Paediatric Programme

More information

Brief overview

The New Zealand Government provides hearing screening for all newborns in New Zealand. For further information on The Universal Newborn Hearing Screening and Early Intervention Programme see http://www.nsu.govt.nz/newborn-hearing-screening.aspx

Some children are born with a hearing loss, and others develop a hearing loss later on. There are varying levels of hearing loss. For an overview of hearing loss in New Zealand, see www.nfd.org.nz. Many children receive adequate benefit from hearing aids; however, a cochlear implant should be considered for children who do not receive adequate benefit from hearing aids.

Suspecting a hearing problem


Usually it is parents or primary caregivers who are the first to suspect something is wrong with a child’s hearing. This may be due to the lack of response from the child when a parent speaks to the child from across a room, or even a lack of response to other unexpected sounds such as a door slamming. Others might become concerned if their child appears reluctant to speak or gets to an age where they seem behind their peers when communicating.




What should you do?


It is never too early to take the first step and talk to your talk to your GP or another Health Professional about your concerns. They are trained to know about children’s development, including the age at which children should be starting to speak and communicate. It is likely they will refer your child for a comprehensive hearing test. If you continue to have concerns and your child is not referred, keep pushing for your child to have a comprehensive hearing test by an Audiologist.




Assessing a hearing problem


Hearing tests for children are painless, even for very small babies, and are an effective way to work out if a child has a hearing loss and, if they do, the extent of that loss. A hearing test measures a child’s ability to hear sounds of different volumes (loudness) and pitch (high and low sounds). These measurements are recorded on a graph of a child’s hearing called an audiogram.

Hearing loss can be defined as mild, moderate, severe, or profound based on the extent of the hearing loss.

The majority of children diagnosed with a hearing loss have a mild to moderate hearing loss and many need a hearing aid rather than a cochlear implant.

If an Audiologist or other Health Professional feels your child may benefit from a cochlear implant, they can refer your child to the paediatric cochlear implant assessment programme for an assessment.




Eligibility and Assessment


Eligibility for a CI depends on a multitude of different factors; your child will be assessed by a multidisciplinary team including an Ear, Nose, and Throat Surgeon, Audiologists and an Auditory-Verbal Therapist.

The length of time required for the assessment will vary for each child, depending on age, previous hearing aid use, and language development. The assessing team meet once the assessment is complete to discuss if a cochlear implant would be appropriate for your child. The child’s parents/caregivers are informed of the outcome at this stage. It is crucial that parents/caregivers are aware of the commitment required of families in order to ensure their child benefits as much as possible from having a cochlear implant. The operation to insert a cochlear implant is simply the first step in helping a hearing-impaired child learn to listen and speak.

The second, much more time-consuming step involves the parents/caregivers helping their child learn to listen and speak. An Auditory-Verbal Therapist will work with you and your child to achieve this goal.




Surgery


An operation under general anaesthetic is required to insert the cochlear implant. Usually the operation can last anywhere between two and three hours for an implant and there is mild discomfort for up to a week after the surgery. A small amount of the child’s hair is shaved before surgery and there is a small scar behind the ear which is almost invisible when the hair regrows. It is common for the ear to stick out a little after surgery, but this eventually settles down. The area where the implant package has been placed is slightly prominent, but it is unusual to have any significant swelling in this area. After surgery, a child stays overnight at Gillies Hospital in Auckland – with their parent in the same room – and then goes home the next day. Sometimes it may be possible to return home the same day. Details of surgery are explained during the assessment process.

A child is prescribed antibiotics for a few days after surgery in order to reduce the risk of infection, and parents are told to keep a close eye on the wound to make sure it doesn’t swell up or become red, which can be a sign of infection. Dissolvable stitches are usually used so that a child does not need to get these removed. Further follow-ups with the surgeon are carried out shortly after surgery and again at a few months later.




Switch-on


Approximately two weeks following surgery, the speech processor is switched-on. The ‘switch-on’ involves careful programming of the speech processor to ensure the cochlear implant provides the right levels so that the child has access to sound. This is termed ‘MAPping’. The child will return again the next day for continued ‘MAPping’ and will typically require approximately 10 appointments within the first year for further refinement. Generally speaking, after one year, the levels are stable, and the child will be seen either once or twice a year, depending on age. Each child’s progress is monitored carefully.




