimulation Mode
    Sequential Versus Simultaneous Stimulation
    Interpolation
    Sweeping
    Loudness Balancing
    Radio Frequency
    Telemetry
    Impedance
    Voltage Compliance
    Mixing Ratio
Basic Cochlear Implant Signal Coding Strategies
    Continuous Interleaved Sampling
    HiResolution Sound Processing
    n-of-m Strategies
    Spectral Peak (SPEAK)
    Advanced Combination Encoder
    Fine Structure Processing
    Simultaneous Analog Stimulation
Intensity Coding in Cochlear Implants
Intensity Coding in Advanced Bionics Cochlear Implants
    Input Dynamic Range
        Automatic Gain Control–2
        Effect of T and M Levels on Intensity Coding
        Volume Control
        Sensitivity
        Channel Gain
Intensity Coding in Nucleus Cochlear Implants
    Input Dynamic Range, Instantaneous Input Dynamic Range, T-SPL, C-SPL, Automatic Gain Control, Sensitivity, and Autosensitivity Control
        Volume Control
Intensity Coding in MED-EL Cochlear Implants
Input Dynamic Range, Electrical Dynamic Range, and Adaptive Sound Window
    Dual-Loop Automatic Gain Control
    Maplaw
Key Concepts

Chapter 2. Basic Principles of Programming
Jace Wolfe and Erin C. Schafer
Preactivation Procedures
    Realistic Expectations Prior to Activation
    Reviewing Logistics of Cochlear Implantation
    Familiarity With Cochlear Implant Hardware
    Setting the Stage
Programming After Implantation
    Physical Evaluation
    Selecting a Signal Coding Strategy
    Streamlined Versus Comprehensive Programming
    Measuring Stimulation Levels
        Setting Threshold Levels for Adults
        Special Considerations for Setting Threshold Levels for Children
        Additional Measure to Ensure Adequate T Levels and Confirm Audibility
        Setting Upper Stimulation Levels for Adults
        Setting Upper Stimulation Levels for Children
        Additional Considerations in the Measurement of Stimulation Levels
    Adjustments to Special Parameters
        Stimulation Rate
        Pulse Width
        Channel Gain
        Frequency Allocation
        Input Dynamic Range
        Maxima
Key Concepts

Chapter 3. Advanced Bionics Hardware
Jace Wolfe and Erin C. Schafer
Advanced Bionics Sound Processors
    Naída CI Marvel and Sky CI Marvel Sound Processors
        Sound Processor Microphones
        Digital Signal Processing
Processor Controls
    Marvel CI M AquaMic
    Naída Marvel CI LED Light and Internal Alarms
    Naída CI Marvel Connectivity
AutoSense OS 3.0
Phonak Link Hearing Aid and Adaptive Phonak Digital Bimodal Fitting Formula
    Adaptive Phonak Digital Bimodal Fitting Formula
    Advanced Bionics AB Remote App
Advanced Bionics Chorus Sound Processor
    Advanced Bionics Universal and AquaMic Headpieces
    Naída CI Q Sound Processors
    Naída CI Q Battery Module
    Neptune Sound Processor
Advanced Bionics Internal Hardware
    HiRes Ultra Cochlear Implant
    Mid-Scala Electrode Array
        HiFocus SlimJ Electrode Array
    HiRes 90K Advantage Cochlear Implant
HiRes 90K Implantable Cochlear Implant
Key Concepts

Chapter 4. Programming Advanced Bionics Implants
Jace Wolfe and Erin C. Schafer
Advanced Bionics Programming Interface
Advanced Bionics CI Target Programming Software
    Step 1: Client Section—Enter Patient and Implant Information/Telemetry Measures
        Home Page and Training Mode
    Workspace Tabs
        Implant Settings
        Audiogram
    Step 2: Instruments Section
        Impedance Measurement
Fitting Section
    Mapping
        Signal Coding Strategy
    Pulse Width and Stimulation Rate
    Filter Type
    Radio-Frequency Lock
    Step 3: Setting Stimulation Levels
        Maps Versus Programs in Target CI Software
        Creating Multiple Maps
    Fine-Tuning
        Programs
        Manual Programs
        Additional Considerations for AutoSense OS 3.0 and Manual Programs
Span
Progressive Levels
Program Manager
Maps and Programs in the Marvel Sound Processor
    Bilateral Maps
Data Logging
Device Options
Save and Close
Presenting Programming Stimuli
    Measuring T Levels
    Measuring M-Level Stimulation
    Electroacoustic Stimulation—Marvel Acoustic Earhook
    Programming Advanced Bionics Bimodal Recipients in Target CI
    Advanced Bionics Active Insertion Monitoring System
Programming in Advanced Bionics SoundWave Software
    Step 1: Create or Select Recipient
    Step 2: Connect Sound Processor and Conduct Electrode Impedance Measurement
    Step 3: Create a MAP in the SoundWave Software
    Select Sound Processing Strategy
        Pulse Width and Stimulation Rates
        ClearVoice
        SoftVoice
Stimulus Units and Measuring T Levels
    Measuring M-Level Stimulation
        Channel Clipping and Span
    Input Dynamic Range and Automatic Gain Control
    Microphone Sensitivity
    Lock
        Extended Filtering
        Channel Gains
Load MAPs Onto Sound Processor as User Programs
    DuoPhone
    ZoomControl
    StereoZoom
        Mic Mode
        WindBlock, SoundRelax, EchoBlock
        Audio-Mixing Ratio
        Internal Telecoil
    Volume Minimum and Volume Maximum
    DirectTouch
        Clear Slot and Stimulate
    Audible Alarms and QuickSync
    Additional User Options
Loading Programs Into Advanced Bionics Sound Processors
    Data Logging
        Ground (Return/Reference) Electrode
Key Concepts

