Thursday, March 22, 2018

Choosing A Cochlear Implant – Is Your Provider Giving You All The Information?

By Eric Sherman



Recently, I found myself in a Facebook group chat discussing how someone decided on their cochlear implant.  The person shared that they “naively” went along with their surgeons recommendations.  Fortunately, the implant worked out well for the person, but it raised an interesting question.  How much influence does the healthcare provider have over the individual’s decision in selecting a cochlear implant brand? 

I posed this question in several cochlear implant Facebook Groups. What influenced your decision to choose a specific brand? And why?  177 people responded and interestingly 60% of those respondents stated their choice was influenced by the cochlear implant center (hospital included), audiologist, and surgeon.  This is reasonable considering people generally trust their hearing healthcare providers.  But another picture emerged about hearing health professionals I did not expect.

I found people were unaware they had a choice when they were going through the selection process for a cochlear implant.  Certain facilities and government run healthcare systems have contracts with certain manufactures and insurance, limiting the devices that were offered.  Also, choices were limited because of known recalls or device failures. Audiologist and surgeons have a certain level of comfort and experience working with certain brands, so they would guide patients toward one brand over another.  One person even shared that one of the cochlear implant manufacturers settled a lawsuit with the U.S. Department of Justice for alleged kickbacks to health care providers.

Trust and comfort is important when dealing with your hearing health professionals, and you should have all the facts when your audiologist, surgeon, or implant center recommends a life-long implant for you or a family member.   This includes knowing if their recommendations are based on business reasons, experience, or personal preferences. 

In the end, when going through your selection process for a cochlear implant, you need to do your research and due diligence.   If you can’t get the device you want implanted, you may have to switch providers or facilities. 

#cochlearimplant

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Ci Wear is a patented shirt designed to secure and help protect cochlear implant (CI) processors and other mobile listening devices. Use as a rash guard, swim shirt or an exercise apparel.    Ideal aqua accessory for waterproof cochlear implant sound processors. 

Friday, February 23, 2018

Troubleshooting Cochlear Implant | Processor Will Not Turn On

By Eric Sherman


Have you ever placed a fully charged battery into your cochlear implant processor only to find out it doesn’t power up? 


Dirt on battery terminal
In a blog story, AAA Batteries For Cochlear Implant Processors, I wrote about how rechargeable batteries can lose their capability to store a charge above 750 milliamps (mAh). When this happens the processor tends to turn on and then shut down or may not power on at all.  Well there may be another issue with the battery that can fool you into thinking your processor has gone bad.

Over time, the processor’s battery terminals can become dirty.  When this happens, the dirt forms a barrier between the battery and the processor’s battery terminals preventing your processor from turning on.
This happened to my son’s processor.  After a weekend of totally refreshing the rechargeable batteries, one of his processors didn’t power on.  I knew the batteries were good because they all tested above 900 mAh and they worked in the other processor.  Plus, my son had recently seen his audiologist for a mapping session and all his equipment checked out.  I thought I was going to have to buy a new processor because his is out of warranty.

Materials to Clean AB Neptune Processor
My son is bilaterally implanted and wears Advanced Bionics Neptune processors on a daily basis.  The Neptune processors are very durable, so it is hard to imagine that it would die from everyday use.

When examining the processor, I noticed what looked like a scuff mark on the brass battery terminal.  I grabbed a Q-tip and 91% isopropyl alcohol and cleaned the terminals in the processor.  The scuff mark came right off.  After making sure everything looked clean, I popped in a fully charged battery and the processor powered right up and has been working ever since. 

Practicing good maintenance on your hearing devices will help them last and stay in good working order. Make sure you follow your manufacturer’s instructions on maintenance and troubleshoot before you start looking at replacing your device. It might just save you time and a lot of money.


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Tuesday, January 2, 2018

AAA Batteries For Cochlear Implant Processors

by Eric Sherman

Have you ever put a fully charged AAA battery into your AB #Neptune processor and had it blink as if it had full power and then shortly after shut down? When we found ourselves in a similar situation, we would replace the battery with another fully recharged battery only to have the same thing happen.   Right away you think, “oh no, my processor is bad,” and then next thing you know, you are on the phone with customer service looking at replacing your device.

The beauty about the AB Neptune Processor is that it’s waterproof and very durable.  People participate in all kinds of extreme activities with their Neptune Processors and they continue to work.  Last year, we shared a story about a father who found his child’s Neptune at the bottom of the ocean (after three days) and the processor still worked.  For many recipients and their families, it’s disconcerting to see their processor shut down unexplainably. Well, it may not be a processor problem at all.

