Cochlear Implant Practice Patterns: The U.S. Trends with Pediatric Patients

Abstract

Overall, the findings support other recent studies that suggest the development of CI guidelines that may standardize programming and follow-up practices of CI audiologists. This could prove valuable for the continual improvement of CI outcomes, particularly in the pediatric population.

Cochlear Implantation for Children and Adults with Severe-to-Profound Hearing Loss

“…For these reasons, follow-up appointments for pediatric recipients typically continue more regularly well beyond the first year of device use. 25 Establishing the Electrical Dynamic Range The goal of CI device programming is to create a program that adequately maps the acoustic auditory environment onto an electrical dynamic range (EDR) that is delivered to electrodes across the internal array. 26 The EDR consists of the area of stimulation between an individual's threshold (known as T level where the softest level of stimulation occurs) and their upper stimulation level (known as C or M level) on each electrode.…”

“…Determination of EDR based on behavioral measures of loudness is the most commonly utilized method for establishing the EDR. 24,25 Threshold, similar to pure-tone audiometry, is defined as the softest sound the patient responds to consistently. Conversely, maximum stimulation level refers to the loudest sound a patient can pleasantly tolerate or the most comfortable listening level.…”

“…26,31 The electrically evoked compound action potential (ECAP) and electrically evoked stapedial reflex threshold (ESRT) measurements have been identified as two of the more common objective measures used in CI programming. 24,25 ECAP is the measurement and recording of whole-nerve action potentials in response to electrical stimulation, 32 and generally falls within a CI user's EDR of audibility. 26,33,34 A review of the literature by deVos and colleagues demonstrates that the point at which ECAP falls within the EDR is variable across CI users, making it difficult to confidently determine appropriate T and/or C/M levels with information based solely on ECAP thresholds.…”

“…ECAP was reported to be most commonly used at the activation appointment to set initial stimulation levels for the device, but was not commonly used in subsequent programming appointments. 25 These findings are concerning given the challenges routinely experienced by CI audiologists when programming pediatric patients, as well as the research supporting the use of objective measures such as ECAP and ESRT as a means of validation of audibility and assisting in establishing the EDR for children and adults. 40,47 More research is needed to better understand why these measures are not often implemented in the clinical setting.…”

“…51 Many audiologists report using some form of loudness balancing during programming. 24,25 However, loudness balancing may be difficult to complete for some CI users, such as those who are early-implanted or long-term deafened. 26…”