Patricia M. Chute and Mary Ellen Nevins

Chapter Five: The Post-Implantation Stage - Initial Switch-On and Counseling about Device Maintenance

Parents and children often approach the period known as the initial switch-on or tune-up with a great deal of anticipation and anxiety. The waiting period of approximately one month after surgery is often filled with feelings that range from excitement to doubt. For this reason, it is important for parents and child to have a complete understanding of the initial switch-on experience so that the range of responses that are possible is clearly understood. It is much more productive for the audiologist working with the child to explain everything that will happen before beginning the process rather than explaining it as it occurs.

The switch-on, or initial tune-up, usually takes place over a two-day period during which the device is activated and the parents learn how to manage the equipment. Individual centers have developed their own calendars for switch-on, so the time span and sequence of activities may differ from center to center. Regardless of the exact schedule, a number of tasks have to be done during this initial period of activation, including:

• dispensing and fitting the child with the external equipment and accessories,
• adjusting the electrical levels,
• assessing the initial auditory responses with the implant, and
• counseling parents, implant recipients, and caregivers about the maintenance of the system

INITIAL SWITCH-ON

Dispensing and Fitting the Child with the External Equipment and Accessories

When the switch-on begins, the child is wearing the external equipment that is attached via a cable to the programming station and computer. (See figure 5.1.) This effectively connects the implanted portion of the device with the external portion of the system. Young implant recipients require two audiologists working together during the session. A programming audiologist sits at the computer and makes adjustments to the device through special computer software. The other audiologist works directly with the child to monitor auditory responsiveness. This test environment is not unlike a traditional audiological assessment in which one audiologist sits at the audiometer and the other sits with the child to assist with the listening task. However, unlike an audiological evaluation, the programming session does not have to be done in a soundproof room. For young children especially, it is important that they be in a friendly, nonthreatening environment. For this reason, it is not unusual to see numerous toys, games, and videos in switch-on rooms.

In order to link the total implant system to the computer, the child must wear the headset. This portion consists of the microphone, magnet, and transmitter. When the external magnet on the transmitter is placed near the implanted magnet of the receiver, the two components will connect easily. This allows the audiologist access to the electrodes implanted in the cochlea. Under most circumstances, getting the child to wear the headset for the first time takes only a few seconds. However, toddlers sometimes show initial resistance. This should come as no surprise to anyone who has ever parented a two-year-old. Often distraction techniques, which engage the child in some other activity, enable the audiologist to put the headset in place. Experience suggests that even the most reluctant child will eventually wear the external equipment after a brief period of acclimation.