Our son, Ike, was diagnosed with severe-profound hearing loss in his left ear and moderate-severe loss in his right ear. He was fitted with hearing aids at the age of two months old. When he got his hearing aids, there was some difference in how he responded to sound, but it wasn't as drastic of a difference as we had hoped. We (including his audiologist and speech therapist) questioned if the hearing aid in his left ear was actually doing anything for him, and thought he might be a good candidate for a cochlear implant.
We knew from the get-go that getting a cochlear implant was a possibility (specifically for Ike's severe-profound hearing loss ear). What I didn't realize was all of the hurdles ... I mean tests ... that needed to be done to qualify. You would think that being diagnosed with severe-profound loss would be enough to qualify for the implant surgery, but there are a few other requirements.
3 Main Requirements for Cochlear Implant Surgery in Children:
Profound hearing loss in both ears
Get little-no benefit from hearing aids
Auditory nerve is present (If the auditory nerve is not present, there will be nothing for the CI to stimulate and transmit signals to the brain.)
Now, Ike's case was a little trickier because he has asymmetric hearing loss (different levels of hearing loss in each ear). Since his right ear was not as severe as his left, we had to do more tests to prove the hearing aids were not benefitting him as much as they should.
To get Ike qualified for his cochlear implant, we had to do the following:
ABR - Electrodes placed on the head measure the brain's response to sound. This measurement determines the amount of hearing loss. (Read more about our ABR experience HERE)
Unaided and Aided Thresholds - This test is the traditional hearing test, we call them "Booth Tests." For most people this is where you sit in a sound-proof booth with earphones on and raise your hand when you hear different pitches of sound. For babies, however, we look for behavioral observations (eye movement, turning toward a sound, sudden quieting, etc...). They tested to see how well Ike could hear with his hearing aids on verses how well he could hear with them off.
Hearing Aid Verification Measurements - This basically verifies that the hearing aid is functioning correctly, and measures the output of the hearing aid into the ear. It is an objective measurement done with special equipment by the audiologist. This is actually pretty cool because they measure the ear canal acoustics and adjust the hearing aid settings to "fit" the ear. (more on this later!)
Cortical Auditory Evoked Potential Testing - This test is used in babies and other patients who are hard to test or difficult to observe behavioral cues during hearing tests. It is similar to an ABR, but they don't have to be asleep (thank goodness!). Electrodes are placed on the head, which measure the brain's response to different speech sounds played at different sound levels. It gives a good measure of what speech sounds the child can hear without the subjectivity of the booth test.
MRI or CT Scan - This is done to ensure the auditory nerve is present. The MRI will show if the auditory nerve is present and the CT scan will show the bone structure of the skull (if it is formed correctly, with a wide enough canal for the auditory nerve to pass, it can be assumed the nerve is present). Luckily, we only had to do the CT scan!
Needless to say, we had a lot of tests and a lot of hoops to get through to finally get Ike qualified for his cochlear implant. While the process seemed long and tedious, I do understand there needs to be ample data to qualify. Luckily modern science allows for quicker diagnosis, meaning a faster track to qualification than ever before (and I am sure it will continue to keep getting faster ... which will be awesome!). I am just thankful that we had a team around us who advocated for Ike and guided me through the process so we could get him the tools he needed to learn to listen and speak.
To give you a better idea of the timeline, we finished the last test (CT scan in our case) in December of 2018 and scheduled Ike's surgery for January 2019. That's 6 months after his initial diagnosis!
NOTE: The qualification process is different depending on the type and severity of hearing loss. For example, children born with profound hearing loss in both ears might move through the testing more quickly (and may not have to do as many). Everyone's journey will be a little bit different, so be sure to check with your hearing loss team!
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