Cochlear Team

The cochlear implant team is a subset of the Ear & Hearing Center at Texas Children's Hospital is dedicated towards the evaluation and management of pediatric patients with profound sensorineural hearing loss. This team works closely to provide individualized, yet highly specialized, care for this diverse and complex patient population. Each team member gets to know each patient and their family quite closely during the cochlear implant evaluation process.

Members of the team include:

Otology, neurotology and skull base surgery
The leader of the cochlear implant team is an otolaryngologist-head and neck surgeon who has undergone fellowship training in surgery of the temporal bone and cranial base. This physician has the first contact with the patient, performs a medical evaluation, and makes the decision whether or not to consider cochlear implantation. If the decision is made by the entire cochlear implant team to proceed with cochlear implantation, this physician will perform the surgery.

Cochlear implant program coordinator
The program coordinator tracks all patients undergoing cochlear implant evaluation, and works very closely with the patient and their family. All tests and evaluations are scheduled through the coordinator, and when completed, the coordinator gathers the information to present at team meetings. The coordinator spends a great deal of time counseling the family. This includes teaching what a cochlear implant is and what it can be expected to do. Additionally, family members need to understand the degree of time commitment and hard work it will take on their parts to achieve an optimal long-term result. Often, the coordinator will learn about the child’s school environment by talking with their teachers or making a school visit. Visits to the home are sometimes required.

The audiologists who work with cochlear implantation are specially trained in this area. Pre-operatively, they determine the nature and severity of the hearing loss. This includes diagnostic hearing tests, hearing aid evaluations, and fittings. Additional tests such as auditory brainstem response and auditory steady state evoked potentials are commonly used to evaluate children with profound hearing loss. Finally, an auditory skill evaluation is performed to determine the child's ability to attend to and integrate sound using conventional amplification.

During the surgery, the audiologist is present in the operating room. Immediately before and after the cochlear implant is placed, they interface it to an external computer to verify that the internal electronics are working. If there is a device malfunction, a backup device is on hand so that it can be replaced before closing the wound.

After surgery, the audiologist has a long-term commitment to help the patient use the cochlear implant to the best of his or her abilities. Four weeks after surgery, they activate the device and begin initial programming. Repeated visits will be needed to determine what works best for each patient. This involves behavioral observation and condition response audiometry to set the current for each electrode site that will provide a tolerable, yet audible, level of electrical stimulation for the patient. The audiologist also obtains behavioral measurements of the child's response to sound using the implant and monitors and manages the hearing loss in the implanted and contralateral ear.

Speech, language and learning (speech pathology)
Speech, Language and Learning provides evaluation, management and consultation for infants, children, adolescents, and young adults with hearing impairments who are in the candidacy process for a cochlear implant. An initial evaluation is performed to determine the child’s performance levels in receptive and expressive language, speech and audition. The tests used during the initial evaluation are selected to fit the needs of the patient. Following the evaluation, results are shared with the cochlear implant team and parents. Occasionally, these services may include conferences with parents, teachers and other professionals. Recommendations are made and a report is written. Reevaluations are also conducted to document progress post-cochlear implantation. As a result of the initial evaluation, the speech-language pathologist may recommend speech therapy services for the patient. These regular sessions are designed to help the patient overcome or compensate for any problems identified in the evaluation related to the hearing loss. The sessions, usually held individually, are planned with activities appropriate for the patient based on the results of the evaluation. Not all patients seen for evaluation are enrolled in therapy with us. Other recommendations may be made, such as a referral for outside community services.

Genetic mutations are responsible for over half of the cases of childhood hearing loss. Children seen in The Hearing Center are evaluated by a geneticist specializing in pediatrics to look for syndromic features. This is so that other potential medical problems can be identified prior to serious illness occurs. Additionally, genetic counseling will be performed to help the parents understand their risk of having other children with hearing loss.

Developmental neurology
Some children being evaluated for cochlear implantation require an assessment by a child neurologist with expertise in neuro-developmental disability. This evaluation looks at the overall general pediatric, developmental and psychosocial condition of the child, in addition to whether there is any evidence of a neurological or genetic syndrome. It is very important to estimate each child’s future neurological status, as this can affect their ability to use a cochlear implant.

All children who are being considered for a cochlear implant will undergo extensive testing to assess their ability to learn to use an implant. This is because children with difficulty concentrating on tasks or learning may need additional support services after surgery to allow them to grow to their fullest potential. Testing of the parents is also performed because parental involvement in the child’s education is critical to achieving good outcomes. These tests are performed at regular intervals after implantation has been performed to allow us to adapt our rehabilitation strategy to the child’s needs.