Now of course, we have wireless streaming and/or speaker phones, or captioning even on our cell phones and don’t routinely teach them Telephone Code. It was cumbersome and difficult for many who were embarrassed and didn’t want to tell others what to do. The caller was then instructed to respond by saying either “No”, “Yes” or “I don’t know that”. The patient had to take control of the conversation, explaining they were deaf, but could communicate with the caller by asking questions. Wendy Myres: Back then, when a patient didn’t have speech understanding, we would train them to use a Telephone Code. Cochlear: How did you counsel your patients about making phone calls 30 years ago? How do you counsel them about phone calls now? Those kids, who at one time used to hide under a table or refuse to play whatever listening game was offered, now come back and share all the good memories they have of their time coming to the clinic as young children. It has also been rewarding to watch the young children who were implanted as infants and toddlers now using normal speech and language and functioning well in their chosen line of work. This is not always possible for everyone and can be frustrating for those who don’t achieve that, but in the majority of cases we now see patients understanding speech without visual cues in normal quiet environments when they use their CIs consistently. Wendy Myres: Patients now expect to understand speech without visual cues. Cochlear: How have outcomes changed with regard to these changes? Early on, I never thought we would implant someone who is able to use the telephone, but when they are in a group setting or other noise, they have trouble understanding and the implant makes their lives easier. It can be heart-breaking to turn someone away because they scored too well on our pre-op candidacy test protocol, but you know they are obviously struggling in their day to day communication. ![]() ![]() I’m not referring to those who qualify for Hybrid implants necessarily, but those who used to be considered “borderline” candidates, at best. Wendy Myres: I would say the most pivotal change is implantation of individuals with residual hearing. Cochlear: What indication changes do you consider to be most pivotal in the CI industry? They would come for four hours for four days in a row and received intensive auditory training while they learned to listen with their CI. Back then we would see them for almost a whole week of “Basic Guidance”. Today our appointments are usually two-hours in length. The sound can help their lipreading scores improve. Expected outcomes have changed so much because most of the adult patients were going from nothing to something, they were so appreciative to have sound awareness and feel more involved in what was going on around them. Although we had a few pediatric single-channel patients who achieved open-set speech understanding, most of the patients just experienced sound awareness and lipreading enhancement with their single-channel CIs. If a hearing aid was of no benefit, we would fit them with a loaner vibrotactile device so that we could work with them on the basic suprasegmental features they would be hearing with the single-channel CI. That’s why I have to laugh when my patients today look at the size of the Nucleus® 7 Sound Processor or Kanso® 2 Sound Processor and ask if there is anything smaller.Īnother big difference was the fact that we initially started clinical trials with children no younger than four years of age – we’ve learned a lot since then. The microphone was glued to a wire hook we placed over and behind their ear or glued to the eyeglass temple. Initially we did not have the use of magnetic coupling between the internal and external transmitter, so we would either place a bracket on the patient’s eyeglass temple or they could wear a wire headband to try to keep the coil in place. The patient had to unscrew the box to open it and change batteries. The first CI sound processors I worked with were metal boxes that took two 9-volt batteries. We would establish the threshold level or carrier signal using stimulation from the interface box and then make a sound like “oooo” and watch the oscilloscope to set the maximum comfort level. CIs consisted of one-ball electrode and we used an oscilloscope and an interface box to set the device with a screwdriver. ![]() Hearing aids were usually large body-worn aids or large analog behind-the-ear (BTE) devices. Back then our patients had bilateral profound sensorineural hearing loss. Wendy Myres: I started working with cochlear implants (CIs) in 1983. Cochlear: What do you remember from when you first started working with CIs?
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