Habilitation


Habilitation is the process of teaching the deaf child to match sound to meaning. Young children will begin with “a clean slate” and learn to listen and match the sound to meaning in the same way a new-born baby does.

If the child or teenager has already developed language prior to getting a cochlear implant, habilitation will help them to acquire what they have missed while they had compromised access to sound. It is important to ensure a child receives as much benefit from the implant as possible. The Hearing House and Kelston Deaf Education Centre are joint providers of habilitation services for the northern region. After surgery, a child embarks on extensive therapy to meet their communication potential. It is recognised that children will achieve best if the family are given regular intensive guidance at therapy sessions to enable them to work daily on listening targets in the home.

Auditory-Verbal Therapy uses the child’s access to sound to learn to listen and speak. This works by accelerating the natural way a child would develop language, and requires the family to be the main teacher of their child’s language. The ultimate aim of Auditory-Verbal Therapy is for the child to speak as clearly and naturally as their hearing peers — and ideally, to attend a mainstream school by the time they are five.

Most children attend therapy with their parents or carers once a week for an hour, even if they are babies. Each week, parents/carers are given new sounds or words to focus on with their child at home and the Auditory-Verbal Therapist works closely with children and families to maximise opportunities to learn to listen and speak. Those who interact with the child regularly, such as grandparents, guardians, and other caregivers (such as preschool teachers) are also encouraged to help the child learn to listen and speak by understanding their language goals.

Over time they will attend less regularly, but this first period is important to try and catch up on auditory stimulation the child missed out on before they got their device.

Children aged five and over receive habilitation services from Kelston Deaf Education Centre (KDEC) but receive audiology services from the Hearing House. KDEC has a residential facility and core school in Auckland, ranging from preschool to students who are preparing for tertiary study or the workforce. KDEC also operates classes in satellite units for students in mainstream schools and has responsibility for managing Resource Teachers of the Deaf who work in the catchment area for the Northern Cochlear Implant Programme (north of Taupo). Kelston’s communication philosophy is based on the following principles:

  • Full access to all communication;
  • Respect for the communication needs of every student;
  • Acceptance of all modes of communication, including New Zealand Sign Language, and spoken and written English;
  • Bridging sign and English speech reading; and
  • Using residual hearing for all children unable to access communication through an oral mode.





The Northern Cochlear Implant Trust holds contracts with the Ministry of Health and Ministry of Education for the Northern Cochlear Implant Programme. Patients eligible for a publicly funded cochlear implant receive services from providers listed below:

Suspecting a hearing problem


Sometimes people do not realise how bad their hearing has become unless someone else tells them. Most often it is a family member who realises that their relative is unable to hear them properly. Sometimes a hearing loss is relatively mild – you may not be able to pick up conversations at a noisy party - but sometimes the hearing loss progresses to the point where you need either hearing aids or a cochlear implant to help you hear better. The best plan is to talk to your GP or Health Professional who can refer you to an Audiologist or, if you prefer, you can contact an Audiologist directly who will perform a hearing test.




Assessing a hearing problem


A hearing test is pain-free and can reveal if an adult needs to be referred to the adult cochlear implant assessment programme, which is run at the University of Auckland’s Tamaki campus. The hearing test can measure an adult’s hearing levels on an audiogram, which is basically a graph plotting how well someone can hear. If an audiologist diagnoses that an adult has a severe to profound hearing loss, they are referred to Auckland University’s audiology clinics for further tests.




Eligibility


An adult may be eligible for a publicly-funded cochlear implant if they have a severe to profound hearing loss and hearing aids are unable to help their level of hearing loss. There is no maximum age for referral to the Adult Cochlear Implant Programme based at the University of Auckland, which provides audiology assessments for those referred to the cochlear implant programme. Currently the Government caps the number of adults eligible for a publicly-funded operation. There is no maximum age for referral. Patients with additional needs are not excluded.

