Case Study:
Team Helps Patient Regain Hearing, Balance, and
Autonomy After Cochlear Implant
SIG 7: Aural Rehabilitation and Its Instrumentation
Summary
After recovering from meningitis, 72-year-old Jon continued to suffer from hearing loss,
severe dizziness, and imbalance. Struggling with daily activities, he sought information
from a team of professionals about a cochlear implant (CI) and help improving his daily
life. After the implant surgery, the interprofessional practice team helped Jon navigate life
with the CI and regain his balance.
Patient Info Meet The Team
JON
72-YEAR OLD
Audiologist Neurotologist Physical SLP Social worker
(team facilitator) therapist (PT) (added later)
Current Diagnosis:
Sensorineural hearing loss
Patient
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Background
Jon, a 72-year-old man, suffered sudden bilateral hearing loss and dizziness after contracting meningitis
approximately 6 months ago. His hearing loss has caused him to lose his job as a store clerk, has strained
his personal relationships, and has made it difficult to schedule appointments and get medical information
over the phone. His dizziness has resulted in multiple falls and makes daily tasks—such as walking, bathing,
cooking, and driving—difficult. Jon is single and gets little support at home. His initial post-meningitis audiogram
revealed undetectable pure-tone audiometric air conduction thresholds bilaterally across frequencies. He sought
information regarding CI candidacy and help improving his daily life.
How They Collaborated
The initial team of the neurotologist (team facilitator), audiologist, SLP, and PT met to review Jon’s history and
concerns. The team decided to add a social worker to address issues related to loss of income and lack of at-
home support. The team members also decided that when unanimous agreement isn’t possible, they would go
with the majority opinion.
The team members developed a plan to assess Jon’s needs. They would each evaluate Jon in accordance
with their specialties. Also, the social worker would determine Jon’s Medicaid eligibility, provide the necessary
paperwork, and review the need for assisted living.
Following the conclusion of their assessments, the entire team met and discussed their findings. The audiologist
reported that Jon has profound sensorineural hearing loss. Following an MRI, the neurotologist decided to
pursue cochlear implantation in Jon’s left ear but to preserve Jon’s right ear. The neurotologist planned the
surgery soon after the assessment. Both the audiologist and the PT found issues with Jon’s balance. The SLP
reported normal scores on cognitive linguistic tests and thought that Jon could communicate by writing until
his surgery.
After discussing the evaluation results, the team agreed upon a treatment plan. The social worker would help
identify an assisted living facility for Jon. Afterward, the neurotologist would perform the CI surgery, and the
audiologist would handle the implant’s activation, programming, and testing. The SLP would follow up by setting
listening goals and auditory training for Jon. Also following the CI surgery, the PT would reassess Jon’s gait and
balance and would start a rehabilitation program.
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Outcome
Three months after Jon’s CI surgery, sound-field warble-tone thresholds improved from being undetectable
to measuring at 30–35 dB HL in the left ear. On his hearing in noise test, Jon recognized 70% of
words correctly.
Jon continued to attend weekly auditory training sessions and made improvements on phoneme,
word, and sentence recognition. Jon was initially completing daily telephone practice and was
experiencing increased success in using the telephone with familiar listeners. However, after a while,
he stopped working on his home auditory training program. He also continued to participate in
biweekly physical therapy and can now walk with limited assistance. Although improved, his balance
and gait remained barriers to independence. In separate conversations with the team members, Jon
expressed a desire to move home and out of assisted living.
The team discussed Jon’s lack of follow-through with the home telephone practice. Jon mentioned
to the PT that he is more focused on walking and does not see the value of the telephone practice.
The team discussed how to reiterate the importance of all facets of his educational program. In
particular, the SLP, audiologist, and PT thought of ways to reinforce the other team members and
increase Jon’s compliance.
Ongoing Collaboration
The team continued to check in every other week. They monitored Jon’s response to treatment
and reviewed his candidacy for CI in the right ear. Jon continued speech-language pathology and
physical therapy services to address his listening, balance, and gait goals. Jon’s goal continues to be
a return to living independently at home.
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Case Rubric:
Team Helps Patient Regain Hearing, Balance, and
Autonomy After Cochlear Implant
SIG 7: Aural Rehabilitation and Its Instrumentation
Patient Info Meet The Team
Audiologist Neurotologist Physical SLP
(team facilitator) therapist (PT)
JON
72-YEAR OLD
Current Diagnosis:
Sensorineural
hearing loss
Social worker Patient
(added later)
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Jon is a 72-year-old male who suffered sudden bilateral
sensorineural hearing loss and dizziness due to meningitis
approximately 6 months ago. Following the recovery of
History and Concerns
his general central nervous system back to near baseline,
(Share key information his resulting hearing loss led to an inability to perform his
gathered from team)
job as a store clerk, strained personal relationships, loss of
independence in scheduling appointments over the phone,
and difficulty obtaining information from medical professionals.
His dizziness results in multiple orthopedic injuries due to
falls and loss of independence in mobility for tasks such as
walking, bathing, dressing, cooking, and driving. Jon is single,
with little reports of support from his home environment. His
initial post-meningitis audiogram reveals undetectable pure-
tone audiometric air conduction thresholds bilaterally across
frequencies. He is seeking information regarding cochlear implant
(CI) candidacy and recommendations for improved function, daily
activity, and participation in activities of daily living.
