About Cochlear Implants

What is a cochlear implant? When is a child a candidate for a cochlear implant? What are the risks of cochlear implantation? How well should I expect my child to hear?

A cochlear implant is made up of pieces worn outside the ear and pieces surgically placed inside the ear.  During surgery, a cut is made behind the ear and the internal piece is secured under the skin and hair. The electrode array is put into the cochlea, stimulating the hearing nerve.Schematic of an ear with a cochlear implant.
 1.  External hardware (includes microphone, speech processor, coil/cable and battery) 
  • The microphone captures sound in our environment. 
  • The speech processor converts the environmental sound into a digital signal. 
  • The signal is sent through the cable to the coil.  
2.  Internal receiver 
  • The signal is sent across the skin to the implant, where it is converted to electrical energy and decoded.  
3.  Electrode array 
  • The electrical energy is sent to the electrode array within the cochlea, where it   stimulates the hearing nerve.  
4.  Hearing nerve 
  • The stimulation of the hearing nerve is perceived as sound.
Cochlear implants are recommended when a person has significant sensorineural hearing loss and has limited benefit from a hearing aid:
  • Children at least 12 months of age
  • Children with severe-to-profound hearing loss
  • Children who are not making appropriate progress with speech and language development despite appropriately fit hearing aid
  • Children who are healthy enough to have the surgery
  • Children whose families are motivated to follow through with therapy and full time device use.
 **Each case is evaluated on an individual basis, pending the case; recommendations might be outside FDA criteria
1. At least two audiology appointments to:
  • Talk about your child’s health and school history
  • Understand your child’s hearing status with and without hearing aids
  • Provide information to you about hearing, hearing loss and cochlear implants
  • Talk about your hopes and goals for the child 
  • Answer any questions
 
2. A speech and language evaluation to:
  • Assess your child’s communication abilities
  • Provide information on speech and language development
  • Collect information about your child’s current educational plan and offer support
  • Inform you about therapy options through our program 
3. At least two doctor visits to:
  • Decide if your child is medically a candidate for a cochlear implant
  • Look for the cause of hearing loss (genetic testing, MRI or CT scan)
  • Talk about the surgery and risks involved 
Your surgeon will talk with you about these in as much detail as you need: 
  • Risks of cochlear implant surgery
    • Loss of remaining hearing in the implanted ear
    • Higher risk for meningitis (men-in-gi-tis)
    • Facial nerve stimulation/involuntary facial movement
    • Inflammation/extrusion/swelling
      • Soreness, redness or breakdown of skin in area around the implant, which may need more medical treatment, surgery and/or removal of device
    • Failure of surgery, possibly requiring removal of the implant
    • Failure of implanted pieces, which may need replacing
      • The CI may not work correctly or it may cause your child to feel or hear odd or uncomfortably loud sounds
  • Risks associated with any ear surgery
    • Numbness/tenderness around implant site
    • Neck pain
    • Loss of feeling in face
    • Change in taste
    • Fluid leak
    • Dizziness (vertigo)
    • Tinnitus or “ringing in the ears”
    • Blood, fluid or infection at the site or close to the site of surgery
    • Skin reactions (rashes)
  • General risks
    • Pain, scarring, bleeding and infection
    • Anesthetic risks (medicines used to put the child to sleep) associated with the heart, lungs, kidneys, liver and brain
Cochlear implants are made up of inside and outside pieces that work together. The design of the inside device and outside pieces may look different, but they function very similarly. There is no clear-cut evidence that one implant system provides better results than another. 
 
We will review each cochlear implant system during your appointments. Please consult the websites or the booklets provided for more detailed information.
 
There are 3 cochlear implant companies on the market today, each offering a 5 year warranty on the external speech processor:                                               


Advanced Bionics Advanced Bionics

Cochlear Americas  Cochlear

Med El  Med-El

*All manufacturers offer a 10-year warranty for the inside portion of the cochlear implant system.

Bacterial meningitis (bak-teer-ee-al men-in-gi-tis) is a serious infection of the brain and the fluid around the brain. It is a life-threatening infection. People who have a cochlear implant are at higher risk for bacterial meningitis. Although this risk is small, it is important for children and adults with a cochlear implant to be vaccinated.
 
Cochlear implant users and their families should know that vaccines against the bacteria that cause meningitis are available. These vaccines strengthen the body’s ability to protect against the common causes of bacterial meningitis.
 
More information is available from this CDC website:
 
  
Vaccinations do not eliminate the risk of meningitis. Children and adults with cochlear implants who develop a middle ear infection (otitis media) or a fever of uncertain cause should see their doctor. Infections in a child or an adult with a cochlear implant should be taken seriously. Untreated middle ear and other infections may spread to produce meningitis.
 
In addition, if an ear with a cochlear implant develops fluid that leaks from the ear canal, or has unusual ear symptoms or a watery fluid from the nose, it is important to have that ear checked by a cochlear implant surgeon.
For the best outcomes with a cochlear implant, the device should be worn during ALL waking hours, with the exception of bathing.

To ensure your child is hearing, the cochlear implant headpiece/coil must be connected to the internal device via the magnet. If the magnet is not attached, your child is not hearing. If you are struggling with CI retention or wear time please contact your audiologist for support.

