A collaborative effort of the Texas School for the Blind and Visually Impaired And Texas Commission for the Blind Winter 2003 volume 8, No, 1




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The guide is available in English, Spanish, and Braille.


Notice of Procedural Safeguards: Rights of Parents of Students with Disabilities

The Procedural Safeguards document explains the specific rights and responsibilities of the parent in the special education process. The table of contents includes:


• What Are Your Rights Related to Identification and Referral?

• What Are Your Rights Related to Evaluation and Reevaluation?

• What Are Your Rights Related to ARD Committee Meetings?

• What Are Your Rights Related to Discipline?

• What Are Your Rights Related to Accessing Your Child’s Records?

• What Are Your Rights if You Choose to Send Your Child to a Private School?

• What Are Your Rights for Public Reimbursement if You Choose to Send Your Child to a Private School?

• What Are Your Rights When Your Child Turns 18?

• What Are Your Rights if You Are a Surrogate Parent?

• Resolving Disagreements

• Contact Information


Public schools, which include district and charter schools, must provide parents of students with disabilities and adult students with disabilities a copy of the procedural safeguards, at a minimum, upon:

1. Initial referral for evaluation;

2. Each notification of an ARD committee meeting;

3. Reevaluation of the child; and

4. Receipt of a request for due process hearing under 34 CFR Section 300.507.


Schools must no longer distribute the outdated 1997 version of the notice, and immediately begin to issue the new edition on the occasions listed above. Each school is responsible for downloading, printing, and distributing the Notice of Procedural Safeguards: Rights of Parents of Students with Disabilities, available online at: < http://www.tea.state.tx.us/special.ed/>. Each school must ensure that the notice is provided in the native language of the parent, or other mode of communication, unless clearly not feasible to do so. English, Spanish, and Braille versions are available from the TEA website. If the native language or other mode of communication is not a written language, the school must translate the notice orally or by other means so that it is understood by the parent.


Assistive Listening Devices

By Jim Durkel, Coordinator of Statewide Staff Development, TSBVI Outreach


Noise and distance make listening hard for anyone. The more background noise there is, the harder it is to hear. The farther away a speaker is, the harder it is to hear. For people with auditory impairments, noise and distance are additional problems on top of the impaired hearing.


Hearing aids don’t amplify just speech, they amplify everything. This includes the background noise. Ideally, what you want to hear (called the signal) should be louder than background noise. This relationship is called the signal-to-noise ratio. A good signal-to-noise ratio is 20 dB. That is, the signal is 20 decibels louder than any noise. A more usual listening situation is a signal-to-noise ratio of 10 or 0. That is, the signal may be only 10 decibels louder than the noise or the signal and noise may be of equal loudness. In many classrooms, the signal-to-noise ratio can be 10 or 0. Rustling papers, children moving in their seats, the air conditioner running – all of these normal background noises can overwhelm a teacher’s voice.


In many classrooms, the teacher does not stay within 3 feet of the child. Sometimes the teacher may turn his or her back to the child (as when talking while writing on the blackboard). These actions decrease the intensity of the signal, making it harder for the child to understand what is being said.


A group of devices, called assistive listening devices (ALD), were designed to help a person with a hearing impairment better cope with the problems of noise and distance. An ALD works by having the speaker wear a microphone connected to a receiver, worn by the listener. The speaker’s voice is then sent directly to the listener’s ear. No matter where the speaker is in the room, his or her voice is as far from the listener as the microphone is from his or her lips. Background noise is not picked up by the microphone and so its effects are decreased.


ALD’s vary in how the microphone and receiver are connected to each other. In schools, the most common type of ALD is the FM unit. The microphone broadcasts the speaker’s voice on an FM radio channel. The listener’s receiver is tuned to that special frequency and picks up the radio signal. Many movie theaters, large churches, and public auditoriums use an ALD that sends the speaker’s voice to the receiver by way of infrared light (kind of like your TV remote control). Some very inexpensive units connect the microphone to the receiver with a wire (these are called “hardwired”). This type of device is fine when the speaker and listener are not going to be very far apart, such as when they are sitting at a table together. If you have used headphones to listen to a stereo, you have used a hardwired ALD. There are infrared and hardwired devices for use at home for watching TV or listening to music without driving everyone in the house nuts with fights over the volume control!