Our son has been wearing the Neptune Processors every day since he received them in 2012.  We have found that the processors will shut down if the battery drops below 750 milliamps (mAh).  Recently, our son’s processors were shutting down. We identified the batteries and did a refresh cycle in our smart charger.  After being refreshed, the batteries could barely make it to 500 mAh and the result was the processor would turn on, beep once and then shut off

Most rechargeable nickel–metal hydride (NiMH) batteries that are available in stores are 850 mAh and come in packs of 2 or 4.  If you are buying rechargeable batteries that are not 1000 mAh and you’re not using a smart charger (see blog story “Making Your Rechargeable Batteries Last Longer For YourCochlear Implant”) you may be misleading yourself into thinking your processor is bad.
Batteries for Cochlear Implant Processors


We buy our 1000 NiMH batteries online and have found that these brand batteries last at least a year or longer if refreshing and charging them with a smart charger.  The ones we recommend are Powerex, Sanyo, Panasonic or FDK.

If your processor is shutting down or doesn’t seem to power up when you put in a fully charged battery, do this simple test:
  1. Take a brand new alkaline Energizer battery, place it in your processor and see if it powers up and works for the day. 
  2. If it does, you have a rechargeable battery problem not a processor issue.  Often people will replace a bad battery with another bad battery unknowingly and think it is a processor issue.
  3. Lastly, try refreshing new batteries as it will help them properly hold a charge. You can get over 1,000 uses out of these batteries if you take care of them in the right way.

Tuesday, September 26, 2017

Back-to-School with Cochlear Implants – What You Need to Know

By Eric Sherman

School is back in session. Is your child prepared?  I’m sure you’ve already purchased items such as, backpack, pencils, paper, pens, etc., but what about your child’s cochlear implant(s)?  If you are like our family and sending your child off to school with cochlear implants, there are things you should know to help your child succeed in the classroom.  

Cochlear implants have been around for more than 30 years, but it is amazing how few schools or teachers are aware of this wonderful technology.  In our experience, most teachers and schools have never worked with a student who has cochlear implants, and we are in the second largest school district in the country. 

The population of school aged children receiving cochlear implants is growing. Unfortunately, parents have to make sure teachers and schools are educated about their child’s cochlear implants and hearing needs.  If you child is entering a public school in the U.S. with a cochlear implant, you should have an IEP or a 504 plan agreement in place.  These are legal documents under the Individual Disability Education Act (IDEA) to insure your child receives the necessary support in the classroom.  

The Individualized Educational Program (IEP) or a 504 plan is developed to ensure that a child with a disability receives specialized instruction, related services, and accommodations that will ensure their academic success and access to the learning environment.  Similar laws or rights may exist in other countries.

seating for DHH student
Classroom seating arrangement is important
to the success of a DHH student.
When appropriate accommodations are provided children with cochlear implants do very well in mainstream classrooms or in a special education programs.  We have found that the following steps are helpful to our child’s success in the classroom: 
  • Pack a bag in your child’s backpack with extra accessories (i.e. sound cord, audio jacks, etc.), batteries and troubleshooting instructions with your contact info. 
  • Make sure the school has appropriate assistive listening equipment in place, per IEP or 504 plan, at the start of school year.  This is generally an FM system that can directly connect to your child’s processor(s).
  • Meet with teachers during the first week of school and explain how the cochlear implant works, troubleshooting, etc. If your child is old enough or has the ability to advocate for themselves, great!  If not, you’ll still want to discuss the following:

o     Optimal seating for hearing needs in the classroom
o    How to change batteries, sound cords and headpieces, different programs on processor
o    Breaks if needed.  The sounds of a noisy classroom can be overwhelming for some children and small breaks can be helpful.
o     Possible behaviors that might occur if the processors aren’t working properly
o     Speaking naturally, in a clear voice, not talking to fast or shouting
o     Making sure child is following along with instruction
o     Repeating questions and answers during class discussions
o    When using audio & video equipment making sure it can connect to assistive listening equipment
o  Explaining to the teacher the importance of using the assistive listening equipment (i.e. FM system, Roger Pen, etc.)

Every child entering school has different hearing needs and it’s good to look for resources that will best support your child.   We found Advanced Bionics Tools for Schools had a pretty comprehensive list of materials. They have communication logs, tips for teachers, assessment tools, as well as other information that could be helpful in addressing your child’s needs.

If your child participates in school sports, extra-curricular activities, or just plays on the playground, make sure you have an accessory that secures and helps protect the processors.    Our son uses the specialty shirt Ci Wear to secure his devices.

It’s important to be involved and collaborate in your child’s education.  Nobody knows your child’s hearing needs better than you do.  The more the school knows the greater success your child will have in the classroom. 

If you like stories like this, we invite you to subscribe to our blog as well share with others.

Tuesday, May 16, 2017

Overstimulation May Be Why Your Child Won’t Wear Cochlear Implant processors

By Eric Sherman


Recently I shared why my child refused to wear his CochlearImplant(s). Unfortunately, the recommendation from others, including hearing health professionals, was just do your best to keep your child’s processor on.

