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Doris Vercelli answers the questions of experts and parents in the seminar on Remote Fitting and Rehabilitation 26.05.2013

[Artur Salmiyarov-Surgut] Is a CI programmed by one person, and a HA by another? Or will it be the same expert?
Yes, this is the same remotely operating expert. He also carries out speech tests, which is important for patients.

[Artur Salmiyarov-Surgut] In Russia we’ve encountered the problem of many experts doing the fine-tuning on HAs, but not having any involvement with CIs, and vice versa. This leads to a poorer quality of bimodal fittings. What training do experts in fitting CIs and HAs receive?
Getting qualified as a HA acoustician in Germany takes 3 years; another year is devoted to writing a Master’s paper. Once you have that, you take a short theory and practice course to become a CI acoustician.

[Nikiforov Konstantin] Hearly all experts skilled in programming a CI, can also fit a HA. When the child is not wearing a HA on the other side, we must ask ourselves whether a fitting might be to blame. The child gets lots of input from a CI and the HA is an impediment – at the start. This is an organizational issue, too, so the fitting of the HA is not always a significant influence.

[Anastsia-BobruiskBelarus] I really need to know whether the number of electrodes has an influence on speech intelligibility.
I my experience, patients with different electrode counts can achieve an identical intelligibility level.

[Nikiforov Konstantin] The number of electrodes does impact intelligibility. However, we must understand that the difference between 22 and 24 electrodes is fairly small. What matters is the number, the percentage, of the ones that become defunct.

[Anastsia-BobruiskBelarus] My child, implanted with Combi 40, has only 9 out of 12 working electrodes, and the 9th is borderline.
What do you see about the performance of your son: does he really understand less? How has his progress been affected since the electrodes started failing?

[Nikiforov Konstantin] Anastasia, it’s fine. 9 electrodes are quite enough. I don’t think reimplantation should be considered. Just keep a close eye on the situation. Fewer than 4 electrodes failing means no reimplantation.  More than 4 means a new implant. These guidelines were issued by MedEL for CIS.
When electrodes fail in the device, regardless of manufacturer, we check to see whether this affects speech understanding and other hearing capacities of the child.

[Anastsia-BobruiskBelarus] Our electrodes did not fail – they were not inserted into the cochleum properly. The processor failed several times. I have a fear of something happening to the implant.
This is a surgical issue. We recommend that a competent person – from the side of the clinic or of the manufacturer – have a look at the child and assess the situation.

[Nikiforov Konstantin] If I were you, I would not worry. Implant failure rate is extremely low. But you do have to keep monitoring this.

[Anastsia-BobruiskBelarus] Should we not have a CI in the second ear?
This is not so easy to answer. Why could all electrodes not be fitted into the first ear? The second ear should be thoroughly assessed; the physiological structure and residual hearing analyzed.

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