CI Atlas · Case library
Clinical case library
All 12 interactive cases from across the atlas, gathered in one place and grouped by module. Each vignette poses a real decision; choose an option to reveal the reasoning and the teaching point. To study a case in its full context, follow the module link. For self-test questions, see the self-assessment page.
Module 2 · Impedance & electrode interface
A 4-year-old, implanted 18 months ago, is brought in by parents who report she has become less responsive to her name over the last two visits. Speech-perception scores have dropped. At today's session, electrode 3 shows an impedance of 28 kΩ against a 4–6 kΩ profile elsewhere; three visits ago it read 7 kΩ.
What does the impedance finding tell you, and what is the immediate programming step?
Module 3 · ECAP / Neural Response Telemetry
At first fitting of a congenitally deaf 2-year-old, AutoNRT returns no measurable response on the three apical electrodes you try. The audiologist is concerned the auditory nerve is non-functional and questions whether the implant will work.
What is the most appropriate next step before drawing conclusions about the nerve?
Module 4 · ECAP threshold & functions
An adult CI user with normal impedances and measurable ECAP thresholds across the array nonetheless struggles with speech in noise and music. On testing, the spread-of-excitation functions for several mid-array electrodes are unusually broad and overlapping.
What do the broad SOE functions suggest, and how might they guide programming?
Module 5 · Electrical stapedius reflex
You are activating a 14-month-old who, predictably, cannot give reliable loudness judgements. ECAP thresholds were recorded at surgery. Post-operatively you obtain clear ESRTs on electrodes 3, 11 and 20 using contralateral immittance.
How should the ESRTs inform your initial MAP?
Module 6 · Electrically-evoked ABR
A child with profound deafness has a small cochlear nerve on MRI, and the team is uncertain whether to proceed with a cochlear implant or plan for an auditory brainstem implant. At implantation, you record eABR under the surgical anaesthetic and obtain a clear, replicable wave eV at moderate stimulation levels.
How does the eABR result inform the decision?
Module 7 · Electrical cortical responses
A 5-year-old with a long history of un-aided profound deafness is implanted. The family asks for objective evidence about how the child's brain is adapting. Serial cortical recordings over the following year show a P1 latency that shortens but remains above the age-normal range.
How should you interpret and communicate this?
Module 8 · Intraoperative ECochG
During a hearing-preservation cochlear implantation, you monitor the cochlear microphonic to a 500 Hz tone burst through the apical electrode. Insertion proceeds smoothly with a stable-to-rising CM until, three-quarters of the way in, the amplitude falls abruptly by about 40%.
What is the appropriate intraoperative response?
Module 9 · Objective measures → the MAP
An adult is activated four weeks after implantation. Impedances are normal. You obtain ECAP thresholds across the array and clear ESRTs on three electrodes. The patient finds formal loudness scaling difficult on the day and tires quickly.
What is the most appropriate way to build the initial MAP?
Module 10 · Troubleshooting & special cases
A long-standing CI user returns with gradually worsening speech understanding over a year. Integrity testing passes. Impedances are within the normal range today, but reviewing the chart shows several basal electrodes have crept upward over four visits. There is no effusion and the MAP is unchanged.
What does the pattern suggest and what is the next step?
Two weeks after activation, a recipient with a history of otosclerosis reports their cheek twitches whenever the environment is loud. The effect is reproducible and bothersome. Impedances are normal.
What is the most appropriate objective-measures-guided management?
Module 11 · Manufacturer systems compared
A patient transfers to your clinic with a summary from another centre that lists 'tART thresholds' and 'MCL values in charge units'. Your clinic primarily programs Cochlear devices and your team is used to tNRT and C-levels in current-level steps.
How should you use the outside report?
Module 13 · Future directions, AI & emerging tech
Your clinic is piloting a machine-learning tool that predicts a full MAP from impedance and ECAP data. For a new adult recipient it proposes C-levels noticeably higher than your usual first-fit, and the patient — who can give some loudness feedback — reports two of the channels as uncomfortably loud at the suggested levels.
How should you use the AI-suggested MAP?