Candidacy for CI

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faire_jour

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Here is a link to an image I want to show everyone. I think it will clear up the whole candidate vs not issue we have been having lately. If you scroll down there is a clear audiogram that shows the hearing loss that is FDA approved for a CI. It is colored by adult, child over 2, and under 2. It also talks about speech recognition.

I don't know how to clip it or I would.

There is no "borderline". Either you are a candidate by these measures or you aren't. I think some people here are going to be very surprised.

http://www.audiologyonline.com/theHearingJournal/pdfs/HJ2008_11_p54-58.pdf
 
Minimum 90db across the board for young children, that sounds reasonable. I am surprised at the minimum criteria for adults:

125Hz: 40db
250Hz: 40db
500Hz: 40db
750Hz: 65db
1000Hz and up: 90db

Todays high end HAs can aid incredible amounts of loss down to normal or near normal hearing. My audiologist said if my high frequency HL was improved to 100db HL, I would have perfect speech comphrension with those HAs I wear.

As for 40db HL in the low frequencies, they already are doing hybrid CI and most people preserve enough low frequency hearing to benefit from a hybrid CI. I thought about the hybrid CI but if I lose any hearing with a shortened CI electode array, my low frequency hearing will then be profound and not enough to benefit from a HA.

From one of the websites that has an audiogram stating how much residual hearing you can have maximum to be a candidate:

125Hz: 70db
250Hz: 75db
500Hz: 85db
750Hz: 90db
1000Hz and up: 95db

They require a person to understand less than 30% of speech when listening to sentences. I probably would not meet their requirements since I may understand like 50% of the words in a given sentence. Id be "borderline" due to significent low frequency hearing. I am only a few db worse than the minimum they require.

Besides, even if someone is a CI candidate, that person should be trying all the best HAs with maxed out gains and transposition enabled(if supported) and get several months of speech training with their best HAs. CI is a last resort and you don't want CI if you can manage to get decent benefits from HAs. You never know till you try every other option. Deafdyke would agree with me 100% when she gets a chance to read this.
 
Todays high end HAs can aid incredible amounts of loss down to normal or near normal hearing.

Bringing hearing to normal or near normal levels does not solve the problem of distortion and lack of clarity.
 
Besides, even if someone is a CI candidate, that person should be trying all the best HAs with maxed out gains and transposition enabled(if supported) and get several months of speech training with their best HAs.

All the AVT in the world won't help a person who cannot discriminate speech due to lack of clarity.

As for trying out hearing aids, how far do you want people to go? Do you really expect someone to try every single high powered hearing aid on the market before receiving a CI?

I find it ironic how the 2 people who suggest this (deafdude and DD) are happy with hearing environmental sounds and have decent enough hearing with hearing aids to understand most speech.

Until you're in the position where you can't discriminate speech well in background noise or in quiet one-on-one situations, you have no way of understanding the frustration many of us go through when using hearing aids.
 
deafdude1 said:
Minimum 90db across the board for young children, that sounds reasonable. I am surprised at the minimum criteria for adults:

125Hz: 40db
250Hz: 40db
500Hz: 40db
750Hz: 65db
1000Hz and up: 90db

Todays high end HAs can aid incredible amounts of loss down to normal or near normal hearing. My audiologist said if my high frequency HL was improved to 100db HL, I would have perfect speech comphrension with those HAs I wear.
As for 40db HL in the low frequencies, they already are doing hybrid CI and most people preserve enough low frequency hearing to benefit from a hybrid CI. I thought about the hybrid CI but if I lose any hearing with a shortened CI electode array, my low frequency hearing will then be profound and not enough to benefit from a HA.

From one of the websites that has an audiogram stating how much residual hearing you can have maximum to be a candidate:

125Hz: 70db
250Hz: 75db
500Hz: 85db
750Hz: 90db
1000Hz and up: 95db

They require a person to understand less than 30% of speech when listening to sentences. I probably would not meet their requirements since I may understand like 50% of the words in a given sentence. Id be "borderline" due to significent low frequency hearing. I am only a few db worse than the minimum they require.

Besides, even if someone is a CI candidate, that person should be trying all the best HAs with maxed out gains and transposition enabled(if supported) and get several months of speech training with their best HAs. CI is a last resort and you don't want CI if you can manage to get decent benefits from HAs. You never know till you try every other option. Deafdyke would agree with me 100% when she gets a chance to read this.
Click to expand...

