Appendix B - Questions for Implant Center

Here are some additional questions you may want consider asking the implant center.

Questions for surgeon:

Describe what happens during the day of surgery, and what the follow-up schedule is?
How long is the hospital stay? If you do same-day surgery for children, are there any possible concerns with the child being released so soon after surgery?
Would you definitely be the one doing the surgery? Or would perhaps a resident do some of the surgery?
Do you use the same anesthesiologist for all your implant surgeries for children? Do any interns ever serve as the anesthesiologist? Will we be able to meet with him or her prior to surgery?
Can we be present with our child until he is out from the anesthesia? Is there any danger to our child if we do this?
How long is it from the time we leave our child till we see him again? How long is the actual surgery?
Did you see from the CT scans any problems with the structure of the cochlea and surrounding area that would cause problems during surgery? Was there any ossification?
Which ear should be used for the implant? Do you implant the ear that has better or worse residual hearing ability. Did the CT scans show any difference that would be a consideration?
Can you describe what you see as the major advantages or disadvantages of the Nucleus-24, Clarion, and Med-El?
Have any of your patients had any device failures with any of these?
Have any of your patients reported electrode problems?
Have your patients experienced any implant device migration, extrusion, exposure, or electrode displacement?
Have any of your implant patients reported adverse side effects from the implant?
Do you have a recommendation as to which model to go with? What if this was your child, what would you select?
In case the device ever had to be explanted, is one easier than the other to extract?
Which device is smaller for the part that fits into the cochlea? How about the part for which you make a bed in the bone?
From Graeme Clark's book "Advances in Cochlear Implants for Infants and Children", ISBN 1-56593-727-9, on p. 123, see Figure 7-7. Would a blow to the head at the implant device location potentially cause more damage with a Clarion than with a Nucleus device?
How can you tell when you're nearing the dura (the lining of the brain)? Have you ever hit it?
Have you ever made a mistake in any of the implant operations you've done?
How large is the incision? How is it closed -staples or stitches? Have any of your patients ever had flap problems?
How big is the bandage/dressing, who takes it off, and are we supposed to check for anything after we take our child home?
What do we do if the bandage/dressing comes off during the first night after surgery - will there be someone who can put a new dressing on?
Have any of your patients experienced nausea or other side effects following surgery?
Where did you receive your training in cochlear implantation?
How many children have you implanted with the Clarion?___ Nucleus-22____Nucleus-24___Med_El___--?
Did Advanced Bionics provide training to you in surgery techniques for their Clarion device and likewise for Cochlear Corp. for the Nucleus-24 and likewise for Med-EL?
Have you trained other surgeons in doing cochlear implants?
During surgery, is it possible to keep us posted with progress reports?
Are there any differences in how you do surgery with the Clarion vs. the Nucleus-24 vs. the MED-EL? Is one easier than the other?
What precautions do you take to make sure you don't hit the facial nerve during surgery? Do you have any kind of monitor for the facial nerve during surgery?
How do you avoid hitting the basilar membrane during insertion? Is the Clarion, MED-EL or the Nucleus-24 easier to make curve around the curvature in the cochlea?
On surgery day, is a backup device available?
Has there been any adverse balance or vestibular reactions among your patients?
On the day before surgery, do we need to have our child brought here or checked by our own local pediatrician to make sure he doesn't have a middle ear infection
Can you tell before, during, after surgery whether the implant is functioning correctly?
Graeme Clark of the Melbourne program wrote that "thresholds are lower when electrodes are placed close to the spiral ganglion cells - and the question is how best to place an electrode array close to the modiola where the gaglion cells are located." Is the Nucleus-24, Clarion, or Med-EL better in this placement?
Have you ever had a perilymph gusher occur?
Is the residual hearing always destroyed in the implant ear, or can different surgical styles result in saving the residual hearing?
When you do the surgery, is the implant located in such a position that the behind-the-ear speech processor fits?
Have any of your implant patients had to be reimplanted?
Have you reimplanted any patients who were implanted originally by other surgeons?
Have any or your implant patients developed meningitis later?
How much does the Clarion, the Nucleus-24, or the Med-EL extrude from the head?
Do you have any feeling as to which company (Advanced Bionics, Cochlear Corp., or Med-el) is more financially sound and is likely to be in business longer?
Do you require an EKG prior t o surgery to rule out the long-QT heart irregularity associated with Jervell and Lange-Nielsen syndrome?
What if one had a Clarion implant, and at some point later there was an emergency that required an MRI for accurate diagnosis?
What would be done? For Nucleus-24?
When an implant is done, do you have a supply of implant devices in stock, or do you special order the implant? In either case,
is there any final testing done before it is to be used for surgery to make sure it is functioning? How is the device sterilized before surgery?
Do you have any personal problems which would interfere with your ability to do implant surgery? Are you planning to remain with this center?
If we decide on this center, how soon would surgery be scheduled?

Questions for Audiologist and other Personnel involved in follow-up

What kind of follow-up do you do with us as parents?
What kind of follow-up or in-service training do you do with our child's teachers and therapists?
Do you have children with implants in both oral and total communication programs? What is your opinion about which is better?
Do you have any problem in working with someone in a total communication program?
When we return for visits, is our child's hearing/speech performance tested for progress?
How quick are replacement cords, microphones, or a replacement speech processor made available if needed?
Is it recommended that our child wear his hearing aid in his other ear (especially during the 4-6 weeks after surgery?)
Will you help with obtaining insurance coverage?
Can you go over the charges?
Are any of the children here using on the Clarion S-Series the "SAS" processing strategy?
Are any of the children here using on the N-24 the ACE processing strategy?
Which device - Nucleus-24 or Clarion or MED-EL - is easier for you to program?
Which device is more reliable in children?
Who sees our child on his follow-up visits?
Is there an 800 number available?
Is there any redundancy or fail-safe measures built-in to either Clarion or Nucleus-22 or MED-EL so that if something goes wrong with the internal device, that having another surgery to explant it and insert another isn't required?
What are the warranties with each device?
What kind of speech processing strategies do the majority of the children implanted here use?
How strong is the magnetic adherence? Any difference between Clarion, MED-EL and Nucleus-24? Does the external
attachment get knocked loose very easily?
How did they arrive that 22 electrodes were to be used in Nucleus-24 and just 16 in the Clarion? Why isn't "more" better?
Can you walk through airport security gates with the implant on without adverse effects?
Can you interface an FM-system with the Clarion, MED-EL or the Nucleus-24?
How do the Clarion, MED-EL and Nucleus do in noisy environments?
Is there any indication that chronic electrical stimulation over a long period of time can lead to deterioration of the auditory nerves?
Which device is better suited to prevent static electricity discharge problems?
Do you have a list of other families with children who have been implanted here that we can contact?

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