ALD’s also vary in how the receiver is hooked up to the listener’s ear. The receiver may be connected to a set of headphones. There may be a wire running from the receiver to a “button” that snaps into a special earmold. The receiver may be connected by a special wire plugged into the listener’s hearing aid. This is called a “boot”. Finally, the listener may use a “loop”. In this set up, the hearing aid on/off switch is set to “T”. “T” stands for telecoil. This is a setting for the hearing aid to use electromagnetic energy instead of sound energy coming through the air. The listener has a special loop of wire, connected to the ALD receiver, that he or she wears around his or her neck. The receiver transforms the sound energy into electromagnetic impulses that the hearing aid picks up. Sometimes, auditoriums have giant loops running around their walls. Anything a speaker says through the microphone on stage can then be picked up through a hearing aid without the listener needing to wear any other type of receiver. There are new behind-the-ear hearing aids with small FM receivers built into the hearing aid. With this device, the speaker wears a microphone and the signal is sent directly to the hearing aid. This is the wave of the future and may soon become the most common ALD. When an ALD can be connected to a listener’s hearing aid, there is less fuss, more consistent hearing aid use, and the sound will be amplified in a way that is most appropriate for that listener.


There is research showing that all children, with and without auditory impairments, benefit from good signal-to-noise ratios. As a result, there is another type of ALD starting to be used in some classrooms. With this device, the teacher wears a microphone. However, his or her voice is sent through speakers located around the classroom. This works like a small PA system. Now, the teacher’s voice is louder than the classroom noise and his or her voice stays constantly loud, regardless of how far away the teacher is from the child.

Children with central auditory processing disorders and children with hearing loss only in one ear may have more troubles with noise and distance than listeners with no impairments. These people may not wear hearing aids or need amplification but may benefit from the use of an ALD.


There are some problems with ALD’s. If they are set so that all background noise is blocked and only sound from the microphone is received, comments from fellow classmates may not be heard by the ALD user. The teacher needs to be sensitive to this and either repeat all comments made by classmates, or pass the microphone to the classmate before allowing him or her to speak. This can be cumbersome. ALD’s can be set to allow some background sound in. This allows for hearing comments from speakers without a microphone, but decreases the effectiveness of the ALD in providing the best signal-to-noise ratio. Many adolescents do not like to wear ALD’s because they make them stand out from their peers. Some teachers feel uncomfortable with wearing a microphone. Some ALD’s require a belt to hook the microphone on, limiting a teacher’s wardrobe. Some teachers complain that the cords get in the way of movement. The microphone may fall in a water fountain and cords get tangled around hands while trying to cook. Wearing a microphone takes some getting used to and once you forget you are wearing it is right when you leave it turned on while taking a restroom break! ALD’s need to be recharged every night and checked at the beginning of every day. There needs to be a process for handling repairs and maintenance in a timely fashion. Finally there is the issue of who will pay. An FM unit typically used in the schools can easily cost $1,000.


If you feel your child may benefit from an ALD, contact your district’s teacher for students with auditory impairments, your district’s assistive technology team, or visit an audiologist. If you can show that your child is in situations where his or her ability to listen is adversely affected by noise and distance, you would have a good case for the use of an ALD. The ALD may not be needed all day. For example, if reading instruction occurs in a very small group in the library, an ALD may not be needed then. However, for your child to hear instructions from the coach during PE in a large, noisy gym, an ALD may be quite helpful. Visit the various settings your child is in during the day. Think about how much background noise was present. How far away from the student is the teacher? Are there times when an ALD would improve the student’s safety? An ALD can keep a child in touch with the teacher’s voice out in the community and on job sites. This may increase the likelihood that the child would hear the teacher’s voice giving an alarm. However, a student wearing an ALD set to block background noise may not hear traffic sounds. You can see there is no simple answer to whether and when a child should wear an ALD. This why a team approach usually yields the best results. If possible, include the child on that team to get a commitment to care for and use the ALD. Once everyone understands the benefit of using these devices, any problems will seem worth the effort.


