Programming Cochlear Implants

Jace Wolfe, PhD, is the Senior Vice President of Innovation at the Oberkotter Foundation. He also is an adjunct Assistant Professor in the Audiology Department at the University of Oklahoma Health Sciences Center and Salus University. He previously served as the Editor for the American Speech-Language-Hearing Association's Division 9 journal and is currently a co-editor for the Plural Publishing, Inc. Core Clinical Concept Series on Cochlear Implants. Dr. Wolfe is a member of the Better Hearing Institute's Pediatric Advisory Board as well as the Audiology Advisory Boards for Cochlear Americas, Advanced Bionics, and the Phonak Hearing Aid Company. He is also serves on the Editorial Board of The Hearing Journal, and he is a reviewer for several peer-reviewed journals. Additionally, Dr. Wolfe co-authors a periodic column entitled the "Tot Ten" in The Hearing Journal and has published numerous articles in professional peer-reviewed and trade journals. His areas of interests are pediatric amplification and cochlear implantation, personal FM systems, and signal processing for children. He provides clinical services for children and adults with hearing loss and is actively engaged in research in several areas pertaining to hearing aids, cochlear implants, hybrid cochlear implants, and personal FM systems. Erin C. Schafer, PhD, is a Professor and Department Chair in the Department of Audiology and Speech-Language Pathology at the University of North Texas, where she has been a faculty member since 2005. Her research programs focus on the assessment and (re)habilitation of adults and children with hearing loss and auditory disorders and have produced over 100 publications and four textbooks. She is the Editor of Audiology Today for the American Academy of Audiology and past President and Journal Editor for the Educational Audiology Association.

• ContentsPrefaceIntroductionAcknowledgmentsContributorsChapter 1. Basic Components and Terminology of a Cochlear ImplantJace Wolfe and Erin C. SchaferBasic Operation of Cochlear ImplantsBasic Components of Current Cochlear Implant SystemsBasic Terminology of Cochlear Implant ProgrammingParameters Affecting Signal Coding in the Intensity DomainStimulation LevelsThreshold of StimulationUpper Stimulation LevelsCurrent Amplitude and Pulse WidthMapping Acoustic Inputs Into the Electrical Dynamic RangeParameters Affecting Signal Coding in the Frequency DomainElectrode Contact Versus ChannelVirtual Electrodes (Current Steering)Frequency AllocationParameters Affecting Signal Coding in the Time DomainStimulation RateBasic Cochlear Implant TerminologyElectrode Coupling Strategy/Stimulation ModeSequential Versus Simultaneous StimulationInterpolationSweepingLoudness BalancingRadio FrequencyTelemetryImpedanceVoltage ComplianceMixing RatioBasic Cochlear Implant Signal Coding StrategiesContinuous Interleaved SamplingHiResolution Sound Processingn-of-m StrategiesSpectral Peak (SPEAK)Advanced Combination EncoderFine Structure ProcessingSimultaneous Analog StimulationIntensity Coding in Cochlear ImplantsIntensity Coding in Advanced Bionics Cochlear ImplantsInput Dynamic RangeAutomatic Gain Control-2Effect of T and M Levels on Intensity CodingVolume ControlSensitivityChannel GainIntensity Coding in Nucleus Cochlear ImplantsInput Dynamic Range, Instantaneous Input Dynamic Range, T-SPL, C-SPL, Automatic Gain Control, Sensitivity, and Autosensitivity ControlVolume ControlIntensity Coding in MED-EL Cochlear