Programming Cochlear Implants

Programming Cochlear Implants, by Drs. Jace Wolfe & Eric Schafer, is a practical straightforward text that delivers what it advertises — a thorough description of how to program cochlear implant processors. It is comprised of seven chapters that cover the basic operation of cochlear implants, defi nitions of programming terms, programming principles, issues specifi c to each cochlear implant manufacturer, suggested programming and rehabilitation schedules, troubleshooting, and hearing assistance technology as it relates to cochlear implants. There is something in this book for students as well as new and experienced clinicians. Chapters 1 – 4 provide students with a basic foundation of how cochlear implants function and methods used to program speech processors. Chapter 5 on ‘ Clinical Considerations ’ offers useful suggestions to the new clinician about how to schedule cochlear implant patients and what to do at each session with both adults and children. The experienced clinician can refer to troubleshooting in Chapter 6 and may benefi t from a review of programming terminology in Chapter 2. Everyone can profi t from the helpful tips in Chapter 7 on hearing-assistance technology and cochlear implants, a topic about which the authors have extensive research and clinical experience. This practical book is well-organized. Bold headings invite the reader to fl ip through the chapters to the topic of his or her interest. Large photographs, fi gures, and tables are clear, easy to read, and apply directly to the text. The descriptions are up-to-date and the photographs show current devices. The authors do a great job of explaining the most recent technology as well as previous strategies and devices that clinicians may encounter with long-term cochlear implant users. There is some redundancy, but that can be useful to novice readers, and it occurs rarely enough that it will not seem repetitive to the experienced clinician. In most cases, the authors refer to previous chapters for a more detailed description when a topic is mentioned more than once. The table of contents clearly lays out the topics in each chapter and the index is thorough and easy to use. For the most part, the authors support their recommendations with research citations. When they make suggestions based solely on their clinical experience, they usually make that clear. I would have preferred a more consistent and balanced discussion of methods to determine upper stimulation levels (also known as Cor M-levels). The authors display a strong preference for using electrically evoked stapedial refl ex thresholds (ESRT), stating that other objective and behavioral methods should be used only as a last resort, although ESRT cannot be measured on approximately 30% of cochlear implant users. Very few details are provided about the electrically evoked compound action potential (ECAP, also known as NRI, NRT, and ART) even though the authors acknowledge that it is a useful measure to determine an audible stimulus level. They correctly state that the ECAP software can be simple to administer; however, they do not mention that the fundamental concepts are complex and important to understand when interpreting results and troubleshooting the procedure. Furthermore, the advice regarding loudness balancing is contradictory. In Chapter 3 the authors initially state that loudness balancing “ is recommended for older children ... and adults when ESRT cannot be obtained. ” However, later in the same section they suggest that “ the clinician should strive to ensure loudness balancing for all recipients whether it is determined with the behavioral procedure or through ESRT. ” In future editions, a more detailed description of the underlying principles and test parameters of ECAP would be helpful. Pros and cons of all behavioral and objective methods of obtaining upper stimulation levels could be presented, and the clinician could then decide for him/herself which method is most appropriate for a particular patient. Overall, I heartily recommend this book as a useful resource in the audiology classroom as well as in the cochlear implant clinic. Drs. Wolfe and Schafer ambitiously cover the current cochlear implant technology to date, and I look forward to seeing new editions as technology emerges.