Chapter 5. Cochlear Nucleus Cochlear Implants and Sound Processors
Jace Wolfe and Erin C. Schafer
Introduction
Nucleus Sound Processors
    Nucleus 7 Sound Processor
        Nucleus 7 Features
        Nucleus 7 Microphone Technology
        Nucleus 7 Electronics
        Nucleus 7 User Options
        Nucleus 7 Acoustic Component
        Nucleus 7 Accessories
        Nucleus 7 Wearing Options
Nucleus 8 Sound Processor
    Nucleus Kanso 2 Sound Processor
        Nucleus Kanso 2 Microphones
        Nucleus Kanso 2 Electronics
        Nucleus Kanso 2 Wearing Options
    Nucleus Kanso Sound Processor
        Nucleus Kanso Microphones
        Nucleus Kanso Electronics
        Nucleus Kanso Wearing Options
    Nucleus 6 Sound Processor
        Wearing Options
        Battery Options
        Processor Buttons and Lights
        Processor Direct Auditory Input Port
        Wireless Remote Assistants
Nucleus Cochlear Implants
    The Nucleus Profile Cochlear Implant
    Nucleus Profile Plus Cochlear Implant
    Nucleus Freedom Internal Device
    Nucleus Electrode Arrays
        Nucleus Slim Modiolar Electrode
        Nucleus Contour Advance Electrode
        Nucleus Slim Straight Electrode
        Nucleus Slim 20
        Nucleus Straight Electrode Array
        Nucleus Double Array
    Nucleus L24 Hybrid Electrode Array
    Nucleus Slim 20 Electrode Array
Key Concepts

Chapter 6. Programming Nucleus Cochlear Implants
Jace Wolfe and Erin C. Schafer
Programming Nucleus Implants
Programming Nucleus Sound Processors
Creating Recipient Files
    The Programming Process
        Dashboard
Measure
    Impedances
        Transimpedance Matrix Measurement
        AutoNRT
Adjust
    Opening or Creating MAP
        Master Volume
Four Options for Creating New MAPs in Custom Sound Pro
    AutoNRT
    Population Mean
    Other Measures
    Thresholds
Initial Activation in Custom Sound Pro
Custom Sound Pro—Follow-Up Programming Sessions
    Parameters
Strategy
    Stimulation Mode
    Channel Rate (Hz)
    Maxima
    Pulse Width (Microseconds)
Power Level Setting
    Tone Level (%DR), Tone Channel, Low Tone Channel
    Volume Adjustment
Manufacturer’s Settings
    Frequency Table
    T-SPL and C-SPL
        Loudness Growth
    Set Levels Screen
        Adjusting Default Parameters
Determining Stimulation Levels for Nucleus Cochlear Implants
    Optimizing T Levels
    Optimizing C Levels
    Optimizing the Electrical Dynamic Range
    Channel Gains
    Voltage Compliance
    Prediction of Stimulation Levels From Other Programs
Progressive MAPs
    Double-Channel Mapping
    Channel-to-Electrode Assignment
        Finalize
    Adjust and Configure Programs and Input Processing
        Input Processing
        Nucleus Input Processing Technologies and Considerations for Use
Autosensitivity Control and Autosensitivity Control Breakpoint
    Adaptive Dynamic Range Optimization
        Beam and Focus
        Zoom
        Forward Focus
SCAN
SCAN 2
    SCAN 2 FF
SNR-NR—Signal-to-Noise Ratio–Noise Reduction
WNR – Wind Noise Reduction
    Whisper
Processor Settings
    Power Level and Battery Life
    Neural Response Telemetry Measurement and AutoNRT
    Programming Previous Generations of Nucleus Implants
Cochlear CR120 Remote Assistant
    Nucleus SmartNav System
Key Concepts