ImplantsInput Dynamic Range, Electrical Dynamic Range, and Adaptive Sound WindowDual-Loop Automatic Gain ControlMaplawKey ConceptsChapter 2. Basic Principles of ProgrammingJace Wolfe and Erin C. SchaferPreactivation ProceduresRealistic Expectations Prior to ActivationReviewing Logistics of Cochlear ImplantationFamiliarity With Cochlear Implant HardwareSetting the StageProgramming After ImplantationPhysical EvaluationSelecting a Signal Coding StrategyStreamlined Versus Comprehensive ProgrammingMeasuring Stimulation LevelsSetting Threshold Levels for AdultsSpecial Considerations for Setting Threshold Levels for ChildrenAdditional Measure to Ensure Adequate T Levels and Confirm AudibilitySetting Upper Stimulation Levels for AdultsSetting Upper Stimulation Levels for ChildrenAdditional Considerations in the Measurement of Stimulation LevelsAdjustments to Special ParametersStimulation RatePulse WidthChannel GainFrequency AllocationInput Dynamic RangeMaximaKey ConceptsChapter 3. Advanced Bionics HardwareJace Wolfe and Erin C. SchaferAdvanced Bionics Sound ProcessorsNaida CI Marvel and Sky CI Marvel Sound ProcessorsSound Processor MicrophonesDigital Signal ProcessingProcessor ControlsMarvel CI M AquaMicNaida Marvel CI LED Light and Internal AlarmsNaida CI Marvel ConnectivityAutoSense OS 3.0Phonak Link Hearing Aid and Adaptive Phonak Digital Bimodal Fitting FormulaAdaptive Phonak Digital Bimodal Fitting FormulaAdvanced Bionics AB Remote AppAdvanced Bionics Chorus Sound ProcessorAdvanced Bionics Universal and AquaMic HeadpiecesNaida CI Q Sound ProcessorsNaida CI Q Battery ModuleNeptune Sound ProcessorAdvanced Bionics Internal HardwareHiRes Ultra Cochlear ImplantMid-Scala Electrode ArrayHiFocus SlimJ Electrode ArrayHiRes 90K Advantage Cochlear ImplantHiRes 90K Implantable Cochlear ImplantKey ConceptsChapter 4. Programming Advanced Bionics ImplantsJace Wolfe and Erin C. SchaferAdvanced Bionics Programming InterfaceAdvanced Bionics CI Target Programming SoftwareStep 1: Client Section-Enter Patient and Implant Information/Telemetry MeasuresHome Page and Training ModeWorkspace TabsImplant SettingsAudiogramStep 2: Instruments SectionImpedance MeasurementFitting SectionMappingSignal Coding StrategyPulse Width and Stimulation RateFilter TypeRadio-Frequency LockStep 3: Setting Stimulation LevelsMaps Versus Programs in Target CI SoftwareCreating Multiple MapsFine-TuningProgramsManual ProgramsAdditional Considerations for AutoSense OS 3.0 and Manual ProgramsSpanProgressive LevelsProgram ManagerMaps and Programs in the Marvel Sound ProcessorBilateral MapsData LoggingDevice OptionsSave and ClosePresenting Programming StimuliMeasuring T LevelsMeasuring M-Level StimulationElectroacoustic Stimulation-Marvel Acoustic EarhookProgramming Advanced Bionics Bimodal Recipients in Target CIAdvanced Bionics Active Insertion Monitoring SystemProgramming in Advanced Bionics SoundWave SoftwareStep 1: Create or Select RecipientStep 2: Connect Sound Processor and Conduct Electrode Impedance MeasurementStep 3: Create a MAP in the SoundWave SoftwareSelect Sound Processing StrategyPulse Width and Stimulation RatesClearVoiceSoftVoiceStimulus Units and Measuring T LevelsMeasuring M-Level StimulationChannel Clipping and SpanInput Dynamic Range and Automatic Gain ControlMicrophone SensitivityLockExtended FilteringChannel GainsLoad MAPs Onto Sound Processor as User ProgramsDuoPhoneZoomControlStereoZoomMic ModeWindBlock, SoundRelax, EchoBlockAudio-Mixing RatioInternal TelecoilVolume Minimum and Volume