NAIP philosophy and approach to the effective use, set up and evaluation of personal radio systems with cochlear implants. Original created on: 10/08/2009 Last Revised: November 2017 Revised by: Clare Boddy, Gill Datta Next Revision due: November 2018, pending full publication of the NDCS Revised FM quality standards* Overview: NAIP philosophy and approach to the effective use, set up and evaluation of personal radio systems. In certain situations the benefits of personal radio systems are widely recognised. If set up and used correctly, they improve the audibility of voices and speech in situations where distance, background noise and reverberation make listening difficult. NAIP actively encourages the use of personal radio systems in conjunction with sound processors. The potential benefits of radio systems should be considered for all patients, including very young children and children with complex learning difficulties. This will include patients not able to feedback via standardised protocols on signal quality. This protocol is based on guidance provided in the NDCS Quality Standards (QS) for the use of Personal Radio Systems (2017), in conjunction with advice from the Manufacturers (see Appendix One), and in consultation with other Cochlear Implant centres and local professionals. Within this document, the term personal radio system refers to both personal FM and digital radio systems. NB NAIP provides advice and support as requested but does not finance or supply personal radio systems. Candidacy NAIP recommends the following conditions are met prior to fitting a personal radio system: Radio systems should be considered for all patients, including very young children or children with complex learning difficulties. This will include patients not able to feedback verbally on signal quality. Appropriate progress of Mapping, as decided in consultation with the NAIP audiologists. In the cases of patients with sequential implants, the second processor needs to be considered as a discrete case i.e. the progress of mapping with the second device needs to be considered separately from the established Mapping levels in the first ear. Established, consistent sound processor use, wherever possible with evidence provided by data logging information. Evidence that the sound processor provides benefit, supplied by behavioural observations, profiles of progress or direct feedback from the patient when possible.
An appropriate level of support available from the family and/or local professionals to implement effective use of the technology Revised QS1 Every deaf child should be considered as a candidate for a personal radio system Financial Provision NAIP does not finance the provision of personal radio systems. In some cases the equipment needed e.g. a specific adaptor, cable, battery module or sleeve, to enable radio system use is a choice in the initial or upgrade kit. (see below). Any repairs or replacements of this additional equipment are not provided by NAIP and will need to be funded by individual patients or their local authority. A range of personal radio system models which are compatible with sound processors are available for private purchase by individuals or by local Education Authorities. These include: body worn, ear level or neck loop systems. Prior to purchase it is important to ensure that the preferred system is compatible with the patient s sound processor. This information should be available on the manufacturers website or from a member of the Outreach Support Team at NAIP. NB: The advice below is current in November 2017. However technology updates happen frequently and prior to purchases it is advisable to check manufacture websites to obtain the latest guidance. Cochlear: N6, N7 The MM2+ which can be used as a personal radio system can be selected by the patient as part of the initial kit or upgrade. Repairs and replacements are the responsibility of the patient and are not provided by NAIP. The R20 Roger receiver module for use with the N7 processor is not offered as a choice but can be purchased by the LEA or privately. Advanced Bionics: Naida, Neptune For the Naida processor, the 170 battery can be selected by the patient as an additional battery option with initial kits and upgrades. After the 1 year warranty period expires, repairs and replacements are the responsibility of the patient and are not provided by NAIP. The Neptune Connect is provided as standard in the initial kit. Medel: Opus 2, Sonnet For the Opus 2 and the Sonnet processors, the FM sleeve can be selected by the patient as part of the initial kit or upgrade. After the 1 year warranty period expires, repairs and replacements are the responsibility of the patient and are not provided by NAIP. The R21 FM sleeve with integrated Roger receiver for use with the Sonnet processor is not offered as a choice but can be purchased by the LEA or privately. NB: See Appendix Two for more detailed information about equipment required for fitting. Revised QS2 There is an identified budget and clear accountability for funding personal radio aids where the candidacy criteria are met.
