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Cochlear Implants - by Dr. Matthew Cox

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Cochlear Implants - by Dr. Matthew Cox

Do you no longer receive adequate benefit from conventional hearing aids?

 

 

 

 

 

What is a Cochlear Implant?

A cochlear implant is a device that is useful for people with severe-to-profound hearing loss. Cochlear implants consist of two main parts: an external device (processor and microphone) and a surgically-implanted device (magnet, receiver/stimulator and electrode array). The external device is worn on or behind the ear, similar to a hearing aid, but with a magnet that allows communication through the skin with the internal device. The main portion of the internal device is located behind the ear, and the attached electrode goes into the bony canal of the cochlea.

 

Source: NIH/NIDCD

 

How Does a Cochlear Implant Work?

Sounds are picked up on the microphone, which is part of the external device. Within the external component, this information undergoes processing and is transmitted through the scalp skin to the internal cochlear implant device. The implanted device sends signals via an electrode (that is located within the spiral bony canals of the cochlea) to directly stimulating the nerve fibers of the inner ear, which sends these signals to the brain to allow for useful hearing sensation.

 

Is a Cochlear Implant Like Natural Hearing?

The hearing sensations created by a cochlear implant are completely different from the natural hearing sensations created by the human ear. One of the most notable differences is in the way cochlear implant recipients perceive music. There have been many attempts at describing the changes in music perception after implantation, but none are universally accepted. At this time, many implant recipients do not appreciate music the same way as a person would with normal hearing; or with conventional hearing aids. While implant recipients do generally receive excellent improvements in speech understanding, the benefit for music appreciation is usually lacking.

 

Who Is a Good Candidate for a Cochlear Implant?

This may be useful for people who have lost their hearing or people who were born deaf. For any potential candidate, it is always important to be certain they would not receive adequate benefit from conventional hearing aids. A trial period with a conventional hearing aid is generally always required (except for people who lose their hearing from meningitis) before further consideration for a cochlear implant. Consultation with a multidisciplinary cochlear implant team is only way to find out if a cochlear implant is right for you. The team approach is the best way to ensure successful cochlear implant use and performance. There are many factors that influence a patient's success in adapting to and learning how to effectively use a cochlear implant after surgery.

 

What is the Process for Candidacy Evaluation?

Specialized testing is performed to determine whether a person is a good candidate for a cochlear implant. This testing is more in-depth than standard audiometry. Potential candidates undergo testing while wearing their hearing aids (i.e. tested in best-aided conditions) and testing in background noise. This evaluation also takes more time than standard audiometry; you should plan to spend at least two hours with the audiologist during this appointment.

 

What Should I Expect Before, During and After Cochlear Implant Surgery?

Before surgery, consultations will be scheduled with a cochlear implant-trained audiologist and an otolaryngologist (ENT doctor) with specialized training in cochlear implant surgery. In some cases, patients also have a consultation with a speech and language pathologist with expertise in cochlear implant recipients. During consultation with the audiologist, a device will be chosen and expectations will be established for activation, programming and learning how to use the device. During consultation with the surgeon, expectations will be established for recovery after surgery, and potential risks and benefits of surgery will be discussed. This discussion will also help you to understand any special considerations that must be taken due to a patient's individual and specific medical history. In conjunction with this appointment, imaging studies (CT scan and/or MRI), vaccinations (to help prevent meningitis after cochlear implantation), and lab work may be obtained.

 

On the day of surgery, you will arrive at the surgery center 1-2 hours prior to the time of your procedure. You will not eat or drink anything after midnight the night before surgery, so you may be hungry due to this fact (this helps make anesthesia safer). You will have a chance to ask any last-minute questions of your surgeon before going to sleep. Medication may be given prior to surgery to help you relax. A small area of hair is shaved behind your ear to allow proper placement of the surgical incision. After you wake up, you will not be able to hear immediately. In many cases, your hearing is worse immediately after waking up. This is due to the device being placed, the presence of blood and fluid behind the ear drum (which is normal at this time), and the gauze wrap that is placed after surgery is finished. You should not have severe pain, but a mild-to-moderate headache is not uncommon for a few days after surgery. During this time, you may also experience some nausea and/or dizziness, but your doctor will prescribe medication to help with both of these, just in case. You will also be given antibiotics to help prevent infection after surgery. After surgery, you will usually be able to go home within 1-2 hours of waking up. You will need to have someone with you to drive you home after surgery and stay with you for at least 24 hours. We do not allow Uber or Taxis to take you home after surgery.

 

A post-operative appointment will be scheduled with your surgeon 2-3 weeks after surgery. This appointment is to ensure proper and sufficient healing to allow for the external device to be worn and activated. After your surgeon approves, activation may proceed immediately. We generally try to schedule the post-operative appointment with the surgeon and the audiologist appointment for activation on the same day. After initial activation, most patients report that voices and other noises sound very 'electronic'. You will have a series of weekly appointments after the initial activation. During these appointments, you will undergo further tuning of your implant to best suit your individual perceptions and help improve your performance in understanding speech. You will be given tasks to practice at home between these sessions, and practice is very important to help get the most improvement in ability to use your cochlear implant. Most cochlear implant recipients report continued improvement in their ability to understand speech throughout the first year after placement.

 

How Much Does a Cochlear Implant Cost? Does Insurance Cover the Cost of a Cochlear Implant?

A cochlear implant (including candidacy determination, pre-operative studies, surgery, the implanted and external devices, activation, programming and clinic appointments) varies somewhat from case to case, but usually falls in the range from $75,000 to $100,000 for one ear. At this time, insurance (including Medicare plus a Medicare supplemental plan) covers the cost of a cochlear implant for patients who are determined to be a cochlear implant candidate, according to criteria that are chosen by the respective insurance companies. In some cases, insurance will cover the cost of a second implant after a patient demonstrates benefit from the first (usually six months after the first implant). Our cochlear implant team specialists help patients to navigate any difficulties that arise in dealing with insurance companies throughout this entire process.

 

How Do I Find Out If I Am a Candidate for a Cochlear Implant?

Call our clinic at (407) 677-0099 or click here to schedule an appointment for a cochlear implant evaluation.

 

Further Reading

https://www.nidcd.nih.gov/health/cochlear-implants

 

 

 

 

“Image provided courtesy of Cochlear Americas, © 2017 Cochlear Ltd.”

 

 

 

 

“Image provided courtesy of Cochlear Americas, © 2017 Cochlear Ltd.”

 

 

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