Forcing a child to wear a cochlear implant that they clearly don’t want to wear is not the correct approach. Refusing to wear CI processor(s) is generally a symptom of a problem that a child can’t necessarily express. Their behavior becomes the only way to communicate the issue.

Pediatric Audiologist Joan Hewitt, Au.D., who specializes in cochlear implants says, “Our brains crave hearing.  Children should want to have their CIs on all the time.  If a child resists putting the CIs on in the morning, cries or winces when they are put on, or fails to replace the headpiece when it falls off, there is a strong possibility that the CIs are providing too much stimulation.   Some children appear shy or withdrawn because the stimulation is so great that interacting is painful. Others respond to over stimulation by being loud and aggressive.” 

In the article, "Overstimulation in Children with Cochlear Implants," Berger et al (2011) found symptoms which indicated children were overstimulated by their cochlear implants. They included: reluctance or refusal to wear the device, overly loud voices, poor articulation, short attention span or agitated behavior, and no improvement in symptoms despite appropriate therapy. When the researchers reduced the stimulation levels, they found very rapid improvement in voice quality and vocal loudness and gradual improvement in articulation.  Finally, they found "surprising effects on the children's behavior" such that the parents reported a marked improvement in attention and reduction in agitation.

If you find that your child is refusing to wear their cochlear implants, an overstimulating map could be the problem.  You should discuss the issue in detail with your child’s audiologist.

Jennifer Mertes, AuD, CCC-A, and Jill Chinnici, MA, CCC-A wrote in their article,
“Cochlear Implants — Considerations in Programming for the Pediatric Population,” (2006) AudiologyOnline, that children are not little adults. To address their CI needs, they require an experienced clinician. Most children are unable to provide accurate feedback while the audiologist programs their cochlear implant and therefore, the clinician must take many things into account:

  1. The audiologist's past experiences with other patients

  2. Updated information regarding the child's progress (from parents, therapists and teachers)

  3. Audiometric test measures

  4. Observations of the child during programming

  5. Objective measurements (NRT/NRI, ESRT)

  6. If age appropriate, the clinician will train the child to participate in programming (Conditioned Play Audiometry (CPA), loudness growth task.
Many of the decisions made during programming appointments come from the clinician's knowledge and experience, rather than the child's behavioral responses.

If your child continues to refuse to wear their processors after a remapping, take into consideration your audiologist’s experience and mapping approach and seek a second opinion.

When we sought out a second opinion with a new audiologist who specializes in pediatrics, she found our child’s map was overstimulating. Once she remapped our son's cochlear implants using a different approach, he didn't have a problem wearing his processors again.


More about the author

Eric Sherman is the inventor and founder of Ci Wear, the patented specialty shirt designed to secure and protect cochlear implant processors. Ideal for sports and water activities. No need for added accessories or clipping processors to collar. Shirts are manufactured in the USA and are available in youth and adult sizes at CIWear.com 

#cochlearimplants, #audiology, #parenting #mapping

Friday, May 5, 2017

Why My Child Won't Wear Their Cochlear Implant Processors?

By Eric Sherman

As a parent of a child with cochlear implants, the answer to this question shocked us and made us feel as if we were torturing our child. 

Our child was first implanted at about a year old and was seeing an AVT on a weekly basis.  Our son could definitively hear with his implant and responded well after activation.  As the weeks went on, our AVT would tell us that our son was not hearing certain vowels or consonants sounds and recommended we see our audiologist to have his map adjusted.
We went to our audiologist and told her that the AVT said our son was not hearing the /p/ or /s/ sound (for example).  The audiologist plugged our son’s processor up to the computer and began saying /ba/, /ba/, /ba/ over and over at different voice levels watching to see how our son responded then she would make changes to the map. 

We made this trip to the audiologist constantly over several months because the AVT kept telling us that our son was not hearing different vowels and consonant sounds.   We were remapping our son’s processor so often that we were starting to hear /ba/, /ba/, ba/ in our sleep. Then one day our son just refused to wear his processor.  He would throw off the headpiece as fast as we stuck it back on his head.  Unfortunately, He didn’t have the language ability to tell us why he wouldn’t wear the processor.  Our AVT suggested we go back to see the audiologist to check the equipment to make sure it’s working properly.

We set-up an appointment with the audiologist and she brought in a rep from the manufacturer to help go through diagnostics of the equipment to see if anything was wrong.  After a thorough review everything seemed to checkout.  Sadly, our son still refused to wear his CI processor.  Our audiologist’s recommended that we do our best to keep his headpiece on at all times, maybe use a headband, noting that maybe this was more of a behavioral issue.

Over the next couple of weeks, we did our best to keep our son’s headpiece on, but he wouldn’t have it. The AVT was starting to have problems working with our son.  He started to have new behaviors and was not responding to therapy. We were feeling that something was wrong with our child other than hearing loss. 