Teaching a Blind Student How to Graph on a Coordinate Plane: No Tech, Low Tech, and High Tech Tools

Susan Osterhaus, Secondary Mathematics Teacher, TSBVI


Editor’s Note: In the author’s words, “Although graphing calculators are mainstays of most secondary math classrooms, it is important for all students to understand the concept of graphing on a coordinate plane before they move to the graphing calculator.” This is especially important for visually impaired students, and Susan Osterhaus, math teacher at TSBVI, ensures that her students learn to do so manually – they must physically plot points, graph lines, and find slope. Below are her answers to questions about how to teach this skill, and her suggestions for students, teachers, and parents.


1. How can blind students graph linear equations, inequalities, and systems of inequalities independently and efficiently? Or is this the time when the VI student doesn’t participate because of the visual nature of the task?

Most academic blind students, even those with spatial orientation problems, are quite capable of graphing, and as one of my students exclaimed, “Not only can we do it, it’s fun!” There are several tools they can use to do so:


The Graphic Aid for Mathematics, from the American Printing House for the Blind (APH), is excellent for graphing algebraic equations. It can also be used in geometry, trigonometry, etc. It consists of a cork composition board mounted with a rubber mat, which has been embossed with a grid of 1/2-inch squares. Two perpendicular rubber bands, held down by thumbtacks, can create the x- and y-axes. Points are plotted with pushpins at the appropriate coordinates. Points are connected with rubber bands (for lines), flat spring wires (for conic sections), or string (for polynomial functions). I like for my students to graph extensively, and they can do so incredibly fast on the APH Graphic Aid. In fact, many print students also like using it because it is fast, fun, and allows them to learn graphing skills in another modality. You can make your own graph board by affixing a piece of raised line graph paper (also available from APH) to a cork board and proceeding as described for the Graphic Aid.


If a student needs to turn in copies of graphs for homework, he can use Wikki Stix and High Dots on APH graph paper. This method can be quite expensive, however, and is very time consuming. It also tends to be more of a test of artistic ability than a demonstration of understanding of graphing concepts.


The ORION TI-34 talking scientific calculator (from Orbit Research) and the Accessible Graphing Calculator (from ViewPlus Technologies) are examples of more high tech solutions for graphing activities. I described them in a previous See/Hear article (Winter, 2002), but strongly recommend that students be able to graph manually as well. It is important for visually impaired students to be able to use a variety of tools, and know when to use each of them. For example, a former student decided to graph a quadratic function manually because it was “too easy to bother with the computer.” Yet, he will use the AGC to graph an exponential function.


2. How do students represent inequalities that require a solid line or a dotted line on the graph?

The APH Graphic Aid described above works well. Plot the points with pushpins and connect them with a rubber band when the boundary line is to be included in the solution (a solid line in print). Leave off the rubber band when the boundary line is not included in the solution (dotted or dashed line in print).


3. How can VI students show shaded parts on a graph?

When graphing one inequality in two variables, I simply have my students place their hand on the shaded side. I check each graph as my students complete them. When graphing a system of two inequalities, the student places one hand on the shaded side of the first inequality. Then they place the other hand on the shaded side of the second inequality. Where the two hands overlap (including the boundary lines where applicable) is the solution. Pretty soon most of my students are able to handle three or more inequalities without multiple overlapping of hands. We even progress to linear programming problems involving four or more inequalities. In these problems, a bounded area with vertices is often found, and it is pretty obvious where the shaded portion (the solution) is located.