Initial set up and evaluation NAIP philosophy for best practice is that personal radio systems are set up by trained local professionals. This means they are evaluated in the environment where the patient will use the equipment, by the people who will be responsible for its on-going care and management. NB: Most modern sound processors do not require any adjustments via the software at a clinic appointment before a radio system can be used. If local staff are unsure, this information is available on the Manufacturers websites or from NAIP staff. However, a clinic appointment is usually required if a neckloop system is chosen. In these cases, it is essential that NAIP Audiologists are informed well in advance so that a short clinic appointment can be arranged. NAIP Responsibilities NAIP staff work closely with both the cochlear implant manufacturers and local educational audiologists and provides advice, support and a regular training forum to share the latest developments. Members of the Outreach Support Team can provide detailed practical instructions, specialist staff time if required and website support Responsibilities of local professionals It is the responsibility of local professionals to follow the guidance and instructions provided by both the cochlear implant and radio system manufacturers and to ensure their training remains current if they are fitting personal radio systems to cochlear implants. NAIP advises objective testing i.e. checking the functioning of the sound processor and personal radio, both separately and when the equipment is linked together. E.g. via Remote Assistant, listening ear phones, lights system, N7 App. NAIP s view, based on current guidance from the manufacturers [See Appendix One]. Is that the use of the testbox for electroacoustic checks of sound processors is not essential. NAIP recognises the need to assess the efficacy of the whole system within the patient s own listening environment by carrying out observations or more formal speech testing, as appropriate, dependent on the developmental stage of the patient. E.g. careful behavioural observations of young or complex patients after fitting in order to make judgements about the added benefit of a radio system. This could include feedback from professionals who work with the child on a regular basis and the family, if the child uses a radio system at home. The views of children who are able to report back should always be sought and given careful consideration. When possible, NAIP recommends the use of speech tests, to verify the benefit of personal radio systems (see Appendix three) Revised QS3 The personal radio aid must be set up with the child s individual sound processor to ensure that the radio signal provides the desired advantage. Revised QS4 The child s listening response must be checked with the complete system in place. Revised QS7 Subjective checks of personal radio aids must take place regularly. Revised QS8 Electroacoustic checks must be performed regularly and whenever a part ofthe system is changed. Revised QS10 Subjective and objective evaluation of a personal radio aid system to determine its benefit must be carried out
On-going Support and Advice Discussions with local staff and families around the effective use of the radio system and the child s developing understanding of its management, are built into pathway visits and relevant information is included within shared visit notes and reports. Demonstrations of the processor checking routine, including regular visual inspections of the processors to include microphone covers, adaptor ports, cable conditions etc, are built into pathway visits. This sits alongside liaison and joint planning with local professionals and families to ensure effective daily maintenance of the processor and radio system when linked together. This could include use of monitor ear phones, an understanding of the light system, the Remote Assistant and N7 App. NB: NAIP recognises the importance of keeping local staff informed of changes in cochlear implant technology which impacts on the use of personal radio systems e.g. if a patient is upgraded to a new sound processor or if a new model is released by the manufacturer. This information is shared about individual patients and local professionals and wherever possible local professionals are alerted in advance to plan changes via the professional Development group so that the information can be cascaded to all local professionals. Revised QS5 Training and written information about the personal radio aid system, its settings and its appropriate use must be agreed and shared with the child, parents, teachers and all those involved in supporting the child. QS6 A programme for developing best use and management of personal radio aids should be agreed, recorded and reviewed at least annually. QS9 Clear identification of roles and responsibilities regarding the management and use of equipment should be in place. QS11 There must be close liaison between health and education teams, including the exchange of written information relating to the use of the child s personal radio aid system. QS12 Where soundfield systems are used in conjunction with personal radio aids, equipment must be selected and set up to ensure that the performance of the personal radio aid system is not compromised. This policy is available via the website References *NDCS 2017 Quality Standards for the use of Personal Radio systems. http://www.ndcs.org.uk/professional_support/news/new_fm_quality.html