Adults can be referred to the NCIP assessment programme if they:

  • Have a bilateral moderate to profound sensorineural hearing loss, one that is above 90 decibels for their better ear.
  • Have developed spoken language; (however, a cochlear implant may be considered on a case by case basis for adults with little spoken language if there is a significant need for hearing of environmental sounds).
  • Receive no or limited benefit from hearing aids.




Assessment


The Northern Cochlear Implant Programme (NCIP) assessment process for adults is a multi-stage process which involves hearing tests, a medical evaluation, and an assessment to check that a person would benefit from a cochlear implant. A Computerised Tomography scan (CT) to check that the surgery is possible may also be required.

Step 1 involves review by the NCIP Adult Programme Team Leader, and then referral to a Hearing Therapist who undertakes a communication needs evaluation and also screens them for speech perception.

If the referral to the NCIP Programme is accepted, then an information pack is sent to the client and they are referred to a local Ear, Nose, and Throat Specialist for a medical evaluation and CT scan.

The client is then invited to a two-day assessment in Auckland. This involves various sessions that may include the following:

  • An audiology appointment where the client is tested with and without hearing aids to verify the level of hearing loss.
  • Rehabilitation appointments where a client’s speech perception is tested
  • Appointments with a cochlear implant user
  • Demonstrations of cochlear implant equipment and how it works
  • Discussions about an implant’s limitations
  • Discussion regarding the client’s expectations about having an implant
  • A 45-minute meeting with an Ear Nose and Throat Specialist where medical issues, the surgical procedure, an ear check, and results of the CT scan are discussed.

A decision is then made by the assessment team, in consultation with the client, on whether to go on the waiting list for cochlear implant surgery.




Surgery


Discussions about the surgery itself take place in a pre-operative consultation where details about what to expect before and after the operation are explained by the ENT Surgeon.

Admission to Gillies Hospital, where the operation will take place, is usually on the actual day of surgery. After admission by nursing staff, there is a consultation with the anaesthetist who explains what happens with the anaesthetic (cochlear implant surgery is done under a general anaesthetic).

Before surgery, both ears are examined to ensure they are free from infection and ready for the implant. The surgery itself, can take several hours to perform and the hair just behind the ear is shaved. There are stitches in this area and the patient receives antibiotics and mild pain relief during and after surgery. Usually the patient goes home the day after surgery. It is common for the ear to stick out a little after surgery, but this eventually settles down. The area where the implant package has been placed is slightly prominent, but it is unusual to have any significant swelling in the area.

The patient usually has a follow-up with the implant Surgeon or an Ear, Nose and Throat Specialist between 10 days and four weeks after surgery.




Living with a cochlear implant


The cochlear implant is switched on three to five weeks after surgery and involves MAPping of the device, and rehabilitation to ensure a patient receives as much benefit from the implant as possible. The switch-on is the first time an adult has access to sound. Some adults find the first few hours quite disconcerting because the noises heard can resemble beeps and whistles, however over time the brain starts to convert those sounds into language. The time that it takes for the brain to perceive the electrical stimulation as meaningful sound differs between individuals. Some people adapt to the new sound very quickly while others can take a few months to make sense of what they hear. As they do with children, an Audiologist works with the cochlear implant client to ensure their device is appropriately MAPped – (sound is heard at an appropriate level and tone). Because it takes time for the brain to make sense of what it is hearing, this process does require a number of visits after switch-on to ensure the implant device is MAPped at the correct level. The Audiologists and Rehabilitationists carefully monitor a client’s speech perception and provide rehabilitation to ensure they are speaking and hearing at an appropriate level.

Advantages of a Cochlear Implant

  • Most recipients can follow a normal conversation and participate more easily in the hearing community.

  • May enable use of the telephone.

  • Avoids problems with acoustic feedback and ear moulds.

  • Can detect soft environmental sounds across the frequency range 250Hz-8KHz.

  • Enables greater ease with high frequency consonant perception and production; e.g. /s/ /sh/ /f/ /t/ /k/ /p/ /h/ /th/.

Disadvantages of a Cochlear Implant

  • Requires significant time commitment to rehabilitation following surgery.

  • Residual hearing in the implanted ear may be lost as a result of the surgery.

  • The speech processor must be removed during water activities (such as swimming or showering), and the cochlear implant recipient will not be able to hear during this time.