The initial team of the neurotologist (team facilitator),
audiologist, speech-language pathologist (SLP), and physical
therapist (PT) meet to review his history and concerns. The team
Assessment Plan
decides to include a social worker to address issues related to
(Determine roles/
loss of income and at-home support. Team members agree
responsibilities for
to consider all viewpoints, and use majority agreement when
evaluation)
100% agreement did not occur. Together, the team members
develop a comprehensive assessment plan, with the following
assigned areas:
Audiologist – Conduct audiometric and vestibular
assessments
SLP – Conduct cognitive-linguistic assessment; establish
alternative communication
PT – Conduct balance and gait assessments
Social Worker – Assess benefits and level of at-home
support
Neurotologist – Conduct a medical assessment for
operative candidacy and anatomical suitability for CI
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Following the conclusion of the assessment, the entire team meet,
share, and discuss the findings:
Assessment Results
(Summarize key diagnostic A
udiologist – Reports profound sensorineural hearing loss
results) bilaterally; they perform aided speech recognition testing,
which reveal 0% recognition for Hearing in Noise Test
(HINT) sentence materials in right, left, and binaural best-
aided conditions. Results of the vestibular assessment reveal
bilateral caloric weakness, with no response to warm irrigation
on the left and a very weak response on the right (5 deg/sec
right-beating). A video head impulse test demonstrates highly
reduced gain for all semicircular canals, suggesting a diffuse
bilateral vestibular hypofunction. The audiologist administers
a baseline Dizziness Handicap Inventory (DHI), and Jon
scored 76 of 100 total points, indicating a severe handicap.
S
LP – Reports normal scores on the Cognitive-Linguistic Quick
Test, which the SLP modifies using written instructions and
visual-only stimuli. In addition, informal measures of reading
and writing indicate adequate performance for use of a
paper-and-pencil communication mode until CI could take
place.
P T – Completes an initial assessment of balance and gait that
indicates poor balance, decreased step length, and need for
assistance by another individual or a two-wheeled walker.
Jon’s Functional Gait Assessment (FGA) score is 15 of a high
score of 30.
S
ocial Worker – Determines Jon’s Medicaid eligibility
and provides the necessary paperwork. In addition, she
determines a need for assisted living, which would promote
safety, facilitate activities of daily living, and reduce fall risk.
N
eurotologist – Obtains an MRI with intravenous gadolinium
of the temporal bones and internal auditory canals, which
demonstrates fluid signal within the bilateral cochleae. These
findings suggest the feasibility of placing a CI electrode
array into either cochlea. The neurotologist elects to pursue
cochlear implantation in the left ear; the right ear was worth
preserving based on the presence of bilateral vestibular
hypofunction with a small degree of caloric response.
The neurotologist plans surgery to occur very soon after
the assessment. Expeditious surgery will promote a full CI
electrode array insertion before substantial labyrinthine
fibrosis could occur.
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The IPP team members share and discuss the evaluation results
at a group meeting. Together, they agree upon the following
recommendations:
IPP Treatment Plan
(Discuss, reflect, and
modify recommendations A
udiologist – Follow up by performing CI activation,
to develop a coordinated programming, and audiometric testing.
plan)
S
LP – Follow up by setting listening goals and initiating
post-CI auditory training.
P T – Follow up by reassessing gait and balance, and
initiating vestibular rehabilitation post-CI.
N
eurotologist – Perform left CI following identification of
assisted living facility.
ocial Worker – Follow up by reassessing appropriate
S
support post-CI.
At 3-months post CI, sound-field warble-tone thresholds improve
from being undetectable to measuring at 30 dB to 35dB HL
Treatment Outcomes in the left ear. Additionally, speech recognition scores are
(Discuss results of 70% words correct in HINT sentences in quiet. Jon attends
treatment) weekly auditory training sessions, making improvements
on phoneme, word, and sentence recognition tasks; he was
initially completing daily telephone practice at home and
finding increased success using the phone with familiar
listeners. However, he stopped working on his home auditory
training program. He participates in biweekly physical therapy
appointments focusing on neuromuscular re-education
and functional mobility exercises. As a result, his FGA score
increased from 15 to 22, and his DHI score decreased from
76 to 58, indicating improvement. He ambulated with limited
assistance. Although improved, his balance and gait remain
barriers to independence. In separate conversations with all
professionals on the IPP team, Jon expresses a desire to return
home to an independent living situation.
The team discusses Jon’s lack of follow-through with the
home telephone practice. Jon mentions to the PT that he is
more focused on gait and doesn’t see as much value to the
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telephone practice. The team discusses how they could each
Treatment Outcomes reiterate to Jon the importance of all facets of his educational
(Discuss results of program. In particular, the SLP, audiologist, and PT each find
treatment) ways to reinforce what other team members are addressing in
intervention across disciplines to increase Jon’s compliance.
For follow-up, the team communicates biweekly to confirm an
appropriate response to treatment. Speech-language pathology
Team Follow-Up and physical therapy services remain ongoing to address
continued listening, balance, and gait goals. The team monitor’s
(Determine meetings &
Jon’s continued response to treatment for his eventual safe
communication plan)
return to living independently at home and for consideration of
future CI candidacy in the right ear.
Acknowledgement
ASHA extends its gratitude to the subject matter expert(s) who were involved in the
development of the original version of this IPP case:
Christin Ray, PhD, CCC-SLP
Kara J. Vasil, AuD, CCC-A
Aaron C. Moberly, MD
Special Interest Group 7 (SIG 7): Aural Rehabilitation and Its Instrumentation
Citations
American Speech-Language-Hearing Association. (n.d.). Team helps patient regain hearing,
balance, and autonomy after cochlear implant. https://www.asha.org/practice/ipe-ipp/case-
studies/case-study-8/
Find more case studies at https://www.asha.org/practice/ipe-ipp/case-studies/.
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