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Information About Cochlear Implants

Children with severe to profound hearing loss benefit from cochlear implants. The device is appropriate for those who are unable to understand speech with appropriately fit hearing aids. The Pediatric Hearing Loss and Cochlear Implant Program at Floating Hospital for Children in Boston considers infants, children, and adults with pre-lingual and post-lingual hearing loss. While results vary from patient to patient, the majority of those implanted receive significant benefit over their performance with hearing aids.

What is a Cochlear Implant?
How Cochlear Implants Work
The Two Types of Cochlear Implants We Use
Is a Cochlear Implant Right for Me?
General Criteria for Cochlear Implant Candidacy
The Process
Current User Support

What Is a Cochlear Implant?
A cochlear implant provides a new mechanism for hearing when a hearing aid, which simply amplifies sound, is not enough. With most hearing loss, the hairs of the inner ear are missing or damaged. The Cochlear Implant bypasses damaged hair cells of the inner ear and sends signals to the auditory nerve.

The cochlear implant consists of both internal and external components.

External Components:

  • Speech processor – either worn behind the ear or on the body
  • Battery
  • Microphone
  • A small cable
  • Headpiece

Internal Components:

  • Electrode placed in the cochlea of the inner ear
  • A small receiver/stimulator placed under the skin behind the ear
  • Magnet

How Cochlear Implants Work
The speech processor captures the sounds from the environment through a tiny microphone. It processes the sound into digital information. It transmits the information to the implant via the headpiece. The implant converts the digital information into electrical signals. It then sends signals down tiny wires to the electrode in the cochlea of the inner ear. The electrode delivers the electrical signals to the hearing nerve. The hearing nerve carries the information to the brain, where your brain then processes it as sound.

The Three Types of Cochlear Implants We Use
At Floating Hospital for Children, we use three brands of cochlear implants. Each manufacturer brings its own unique features. Your Implant Team will help determine which is right for you. 

  • Advanced Bionics Corporation, makers of the Clarion implant. 
  • The Cochlear Corporation, makers of the Nucleus implant. 
  • Med-El, makers of the Maestro implant.

We welcome your questions. Please email us at smcdonald@tuftsmedicalcenter.org

Is a Cochlear Implant Right for Me?
This is a great question, and you are on the right track to finding that answer.

  1. The First Step: You’ve taken the first step in discovering the benefits of cochlear implants-- reading about them and learning about your options. We recommend you read all you can about implants. 
  2. The Second Step: To truly determine if an implant is right for you, an evaluation needs to be performed by our team. Email smcdonald@tuftsmedicalcenter.org or call us to schedule an evaluation.
  3. The Third Step: If you are a candidate, the next step we recommend is talking to current users. We can connect you with patients we work with who are similar to you. 

General Criteria for Cochlear Implant Candidacy
Although a thorough, individualized evaluation of your history and current situation should be the determinant as to whether you are a candidate or not, here are some general criteria we follow.

Adults

Profound bilateral sensorineural hearing loss of 90 dB HL or greater.

  • Healthy adult over 18 years of age.
  • Postlingual onset of deafness (after age 6), peri lingual and prelingual onset will also be considered.
  • Lack of benefit from hearing aids.
  • CID Sentence score <= 20% in the best-aided condition.

Severe-Profound bilateral sensorineural hearing loss of 70 dB HL or greater.

  • Healthy adult over 18 years of age.
  • Postlingual onset of deafness (after age 6), perilingual and prelingual onset will also be considered.
  • Lack of benefit from hearing aids.
  • HINT Sentence score <= 40% in the best-aided condition.
  • CNC Words <= 30% non-implant ear, <= 20% implant ear.

Children
Profound bilateral sensorineural hearing loss of 90 dB HL or greater

  • Healthy child, 2 through 17 years of age.
  • Lack of benefit from appropriately fit hearing aids.
  • In younger children, lack of benefit is defined as a failure to attain best auditory milestones such as a child’s inconsistent response to his/her name in quiet or to environmental sounds (MAIS).
  • In older children, lack of benefit is defined as a 0% score on open set word recognition, PBK word list administered live voice.
  • Both younger and older children should demonstrate only minimal ability on age- appropriate open set sentence measures and a plateau in auditory development.

Take the first step. Call or email us to schedule an evaluation.

The Process
The process of cochlear implantation is a journey of continuous improvement. It takes dedication and commitment by the patient. It also takes a strong support system around that patient. The process includes the following steps:

Evaluation
The surgeon evaluates the medical condition of the ear, the cause of hearing loss, and the overall health of the patient.  The physician determines whether the patient meets the medical criteria for a cochlear implant. A CT scan of the inner ears is obtained along with other necessary medical tests and evaluations. A nurse practitioner is another member of the team who will be involved in both your pre- and post-op care and education.

The audiologist performs various measurements of auditory function and determines whether the patient meets audiological criteria for cochlear implantation. Expectations, family support, and commitment are discussed.

The speech-language pathologist evaluates the patient’s speech-language functioning as it pertains to the hearing loss and primary mode of communication. If, through this evaluation, it is determined that speech therapy post-implantation would be needed, a plan is developed.

Family dynamics, the expectations from a cochlear implant, and the level of commitment to succeed with an implant are issues that are often interconnected. Our team will help to clarify these issues and bring the patient and family to a unified understanding. There is a strong focus on the development of realistic expectations

Once a patient is deemed to be a candidate for a cochlear implant, the next step is to obtain insurance approval.

Insurance Approval
Most insurance carriers provide coverage for the cochlear implant, the surgery, and associated services. We will work closely with you to ensure that you get the maximum coverage possible from your health insurance.
Once insurance coverage is granted, the surgery date can be scheduled.

Surgery
Cochlear Implant surgery involves placement of the internal device. The electrodes are inserted into the inner ear. The surgery typically is a 3-3.5 hour procedure. Patients generally go home the following day.

Initial Activation and Programming
Approximately four weeks after surgery, the patient comes to the Cochlear Implant Center so that the audiologist can activate and program the device. The patient returns the following day to check the program settings.

Routine Programming
The audiologist provides ongoing support through periodic programming adjustments. For some newly implanted patients, this may be once per month. For others, it may be once every three months. After a period of time, some patients come once a year. Your audiologist is always available to you.

Aural Rehabilitation
The rehabilitation will be set up before surgery. We want to make sure you have a program in place that is convenient and a good fit for you and your objectives. Adherence to this program is a key to the continued success the patient will have.

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