Chapter 7. Cochlear Implant Hardware
Jace Wolfe, Sharon Miller, and Erin C. Schafer
MED-EL Corporation
    SONNET 2 Sound Processor
        SONNET 2 Wearing Options
    DL-Coil With Magnets
    SONNET Sound Processor
    OPUS 2 Sound Processor
    Battery/Wearing Options
    RONDO 3
        RONDO 3 Cover
        Battery Options
        RONDO 3 Magnets
    RONDO 2
        Battery Options
        AudioLink Wireless Accessory
    FineTuner Echo Remote Control
        FineTuner
        Additional Features in MED-EL Systems
MED-EL Speech Processor Test Device
    MED-EL Microphone Test Device
SYNCHRONY Cochlear Implant
SYNCHRONY 2 Cochlear Implant
MED-EL Electrode Array Options
    MED-EL FLEX Series
    MED-EL FORM Series
    Classic Electrode Array Series
    Additional MED-EL Electrode Arrays
        MED-EL Auditory Brainstem Array
Additional MED-EL Cochlear Implants
    MED-EL CONCERT Internal Device
    SONATA TI100 Internal Device
    PULSAR CI100 Internal Device
SONNET 3 Audio Processor
Key Concepts

Chapter 8. Programming MED-EL Cochlear Implants
Jace Wolfe, Sharon Miller, and Erin C. Schafer
Programming MED-EL Implants
    Patients
    Programming Interface
    Telemetry—Impedance and Field Telemetry Measurement
    Creating a MAP in MAESTRO
        Setting Stimulation Levels to Create a MAP
        Measuring MCL
        Setting MCLs With a Flat-MAP in Live Speech
        Electrically Evoked Stapedius Reflex Threshold Measurements
        Sweeping, Balancing, and Interpolation
        Set Levels Grid/Table
    Measuring THR
    Shift & Tilt, Pivot, Interpolation
        Strategy Section
        Stimulation Rate
        Channel-Specific Sampling Sequence Channels
        Compliance Level Control
        Volume Mode
        Channel Interaction Compensation
        Pulse Characteristics
        Frequency Bands
        Maplaw
        Indicators
    Loading Programs Onto MED-EL Sound Processors
        ASM 3.0 Input Processing Parameters
        Adaptive Intelligence
        Microphone Directionality
        Ambient Noise Reduction, Transient Noise Reduction, Wind Noise Reduction
        Compression Ratio and Sensitivity
        Additional Considerations for ASM 3.0 Settings
        Additional Programming Options
        Settings Menu
    Electroacoustic Stimulation of MED-EL Recipients
    MED-EL-Specific Troubleshooting
    Additional Considerations
    Auditory Response Telemetry, AutoART, ARTFit, and Electrically Evoked Auditory Brainstem Response
    MED-EL OTOPLAN

Chapter 9. Clinical Considerations: Putting All of the Pieces Together
Jace Wolfe
Collaboration With the Cochlear Implant Surgeon/Medical Evaluation
Programming Schedule
    Initial Activation Session
    Initial Activation
    Realistic Expectations
    Measuring Stimulation Levels at Initial Activation
    One-Week Postactivation Appointment
    One-Month Postactivation Programming Session
    Remainder of Programming Schedule
The Role of Electrically Evoked Potentials in Programming
Additional Habilitative/Rehabilitative Considerations
Considerations for Bilateral Cochlear Implantation
    The Benefits of Binaural Hearing
    Programming Considerations for Bilateral Cochlear Implant Recipients
    Considerations for Bimodal Users
Programming Considerations for Bimodal Users
    Considerations for Individuals With Single-Sided Deafness and Cochlear Implants
Key Concepts

Chapter 10. Troubleshooting and Managing Patient Complaints and Complications
Jace Wolfe and Erin C. Schafer
Introduction
Patient Complaints and Complications
Managing Recipients Who Experience Disappointing Outcomes
External Hardware
    Determine Wear Schedule and Facilitate an Auditory Lifestyle
    Evaluate the Appropriateness of the Cochlear Implant Program
    Assessment of Internal Hardware
Identifying “Ref Flags”
Cochlear Implant Programming Tips to Address Common Recipient Complaints
Insufficient Audibility for Low-Level Sounds (Poor Understanding of Soft Speech/Aided Thresholds Poorer Than 25 to 30 dB HL)
    Poor Speech Recognition in Noise
Facial Nerve Stimulation/Other Nonauditory Side Effects Associated With Stimulation From the Cochlear Implant