4. Is there a way for them to do multiple problems on a piece of paper? What if they need to be turned in to another teacher, or you can’t check each graph as it’s completed?

If a student-made, manually produced paper copy is required, the student could use APH graph paper attached to a corkboard. She could plot her points using stick-on high dots, puff paint, etc. and could form solid lines using Wikki Stix. She could actually use a colored pen, pencil, or crayon to color the shaded area of the solution. This would take much longer, however, and would be very labor intensive. It will be important to know the purpose of the assignment and the concept(s) being taught. A paper copy of a single function can be created on the AGC (it can’t graph multiple functions on the same graph). Often, it is possible for a sighted person (teacher, peer, parent, teaching assistant) to make a print copy of the student’s graph – the visually impaired student graphs on the Graphic Aid and someone copies it exactly onto a piece of paper to turn in. You can also divide the Graphic Aid into 4 to 6 small, separate coordinate planes for multiple problems. If you have a digital camera, you could even e-mail or print a picture of the student’s graphs. Better yet, have the student take her own photos!


Please be sure that visually impaired students are allowed to participate in all kinds of graphing activities and that they are supplied with the proper tools. I would rather see them become proficient using a rubber graph board because they will learn so much more with this method, and they can do so independently. Creative exploration should begin in the early grades and allowed to blossom. Remember, the beauty of a tactile graphic is found in the fingertips of the beholder. And there can be no more beautiful and meaningful graphic than one created by those very same fingertips.


Sources for materials described in this article:

APH Graphic Aid for Mathematics and APH Graph Paper:

Wikki Stix:

High Dots:

ORION TI-34 Talking Scientific Calculator:

Accessible Graphing Calculator (AGC):


Distance Education

Holly Cooper, Ph.D., Technology Consultant, TSBVI Outreach


In Outreach, we do a lot of training for teachers, parents, and others who spend time with students with visual impairments. We do the big conferences like Texas Focus and the Texas Deaf/Blind Symposium, as well as smaller sessions at Education Service Centers, and individual training when we do consultation visits. In spite of that, we often get requests for training from people who couldn’t get to, or didn’t know about, the sessions we offered. We can only be in one place at a time. Or can we? Well, through the magic of technology, we can and routinely are, in many places at once!


Last year, Outreach math and technology consultants, as well as others, did training over an interactive video system. Some vision teachers are familiar with this training medium since they took vision teacher certification courses this way. While it’s not as engaging as real live face-to-face interaction and communication with colleagues, it’s a good way to get information to people who need it.


Getting Connected

Do you want to find out what is scheduled for the remainder of this year? Math and Tech Outreach staff are both doing presentations once a month on Wednesday afternoons. You can see the list of topics and dates at: for technology, and for math. To view the presentation, contact your local Education Service Center. Currently, about half of the ESC’s are connecting and participating. Many local school districts also have the capability of connecting. In the Dallas area, Region 10 has researched and found a variety of sites in high schools and other local campuses that have connected and viewed our presentations live.


Audiences have included teachers, parents, and students, all of whom have had questions and needed information about how to use a specific device, or how to make the device more useful in the educational environment. If your ESC is not making this service available, contact them, and ask others to contact them and request these distance education sessions.


Be Prepared

To get the most out of a distance education session, it is crucial to come prepared. If the training is on a particular device, such as a notetaker, bring the device with you to the training. If it is on a computer application such as JAWS, bring a computer with JAWS installed on it. Many computer applications for people with visual impairments are available as downloadable demo versions from the manufacturer’s websites. A demo version is great way to familiarize yourself with a product. So bring your computer with the software installed on it to the training session. Bring along user’s manuals and other materials that you have on the device.