At your final visit before surgery, we will review the Candidacy Profile with you.  This is a summary of the factors that affect outcome with a cochlear implant.  It includes the information collected during the evaluation.  The Profile helps identify areas that can be affected by change, and helps families develop realistic expectations for their child’s use of an implant.    The items we review include those shown on this figure: Schematic of the factors that affect cochlear implant outcomes
  • A surgery scheduler will call you with your pre-op date and time; PLEASE make sure we have the right contact information. 
  • At least 2 weeks before the surgery date call the ENT Department Financial Counselor at (984) 974-4206 to confirm that surgery is APPROVED/COVERED. 
  • The day before surgery a scheduler will call you to confirm your surgery time. 
  • Let us know about any signs of illness or temperature that occur within 3 days before surgery to the ENT office (984) 974-6484. 
  • Do not give your child aspirin or aspirin containing products within 2 weeks before surgery as it acts as a blood thinner. 
  • Your child should have nothing to eat after midnight the day before surgery and only small amounts of clear liquids the day of surgery. 
  • Cochlear implant surgery lasts about 3-4 hours.  Children are usually sent home the day of surgery but parents should come prepared to stay overnight. 
  • Your child will wear hospital clothes for the surgery but bring his or her own clothes to wear home.  A shirt that buttons or zips up the front is best as the bandage will be too big for a pullover type shirt. 
  • A nurse will teach you how to care for the stitches and bandages at home.  Keep the area clean and dry until your child returns to the doctor to have the stitches and bandage taken off about 7 days after surgery. 
  • Your child will see the surgeon one week after surgery. However, if you have any concerns about the stitches, call the ENT office right away at (984) 974-6484. 
  • We will turn on the device about 3 weeks after surgery.  Your child may continue to wear his or her hearing aid in the other ear.  Talk about this with your audiologist. 
3 weeks after surgery, after the stitches have healed, the child returns to the implant center to be fitted with the outside parts of the device and to have the speech processor “mapped” or programmed. 
The first few months of implant use, as hearing improves, reprogramming happens often; later on fewer visits are required.

The first visit is about two hours long and has the following goals:
  • Fit the sound processor, microphone, headpiece
  • Create a “first-pass” map or program that is comfortable for the child. More maps will be created for the child to try before the next clinic visit
  • Counsel family about the use of the device, troubleshooting, equipment care and maintenance
  • Complete Product Registration and Warranty information
     
Programming (mapping)
  • The speech processor is connected to a computer. 
  • The appointment will begin with a check of the internal device (impedances).
  • Some or all of the electrodes may be stimulated. Each electrode carries a slightly different frequency or pitch.
  • If old enough, the child may report when sound is heard. Younger children play a game to indicate when a sound is detected. For very young children, parents and audiologists observe the child’s behavior for any evidence that sound is heard. 
  • Responses vary and can range from crying, to smiling, to no response at all.
  • You are welcome to invite a few family members or educators/therapists to the visits and you may videotape at the appointments. Please keep the size of our clinic rooms in mind when you are inviting guests.
     
Follow-up Appointments
  • Because of the quick adaptation of the hearing system, many mapping changes are needed in the first year of cochlear implant use. For this reason, we have made the following schedule after surgery: 
    • First fit (3-4 weeks after surgery)
    • Following first fit:
      • 2 weeks
      • 5 weeks
      • 9 weeks
      • 3 months
      • 6 months
      • 9 months
      • 1 year
  • Children are then seen at six month intervals while they are school aged and then they are seen once per year
  • Parents may schedule more appointments as needed.
     
Expectations
  • Before children with normal hearing learn to speak, they spend over a year listening to sounds around them. 
  • Speech and language develops with time and experience. 
  • Expose your child to a lot of spoken language by reading aloud every day and by talking about things that happen in your home and during the school day.  
  • The guidance of an experienced speech and hearing professional is important to help parents learn the best ways to help a child make progress.
  • With full time use and appropriate therapy in place, expect the cochlear implant to provide useful sound and improved hearing with practice and patience.
  • Auditory-based therapy is critical to your child’s success with a cochlear implant.
  • Every child is unique!
The surgery, inside the ear device, and outside equipment costs about $70,000. Most of this cost will be paid by insurance.

All outside parts are covered under manufacturer's warranty for normal wear and tear. If you lose a piece of equipment, the manufacturer will replace it one time within those three years. If you lose equipment again, it will be your responsibility to replace it.
 
After the warranty is over, you will pay for replacement parts. Medicaid and insurance plans sometimes cover these charges, as does the CCCDP grant program. It is your responsibility to be sure of what will be covered. You should consider buying an extended warranty (called a service contract) when the warranty expires through the implant manufacturer. It is important that the device be covered for loss and damage after the warranty has expired. 
 
You will get two complete sets of equipment, so that your child will always have backup equipment and should never be “off the air.” Please be sure that both speech processors always contain the most current programs and are working well. Bring both to all appointments.
 
Surgery:                                                                                           $80,000
External Speech Processor:                                                            $8,500
Accessories:                                                                                    $5 - $1500
At some point in time the CI will break due to accidents and normal wear and tear.  It’s easy to get overwhelmed when you learn your child is “off the air.” The first thing to do is to pull out the user guide you got at the first fitting and check the troubleshooting section.
 
If the device breaks or if it is not working properly, check to see if the device is still under warranty (based on time of first fitting). Call the cochlear implant manufacturer directly to receive help on troubleshooting the problem. 
 
Anytime you are making a phone call about your child’s device be sure to have the serial number of the processor and know the names of the parts that need repaired. 
 
Manufacturer Contact Info