Appendix One- manufacturer s guidance Cochlear Thu 27/04/2017 16:19 For advice on balancing FM and cochlear implants there is no more comprehensive document than the Quality Standards document. The document has been established in consultation with the various manufacturers and forms a fairly sound basis for objective balancing. There are arguments over test levels and features enabled, but broadly it gets you to about the right point IF you follow it carefully. Use of the testbox Is such a procedure necessary to set up an FM system with a CI? From our perspective, the answer is a definite "no". Phonak and Cochlear both believe that their systems work in tight tolerances nowadays and if you use these products on their recommended settings for paediatric use, then this is "close enough" to gain good benefit. We would additionally recommend a listening check to make sure the mixing "sounds right" and in Cochlear's case we also advise checking the "FM advantage" via the CR230 (Remote Assistant, N7 App) to make sure there is evidence of a clear benefit from the FM. Information from Barry Nevinson Supplied by Kelvin Hawker MEDEL Tue 18/07/2017 11:31. The advice from our side at present would be; MED-EL UK suggests setting up FM systems using the information provided by our ALD database that can be accessed via the website, and using the SPTD to check the system, along with some form of appropriate speech testing via the FM system where appropriate. We are aware of electro-acoustic methods for testing FM systems used in combinations with sound processors, and foresee no particular risks in employing such measures, but at this stage cannot officially endorse or recommend them. MED-EL considers the judgment of readiness for fitting an FM system / similar to be in the hands of the professionals dealing with the case. We do not have official guidance, or a 'checklist' for readiness, but given that the FM system may introduce changes to the sound signal, intermittency, and other issues, it may be appropriate to consider the patient's ability and reliability to report on sound quality etc. Susan Copperwheat Senior Clinical Specialist
Appendix Two Set-up and equipment required, depending on the radio system selected Cochlear: Nucleus 5, Nucleus 6, A Euro Accessory adaptor, plugged into the sound processors accessory socket is needed for use with FM Direct Audio Input (DAI) devices eg ear level receivers, body worn aids. NB: The Euro Accessory adaptor is not provided by NAIP Phonak Roger 14 ear level receivers do not require an adaptor and can be plugged directly into the processor accessory socket. The Tele-coil setting is required for use with a neck loop system. The volume control may need to be activated for use with a neck loop if the personal radio system transmitter does not have a volume control. NB: The Tele-coil setting and volume control will need to be activated at a clinic appointment. Any changes in processor set up will need to be requested well in advance of the proposed fitting day. Cochlear: Nucleus 7 Currently, compatibility with radio systems is limited to the MM2+, either as an independent system or as a streamer. See manufacture website for updates. Roger R20 radio modules will soon be available for use exclusively with Nucleus 7 processors Advanced Bionics Harmony/Auria An I-connect hook containing an A10 battery is needed for use with FM DAI. A T-coil programme is required for use with a neck loop see information as above Naida A 170 battery is required to be used with a Roger 17 receiver only. The Compilot can be used with an FM ear level receiver plugged in but the processor needs programming correctly. A Tele-coil programme is required for use with a neck loop. This will need to be activated at a clinic appointment. Any changes in processor set up will need to be requested well in advance of the proposed fitting day. Neptune The Neptune Connect is required for all FM and DAI. NB: The I-connect is not provided by the CI centre. The Compilot and the 170 battery are optional extras.
Medel Opus 2/ Sonnet A specific FM sleeve[battery cover] is required for use with direct audio input [DAI] A Tele-coil programme is required for use with a neck loop. Any changes in processor set up will need to be requested well in advance of the proposed fitting day. NB: The specific FM sleeve [battery cover] is an optional extra Appendix Three The purpose of the speech test is to establish the level of additional benefit provided by a personal radio system. Ideally this needs to be evaluated in the sort of listening conditions where the radio system will be used ie at distance and against background noise as well as in quiet. Speech tests can be used with a wide range of children. Younger children tend to respond more reliably to a live voice than recorded, but for consistent measures of benefit, repeat testing should use the same sound source. Available tests McCormick Toy Test Manchester Picture Test Manchester Sentences Arthur Boothroyd AB word lists BKB sentences