Eventually, our AVT recommended we see another audiologist to get a second opinion about our son’s equipment and map.  She sent us to an audiologist who is an expert working with cochlear implant pediatric patients.  This new audiologist was known for fixing issues children may be having with their implants.   

I remember how distraught my wife and I were as we shared our story with the new audiologist and showed her how our son was resisting wearing his processor.  She assured us that she would look at everything and see what she could do to help.  After running diagnostics, the audiologist turned to us and said, “there’s nothing wrong with your child or his equipment.”  After a massive sigh of relief, the audiologist told us our son’s map was over stimulating and probably the main reason why he is resisting wearing his processor.

The audiologist used the analogy of driving through the mountains with the radio volume turned all the way up with bad receptions; she said that was how your son’s processor was mapped.  She couldn’t blame him for not wanting to wear it.  We felt horrible as if we had tortured our child for weeks trying to make him wear his headpiece all the time.

What happened next truly shocked us.  This new audiologist began mapping our son using different consonant and vowels sounds, no more /ba/, /ba/, /ba/.  With her partner they elicited responses from our son using different vowel consonant sounds like /s/, /oo/, /ah/, /p/, /t/ etc.  After they were done, our son seemed very happy and joyous about the sounds around him.  From that moment on, our son never had a problem wearing his processor again.

I share this story because too often I hear similar stories and the recommendation to the parents is always try to keep your child’s processors on.  A behavior, such as refusing to wear a processor, is generally a symptom of a problem that a child can’t necessarily express. A behavior becomes the only way to communicate.  If your child is refusing to wear their processor(s), find out why.  Your child might not like the feel on their ear or the magnet strength is to strong, etc.  If the physical comfort of the processor is not the problem, check with your audiologist about the equipment and map.  If you walk out of your audiologist office and they have not resolved the issue, get a second opinion.

Don’t torture your child like we did by making them wear a poorly mapped processor.  Every day, when putting on your child’s device, do a simple check to see if your child can repeat or respond to different speech sounds or words.   If you feel there is a problem, talk to your speech or AVT therapist at your next visit or schedule an appointment with your audiologist.   Finally, if your audiologist doesn’t map your child using different speech sounds, it might be time to find a new audiologist.

Sounds used to map my child's cochlear implant processor
More about the author
Eric Sherman is the inventor and founder of Ci Wear, the patented specialty shirt designed to secure and protect cochlear implant processors. Ideal for sports and water activities. No need for added accessories or clipping processors to collar. Shirts are manufactured in the USA and are available in youth and adult sizes at CIWear.com

Friday, December 2, 2016

Don't Risk Losing Cochlear Implant Processors When Swimming

Recently, this story was sent to us by an audiology group about one of their patients who was surfing with cochlear implants while on vacation.

A storm was brewing, and a large wave pulled off my son's entire cochlear implant processor and headpiece. Devastated, he swam in to tell me, but searching for it was nearly impossible in the strong surf. For the next 3 days while the storm raged, I went down to the shore and watched the pattern of the wind and the waves. On my family's last day of vacation, the storm had finally subsided so the I decided to snorkel near some rocks the waves had been hitting. During one dive as a wave pulled away sand from the floor of the ocean, the dad saw something red under a rock. When I swam down to investigate, I found the processor still connected to the headpiece, which was stuck under the rock! When I  pulled on the processor, the headpiece would not budge. I knew that I was running out of air and if he went back to the surface to get a breath, another wave would come and bury the device again. So, I gave one final tug which pulled the headpiece free. I returned to the surface with the entire device! As if finding the processor after 3 days in the ocean was not amazing enough, my family was astounded to see that it still worked!

This is a truly amazing story with a happy ending, but many families and individuals around the world are not as lucky. Some people clip their processor to some part of their clothing only to find it lost after being tossed by a wave, or crashing on mountain bike. Mishaps during recreational activities happen. Unfortunately, for people with cochlear implants those mishaps can be very costly. 

As a parent of a child with bilateral cochlear implants, our greatest fear came when our son participated in any activity where there was a chance he could lose his processors. We became helicopter parents even though we never wanted to limit our child’s ability to participate in any activity. As a result of this problem, we created the Ci Wear shirt.

Ci Wear makes specialty shirts designed to secure and help protect cochlear implant processor(s). It has patented pockets that include elastic bands to clip the processor to and a button hole inside of the pocket to run the sound cord under the shirt. This reduces the risk of a wave, hard fall or crash knocking off your processor(s).

If you have ever spent money on a case to protect your cellphone, then a Ci Wear shirt is for you. It is the perfect accessory for your cochlear implant processor(s), and gives you the security, comfort, and confidence to participate in and enjoy all types of activities without the fear of losing your device.

#swimming #cochlearimplants #Secure #CiWear