Children with Cochlear The Freedom Cochlear Implant Implants

Children with Cochlear The Freedom Cochlear Implant: Implants on their Way to Another Innovation from Cochlear Inclusion Дети с кохлеарными имплантатами на пути к инклюзии Dr. h. c. Monika Lehnhardt Kiev, October 7 th, 2011

"90% of children with a CI will be successfully included in mainstream education provided they do not have an additional handicap and they get adequate rehabilitation with family support".

Step 1: Is there a hearing loss? Neonatal Hearing Screening Programmes

Accurate diagnosis

Neonate’s response to sound De. Casper & Fifer (1980) Spring and Dale 1977 Eimas et al (1971, 1979)

Infant vocalizations Stoel. Gammon & Otomo, 1986 Kent, et al 1987

The Window of Opportunity

Sharma et al, 2002 Ear and Hearing, December 2002

Sharma et al, 2004 13 month old recipient At CI activation 1 week post CI 1 month post CI 3 months post CI 12 months post CI 14 month old recipient Archives of Otolaryngology – Head & Neck Surgery, May 2004

Categories of Auditory Performance ref: P Govaerts, C De Beukelaer et al. , Neurotology and Audiology 2002 (Antwerp) Children with normal hearing use of telephone discrimination of speech sounds response to speech sounds

Govaerts, et al. 2002 Age at implantation Otology & Neurology, vol 23; 2002

Manuel Manrique, et al (2004) >2 yrs 2 to 6 yrs Laryngoscope, August 2004

Svirsky, et al (2004) Audiology and Neuro-Otology, vol. 9, 2004

Factors Key Factors supporting the dramatic changes in indication Continuous advances in technology (diagnostic equipment, hearing aids, implants, FM, assistive listening devices) Improved imaging and surgical techniques User friendly software for fitting and trouble shooting of cochlear implants Proven rehabilitation methodologies (e. g. oral education, auditory verbal approach)

Indication Broadening of indication Age (6 months - > 80 years) Severity of hearing loss (“totally deaf” – “severely hearing impaired” – “partially deaf”) Bilateral deafness – unilateral deafness Unilateral CI – bimodal (HA + CI) Children whose mother tongue is not the language of the country they are living in Multiple handicapped children / autistic children Deaf children with deaf parents

"90% of children with a CI will be successfully included in mainstream education provided they do not have an additional handicap and they get adequate rehabilitation with family support".