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Taking Action: Cochlear Implants

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Introduction to Cochlear Implants
Cochlear Implants and Hearing
Parts of a Cochlear Implant
Surgery and Activation
Expectations
Issues when considering a cochlear implant
Follow-up and Rehabilitation
Are cochlear implants expensive?
Frequently Asked Questions

INTRODUCTION TO COCHLEAR IMPLANTS

A cochlear implant is a small, electronic device that can help provide a sense of sound to a person who is profoundly deaf or severely hard of hearing. The implant is surgically placed under the skin behind the ear. A cochlear implant does not restore or create normal hearing. Instead, it can give a deaf person a useful auditory understanding of the environment and help him or her to understand speech. Since 1990, thousands of children and adults have received cochlear implants.

Cochlear implants were designed for persons with severe to profound hearing loss who obtain little benefit from hearing aids. Cochlear implants compensate for damaged or non-working parts of the inner ear. The inner ear converts sound waves into electrical impulses. These impulses are then sent to the brain. A cochlear implant works in a similar manner as it electronically finds useful sounds and then sends them to the brain.

Hearing through an implant sounds different from normal hearing. However, cochlear implants allow many people to communicate orally in person and over the phone.

COCHLEAR IMPLANTS AND HEARING

In order to understand how a cochlear implant works, it is important to understand how we hear.

The outer ear collects sound waves and sends them to the middle ear
The sound waves bounce off your eardrum and are made louder by three tiny bones: the hammer, anvil, and stirrup
The sound waves travel into the fluid filled inner ear
The waves go through the cochlea (the organ of hearing)
Microscopic hair cells in the cochlea turn the vibrations into electrical impulses
Your brain receives and interprets this energy as a sound or speech

Cochlear implants take advantage of the things an ear can still do after hair cells have been damaged or destroyed. It also takes advantage of how smart and flexible the human brain can be as the cochlear implant creates a new way of hearing. A cochlear implant consists of five basic parts:

Microphone
Speech Processor
Transmitter
Receiver/Stimulator
Electrode Array

Representation of a cochlear implant device.

PARTS OF A COCHLEAR IMPLANT

Here's how the basic parts of a cochlear implant work:

This graphic is a representation of a Cochlear processor.

A tiny microphone turns sounds into electrical signals.

The electrical signals are sent to a speech processor. The processor selects, arranges, and codes these signals.

A transmitter sends these signals across the skin by radio waves to a receiver/stimulator.

The receiver/stimulator sends these electrical signals to the electrode array in the cochlea.

This graphic is a representation of a cochlear transmitter and receiver / stimulator.

This graphic is a representation of an electrode array in the cochlea.

The auditory nerve picks up the signals from the electrode array and sends them to the brain.

Finally, the brain recognizes these signals as sounds.

Representation of the whole process of how a cochlear implant works.

SURGERY AND ACTIVATION

A surgeon puts the receiver/stimulator and the electrode array under the skin behind the ear and into the skull. The surgeon then threads the electrode array into the cochlea past the damaged hair cells. Surgery lasts from 2-3 hours and most children resume normal activities within days after surgery. It generally takes 3 to 5 weeks for the incision to heal.

The device is activated at the clinic 4 to 6 weeks after surgery. The process of adjusting the cochlear implant system to meet a child's needs takes time. Adjustments will require numerous clinic visits. As the child's use of the implant changes, adjustments are also made. This process of adjusting the output of the system is called mapping.

Children with cochlear implants can participate in all common childhood activities. The transmitter (on the outside of the skin) is magnetically held to the receiver (located just under the skin). It is quick and easy to remove the external parts for activities like swimming or bathing.

EXPECTATIONS

The decision to choose a cochlear implant must be made after carefully weighing all of the pros and cons. There are usually a wide range of emotions, conversations and research that contribute to that decision.

The benefit a child may obtain from a cochlear implant is difficult to predict, however, many resources show children with implants who are very skilled listeners and speakers. Parents must remember that implants are tools, not miracles and not every child with an implant performs in the same way. Reasonable expectations may include improved detection of sounds and speech. Some children with implants have an increased awareness of sound and can detect and recognize sound patterns. Other children are able to understand speech through listening alone. Even these children, however, benefit from speech reading cues and assistive listening devices particularly in noisy places.

Learning how to use an implant requires the child, family and support system to work together. It takes a lot of practice to recognize and understand sounds and speech. In fact, it's been said that “the cochlear implant is 10% hardware and 90% software, and the software is us.” By involving siblings and other family members, you can build a better understanding of your child's needs. Remember, although sometimes astounding things happen, most changes occur in small steps.

ISSUES WHEN CONSIDERING A COCHLEAR IMPLANT

The criteria for determining who can benefit from cochlear implants have changed over time. Currently, cochlear implants are approved by the Food and Drug Administration for children 12 months and older. Typically a child uses a hearing aid for 3-6 months, then a decision about a cochlear implant can be made. However, the timelines can vary based on your child's situation and implant center practices.

