Working as an SLP with Patients with Cochlear Implants

Cochlear implants bring the magic of hearing to people who once had no hope of experiencing sound ever again. A cochlear implant (CI) is a two-part device that bypasses much of the mechanical auditory system built into the human ear.

Cochlear implants give patients whose hearing has been impaired by damage to their peripheral auditory system, whether through trauma, disease, or genetic factors, an opportunity to hear again. The technique does not address neurological deafness or deafness that is caused by damage downstream from the cochlea, the spiral of bone and tissue that acts as an amplifier for the auditory nerve that connects directly to the brain.

Although hearing can be restored by the implant surgery, speech and language skills that have gone unlearned or that have atrophied during the period of deafness do not magically return. This is where speech-language pathologists come into the picture. Their role is to help evaluate CI implant candidates, and to help them learn or relearn lost language and communication skills after the surgery has been performed.

Cochlear Implants Are Bionic Ears

The cochlear implant has been described as a bionic ear.

The real capabilities of a cochlear implant are more mundane, but the way the device performs is something that almost seems like it could be out of a science fiction movie.

This very real technology involves a two-part system with internal and external pieces that come together to replace a host of functions normally performed by the periphery of the human auditory system.

The internal components include a receiver, just under the skin of the patient’s skull and usually just behind the ear, and an electrode array from the receiver wired directly into the cochlea to cause it to react just as it would if it perceived the sound directly.

The external part of the system consists of a microphone, speech processor, and transmitter. This part of the system provides power and receives and processes sounds to be sent to the internal receiver. A magnet is used to connect the two and signals are sent through the skin, where they bypass the peripheral auditory system and go straight to the auditory nerve.

This technique was invented in 1961 by a gentleman named Dr. William House. House was initially ridiculed for the idea of directly stimulating the auditory nerve and it took more than a decade to perfect an implant that would be accepted by the human body and work properly. But by 1977, an independent Australian team was successful in developing a commercial cochlear implant. They received FDA approval for implanting them in adults in 1985, and then for children in 1990.

The implants can be made in one or both ears. For patients who are deaf in both ears, bilateral implants are recommended if they are physically feasible. Studies have shown that bilateral implants improve language development, sound localization skills, and enhanced understanding of speech in noisy environments.

The Role of the SLP on a Cochlear Implant Case

SLPs working with cochlear implant patients do so most commonly as part of a larger team. The surgery, post-op recovery and therapy process for CI patients involves working with:

• Doctors, nurses, and surgeons
• Psychologists and social workers
• Geneticists and neurologists
• Occupational therapists

SLPs on such teams have to be familiar with the concerns and expertise of these other roles, and must be skilled at communicating and coordinating treatment plans with other professionals. Such plans will usually be developed in consultation with all members of the team as well as the patient and their family.

The SLP’s participation will vary at different parts of the process. Early on, prior to the surgery, the SLP may be involved in assessment of the patient’s current skill levels and capabilities, as part of the process of determining whether or not they’re a suitable candidate for the surgery. In the immediate phase after the surgery, however, other medical professionals may be at the forefront of treatment.

In the long term, however, the SLP will probably have the longest involvement with most patients.

Treatments do not vary from those used with other hearing-impaired patients. CI recipients simply have more options and a better prognosis. SLPs do not have to work around the impairment itself after hearing has been restored, but can focus on training speaking and language skills directly.

This process is called aural habilitation (or rehabilitation, if retraining), the process of helping the patient attain listening and communication skills. Techniques can include:

• Speech reading
• Voice therapy
• Music training

The ultimate goal is to restore complete speech and language abilities to go along with the restored ability to hear.

Credentials for SLPs Who Work With Cochlear Implant Patients

The impact of the technology has been most dramatic for children. Around 38,000 kids in the U.S. had been fitted with cochlear implants as of 2012 according to the National Institutes of Health (NIH). The technology has been shown to dramatically improve the odds of kids with hearing disabilities being able to achieve age-appropriate language skills. SLPs are familiar with the importance of hearing when it comes to acquiring spoken language skills, so it’s no surprise that the earlier in life children receive implants — especially in the pre-lingual phase — the better their outcomes are.

This can make the SLP’s job with such patients dramatically easier. Most SLPs who work frequently with CI patients do so simply by virtue of working primarily with hearing-impaired populations. Cochlear implants themselves do not constitute a specialty practice in speech-language pathology.

Many SLPs working with such populations find it valuable to obtain a certification as a Listening and Spoken Language Certified Auditory-Verbal Therapist (LSLS Cert. AVT). The LSLS certifications are offered by the Alexander Graham Bell Academy. The stringent requirements include:

• Holding a bachelor’s or master’s degree in SLP, audiology, or deaf education.
• Having your CCC-SLP.
• Submitting a statement of your experience working in auditory-verbal practice areas.
• Acquiring 900 clock hours of professional experience in conducting AVT therapy within three to five years.
• Undergoing at least 20 sessions of mentoring by a currently certified LSLS professional within three to five years of the application.
• Submitting letters of recommendation from professional peers and parents of patients.
• Passing an examination on AVT.

The certificate costs $495 plus a $50 exam fee, and must be renewed every two years for $195. Additionally, at least 15 CEUs in an LSLS-approved program must be taken within the renewal period.

The commitment required to obtain and maintain this certification make it something of a gold standard in treating deaf and hearing-impaired populations. Since these are also the target population for CI surgery, an LSLS AVT is an excellent recommendation for any SLP choosing to work with CI patients.