Introduction
The professional staff of Dallas Otolaryngology Associates and HEAR In Dallas joined forces to form the Dallas Otolaryngology Associates Cochlear Implant (DOA-CI) Team. Together they provide assessment and treatment to patients seeking cochlear implantation. The team maintains one philosophical goal-- the maximal use of sound for verbal communication and environmental monitoring for deaf patients ranging in age from infants to seniors. It is the team's philosophy that meaningful use of sound can enhance the quality of life for almost every deaf person.
The DOA-CI team includes the following: patient and their family members, a neurotologist, four audiologists, a nurse, billing/reimbursement people, two secretaries, a neuropsychologist, a rehabilitative audiologist/Certified Auditory-Verbal Therapist, two speech-language pathologists, an occupational therapist and the administrator of the Dallas Hearing Foundation. Other consultants and therapists are involved as dictated by individual patient needs. The team members pool their expertise to form long-term management programs for patients of all ages.
Upon conclusion of the initial audiometric evaluation, the audiologist recommends one of three options:
- The patient participates in a program of aural rehabilitation with his/her current hearing aids. Patients referred for aural rehabilitation with hearing aids are monitored: their hearing aid progress is compared to the outcome anticipated with appropriate cochlear implantation and aural rehabilitation.
- The patient tries new hearing aids, participates in short-term aural rehabilitation and is re-evaluated for implant candidacy as needed.
- The patient proceeds with a full evaluation to determine cochlear implant candidacy and appropriate post-implant aural rehabilitation.
Implant centers vary greatly in the criteria used to determine patient candidacy for cochlear implantation. Consistent with their view of hearing as important for quality of life, the DOA-CI team views the implant as a tool that provides a range of benefit to patients. Long-term outcome or benefit from a cochlear implant is impacted by numerous variables. In determining patient candidacy for implantation and expected benefit, the team attempts to ascertain patient variables likely to impact their meaningful use of sound with an implant.
Significant factors include the patient's age, health, hearing history, hearing technology history, speech/language/reading/writing status, communication mode of patient/family/peers, psychological status, neurological/cognitive status, patient knowledge/goals for CI, educational options, motivation/compliance, support for developing auditory behavior, results of trial therapy, finances, time/availability and distance from the treatment program. Each of these is examined to formulate a complete picture of the patient and their life. This information is used to (a) determine candidacy for implantation, (b) counsel the patient and family members regarding expected benefit, (c) address issues that would need to change in order to proceed with implantation, (d) discuss how each issue would impact performance with the device and (e) explore options for optimizing benefit.
One key factor that leads to patient satisfaction is the free flow of communication among CI team members. Each member of the team recognizes and respects the expertise of the other team members and all regularly exchange information. The physician considers the opinion of each team member when deciding whether or not to proceed with surgery. The programming audiologists rely on feedback from the aural rehabilitation team regarding the patients' performance with each MAP on speech perception tasks. The insurance person requests progress reports to ensure continued coverage of needed services. The neuropsychologist assesses and treats patients for special learning needs and assists the team and patients with issues that may arise. Family members share situations and concerns about the patient's use of hearing and speech in daily life: these are used to individualize the aural rehabilitation program as well as modify the programming of the device. All members of the team work closely together for optimal care of each patient.