Cochlear Implant Surgery
Cochlear implants are devices that can provide sound for people who receive little or no benefit from hearing aids. Hearing aids make sounds louder. However, for children and adults who have severe to profound hearing loss, making sounds louder may not be enough to allow the ear to process sound. A cochlear implant may be more successful than hearing aids in some cases, because it bypasses the damaged sense organ of hearing (cochlea) and directly stimulates the hearing (auditory) nerve.
Cochlear implant is an electronic system. It has tiny electrodes that are surgically inserted into the cochlea, a part of the human hearing apparatus. The cochlear implant converts sound into electrical signals that go to the auditory nerve [nerve responsible for hearing] and then to the brain.
What Is a Cochlear Implant and How Does it Work?
Cochlear implants are implantable devices designed with the goal of providing sound detection and speech recognition for people who receive little or no benefit from hearing aids. There are several types of cochlear implants. All cochlear implants consist of internal and external components.
The internal portion, which is implanted surgically, has a receiver and tiny electrodes. The receiver is surgically imbedded under the skin behind the ear. The electrodes attached to it are surgically inserted into the cochlea.
Is My Baby a Candidate for a Cochlear Implant?
Hearing aids must be tried for at least 3-6 months before deciding to opt for cochlear implants.
In case a child has suffered meningitis, it may become deaf. In such cases hearing aid trial may be of a shorter duration or may not be done. Bony growth in the cochlea following meningitis may create problems for implantation. We may have to think of implant surgery before the child is 12 months old to ensure proper insertion of the electrodes into the cochlea. If we operate late, bony growth fills the cochlea.
Degree of hearing loss:
Children between 12 months and 18 months of age: Profound, sensorineural hearing loss of 90 decibels or greater in both ears.
Children 18 months of age and older:
Severe-to-profound sensorineural hearing loss of 70 decibels or greater in both ears.
Lack of benefit from appropriately set hearing aids, is best shown by examples like inconsistent response to his/ her name in a quiet ambience and failure to show alertness to environmental sounds while wearing the hearing aid.
When not to use cochlear implants
- When the auditory nerve is absent
- Medical conditions or developmental delays that may severely limit participation in aural rehabilitation
- Active middle ear infections
Children should be in a rehabilitative or educational setting where the development of listening and speaking skills are emphasized. Rehabilitative or educational environments that encourage auditory skill development are likely to have a positive effect on the speech and language progress in children.
High motivation, positive family environment, and realistic expectations are all important factors in a child’s performance with the cochlear implant.
As part of the cochlear implant process, a pre-implant evaluation is necessary to determine if a child is an ideal candidate for a cochlear implant. The pre-implant evaluation process may include the following:
Cochlear Implant Orientation
The purpose of this is to orient a child and its family to the cochlear implant process. This includes explaining what is a cochlear implant, the surgery and post-surgery process; follow up schedules, the cost of implantation, realistic expectations of cochlear implant benefits and warranties and insurance of the devices.
As part of the pre-implant evaluation, an audiologist will measure the child’s hearing levels. Testing will also be completed to see if amplification with high-powered hearing aids can provide enough auditory information.
We determine if the child can safely undergo general anesthesia and review x-rays, CT scans and MRI of inner ear to ensure that the cochlea are suitable for insertion of the electrode array. We also look for any other medical conditions that would prevent the use of an implant.
What to Expect
It is necessary to discuss expectations of the benefits and limitations of a cochlear implant device. The following topics must be discussed with the patient and its family.
- Whether the family’s expectations for the child’s performance with the cochlear implant are realistic?
- Has the family talked with other implant users?
- How supportive are the immediate and extended family members to the idea of an implant?
- How committed will the family be for follow-up therapy?
- Whether the family knows about assistive devices in addition to the cochlear implant?
Vestibular testing may be requested to determine the health of a child’s balance system.
A psychosocial assessment looks at other factors that can influence adjustment to or benefit from a cochlear implant. It addresses questions about reasonable expectations and ensures that a child and the family are highly motivated and willing to participate in an extended rehabilitation program. In addition, this type of assessment can examine the potential candidate’s cognitive abilities to rule out factors other than hearing loss, which may account for poor auditory and speech-language development.
Cochlear implant surgery requires general anesthesia and lasts about 2 to 3 hours. The child stays in the hospital for a few days. It generally takes 3 to 5 weeks for the surgical incision to heal, but most children resume normal activities within days after the surgery.
Between 4 to 6 weeks after surgery, the child will return to the clinic to have the device activated for the first time. During the time between surgery and implant activation, the child will not be able to wear a hearing aid in the implanted ear and so will not be able to hear in that ear. If a hearing aid is worn in the non-implanted ear, the child should continue to wear this aid during the time between surgery and activation. Some children will continue to wear a hearing aid in their non-implanted ear after the implant is activated to improve their ability to determine from what direction a sound is coming (localization) and to improve listening in noise.
Device activation may be either a one or two-day process. Up to 20 return visits may be needed within the first year for both fine-tuning of the speech processor and auditory training or aural rehabilitation.
Cost of a Cochlear Implant
Although an expensive surgery, Cochlear Implants should be seen as a surgery to change life. If a child is unable to hear, it will never be able to speak properly. That will handicap its whole life.
But a cochlear implant surgery at the right time, that is young childhood, helps the child grow like any normal child. That is the greatest benefit the child gets.
What exactly is meant by “benefit” or “success” with a cochlear implant? It is important to keep several important facts in mind:
- The benefit from cochlear implants is not immediate
- Improvements occur over a period of months or even years
- The amount of benefit seen is linked to the age of a child at the time of implantation, the cause of the hearing loss, and family support and involvement
- Active middle ear infections
Reasonable expectations may include improved detection of environmental sounds and speech, improved speech reading ability, and improved clarity of the child’s speech. How much speech understanding a child with a cochlear implant will obtain and how clear his or her speech will be is difficult to predict.
Cochlear implant surgery should be viewed as the first step in a long process. Parents should understand that their participation is crucial in their child’s educational process so that the most benefit can be achieved.
Children with cochlear implants need support services from a number of professionals for educational and speech development. The amount of support needed varies from one child to other. A child’s performance with a cochlear implant cannot be predicted. Each child will have varied performance with the cochlear implant. However, providing the right support services and environment can optimize learning and development. It is important to remember that it can take up to one year after the implant is activated for distinct changes to show in a child’s ability to communicate.
In a small number of cases, a child may show only limited benefit from the cochlear implant or seemingly no benefit at all. This can generally be linked to a significant malformation of the cochlea or to a hearing nerve that has a very limited number of nerve fibers. In other words, the cochlear implant is sending a signal, but the structures needed to pass the signal on to the brain are not there.
Contact Shalby Hospitals for Cochlear Implant Surgery, Cost, Cochlear Implant Clinic, Hospital, Pharyngitis Treatment in Ahmedabad, Gujarat, India. Inquiry Shalby hospital at +91-79-40203111.
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