MaximumDirectTouchClear Slot and StimulateAudible Alarms and QuickSyncAdditional User OptionsLoading Programs Into Advanced Bionics Sound ProcessorsData LoggingGround (Return/Reference) ElectrodeKey ConceptsChapter 5. Cochlear Nucleus Cochlear Implants and Sound ProcessorsJace Wolfe and Erin C. SchaferIntroductionNucleus Sound ProcessorsNucleus 7 Sound ProcessorNucleus 7 FeaturesNucleus 7 Microphone TechnologyNucleus 7 ElectronicsNucleus 7 User OptionsNucleus 7 Acoustic ComponentNucleus 7 AccessoriesNucleus 7 Wearing OptionsNucleus 8 Sound ProcessorNucleus Kanso 2 Sound ProcessorNucleus Kanso 2 MicrophonesNucleus Kanso 2 ElectronicsNucleus Kanso 2 Wearing OptionsNucleus Kanso Sound ProcessorNucleus Kanso MicrophonesNucleus Kanso ElectronicsNucleus Kanso Wearing OptionsNucleus 6 Sound ProcessorWearing OptionsBattery OptionsProcessor Buttons and LightsProcessor Direct Auditory Input PortWireless Remote AssistantsNucleus Cochlear ImplantsThe Nucleus Profile Cochlear ImplantNucleus Profile Plus Cochlear ImplantNucleus Freedom Internal DeviceNucleus Electrode ArraysNucleus Slim Modiolar ElectrodeNucleus Contour Advance ElectrodeNucleus Slim Straight ElectrodeNucleus Slim 20Nucleus Straight Electrode ArrayNucleus Double ArrayNucleus L24 Hybrid Electrode ArrayNucleus Slim 20 Electrode ArrayKey ConceptsChapter 6. Programming Nucleus Cochlear ImplantsJace Wolfe and Erin C. SchaferProgramming Nucleus ImplantsProgramming Nucleus Sound ProcessorsCreating Recipient FilesThe Programming ProcessDashboardMeasureImpedancesTransimpedance Matrix MeasurementAutoNRTAdjustOpening or Creating MAPMaster VolumeFour Options for Creating New MAPs in Custom Sound ProAutoNRTPopulation MeanOther MeasuresThresholdsInitial Activation in Custom Sound ProCustom Sound Pro-Follow-Up Programming SessionsParametersStrategyStimulation ModeChannel Rate (Hz)MaximaPulse Width (Microseconds)Power Level SettingTone Level (%DR), Tone Channel, Low Tone ChannelVolume AdjustmentManufacturer's SettingsFrequency TableT-SPL and C-SPLLoudness GrowthSet Levels ScreenAdjusting Default ParametersDetermining Stimulation Levels for Nucleus Cochlear ImplantsOptimizing T LevelsOptimizing C LevelsOptimizing the Electrical Dynamic RangeChannel GainsVoltage CompliancePrediction of Stimulation Levels From Other ProgramsProgressive MAPsDouble-Channel MappingChannel-to-Electrode AssignmentFinalizeAdjust and Configure Programs and Input ProcessingInput ProcessingNucleus Input Processing Technologies and Considerations for UseAutosensitivity Control and Autosensitivity Control BreakpointAdaptive Dynamic Range OptimizationBeam and FocusZoomForward FocusSCANSCAN 2SCAN 2 FFSNR-NR-Signal-to-Noise Ratio-Noise ReductionWNR - Wind Noise ReductionWhisperProcessor SettingsPower Level and Battery LifeNeural Response Telemetry Measurement and AutoNRTProgramming Previous Generations of Nucleus ImplantsCochlear CR120 Remote AssistantNucleus SmartNav SystemKey ConceptsChapter 7. Cochlear Implant HardwareJace Wolfe, Sharon Miller, and Erin C. SchaferMED-EL CorporationSONNET 2 Sound ProcessorSONNET 2 Wearing OptionsDL-Coil With MagnetsSONNET Sound ProcessorOPUS 2 Sound ProcessorBattery/Wearing OptionsRONDO 3RONDO 3 CoverBattery OptionsRONDO 3 MagnetsRONDO 2Battery OptionsAudioLink Wireless AccessoryFineTuner Echo Remote ControlFineTunerAdditional Features in MED-EL SystemsMED-EL Speech Processor Test DeviceMED-EL Microphone Test DeviceSYNCHRONY Cochlear ImplantSYNCHRONY 2 Cochlear ImplantMED-EL Electrode Array OptionsMED-EL FLEX SeriesMED-EL