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Follow up and habilitation

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How the speech processor is fitted and tuned

Soon after the operation, your child must go to the cochlear implant centre for a check-up. The external part of the implant (the speech processor) will be fitted and programmed. This is sometimes called “switch-on”.

The electrical signals produced by the speech processor are very complex and their levels need to be set carefully to suit your child. The process of programming the speech processor is known as ‘tuning’ or ‘mapping’. The audiologist will take a number of measurements. These measurements help the cochlear implant team to develop an individual program for your child’s speech processor. For children with bilateral implants, often the two implants are activated gradually together.

The cochlear implant team will make sure that the levels that are set are comfortable for your child. Sometimes the first ‘mapping’ is done in one visit but usually it will involve a series of visits to complete all the measurements and choose the best form of electrical stimulation to meet your child’s needs.

Support after the operation and tuning

After the implant is fitted, your child will need long-term support from you, the cochlear implant team and local professionals. This support and care can make the difference between an implant being used effectively or less effectively. As a family, you need to know the vital role you, and other carers of your child, play in helping your child to use their implant and in supporting them to develop their listening, communication and language skills.

Your child will continue to visit the clinic for the process of mapping their implant’s speech processor and making adjustments as they learn to interpret the new signals.

It is important that you know the level of commitment that will be needed, particularly in the early years following implantation. Appointments at the implant centre mean you may need to take time off work and be away from the rest of your family. Ask your implant centre for a schedule of expected visits, both before and after the implant operation.

The sessions in the clinic will include time for the audiologist to tune the processor. There may also be a medical check and sessions with the teacher of the deaf and a speech pathologist.

It is important that you, your child’s school and the cochlear implant centre keep in touch with each other so that there is good communication between all those caring for and working with your child. It also means that any problems with the equipment can be reported and sorted out quickly.

The teachers of the deaf and speech pathologists from the implant team may visit your child at home and school to observe and record your child’s progress. They will also be able to answer your questions, talk to you about how you can help your child, and explain what you can realistically expect of your child’s progress.

As your child becomes older, they need to learn about their implant so that they can become responsible for looking after it. They will learn when to contact the implant centre for changes to the tuning and for repairs, spares, testing and advice. All implant systems have handbooks for users and it will be helpful for your child to become familiar with this. It is important that the implant team provides information that is easy to read and that your child will be able to understand.

If your child develops glue ear or an infection in the implanted ear it is important to contact your GP and get it treated quickly. You should also inform your cochlear implant team.

Communication and language

It is important to remember that it may take a long time for your child to learn to interpret new sounds through the implant. Every child is different and the time it takes will vary with each child. Your child will need to use these new sounds to develop their communication skills and spoken language. For a hearing child, this process starts at birth and takes place over years rather than months. For a child fitted with an implant, the process might take even longer.

After the speech processor has been fitted, you will need to make sure your child wears the system as much as possible. Practical details (such as the comfort and positioning of any body-worn speech processors or battery packs) are important, as your child will not want to wear the system if it is uncomfortable or keeps falling off! You can help your child to develop listening skills by playing games, singing songs and telling stories. With an older child, you may need to provide support and reassurance as they learn to make sense of the sounds around them.

While your child is learning to listen and interpret the new signals you will need to pay attention to listening conditions so that the background noise is kept at a reasonable level.

Before the implant was fitted your child may have been using sign language because they did not have enough hearing to understand spoken language. When your child is used to their implant, they may hear enough to understand and use spoken language. Many children make the change from sign-based communication to spoken communication naturally, but for some children sign language will remain an important part of their communication and identity. The most important factor is that your child can develop fluent language skills to communicate by whatever method is the most appropriate for them.

Issues around cochlear implants

Cochlear implants are increasingly used with very young children, but some people see them as controversial. Some deaf people believe that cochlear implants are unnecessary and that deaf children should not have one before they are old enough to make up their own mind. Other people believe that a cochlear implant gives a profoundly deaf child their best and only chance of gaining access to spoken language.

If you are interested in finding out more about this debate, it’s a good idea to talk to deaf people with and without cochlear implants, and to families and deaf children themselves about their experiences.

The external parts of the system can usually be upgraded in order to get the most benefit from the cochlear implant without having to change the implanted part. As new developments take place, upgrades should be made available to all children, young people and adults with implants.

The technology of cochlear implants has developed rapidly over the past few years and will continue to do so. Electro-acoustic implants are now available. These devices combine amplification of sound (like a hearing aid) with electrical stimulation (the implanted part) at the same time. These enable people with some useful low and mid-frequency hearing to benefit from the hearing aid part, whilst the electrodes of the implant stimulate the high frequency hearing range and therefore give access to the high frequency sounds of speech.

Research that will help us understand more fully the benefits of binaural hearing is ongoing. This includes attempting to clarify any unique benefits and differences using bimodal (hearing aid and cochlear implant together) and bilateral (two cochlear implants) stimulation.

Some young people who were fitted with one cochlear implant as young children are now asking for a second implant to be fitted. It is believed that the closer in time the two implants are fitted, the better the expected benefits from hearing with them together will be. Research is ongoing to help understand better the changes that occur in the non-implanted side and what length of time between implants may result in a second implant providing less benefit than anticipated.

Future technological developments may include the potential for implanting the whole device inside the head so there would be no (or fewer) external parts.

Related articles

Information supplied by the National Deaf Children’s Society. Reproduced with permission.
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