NCIP Adult Programme
More information for adult patients.
Adults may need a cochlear implant if they have problems with progressive deafness – deafness that worsens over time. They may have become socially isolated, struggle to communicate with family, friends and anyone they come into contact with, and/ or if they find it difficult to work or their job is under threat because of their hearing loss. Progressive deafness can occur at any age and may be caused by a genetic condition, an accident or ongoing exposure to noise, perhaps in a factory. Many people start to become deaf as they get older. This is because – like other parts of the body – sometimes the ears are not able to function as well as they used to. A cochlear implant is useful for those with a severe hearing loss and can be useful for adults of any age – from those in their 20s to those in their 80s, or even older.
Suspecting a hearing problem
Sometimes people do not realise how bad their hearing has become unless someone else tells them. Most often it is a family member who realises that their relative is unable to hear them properly. Sometimes a hearing loss is relatively mild – you may not be able to pick up conversations at a noisy party - but sometimes the hearing loss progresses to the point where you need either hearing aids or a cochlear implant to help you hear better. The best plan is to talk to your GP or Health Professional who can refer you to an Audiologist or, if you prefer, you can contact an Audiologist directly who will perform a hearing test.
Assessing a hearing problem
A hearing test is pain-free and can reveal if an adult needs to be referred to the adult cochlear implant assessment programme, which is run at the University of Auckland’s Tamaki campus. The hearing test can measure an adult’s hearing levels on an audiogram, which is basically a graph plotting how well someone can hear. If an audiologist diagnoses that an adult has a severe to profound hearing loss, they are referred to Auckland University’s audiology clinics for further tests.
An adult may be eligible for a publicly-funded cochlear implant if they have a severe to profound hearing loss and hearing aids are unable to help their level of hearing loss. There is no maximum age for referral to the Adult Cochlear Implant Programme based at the University of Auckland, which provides audiology assessments for those referred to the cochlear implant programme. Currently the Government caps the number of adults eligible for a publicly-funded operation. There is no maximum age for referral. Patients with additional needs are not excluded.
Adults can be referred to the NCIP assessment programme if they:
- Have a bilateral moderate to profound sensorineural hearing loss, one that is above 90 decibels for their better ear.
- Have developed spoken language; (however, a cochlear implant may be considered on a case by case basis for adults with little spoken language if there is a significant need for hearing of environmental sounds).
- Receive no or limited benefit from hearing aids.
The Northern Cochlear Implant Programme (NCIP) assessment process for adults is a multi-stage process which involves hearing tests, a medical evaluation, and an assessment to check that a person would benefit from a cochlear implant. A Computerised Tomography scan (CT) to check that the surgery is possible may also be required.
Step 1 involves review by the NCIP Adult Programme Team Leader, and then referral to a Hearing Therapist who undertakes a communication needs evaluation and also screens them for speech perception.
If the referral to the NCIP Programme is accepted, then an information pack is sent to the client and they are referred to a local Ear, Nose, and Throat Specialist for a medical evaluation and CT scan.
The client is then invited to a two-day assessment in Auckland. This involves various sessions that may include the following:
- An audiology appointment where the client is tested with and without hearing aids to verify the level of hearing loss.
- Rehabilitation appointments where a client’s speech perception is tested
- Appointments with a cochlear implant user
- Demonstrations of cochlear implant equipment and how it works
- Discussions about an implant’s limitations
- Discussion regarding the client’s expectations about having an implant
- A 45-minute meeting with an Ear Nose and Throat Specialist where medical issues, the surgical procedure, an ear check, and results of the CT scan are discussed.
A decision is then made by the assessment team, in consultation with the client, on whether to go on the waiting list for cochlear implant surgery.
Discussions about the surgery itself take place in a pre-operative consultation where details about what to expect before and after the operation are explained by the ENT Surgeon.
Admission to Gillies Hospital, where the operation will take place, is usually on the actual day of surgery. After admission by nursing staff, there is a consultation with the anaesthetist who explains what happens with the anaesthetic (cochlear implant surgery is done under a general anaesthetic).
Before surgery, both ears are examined to ensure they are free from infection and ready for the implant. The surgery itself, can take several hours to perform and the hair just behind the ear is shaved. There are stitches in this area and the patient receives antibiotics and mild pain relief during and after surgery. Usually the patient goes home the day after surgery. It is common for the ear to stick out a little after surgery, but this eventually settles down. The area where the implant package has been placed is slightly prominent, but it is unusual to have any significant swelling in the area.
The patient usually has a follow-up with the implant Surgeon or an Ear, Nose and Throat Specialist between 10 days and four weeks after surgery.
Living with a cochlear implant
The cochlear implant is switched on three to five weeks after surgery and involves MAPping of the device, and rehabilitation to ensure a patient receives as much benefit from the implant as possible. The switch-on is the first time an adult has access to sound. Some adults find the first few hours quite disconcerting because the noises heard can resemble beeps and whistles, however over time the brain starts to convert those sounds into language. The time that it takes for the brain to perceive the electrical stimulation as meaningful sound differs between individuals. Some people adapt to the new sound very quickly while others can take a few months to make sense of what they hear. As they do with children, an Audiologist works with the cochlear implant client to ensure their device is appropriately MAPped – (sound is heard at an appropriate level and tone). Because it takes time for the brain to make sense of what it is hearing, this process does require a number of visits after switch-on to ensure the implant device is MAPped at the correct level. The University of Auckland also has its Audiologists and Rehabilitationists carefully monitor a client’s speech perception and provide rehabilitation to ensure they are speaking and hearing at an appropriate level.
Advantages of a Cochlear Implant
- Most recipients can follow a normal conversation and participate more easily in the hearing community.
- May enable use of the telephone.
- Avoids problems with acoustic feedback and ear moulds.
- Can detect soft environmental sounds across the frequency range 250Hz-8KHz.
- Enables greater ease with high frequency consonant perception and production; e.g. /s/ /sh/ /f/ /t/ /k/ /p/ /h/ /th/.
Disadvantages of a Cochlear Implant
- Requires significant time commitment to rehabilitation following surgery.
- Residual hearing in the implanted ear may be lost as a result of the surgery.
- The speech processor must be removed during water activities (such as swimming or showering), and the cochlear implant recipient will not be able to hear during this time.