FORM SeriesClassic Electrode Array SeriesAdditional MED-EL Electrode ArraysMED-EL Auditory Brainstem ArrayAdditional MED-EL Cochlear ImplantsMED-EL CONCERT Internal DeviceSONATA TI100 Internal DevicePULSAR CI100 Internal DeviceSONNET 3 Audio ProcessorKey ConceptsChapter 8. Programming MED-EL Cochlear ImplantsJace Wolfe, Sharon Miller, and Erin C. SchaferProgramming MED-EL ImplantsPatientsProgramming InterfaceTelemetry-Impedance and Field Telemetry MeasurementCreating a MAP in MAESTROSetting Stimulation Levels to Create a MAPMeasuring MCLSetting MCLs With a Flat-MAP in Live SpeechElectrically Evoked Stapedius Reflex Threshold MeasurementsSweeping, Balancing, and InterpolationSet Levels Grid/TableMeasuring THRShift & Tilt, Pivot, InterpolationStrategy SectionStimulation RateChannel-Specific Sampling Sequence ChannelsCompliance Level ControlVolume ModeChannel Interaction CompensationPulse CharacteristicsFrequency BandsMaplawIndicatorsLoading Programs Onto MED-EL Sound ProcessorsASM 3.0 Input Processing ParametersAdaptive IntelligenceMicrophone DirectionalityAmbient Noise Reduction, Transient Noise Reduction, Wind Noise ReductionCompression Ratio and SensitivityAdditional Considerations for ASM 3.0 SettingsAdditional Programming OptionsSettings MenuElectroacoustic Stimulation of MED-EL RecipientsMED-EL-Specific TroubleshootingAdditional ConsiderationsAuditory Response Telemetry, AutoART, ARTFit, and Electrically Evoked Auditory Brainstem ResponseMED-EL OTOPLANChapter 9. Clinical Considerations: Putting All of the Pieces TogetherJace WolfeCollaboration With the Cochlear Implant Surgeon/Medical EvaluationProgramming ScheduleInitial Activation SessionInitial ActivationRealistic ExpectationsMeasuring Stimulation Levels at Initial ActivationOne-Week Postactivation AppointmentOne-Month Postactivation Programming SessionRemainder of Programming ScheduleThe Role of Electrically Evoked Potentials in ProgrammingAdditional Habilitative/Rehabilitative ConsiderationsConsiderations for Bilateral Cochlear ImplantationThe Benefits of Binaural HearingProgramming Considerations for Bilateral Cochlear Implant RecipientsConsiderations for Bimodal UsersProgramming Considerations for Bimodal UsersConsiderations for Individuals With Single-Sided Deafness and Cochlear ImplantsKey ConceptsChapter 10. Troubleshooting and Managing Patient Complaints and ComplicationsJace Wolfe and Erin C. SchaferIntroductionPatient Complaints and ComplicationsManaging Recipients Who Experience Disappointing OutcomesExternal HardwareDetermine Wear Schedule and Facilitate an Auditory LifestyleEvaluate the Appropriateness of the Cochlear Implant ProgramAssessment of Internal HardwareIdentifying "Ref Flags"Cochlear Implant Programming Tips to Address Common Recipient ComplaintsInsufficient Audibility for Low-Level Sounds (Poor Understanding of Soft Speech/Aided Thresholds Poorer Than 25 to 30 dB HL)Poor Speech Recognition in NoiseFacial Nerve Stimulation/Other Nonauditory Side Effects Associated With Stimulation From the Cochlear ImplantChapter 11. Hearing Assistance Technology and Cochlear ImplantsErin C. Schafer, Jace Wolfe, and Sharon MillerBasic Description of Personal SystemsOptimal Systems for Use With a Cochlear ImplantDescription and Programming for Personal Hearing Assistive Technology and Cochlear ImplantsFrequency Modulation and Digital Radio-Frequency TransmittersFrequency Modulation, Radio-Frequency, and Induction Loop ReceiversProgramming Considerations for Frequency Modulation/Radio-Frequency