Really? You can hear the "th" sound? How about "f"? Those are at about 15 db at 4000 hz. I dare you to find a hearing aid that can bring a profound loss at 4000 hz up to 15 db. If you are happy with enviromental sounds, Hurray for you! I wasn't ok with that for my kid. Why stick with something VASTLY inferior when there is a BETTER option? CI's bring better high frequency hearing, improved clarity (so improved that my daughter didn't even realize it hearing, she didn't label it as hearing right away), and speech understanding, not just recognition for many who couldn't get it with hearing aids. WHY NOT?? I just don't get the reason to cling to a technology that isn't helping.
 
Speech training with HAs? That doesn't make sense to me......

Do people actually get AVT upon getting new hearing aids?

Isn't there a reason why AVT does not work for most, if not all, severe-profoundly deaf kids?
 
Daredevel7 said:
Speech training with HAs? That doesn't make sense to me......

Do people actually get AVT upon getting new hearing aids?

Isn't there a reason why AVT does not work for most, if not all, severe-profoundly deaf kids?
Click to expand...

AVT would be nearly impossible with a severe-profoundly deaf hearing aid user. It would be cruel for a child. How can you learn to listen when you can't hear?
 
Daredevel7 said:
Do people actually get AVT upon getting new hearing aids?
Click to expand...

In the 20+ years I've worn hearing aids, I never did -- even when my loss was profound in my left ear and severe-profound in my right.

In my opinion, you either have enough residual hearing to use it effectively or you don't regardless of what the audiogram says.

Simple as that.
 
Yea... that's what I thought..... I mean I see AVT more towards for CI users because the signal is there, but it's presented in an unnatural way. Same as learning braille, or some form of a tactile method. So you have to actually train to hear (and also to find where you need the adjustment if you have never heard before). With hearing aids, you're hearing things "naturally" but thru a filter and a distorter.

That's my opinion anyway.
 
Daredevel,

I think the reason why AVT is given to CI recipients is because there is more hearing to work with. Since a person is able to hear (generally) between 20 and 30 dB, it makes sense that they would be trained in regards to being able to hear/understand speech, use lipreading cues as well as identify sounds.

I had the opportunity to receive AVT after my first CI was activated, but since I did pretty well understanding speech 3 months later, I didn't see the need for it.
 
Daredevel7 said:
Yea... that's what I thought..... I mean I see AVT more towards for CI users because the signal is there, but it's presented in an unnatural way. Same as learning braille, or some form of a tactile method. So you have to actually train to hear (and also to find where you need the adjustment if you have never heard before). With hearing aids, you're hearing things "naturally" but thru a filter and a distorter.

That's my opinion anyway.
Click to expand...

Nope. AVT is to teach children to hear, but profoundly deaf kids with aids can't hear. They are not able to hear far enough into the speech banana to learn language without visual cues. That is why they can't (successfully) do AVT.
 
You never know till you try every other option. Deafdyke would agree with me 100% when she gets a chance to read this.
Click to expand...
Agreed.
Faire_jour and Hear Again,
I'm aware that there are FDA reccomended guidelines for implantation.
However, that doesn't mean there isn't "off label" implantation going on for folks who are borderline. Matter of fact, with the current state of health care costs in the US, it would surprise me if this wasn't happening! You know.....high insurance premiums PLUS the out of pocket costs for hearing aids. I do know of two boys who could hear in the high 60ish percentages aided getting implanted.
If I recall correctly the mom got them implanted b/c unaided they could only hear 10% unaided.
Yes, hearing in the high sixites isn't perfect, but it's a lot more then the little to no benifit from HA that CI folks claim is needed for implantation.
I mean it wasn't like they were hearing in say the low 30 percents with amplification. Up to or around 45% WITH amplification, I think should be implanted without a huge hassle. That's like a hoh person upgrading from ITE aids to BTEs.
"Off label" use of the CI is being seen. Yes, it prolly would be impossible to get it for a unilateral profound loss or whatever. And I do think that the majority of implantees opt for it after a long hard period of decision.
But there's the fact that some of the marketing practices about CI haven't been exactly kosher. (ie "comissions to audis for referring clients to CIs, stuff like random people IMing potentional CI implantees and telling them they should get a CI)
 
I know how you feel about CIs and "borderline" candidates DD -- although I agree with faire_jour that either you are a CI candidate or you're not. There are no two ways about it.

