Ear Center: Cochlear Implant Basics

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Cochlear Implant Overview
History
Candidacy
Cochlear Implant Evaluations at the Ear Center
Evaluation
Diagnostic Imaging
Costs & Insurance
Recommended Vaccinations 
CI References
CI Performance
Cochlear Implant Animation

Cochlear Implant Overview 

Components: Cochlear implants are electronic devices that are surgically implanted under the skin behind the ear consisting of an internal receiver and an electrode array that is inserted in the inner ear (cochlea) with the hope of restoring some hearing function for patients with severe to profound deafness in both ears. An external processor is worn behind the ear (or on a belt) and contains a microphone and transmission system (telemetry). The external processor microphone detects environmental sound, processes the signal, and transmits it, through the skin, to the implanted internal receiver. The internal receiver is attached to an electrode array that is implanted within the cochlea.  The electrodes transmit the sound as an electrical signal to the inner ear. Remaining inner ear nerve cells transmit the sound signal to the brain which must interpret the signals as sound and words. The signals are not sounds as they are heard by normally hearing individuals but are signals that deaf or profoundly hearing impaired people must learn how to interpret into words.

Three cochlear implants are available that have been cleared by the U.S. FDA:

Surgical Procedure: Cochlear implants are surgically implanted under the skin behind the ear. The operative procedure for each of the three cochlear implants above is very similar, depending on electrode design and configuration.

Depending on anatomy and other considerations, the poorer hearing ear is usually implanted first. Again, depending on anatomy and patient preference, the other ear may be implanted either in a staged fashion (usual) or simultaneously (more rarely).

The operation is performed under general anesthesia and takes 2.5 - 4 hours depending on anatomy and underlying medical conditions. Procedures are performed in either an ambulatory surgical center (SCA Surgical Center of Greensboro or Cone Day Surgery Center) with overnight stay capability or at our hospital (Cone Health/Moses Cone Hospital campus). Ear Center patients stay overnight and are discharged the following day. Patients return in 7-10 for follow-up and suture removal.

Cochlear implantation usually results in some minor, transient incision and ear pain for a few days. Vertigo or unsteadiness may be present in some patients for one to four weeks. Some patients experience transient taste disturbance for up to one month. Patients take postoperative antibiotics for 10 days.

CI Activation: Cochlear implant activation is performed 4-6 weeks postoperatively depending on healing. Follow-up cochlear implant programming is performed by highly trained audiologists and is individualized per patient.

Performance: The most important determiner of success with a cochlear implant is the length of time of deafness prior to implantation. Some brains are able to interpret the signals very well and others struggle to make sense of the signals. This results in 1/3 of patients being low performers, 1/3 medium performers, and and 1/3 high cochlear implant performers, respectively. Currently, no preoperative tests are available to predict postoperative performance. Some, but not all, patients function well enough to be able to talk to familiar speakers over a telephone or cellphone. There are no guarantees that cochlear implantation can help to restore any hearing, in either ear, in any one individual.

Brain Training: After a cochlear implant is performed, a one to two year period is needed for practice and brain training. Immediately after activation, patients do not hear normally or as they remembered before their hearing deteriorated or disappeared. Sophisticated computer programming or "mapping" performed over several years is required for patients to achieve their maximum hearing.

Video - How Cochlear Implants Work

History

Cochlear implants were started in 1960 by William F. House, D.D.S., M.D. of the House Ear Institute. The first human patient was implanted in 1973. Currently, there are three approved multi-electrode cochlear implants available - Cochlear Americas, Advanced Bionics, and Med-El.

wm_house_image
William F. House, D.D.S., M.D.

 

To date, over 100,000 people worldwide have been implanted with cochlear implants. In the United States, more than 22,000 adults and 15,000 children have been implanted.

Experience Matters...a lot: Dr. Kraus has been implanting cochlear implants in adults and children since 1986. He was one of the original co-investigators working with Cochlear Corporation during the Pediatric Cochlear Implant investigational trials from 1987-1990. Along with 14 other co-investigators, it was their results that help lead to FDA approval for cochlear implants in children 2 years or older in July 1990.