Chapter 11. Hearing Assistance Technology and Cochlear Implants
Erin C. Schafer, Jace Wolfe, and Sharon Miller
Basic Description of Personal Systems
Optimal Systems for Use With a Cochlear Implant
Description and Programming for Personal Hearing Assistive Technology and Cochlear Implants
    Frequency Modulation and Digital Radio-Frequency Transmitters
Frequency Modulation, Radio-Frequency, and Induction Loop Receivers
Programming Considerations for Frequency Modulation/Radio-Frequency Receivers and Sound Processors
    Programming and Fitting Remote Microphone Receivers
    Sound Processor Programming and Hearing Assistive Technology
        Audio-Mixing Ratios
        Input Dynamic Range
        Microphone Sensitivity
    Fitting Procedures for Personal Remote Microphone Systems
Monitoring and Troubleshooting Personal Frequency Modulation/Radio-Frequency Systems for Cochlear Implants
Hearing Assistive Technology to Improve Telephone Conversations
    Telecoils
    Telecoil Accessories
    Streaming Devices
Summary of Hearing Assistive Technologies for Cochlear Implants
Key Concepts

Chapter 12. Programming Recipient Using Electroacoustic Stimulation
Jace Wolfe and Erin C. Schafer
Introduction
    Electroacoustic Stimulation Hardware
    Electroacoustic Stimulation Sound Processors
    Electroacoustic Stimulation With the Advanced Bionics Marvel Sound Processor
    Electroacoustic Stimulation With the Cochlear Nucleus 7 Sound Processor
    Electroacoustic Stimulation With the MED-EL SONNET 2 EAS Sound Processor
Programming Considerations for Electroacoustic Stimulation Recipients
    Clinical Protocol for Programming Electroacoustic Stimulation Devices
        Audiometric Assessment
        Fitting of the Acoustic Component
    Provision of Electric Stimulation for Electroacoustic Stimulation Recipients
    Additional Considerations Regarding Spectral Allocation of Electroacoustic Stimulation    Additional Consideration: Acoustic Coupling
The Future of Electroacoustic Stimulation
Key Concepts

Chapter 13. Case Studies
Margaret Dillon, Jourdan Holder, Lisa R. Park, Jace Wolfe, and Erin C. Schafer
Case Study 1: Spatial Hearing Abilities With Default Versus Place-Based Maps
    Take-Home Points
Case Study 2: Programming a Child With Normal Low-Frequency Residual Hearing
    Take-Home Points
Case Study 3: Electroacoustic Stimulation and Unilateral Hearing Loss—Place-Based Programming
    Take-Home Points
Case Study 4: Optimizing Hearing Performance for a Bimodal User
Case Study 5: Addressing Poor Hearing Performance and Sound Quality Complaints for a Bimodal User
    Take-Home Points
Case Study 6: Basic Example of Creating Programs for an Adult Recipient
    Take-Home Points
Case Study 7: Establishing a Program for an Adult via Objective Measures
    Take-Home Points
Case Study 8: Creating Programs for a One-Year-Old Implant Recipient
    Take-Home Points
Case Study 9: Creating a Program for a Young Recipient Using the Advanced Bionics HiRes 90K Advantage Cochlear Implant
    Take-Home Points
Case Study 10: Inadequate Stimulation Levels and Narrow Electrical Dynamic Range
    Take-Home Points
Case Study 11: Using Objective Measures to Set Upper Stimulation Levels
    Take-Home Points
Case Study 12: Creating a Program for a Recipient With Multiple Disabilities
    Take-Home Points
Case Study 13: Use of Objective Measures as a Guide to Avoid Overstimulation
    Take-Home Points
Case Study 14: Addressing Speech Recognition Difficulties That May Be Associated With Excessive Stimulation
    Take-Home Points
Case Study 15: Utilizing Behavioral Information to Create a Cochlear Implant Program and Address Recipient Difficulties
    Take-Home Points
Electrode Impedance Case Studies
Case Study 16: Sawtooth Electrode Impedance Pattern Managed With Programming
    Take-Home Points
Case Study 17: Flat Low Common Ground Impedances With Performance Decrease
    Take-Home Points
Case Study 18: Physiological-Related Electrode Impedance Changes
    Take-Home Points
Case Study 19: Impedance Changes Secondary to Excessive Stimulation
    Take-Home Points
Case Study 20: Programming for a Teenage Recipient Who Had Significant Residual Hearing After Implantation
Key Concepts

References
Index