Cochlear Implant

Did you know that

40% of Persons over the age of 65 Report a
Significant Hearing Loss
Todays Youth are also at Risk of Significant
Hearing Loss
At 85 dB, you can listen to music for 8 hours with no
damage. But for every 3 dB increase, cut that time
in half.

4 hours for 88 dB
2 hours for 91 dB (subway, lawnmower)
hour for 97 dB (motorcycle)
15 minutes at 100 dB (school dance)
for a concert which can be 110 dB and above less
than a minute!

Anatomy of the Ear

Outer ear
Middle ear

Normal Inner Ear

Damaged Ear
Inner

Hair Cells
Outer

Inner ear cochlea

Facts about Hearing

Aids
Hearing aids do not completely correct a
hearing loss 100%
Hearing aids amplify all sounds
Hearing aids will help hearing in many
situations
Benefits of hearing aids depend on
several factors
Two hearing aids are better than one
Adjusting to hearing aid(s) is a long
process

Other possible options

Bone Anchored Hearing Aid
Titanium fixture/external abutment/sound processor
Typically for congenital atresia or chronic
ear infections

Implantable Hearing Aid

BAHA

Alternative to an acoustic hearing aid, for mild to severe

sensorineural hearing loss

Cochlear Implant

Vibrant Soundbridge

What is a Cochlear
Implant ?
Surgically implanted device.
Electrode Array and a Receiver-Stimulator

But it works only if used with:

External components:
Speech Processor, Headpiece & Battery

To work, it needs:
Programming with a computer

To work even more optimally:

Rehabilitation sessions necessary

External components: Speech

Processor, Headpiece & Battery

What does it look like?

Illustration from Advanced Bionics

When to refer an Adult for a

CI?
Bilateral severe to profound sensorineural
hearing loss
Limited benefit from appropriate hearing aids
i.e. poor speech recognition
Telephone use is difficult, limited or impossible
Patient relies heavily on speech reading or note
writing to understand speech
Patient is distressed by the inability to
communicate efficiently on a daily basis
No medical contraindications

Children Candidacy
Severe to profound sensorineural
hearing loss in both ears
Lack of benefit from hearing aids and
therapy
No medical contraindications
High motivation and appropriate
expectations for child and family
Placement in educational program that
emphasizes auditory skills
12 months and up; may be indicated
earlier for special cases

Other considerations
Age
Duration of deafness
Language
Mode of Communication
Other handicaps
Motivation

How is a Cochlear
Implant Different from
a Hearing Aid?

Hearing Aids:

acoustically amplify sound

rely on the responsiveness of surviving hair
cells

Cochlear Implants:
bypass damaged hair cells
Convert the acoustic input signal into electrical
impulses to stimulate the auditory nerve fibers
in the cochlea. The resulting electrical sound
information is sent through the auditory
system to the brain for interpretation.

How does it work?

Sound Processor

captures sound from the environment

processes sound into digital information
transmits to the implant.

2. Implant

converts transmitted information into

electrical signals
delivers signals to the electrodes for
stimulating the hearing nerve.

3. Hearing Nerve

carries the sound information to the

brain, where it is interpreted.

Evaluation Process
Audiological
Medical
Psychological & Social Worker
(children)
Auditory-Verbal Therapy (children)
Speech Language Pathology (for
adults, when required)

Audiological
Assessment
Diagnostic testing:

Audiogram
Tympanometry & Acoustic Reflexes
Auditory Brainstem Response
Otoacoustic Emissions

Speech perception tests with

appropriate amplification
Counseling re: types of implants &
expectations

Medical Assessment
Otologic history & examination
General medical health
Pneumococcal meningitis vaccine:
Pneumovax
Diagnostic Imaging

Computed Tomography (CAT)

Magnetic Resonance Imaging(MRI)*

Electronystagmography ENG(Adult only)

Electronystagmography (ENG) is a diagnostic test to record involuntary movements of
the eye caused by a condition known as nystagmus. It can also be used to
diagnose the cause of vertigo, dizziness or balance dysfunction by testing the
vestibular system.

Surgery Risks and/

or Adverse Effects
Facial nerve injury (less than 1/300 to 1/500)
Small possibility of infection
The small amount of hearing in the operated
ear will be lost.
Some discomfort or numbness around the
implanted ear after the surgery
Temporary dizziness, tinnitus or taste
disturbance
MRI precautions after surgery

Surgery
Inpatient procedure
Requires general
anesthesia
Duration ~ 3-4 hours

Behind-The-Ear/Device Marking Template

The Behind-the-Ear/Device
Marking Template is used to
allow adequate clearance
between the pinna, the speech
processor and the headpiece.

Device Coil Gauge

After placing the Device

Coil Gauge, an outline is
drawn around the template.

Incision Line

Note: The surgeon will

determine the length of the
incision line.
A conventional postauricularscalp incision approximately
5.0-6.0cm in length for
children may be used.
The incision may be longer
in adults if the scalp needs to
be thinned.

Recess Marking Template

The Recess Marking

Template is used to
determine the location of
the recess bed and channel
for the electrode lead.

Mastoidectomy-Facial Recess Approach

After completion of a
mastoidectomy-facial
recess approach, the
implant-receiver well/recess
bed and electrode lead
channel are drilled.
Suture tie-down holes to
stabilize the implant are
placed.
A standard cochleostomy is
used.

Electrode Insertion

The insertion tool is used to

insert the electrode array in the
usual fashion.
The Insertion Tube is placed just
inside the cochlea toward the
basal turn of the scala tympani,
with the insertion tube slot
directed toward the modiolar (or
inner) wall.

Closure

The skin incision is closed

in layers.

Electrode Array
Placement Within the
Cochlea

Illustration courtesy of Cochlear Corporation

Audiological testing in the

OR
Impedance
check on all
electrodes
Neural
response
testing to help
estimate
required levels

X-Ray to confirm
position
of internal device

Courtesy of Cochlear Corporation

After the surgery

Initial stimulation: 4-6
weeks post surgery
Adjustments made
regularly based on
feedback from patients,
parents, therapists and
educators
Rehabilitation to meet
specific patient needs
Regular follow-up
appointments

Positive psychological
& social benefits
Increase in:
Decline in:

Self-esteem
-Loneliness
Independence
-Depression

Social integration
-Social isolation
Vocational
prospect

Negative psychological
& social impacts
Concerns about the maintenance
and/or malfunctioning of the
Cochlear Implant
Difficulty in background noise
Unreasonable expectations of
aural-only benefit on the part of
the implant user or their family and
friends

Potential Benefits
1. Better speech understanding compared to a hearing
aid
2. Awareness and responsiveness to environmental
sounds
3. Less dependence on family members for day to day
living
4. Reconnection with the world of sound
5. Facilitation of communication with family and loved
ones
6. Ability to talk on the phone
7. Better appreciation of music