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This article is part 2 in a series about cochlear implants. There are few individual questions some ‘Viners have asked me so I will attempt to make this column an abbreviated FAQ (frequently asked questions) and I will periodically update this column as the need arises.
How does the doctor come to the conclusion one is a candidate for a Cochlear Implant (CI)?
Since, I’m not a doctor, find one and ask them…just kiddingJ. Seriously though, this can be a complicated question to answer and there is no real black-or-white answer. Generally speaking, the auditory nerve must be functioning in order for a CI to work properly because a CI directly stimulates the auditory nerve. However, there are instances where a CI can work with a defective auditory nerve, but the sound quality and success rate following the surgery, is further diminished.
Is a cochlear implant surgery permanent?
Yes, the reason is because a small incision is made in the cochlea in order to feed the cochlear implant electrode array and thus destroying any residual hearing that might be possible.
Does a cochlear implant provide normal hearing?
No, hearing will never sound completely natural when using a CI. In a nutshell, the ‘sounds’ from a CI, are generated from the electrode array that is inserted into the cochlea which artificially stimulates the auditory nerve using tiny electrical pulses. Shocking, isn’t it !?
However, over a period of several months to a full year, a person with a CI, will gradually process the sounds as the brain ‘re-catalogues’ each individual sound. For example, after a CI is implanted and turned on, the pitter-patter of falling rain, may sound like high notes on a piano and not easily recognizable. So the first few months of rehabilitation has the potential to be rather confusing until the brain can adequately adapt to the CI. You will also have to retrain your brain to filter out background noise and focus on the sounds you want to hear (i.e. people’s voices). A few post-CI activation appointments are scheduled in advance so that the doctors can ‘fine-tune’ the device. Since each individual’s CI hearing is unique, each implant is tailored to suit the needs of the individual.
Who can benefit from a cochlear implant?
Adults and children (puberty on up) with some residual natural hearing and post-linguistic hearing loss, tend to have the most successful outcomes. For those who are congenitally deaf (born), success is best between 1 and 2 and half years of age. Understand though that these are general guidelines and a consulting a cochlear implant surgeon/doctor is recommended for each individual’s case.
As described in the wiki entry for cochlear implants, a prime candidate would have some or all of the following characteristics:
- having severe to profound sensorineural hearing impairment in both ears.
- having a functioning auditory nerve
- having lived at least a short amount of time without hearing (approximately 70+ decibel hearing loss, on average)
- having good speech, language, and communication skills, or in the case of infants and young children, having a family willing to work toward speech and language skills with therapy
- not benefitting enough from other kinds of hearing aids
- having no medical reason to avoid surgery
- living in or desiring to live in the "hearing world"
- having realistic expectations about results
- having the support of family and friends
- having appropriate services set up for post-cochlear implant aural rehabilitation (through a speech language pathologist, deaf educator, or auditory verbal therapist).
What kind of preparation guidelines should be taken for the CI surgery, both before and after?
- Before surgery
- Make sure all financial arrangements are made for the surgery, including medical insurance needs.
- It is necessary to have a person drive you home after surgery, preferably a family relative or close friend. It is also recommended that someone be available 24 hours after the surgery.
- Cochlear implant candidates are at a risk for meningitis and thus should have a meningitis vaccination prior to the surgery.
- Drink plenty of fluids the day before surgery, so you are well hydrated.
- No food or drink after midnight, the day before surgery.
- No aspirin or any NSAID’s (ibuprofen, Advil, Moltrin, Aleve) for 7 days prior to surgery.
- After surgery
- No shower for a week
- The risk for bacterial meningitis is significantly increased for CI surgery and a vaccination is administered before surgery.
- Anitbiotics and pain relief medication is prescribed by the doctor. Have your family member fill the prescriptions while you are undergoing the surgery.
- If you experience any swelling, redness, fever, bleeding, and/or excessive pain in the surgical area, these are indications of an infection and you should consult a doctor ASAP!
Note: Since I haven’t yet undergone the surgery, I’m sure there will be more do’s and don’ts to add to the post-op section but you’ll have to wait till then. I also consulted Advanced Bionics website to help answer the ‘preparing for surgery’ question and I’d recommend reading through for more detailed description of Do’s and Don’ts for CI surgery.
Disclaimer: I’m not a doctor so I can’t possibly address all medical questions and it is highly recommended that in-depth questions should be undertaken by a cochlear implant surgical team/department. There are numerous FAQ on the internet and if you have further questions I’ll try to answer them.
For your viewing pleasure, here are a few videos that show a cochlear implant surgery. WARNING: if you are easily disturbed by blood and surgical procedures you ought not to watch these videos. I’ll be undergoing the surgery on Wednesday of this week and I could not watch the videos because I was a bit overcome with anxiety.
Video 1 – general computer simulated video of how a CI operates, no blood, not gory.
Video 2 – actual surgical video, WARNING, not for the faint of heart.
Video 3 - actual surgical video, WARNING, not for the faint of heart.
Click here for the first article in this series: 'An introduction to cochlear implants'
