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Cochlear implants have revolutionised the lives of many severe to profoundly deaf people.”

BLACK, B (1998). INTRODUCTION TO EAR DISEASE, SINGULAR PUBLISHING GROUP

What is a cochlear implant?

A cochlear implant is a highly technical medical device consisting of internal and external parts and is designed to bypass damaged hair cells in the inner ear and directly stimulate the auditory nerve. The brain interprets this stimulation as sound. It may allow severely or profoundly deaf people who get little or no benefit from hearing aids access to sound. In the case of children, access to sound, together with habilitation support, may enable them to develop spoken language.

Cochlear implants, coupled with intensive post-implantation therapy, can help young children to acquire speech, language, and social skills.”

NATIONAL INSTITUTE OF DEAFNESS AND OTHER COMMUNICATION DISORDERS, HTTP://WWW.NIDCD.NIH.GOV/HEALTH/HEARING/COCH.ASP

How does a cochlear implant work?

A cochlear implant consists of internal and external parts. The external part has a microphone that captures sound, and then sends it to a speech processor that converts it to digital signals. The processor sends those digital signals to the internal implant via a transmitter coil that sits just behind the ear. The internal implant turns those digital signals into electrical energy which is sent to the electrode array which sits inside the cochlear. Those electrodes stimulate the hearing nerve, bypassing damaged hair cells, and the brain perceives those signals as sound.

Cochlear implant diagram.
  1. External speech processor captures sound and converts it to digital signals.
  2. Processor sends digital signals to internal implant.
  3. Internal implant turns signals into electrical energy, sending it to an array inside the cochlea.
  4. Electrodes stimulate hearing nerve, bypassing damaged hair cells, and the brain perceives signals; you hear sound.

Without a doubt the greatest ever advance in the treatment of deafness.”

RAMSDEN, R; COCHLEAR IMPLANTS AND BRAIN STEM IMPLANTS, BRITISH MEDICAL BULLETIN, (2002). 63:183-193.

Who does a cochlear implant help?

  • A child with a severe to profound hearing loss has been diagnosed, and hearing aids are not effective enough.
  • A child who has suffered a significant hearing loss from recent meningitis.
  • A child who has auditory neuropathy spectrum disorder and his/her speech and language development is not progressing as expected.
  • Adults who find that hearing aids are unable to help them hear because they have an extensive hearing loss.

[Children] report considerable benefits from the cochlear implant both in terms of improved ability to hear and to communicate and in areas such as social interactions and academic performance.” “Children perceive the positive impact of cochlear implantation on their quality of life even if they do not receive the cochlear implant at a very young age.”

Schorr, E.A., Roth, F.P., & Fox, N.A. (2009). Quality of Life for Children with Cochlear Implants: Perceived Benefits and Problems and the Perception of Single Words and Emotional Sounds. Journal Of Speech, Language & Hearing Research, 52(1), 141-152.

History

Work on whether a mechanical device might be used to stimulate hearing started in the 1950s and 1960s when French and American researchers started implanting single and then six-channel devices into adults with hearing loss.

By the late 1970s, researchers in Austria and Australia were also investigating how to create a device that would effectively stimulate the auditory nerve and allow deaf or severely hearing-impaired adults to access sound. Australian Professor Graeme Clark is considered the pioneer of the multi-channel implant that successfully enabled hearing-impaired adults to hear again. In 1985, the United States Food and Drug Administration allowed adults aged over 18 with progressive deafness to receive cochlear implants. That same year, Clark performed the first implants on children.

In the past 20 years, more than 200,000 people have received cochlear implants around the world, including more than 500 adults and 300 children in New Zealand.

…children who received a cochlear implant before 12 months of age developed auditory comprehension and expressive communication similar to their normal-hearing peers…”

CHING, T., KING, A. & DILLON, H.; EVIDENCE-BASED PRACTICE FOR COCHLEAR IMPLANT REFERRALS FOR INFANTS, WWW.NAL.GOV.AU

Will I be able to swim or have a bath with the cochlear implant on?

The external processor and coil of the cochlear implant needs to be taken off before any interaction with water. Water can interfere with the workings of the processor so all care should be taken to keep the device as dry and clean as possible. For further information about sports, leisure, and play go to http://www.bcig.org.uk/downloads/pdfs/Safety%20document.pdf.

Children who were good CI users or appropriate CI candidates were more consistently able to achieve better speech perception scores in the bilateral versus unilateral implant condition when the delay between the first and second implants was less than 12 months …….”