Candidacy

Patients who are considering a cochlear implant receive special preoperative counseling and require a standardized audiometric evaluation to determine candidacy.

  • It must be determined that the patient is anticipated to perform better with a cochlear implant than with their hearing aids that have been optimally fit. Discrimination scores (WRS or understanding ability) must be 40% or less in the best aided condition.
  • CT, and sometimes MRI scans, of the head are necessary in order to determine candidacy.
  • The patient must be healthy enough to have a 2.5-4 hour general anesthetic, have no bleeding problems, and be of sound mind enough for postoperative computer mapping to program the device.
  • A Pneumovax® vaccine is required for adults. Children are required to have Prevnar®, Pneumovax®, and HIB vaccines along with their standard pediatric immunizations.

The cochlear implant operation is performed under general anesthesia and requires an overnight stay. CI processor fitting is performed approximately 4-6 weeks after implantation depending on healing and other individual factors. At least 1-2 years of cochlear implant computer mapping and auditory habilitation therapy is required to maximize hearing potential.

Older Patients: Cochlear implantation can be safely performed in patients over 70 years of age who cannot be helped by conventional hearing aids. Usually, their duration of hearing loss is longer than in younger patients. Decreased performance correlates with duration of deafness, rather than with age. Profound hearing loss may have adverse effects on social isolation, depression, cognition function, and quality of life. Regaining some hearing is particularly important if visual impairment or compromise is present caused by conditions such as macular degeneration or retinal detachment.

Older patients must be able to undergo a 2.5 - 4 hour anesthesia and are usually required to have a complete history and physical examination, including a chest x-ray, EKG, and blood tests, performed by their primary care physician or cardiologist for preoperative anesthesia clearance prior to determining candidacy.

Cochlear Implant Evaluations at The Ear Center

Thank you for choosing our center for your cochlear implant evaluation. As you know, cochlear implants represent the cutting edge of sophisticated medical technology. In many cases, multi-electrode or multi-circuit cochlear implants can help to restore useful hearing to children and adults who have:

  • severe to profound hearing loss in both ears with less than 40% word recognition scores,
  • who derive little or no benefit from conventional hearing aids
  • who have failed other middle ear implants (such as Envoy Esteem, Maxum or Vibrant Soundbridge hearing implants)

Evaluation

Time: In order for our cochlear implant team to properly evaluate you or your loved one for a cochlear implant, it will be necessary for you to spend several hours or longer with us in the office. During your visit, your hearing will be tested by our audiologists and our cochlear implant surgeon will perform a complete medical evaluation. You or your child may also require a complete physical examination by your family doctor/internist/cardiologist/pediatrician/depending on individual circumstances and medical history.

Hearing Tests: During the hearing evaluation, which may be lengthy, our audiologists will perform many tests of your hearing ability with and without your hearing aids. In order to facilitate the testing, it is essential that you bring your most recent hearing aid(s), ear molds, etc. with you to your visit even if your hearing aids are not working or if you do not wear them regularly. CI testing includes comprehensive audiometric testing, CNC, and AzBio testing (hearing in noise testing).

Medical Records: In addition, please remember to bring all of your past medical records, including previous hearing tests (audiograms), to help us better understand your health history. Literature and DVD's concerning cochlear implantation are available to help you understand the science and process of cochlear implantation. Information about the three types of CI that have been cleared by the U.S. FDA is available. By the end of your visit, a member of our staff will attempt to answer all of your questions.

Diagnostic Imaging

CT/MRI Scans: If it is felt that you would benefit from a cochlear implant, it will be necessary for you to have a special x-ray and/or diagnostic test(s) of your ears (CT scan of your ears and/or an MRI head scan). These studies are necessary in order to properly assess the anatomy of your inner ears (cochleas) and for preoperative planning. Simply stated, there must be an open channel within the cochlea (patent cochlea) present in which to place the active cochlear implant electrodes. You must have an intact hearing nerve to carrier the hearing signals from your inner ear to your brain.