If your student or child is mature enough to participate, try to arrange to have them come with you. Two heads are better than one. It’s a lot of information at one time, and impossible to remember it all when you get back in the classroom. If you can have another vision teacher or paraprofessional come along with you to take notes, that can be a great help. Before coming to the session, spend a little time trying to use the device or software and exploring its features. Make a list of the questions you have, and features you would like to ask about. The strength of interactive video conferencing is in the interactivity, so come prepared to ask, and don’t be afraid to speak up during the session.


As presenters, we really appreciate questions and comments from the audience, especially feedback sharing ideas about how others have used a device or software application. If you have a question, chances are the other people do also. If you plan to come to a session, you can send us an email to ask us in advance to spend time really explaining a particular aspect of the topic. We want to give our viewers the information they need!


We send the preliminary version of the handouts to the ESC’s by the Friday prior to the session. Typically we email them, and the local people furnish print copies. Often we will have a list of web resources that will help you with tutorials, lesson plans, user’s guides, and other supporting material. We are doing training both on specific devices and computer applications as well as about instructional strategies and general overviews of topics. In the spring we will be planning for next year, so send us an email about training sessions you would like to have in the 2003-2004 school year. Tell us what you want; we aim to please!


Why come to a distance education broadcast?

• Save travel time and expense; stay in your area and learn in a statewide workshop.

• Use the opportunity to ask questions and troubleshoot the device.

• Watch as we plug cords and flip switches to make devices work together.

• Work along with us and make sure you can use the devices and understand the instructions.

• Hear about on-line lesson plans, tutorials, web sites and other resources.

• Talk to the trainers and other teachers of students with visual impairments, and sometimes parents and students, about issues and questions of concern to you.


The Early Braille Readers Project

Holly Cooper, Ph.D., Technology Consultant, TSBVI Outreach


We in Outreach Technology are pleased to announce the launching of a new project: the Written Communication Technology for Early Braille Readers Project. This project will provide electronic braille equipment for a limited number of students who apply and are selected as participants. For more information about the project and how to apply, parents should contact their child’s vision teacher. Teachers can contact the regional Education Service Center specialist for students with visual impairments.


What’s It All About?

The Early Braille Readers Project was designed to explore the potential of electronic braillewriter technology for very young students. We believe putting braille technology into the hands of students and their teachers in the primary grades will give students access to a virtually unlimited supply of written material. With such expanded access to materials, students will have more opportunities to learn literacy skills in a variety of contexts, increasing their learning opportunities. They will be able to participate in classroom activities more fully because the technology can receive input from a standard computer keyboard and output it in braille! General education classroom teachers and students can enter information in print, and the braillewriter can immediately emboss it into braille. No longer will all printed matter have to go to the vision teacher for the braille reading student to have access. The braille reading student also will be able to write in braille and output materials in print with a computer printer.


So what is this braille technology, and why haven’t we been using it already? We have! It’s a new version of a device that is familiar to many who work with visually impaired students: the Mountbatten Pro braillewriter! The exciting thing about the Mountbatten that led us to choose it for this project is it’s ability to interface with a computer. Pulse Data has released a new version of the Mountbatten with a multitude of ports and connectivity features. They have revised some of the function keys, so students will be much less likely to access the internal menus of the device, and unintentionally store or delete files.

Not Just Gadgets!

Equipment is great, but practical use of equipment in classrooms with children is another matter. We in Outreach Technology know that just having a piece of equipment doesn’t necessarily help the student. We believe in support! An important feature of our project is training and support for the vision teacher, other teachers, support staff, and interested people who will be assisting the student, or using the electronic braillewriter themselves to produce accessible materials. We will do a series of initial face-to-face trainings, and scheduled trainings and trouble shooting sessions on interactive video or web-based interactive video. We will have a supporting listserv for users to ask questions and share ideas. Our project will have the capacity to add other supports as participants have needs.


