Auditory-verbal therapy

27. September 2018

In 2017, Hear the World donated cochlear implants (CI) for the first time, to three children in need in Panama. This spring, four more children with a profound hearing loss received the gift of hearing thanks to CI. Carina Rodríguez, Educational Audiologist & Research Project Manager at Advanced Bionics, volunteered in Panama when the implants were activated – a moment neither she nor the children will ever forget. But what happens before and after the activation?

Cochlear implants have to be surgically implanted. What happens after the surgery?

Right after the implantation of the CI, the patient cannot hear yet, because the external transmitter part is missing. The patient receives this part only about a month after the surgery during the first programming session. The time in between is necessary for the operative incision to heal completely. Once the swelling is gone, the clinician can do the first fitting and programming of the cochlear implant system. The audiologist may use the time period between surgery and initial stimulation to set up a programming plan.

How does the activation work?

This first fitting is often referred to as the initial stimulation, activation or hook-up. During the activation an audiologist adjusts the sound processor to fit the implanted patient, tests the patient to ensure that the adjustments are correct, determines what sounds the patient hears, and gives information on the proper care and use of the device.

And how does the activation work with children?

Audiologists who specialize in pediatrics use their experience to fit the device. Because programming a cochlear implant for children is different than it is for adults. Children typically do not have the experience to report when a sound is perceived as soft or loud. In addition, children do not have the attention span to sit for an hour of programming. Further, programming requires frequent adjustments as the child adapts to the device. While some children adjust very quickly, others require several weeks or months. How much sound a child perceives depends on several factors, including the age at implantation, length of deafness, previous experience with sound, and access to aural rehabilitation and therapy services.

What kind of sounds do the patients hear in the beginning?

At first, speech and sound from the environment can sound or feel like vibrations, clatter, or garbled noise. Some people can recognize speech right away, it may start out sounding natural, just like they remember. Very young children may not have association of sound, so they don’t know right away that they are hearing.
For children who have already learnt to speak (post-lingual), adjustment and progress with a CI may be faster than for children who didn’t learn to speak yet or who were born deaf. The Post-Lingual child has developed a “bank” of auditory skills from which to compare and expand with the new sound. The new sound with the CI is most likely different at first compared to sound remembered prior to the CI; however very quickly the difference fades and sound becomes natural.

How are children best introduced into the world of hearing?

Auditory therapy is essential for children. Helping a child learn to understand and utilize the hearing benefit provided by a CI is a complex process that requires experience and specialized training. That’s why language habilitation should be provided by someone knowledgeable about the hearing and listening needs of a child with a CI. Working with a music therapist often leads to improved perception of melody, rhythm, pitch and timbre, for both children and adults. Also involving parents in the therapy process for children has a positive effect on a child’s progress.

What is needed in terms of follow-up care after the successful activation?

Consistency of device use is very important. Within the first 30 days of initial stimulation, full time use of the implant system should be established. Motivation to practice listening and a support network are also important factors. A child should be seen by their audiologist on a regular basis, to assure access to optimal sound levels. Visits in the first couple of years can be as much as four to six times per year, depending on the age and progress. Later an annual visit is required to monitor progress and continue fine tuning. Definitely, a CI-user will need lifelong monitoring and control of the operation of the devices, as well as the optimization of the fitting to the specific demands of each stage of hearing. Overall, a rehabilitation program will offer information to the family or CI-user on what to expect with the device, as well as how to manage daily life with hearing loss.