Gordon, K., Papsin, B.C. (2009). Benefits of Short Interimplant Delays in Children Receiving Bilateral Cochlear Implants. Otology and Neurotology, 30(3):319-331.

What happens if the cochlear implant doesn't work?

Sometimes recipients are unable to access sounds, despite the implant, and have to learn to use other modes of communication, such as sign language. In the rare circumstance that an implant is suspected to be faulty, a series of tests – known as integrity tests – are carried out; if a defect is confirmed, the implant can be removed and a new one surgically fitted.

Cochlear implant recipients experience a significant improvement in their quality of life, and have improved speech recognition.”

OTOLARYNGOLOGY—HEAD AND NECK SURGERY 2008 HTTP://WWW.EUREKALERT.ORG/PUB_RELEASES/2008-03/AAOO-CIR030408.PHP

Do I sleep with the cochlear implant on?

Usually it is more comfortable to remove the external processor while sleeping, much like taking glasses off at night.

Children who receive a cochlear implant show significant improvement in auditory perception and speech intelligibility skills over time. Age at implantation has a significant benefit, particularly for speech intelligibility ”

Phillips, L., Hassanzadeh, S., Kosaner, J., Martin, J., Deibl, M. and Anderson, I. (2009), Comparing auditory perception and speech production outcomes: Non-language specific assessment of auditory perception and speech production in children with cochlear implants. Cochlear Implants Int., 10:92-102

Is it safe to have an MRI after cochlear implantation?

MRI must be approached with extreme caution and other imaging techniques should always be considered first. A person with a cochlear implant must never have an MRI scan without first seeking the advice of the medically responsible person from their cochlear implant team. For further information about medical treatments, go to http://www.bcig.org.uk/downloads/pdfs/SAfety%20document.pdf

Early implantation in infants and toddlers was associated with significantly accelerated spoken language and learning”

Nirparko, J.K., Tobey, E.A., Thal, D.J. et al (2010), Spoken Language Development in Children following Cochlear Implantation. JAMA, 303(15):1498-1506

Radiotherapy

For guidance three risk classes are used: High, Medium and Low. High risk issues are contra-indicated for CI patients. Medium risk issues can be exercised with respective caution outlined in the issue. Low risk issues require only minor caution or are generally safe.

The use of Radiotherapy carries a medium risk classification.

Background
Radiotherapy is broadly used in the treatment of tumours and is applied with a so-called accelerator. Accelerators produce ionizing radiation (γ-rays) with a higher energy and dose than X-rays for medical imaging.

Potential Interactions
γ -rays have the potential to damage electronic circuits by destroying the atomic grid of semiconductors.

Recommendation
If clinically practicable the implant site should not be included into the radiation beam pathway. Studies have shown that irradiating the implant up to a dose of 50 Gray does not cause any damage to the implant. Nevertheless, monitoring of T/C levels following radiation therapy on a weekly basis is recommended as slight changes to current output (up to 7%) were observed. External parts should be taken off.

Studies have shown that irradiating the implant up to a dose of 50 Gray does not cause any damage to the implant. Nevertheless, monitoring of T/C levels following radiation therapy on a weekly basis is recommended as slight changes to current output (up to 7%) were observed.”

Ralston et.al., Int. J. Radiation Oncology Biol. Phys. (1999) 44 : 227 - 231
Klenzner et.al., Radiation Effects, Eur Arch Otorhinolaryngol (2004) 261 : 251-255
Klenzner et.al., Influence of ionizing radiation on Nucleus 24 cochlear implants, Otology&Neurotology (2005) 26 : 661-667

Is it safe to go through an airport security system?

It is usually safe to go through the airport security system, and you should leave your processor on in case the security guard needs to speak to you. If the metal detector alarm goes off for no other apparent reason, do not worry if security uses a handheld wand to screen you. The wand will not harm your cochlear implant, but it will beep when it passes over your sound processor.

For further information, please see: http://www.cochlear.com/au/travelling-your-cochlear-implant#3

A routine treatment which is safe, effective, and indeed, cost-effective.”

RAMSDEN, R; COCHLEAR IMPLANTS AND BRAIN STEM IMPLANTS, BRITISH MEDICAL BULLETIN, (2002) 63:183–193.

If you have any questions, please contact

Paediatric Programme 0-19 years
Clinical Services Coordinator P: 09 579 2333 or 0800 254 783 F: 09 579 2310 M: 027 503 4388

Adult Programme 19 years plus
Cochlear Implant Coordinator P: 09 373 7956 F: 09 303 5978