Facilities: These tests will be arranged for you by our medical staff. The imaging tests are not performed in our office and are scheduled on another day. Because they are special tests, they are usually performed in our local free-standing, radiology imaging facilities (Greensboro Imaging, Triad Imaging, etc.) or in local hospital (Moses Cone Hospital/Cone Health) that is located directly across the street from The Ear Center.

Insurance: Finally, we recommend that you review the terms of your current health insurance policy to check if cochlear implants are a covered service for you. Cochlear implantation is a well recognized technology, is the standard of care for the treatment of severe-to-profound hearing loss that cannot be treated with hearing aids, and is fully approved by the FDA for adults and children 12 months and older. Most health insurance carriers cover cochlear implants. However, some do not. If you have questions after reviewing the terms of your policy, we recommend that you contact your company's health care benefits department.

Cost & Insurance

Currently, the approximate cost for cochlear implantation is in the range of $40,000-$45,000 depending on the type of device implanted, length of surgical center or hospital stay, etc. Please check with your insurance company concerning your individual benefits concerning cochlear implants. Our Ear Center staff can also help you with insurance questions.

We sincerely hope that this information concerning cochlear implant evaluations is helpful to you. Please remember to bring your hearing aid(s) and medical/hearing test records with you or arrange for them to be sent or faxed to us prior to your visit. Our fax number is (336) 273-9936.  Our cochlear implant team genuinely looks forward to meeting you and your family and introducing you to the world of cochlear implants - the cutting edge of medical technology.

Cochlear Implant Animation

 

Vaccination Recommendations for Patients Receiving Cochlear Implants

New recommendations have been issued by the Center for Disease Control:

  • Children should receive PCV13 vaccinations.
  • Older children (ages 2-5 yrs.) should receive two doses of PCV13 if they have not received any doses of PCV7 or PCV13. If they have completed the four doses of PCV7 series, they should receive one dose of PCV13 through age 71 months.
  • Children 6-8 yrs of age may receive a single dose of PCV13 regardless of whether they have previously received PCV7 or the pneumococcal polysaccharide vaccine (PPSV) (Pneumovax)
  • In addition to PCV13, children should receive one dose of PPSV at age 2 or older and after completing all recommended doses of PCV13.
  • Adults 19 yrs of age or older should receive a single dose of PPSV.
  • For both children and adults, the vaccination schedule should be completed at least two weeks before cochlear implant surgery.

CI Performance

Postoperative performance results with cochlear implants reveal that 1/3 of patients are low performers, 1/3 of patients are moderate performers, and 1/3 of patients are high performers. Some patients are able to obtain open set word recognition; some patients are not able to obtain open set word recognition. Some patients are able to use a telephone and some are not (auditory only task).

Many factors, some known and some not known, contribute to the variability in performance among patients. Lingual status, i.e. pre-lingual, peri-lingual, and post-lingual, is a definite factor as well as the length of time of deafness between onset and implantation.

At least three important concepts are intertwined together and include:

  • baseline auditory sensitivity (bottom-up issue): cochlear neurons remaining, status of auditory pathways, hardware & software issues, CI mapping quality, etc.
  • status of baseline linguistic skills (top-down issue): lexical & contextual skills, phonologic & semantic knowledge, etc.
  • status of neurocognitive skills, particularly "working memory" and perceptual organization skills

Usually, 12-24 months of CI use are needed for "brain training" to occur. Highly motivated patients and participation in aural habilitation contribute to CI hearing success.

CI in pediatric patients provide the patient an opportunity to learn to speak and to development abstract thinking ability.

Cochlear Implant References:

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For addition website information concerning the various cochlear implant companies, please click on our "Links" section for their website addresses.

If you would like to learn more about cochlear implants for yourself or a loved one, please contact our office at (336) 273-9932 and ask for our Audiology Department.

Last revised February 18, 2017