Receivers and Sound ProcessorsProgramming and Fitting Remote Microphone ReceiversSound Processor Programming and Hearing Assistive TechnologyAudio-Mixing RatiosInput Dynamic RangeMicrophone SensitivityFitting Procedures for Personal Remote Microphone SystemsMonitoring and Troubleshooting Personal Frequency Modulation/Radio-Frequency Systems for Cochlear ImplantsHearing Assistive Technology to Improve Telephone ConversationsTelecoilsTelecoil AccessoriesStreaming DevicesSummary of Hearing Assistive Technologies for Cochlear ImplantsKey ConceptsChapter 12. Programming Recipient Using Electroacoustic StimulationJace Wolfe and Erin C. SchaferIntroductionElectroacoustic Stimulation HardwareElectroacoustic Stimulation Sound ProcessorsElectroacoustic Stimulation With the Advanced Bionics Marvel Sound ProcessorElectroacoustic Stimulation With the Cochlear Nucleus 7 Sound ProcessorElectroacoustic Stimulation With the MED-EL SONNET 2 EAS Sound ProcessorProgramming Considerations for Electroacoustic Stimulation RecipientsClinical Protocol for Programming Electroacoustic Stimulation DevicesAudiometric AssessmentFitting of the Acoustic ComponentProvision of Electric Stimulation for Electroacoustic Stimulation RecipientsAdditional Considerations Regarding Spectral Allocation of Electroacoustic Stimulation Additional Consideration: Acoustic CouplingThe Future of Electroacoustic StimulationKey ConceptsChapter 13. Case StudiesMargaret Dillon, Jourdan Holder, Lisa R. Park, Jace Wolfe, and Erin C. SchaferCase Study 1: Spatial Hearing Abilities With Default Versus Place-Based MapsTake-Home PointsCase Study 2: Programming a Child With Normal Low-Frequency Residual HearingTake-Home PointsCase Study 3: Electroacoustic Stimulation and Unilateral Hearing Loss-Place-Based ProgrammingTake-Home PointsCase Study 4: Optimizing Hearing Performance for a Bimodal UserCase Study 5: Addressing Poor Hearing Performance and Sound Quality Complaints for a Bimodal UserTake-Home PointsCase Study 6: Basic Example of Creating Programs for an Adult RecipientTake-Home PointsCase Study 7: Establishing a Program for an Adult via Objective MeasuresTake-Home PointsCase Study 8: Creating Programs for a One-Year-Old Implant RecipientTake-Home PointsCase Study 9: Creating a Program for a Young Recipient Using the Advanced Bionics HiRes 90K Advantage Cochlear ImplantTake-Home PointsCase Study 10: Inadequate Stimulation Levels and Narrow Electrical Dynamic RangeTake-Home PointsCase Study 11: Using Objective Measures to Set Upper Stimulation LevelsTake-Home PointsCase Study 12: Creating a Program for a Recipient With Multiple DisabilitiesTake-Home PointsCase Study 13: Use of Objective Measures as a Guide to Avoid OverstimulationTake-Home PointsCase Study 14: Addressing Speech Recognition Difficulties That May Be Associated With Excessive StimulationTake-Home PointsCase Study 15: Utilizing Behavioral Information to Create a Cochlear Implant Program and Address Recipient DifficultiesTake-Home PointsElectrode Impedance Case StudiesCase Study 16: Sawtooth Electrode Impedance Pattern Managed With ProgrammingTake-Home PointsCase Study 17: Flat Low Common Ground Impedances With Performance DecreaseTake-Home PointsCase Study 18: Physiological-Related Electrode Impedance ChangesTake-Home PointsCase Study 19: Impedance Changes Secondary to Excessive StimulationTake-Home PointsCase Study 20: Programming for a Teenage Recipient Who Had Significant Residual Hearing After ImplantationKey ConceptsReferencesIndex