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(s)?

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