We’re Looking For a Few Good Kids

To take part in this project, the vision teacher must complete an application, and the student must fall within the parameters we defined in our grant application. Included in these requirements are the following:


• The student must be an early or emerging braille reader who already is learning to read and write some braille letters (standard size braille);

• The student must be in kindergarten or first grade in the first year in which they participate in the project;

• The student must be educated in the general education environment for the majority of the school day;

• The vision teacher and classroom teacher must be willing to take part in training and the use of the equipment.We realize there are many other students who would benefit from the use of equipment like this who are older or who are educated in other class settings. Our project only includes young students who are ready to read. Probably most will not have other disabilities. We plan to collect information on students’ progress in reading and writing, and feedback from teachers about how increased access to braille has made a difference in skill acquisition, social interactions with peers, and other aspect of the educational experience. With this project as a source of information, we will write and do presentations about (what we expect will be) the benefits of having access to braille through the use of technology. In this way, we hope to give teachers and parents the information they need to advocate for the use of technology and increased availability of materials in braille for younger students, and students who are early braille readers regardless of their age.


Do you think you know a student who would be a good prospect for participation in the Early Braille Literacy Project? We want to know about them. Contact your vision teacher or ESC vision specialist to start the process.


FDA Public Health Web Notification: Cochlear Implant Recipients May Be at Greater Risk for Meningitis

Reprinted with permission from the U. S. Food and Drug Administration Center for Devices and Radiological Health

Originally issued July 24, 2002 – Updated: October 17, 2002


The Food and Drug Administration (FDA) has become aware of a possible association between cochlear implants and the occurrence of bacterial meningitis. Worldwide, we know of 91 reports of meningitis in patients implanted with the three FDA-approved cochlear implant devices: Advanced Bionics Corporation devices (56 cases), Cochlear Limited devices (33 cases) and MED-EL Corporation devices (1 case). A total of 17 deaths have resulted from these meningitis cases.

Within the U.S., the FDA is aware of 52 cases of post-implant meningitis: Advanced Bionics Corporation devices (29 cases), Cochlear Limited devices (22 cases), and MED-EL Corporation device (1). Five cases resulted in death. Cochlear Limited, Advanced Bionics, and MED-EL devices were approved in 1985, 1996, and 2001, respectively. All cases are currently being investigated. According to information supplied by the manufacturers, the one MED-EL Corporation case and the majority of the Cochlear Limited cases had predisposing factors for meningitis unrelated to the implant (e.g., Mondini inner ear deformity, pre-implantation history of meningitis—see Predisposing Factors section below).


Case Information

The ages of the U.S. meningitis patients ranged from 18 months to 84 years but most (33) of the patients were under 7 years of age at the time they developed meningitis.


Patients in the U.S. had onset of meningitis symptoms from less than 24 hours to greater than 6 years after implant. Thirty-two U.S. patients developed meningitis within one year post implantation, many within the first few weeks of surgery.


We have received cerebrospinal fluid (CSF) culture results in 23 cases in the United States. The organisms identified are: Streptococcus pneumoniae (pneumococcus) (16), Haemophilus influenzae (4), Streptococcus viridans (2), and Escherichia coli (1). Although vaccination is usually protective against both pneumococcus and H. influenzae, 2 cases of pneumococcal meningitis and 2 cases of H. influenza meningitis developed after the patient had received the appropriate vaccine.


Predisposing Factors

The cause of meningitis in the cochlear implant recipients has not been established. Some deaf people may have congenital abnormalities of the cochlea which predispose them to meningitis even prior to implantation. People who become deaf as a result of meningitis are also at increased risk of subsequent episodes of meningitis compared to the general population. Other predisposing factors may include young age (< 5 years), otitis media, immunodeficiency, and surgical technique. The cochlear implant, because it is a foreign body, may act as a nidus for infection when patients have bacterial illnesses.

Design of the electrode is also being considered as a possible predisposing factor. Advanced Bionics electrodes with positioners (HiFocus I and HiFocus II) have been withdrawn from the market. The HighFocus I without positioner has been approved for use in the U.S. No Cochlear Limited or MedEl Corporation electrodes have a positioner.