Besides, if the mother you mentioned wanted to have her child implanted and the surgeon agreed, what's so wrong about that? He could be hearing at 15-20 dB across all frequencies and have 90% speech discrimination or better.

By the way, did that child you mentioned have a progressive hearing loss? If he did, that probably explains why he was accepted as a CI candidate.
 
deafdyke said:
Agreed.
Faire_jour and Hear Again,
I'm aware that there are FDA reccomended guidelines for implantation.
However, that doesn't mean there isn't "off label" implantation going on for folks who are borderline. Matter of fact, with the current state of health care costs in the US, it would surprise me if this wasn't happening! You know.....high insurance premiums PLUS the out of pocket costs for hearing aids. I do know of two boys who could hear in the high 60ish percentages aided getting implanted.
If I recall correctly the mom got them implanted b/c unaided they could only hear 10% unaided.
Yes, hearing in the high sixites isn't perfect, but it's a lot more then the little to no benifit from HA that CI folks claim is needed for implantation.
I mean it wasn't like they were hearing in say the low 30 percents with amplification. Up to or around 45% WITH amplification, I think should be implanted without a huge hassle. That's like a hoh person upgrading from ITE aids to BTEs.
"Off label" use of the CI is being seen. Yes, it prolly would be impossible to get it for a unilateral profound loss or whatever. And I do think that the majority of implantees opt for it after a long hard period of decision.
But there's the fact that some of the marketing practices about CI haven't been exactly kosher. (ie "comissions to audis for referring clients to CIs, stuff like random people IMing potentional CI implantees and telling them they should get a CI)
Click to expand...

Did you see the chart? It said that you could have a fairly moderate sloping to profound loss and be approved. Also, speech scores don't show the audiogram, what was the loss like? It also addresses the speech scores in the chart.
 
For children to be eligible for bilateral Implants(NEW NICE guidelines for children) they have to have a severe-profound hearing loss. For adults to be eligible they also have to be severe-profound
 
Deafteen90 said:
For children to be eligible for bilateral Implants(NEW NICE guidelines for children) they have to have a severe-profound hearing loss. For adults to be eligible they also have to be severe-profound
Click to expand...

Actually, to qualify for a CI, adults and children can have moderately-severe to profound hearing loss in one ear and profound loss in the other.
 
Hear Again said:
Actually, to qualify for a CI, adults and children can have moderately-severe to profound hearing loss in one ear and profound loss in the other.
Click to expand...

According to what I posted you can have (for adults)

125- 40 db
250- 40 db
500- 40 db
750- 65 db
1000 and above- 90+

For kids over 2: just change the 40's to 60's
 
faire_jour said:
According to what I posted you can have (for adults)

125- 40 db
250- 40 db
500- 40 db
750- 65 db
1000 and above- 90+

For kids over 2: just change the 40's to 60's
Click to expand...

Despite what those qualifications say, CI candidacy criteria vary from one CI center to another. I know some CI recipients who had severe-profound hearing loss and were denied candidacy because the CI center they were evaluated at only implants those who have profound hearing loss.
 
Hear Again said:
Despite what those qualifications say, CI candidacy criteria vary from one CI center to another. I know some CI recipients who had severe-profound hearing loss and were denied candidacy because the CI center they were evaluated at only implants those who have profound hearing loss.
Click to expand...

Those are the FDA requirements for a Cochlear brand implant.
 
faire_jour said:
Those are the FDA requirements for a Cochlear brand implant.
Click to expand...

It doesn't matter. A CI center can implant whoever they wish. If they choose to only implant those who have 90+ dB loss, that is their perogative.

For example, this CI center in Arizona only implants adults and children who have bilateral severe-profound hearing loss:

http://www.hearaz.com/wst_page7.html

Current Pediatric Candidacy Criteria

12 months to 17 years
Bilateral Severe to Profound Sensorineural hearing loss
Lack of progress in the development of auditory skills
Negligible hearing aid benefit
No medical contraindications
Placement in an educational program that emphasizes the development of auditory skills

Current Adult Candidacy Criteria

Healthy adult over 18 years of age
Severe to Profound Sensorineural hearing loss
Limited benefit from hearing aids
No medical contraindications
Desire to be in a hearing world
 
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