Children should be involved in a program which emphasizes listening and speaking skills. High motivation, positive family environment, and realistic expectations are all important for success.

A comprehensive evaluation is necessary to determine if a child is a candidate for a cochlear implant. This may include the following evaluations:

Hearing
Speech
Language
Balance
Medical
Psychosocial

Any surgery involves risks, particularly when it involves young children. These risks must be discussed thoroughly with your medical team. The implant may affect other medical procedures in the future.

FOLLOW-UP AND REHABILITATION

Between 4 to 6 weeks after surgery, the implant will be Activated. Implant activation may be either a one or two-day Process. Activation of the device does not produce “instant” hearing. Many return visits may be needed within the first year for both fine-tuning the speech processor and for auditory training or aural rehabilitation. Follow your therapist's recommendations about using a hearing aid in the non-implanted ear.

The surgery is merely the beginning. The real work is to help the child learn to listen. Signals from the implant are used to recognize, understand, and produce speech, and the child will learn to identify and use environmental sounds. This is typically a slow process with many small steps. The child, family, therapists, and educators must work together to achieve success. It is critical that the family emphasizes listening and speaking goals in their individualized plan. This emphasis on listening and speaking skills must also be continued as the child enters school.

ARE COCHLEAR IMPLANTS EXPENSIVE?

The cochlear implant process includes the assessment, the device, surgery, adjustments, and training. Costs vary depending upon individual circumstances. Although this process certainly costs a lot of money, it is only a fraction of the lifetime expenses associated with deafness or a severe hearing loss. Even with an implant, there will be long term costs associated with therapy, regular checkups, repairs, and upgrades.

Many private insurance and state Medicaid plans cover cochlear Implants, although coverage and plans vary widely. Most insurance policies have numerous restrictions and procedures that must be followed. It is critical to discuss all costs, financial obligations, and financial support with your team, and carefully explore the financial alternatives available to you. The implant manufacturer may have a specialist, called a consumer representative, who can provide guidance. It may be helpful to talk with other parents about how they financed their cochlear implants. Hands and Voices is a Minnesota parent-to-parent organization that is available to help you with these questions.

FREQUENTLY ASKED QUESTIONS

What is a cochlear implant?
A cochlear implant is a device that helps some deaf or hard of hearing people hear. It has an internal part, and an external part. The internal part placed under the skin behind the ear and inside the inner ear by the doctor. The external part is includes a microphone and a speech processor and is worn outside the ear.

What is the difference between a hearing aid and a cochlear implant?
A hearing aid is a device that amplifies sounds and is worn in the ear. A cochlear implant is a device that amplifies an electrical signal and is implanted in the cochlea by a surgical procedure.

Should my baby get a cochlear implant?
Getting a cochlear implant is a big step. Learn everything you can about cochlear implants and talk with other people about implants:

Talk to the cochlear implant team about how it will help your child. If there is more than one implant center near you, talk to both of them.
Talk to other parents of children who have gotten cochlear implants about their experiences.
Talk to other deaf people about cochlear implants.
Think about what your goals are for your child. Ask yourself how you think a cochlear implant will help your child reach those goals.

Will a cochlear implant help my baby hear better?
A cochlear implant is not a miracle cure for a hearing loss, and the implant alone will not help your baby learn how to talk. The cochlear implant simply provides your baby with an opportunity to hear sound. In fact, the real work begins after your baby is implanted. You will spend many hours practicing listening and language skill before your baby will learn how to talk. The quality and quantity of language and listening practice will determine when and how fast your baby will learn how to talk.

What are the risks of getting a cochlear implant?
Like any surgery, there are risks that you should know about. Keep in mind that most of these operations do not have problems. Your doctor should explain all of the risks to you.

Are different approaches used in cochlear implant centers?
The team approach is used in many implant centers. The people on the team will evaluate your child and family to see if a cochlear implant is a good choice. Here's a list of people who may be on the team:

An audiologist will test your child's hearing with and without hearing aids.
A speech and language pathologist will test your child's language skills.
An otolaryngologist will check to see if your child has an infection or other problem that would interfere with the implant. The doctor may order an MRI or CT scan to look at the structure of the inner ear.
A teacher of the deaf or educational consultant will tell you about educational programs for your child.
A social worker will talk to you about whether your family is able to do the work that is needed. The social worker may also help you figure out who will pay for the implant.
A psychologist will talk to you and your child about your goals, concerns, and fears about cochlear implantation.

How can I get help to pay for a cochlear implant?
Cochlear implants are expensive. With all the testing and therapy required, the total cost may be around $40,000. Most insurance companies cover the cost of cochlear implantation, and Medicaid will also pay for a cochlear implant. Call your insurance company to find out if it covers cochlear implants.

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Information on this web site was obtained from the Infant Hearing Guide developed in a cooperative project between the University of Arkansas for Medical Science, Arkansas Children's Hospital and the University of Arkansas RRTC and we would like to acknowledge their work.

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