Significant Events and Government Actions to Date

In early July, European and U.S. cochlear implant surgeons and experts met to discuss the incidence of meningitis occurring after cochlear implantation. That group concluded that there were more cases of meningitis with the CLARION device with the electrode positioner than with other cochlear implants. The organizers of that meeting recommended discontinuing use of the positioner, and the regulatory authorities of several European countries (e.g., France, Germany, and Spain) accepted those recommendations. Consequently, Advanced Bionics agreed to discontinue use of the positioner in those countries and is marketing one of their current electrode systems (HiFocus I) without the positioner. The company also initiated a voluntary recall of any unimplanted CLARION devices in the United States, but subsequently has received FDA approval for marketing the HiFocus I electrode without the positioner.


Drs. Noel Cohen (New York University) and Thomas Balkany (University of Miami) conducted a survey to ascertain additional cases of meningitis in cochlear implant recipients. They surveyed all North American implant centers. Their survey helped FDA identify cases of meningitis during the early course of this investigation.


The Centers for Disease Control and Prevention (CDC) and the FDA, in partnership with State Health Departments, are presently conducting a formal, comprehensive investigation into the apparent association between meningitis and cochlear implantation. The purpose of this investigation is to gather information that may help determine risk factors that lead to meningitis in this implant population and help to develop strategies to prevent meningitis in cochlear implant patients. This investigation focuses on implant recipients who were under the age of six at the time of implant.


Meningitis

Meningitis is an infection of the lining of the surface of the brain. Early symptoms of meningitis include fever, irritability, lethargy and loss of appetite in infants and young children. Older children and adults may also manifest headache, stiff neck, nausea and vomiting, and confusion or alteration in consciousness. Physicians are encouraged to consider a diagnosis of meningitis in cochlear implant patients when such symptoms exist and to begin appropriate diagnostic testing and treatment as soon as possible.


The younger patient population (< 5 yr) and the elderly are most vulnerable to meningitis.


Cochlear Implants and Otitis Media

In some of the reported cases of meningitis in cochlear implant recipients, patients may have had overt or sub-clinical otitis media prior to surgery or before the meningitis developed. Physicians are encouraged to consider appropriate prophylactic perioperative antibiotic treatment, and to diagnose and treat otitis media promptly in patients with cochlear implants.


Use of Pneumococcal Vaccinations for Cochlear Implant Recipients

Persons less than 2 years with cochlear implants should receive the pneumococcal conjugate vaccine according to the high risk pneumococcal conjugate vaccination schedule. This schedule is the same as the pre-shortage routine immunization schedule used for children less than age 2 years. For high risk infants who start the series before age 6 months, this means they would get four doses, given at 2 months, 4 months, 6 months and 12-15 months.

Persons who are age 2 years and older with cochlear implants should receive pneumococcal vaccines, according to the following schedule:

• High risk children age 2 years and older who have completed the pneumococcal conjugate vaccine (Prevnar®) series should receive one dose of the pneumococcal polysaccharide vaccine (Pneumovax® 23 or Pnu-Imune® 23). If they have recently received pneumococcal conjugate vaccine, they should wait at least two months after completing the pneumococcal conjugate vaccine series before receiving pneumococcal polysaccharide vaccine.

• High risk children between the ages of 24 and 59 months, who have never received either pneumococcal conjugate vaccine or pneumococcal polysaccharide vaccine, should receive two doses of pneumococcal conjugate vaccine two or more months apart and then receive one dose of pneumococcal polysaccharide vaccine at least two months later.

• High risk persons age 5 years and older should receive one dose of pneumococcal polysaccharide vaccine. Pneumococcal conjugate vaccine in not routinely recommended for persons age 5 years and older. If pneumococcal conjugate vaccine has recently been given, then polysaccharide vaccine should be administered 2 or more months after pneumococcal conjugate vaccine.


Use of Hib Vaccination in Cochlear Implant Recipients

Most children born after 1990 will have received the Hib vaccine when they were infants.
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