COCHLEAR IMPLANTATION

PROGRAM
AT

TEXAS ENT & ALLERGY

Photo courtesy of Cochlear Ltd.

Hearing loss is a significant problem worldwide. It has been estimated that one in
three adults over the age of 60 have a significant hearing loss. The propensity
increases to one of every two people by the age of 75.1 Hearing loss can be
divided into three types: conductive, sensorineural, and mixed.

Sensorineural hearing loss involves the inner ear (cochlea), the nerve for
hearing (VIII cranial nerve), and the brain (auditory cortex). The most common
sensorineural hearing loss involves damage to the inner ear while the nerve
transmission and brain function remain intact. Common examples are noise
exposure induced hearing loss and hearing loss associated with age (presbycusis).
This type of hearing loss is also seen in the profoundly hearing impaired (deaf).

Depending on the severity of the hearing impairment, the most common solution
is usually a hearing aid. Conventional hearing aids essentially work by amplifying
the incoming sound. They will “overcome” the hearing deficit by making the
sound loud enough to compensate for the hearing loss. In adults, there are
situations in which the hearing aids can no longer overcome the amount of
hearing loss. In others, there may be an acute event (such as a severe infection)
that leads to deafness. In these situations, a cochlear implant may be a unique
option.

What is a cochlear Implant

A cochlear implant is an implantable device designed to restore the perception of
sound or the sensation of hearing. The implant converts mechanical sound
energy into an electrical signal. This electrical current is then transmitted directly
to the auditory nerve which sends the information to the brain and provides the
perception of hearing.

A cochlear implant consists of three main components:

11
Copeland BJ, Pillsbury HC. Cochlear Implantation for the Treatment of Deafness. Annu Rev Med. 2004. 55: 157-
167.
 1. Sound Processor (figure 1): The external device (microphone) that
captures the environmental sound energy or mechanical energy. The
sound is transmitted to the internal component through a magnetic
connector on top of the internal device.
2. Digital Processor (figure 2): the internal (implantable) component that
changes the sound energy into digital (electrical) signals.
3. Electrode Array (figure 2): This is the “thin wire” that is attached to the
digital processor and inserted into the cochlea. It transmits the electrical
impulse to the auditory nerve.

Figure 1: External processor and magnetic connector

to internal device. (Photo courtesy of Cochlear Ltd.)
Figure 2: External processor and magnetic connector (1) to internal
device (2). Electrode array inserted into the cochlea (3). (Photo courtesy of
Cochlear Ltd.)
Who is a Candidate?
Cochlear implantation can be considered in both adults and children. Currently,
the main indications include:
• Bilateral, profound sensorineural hearing loss (deafness in both ears).
• Bilateral, severe to profound hearing loss in which other hearing devices do
not help significantly.
The criteria may change to include more potential candidates. If you or someone
you know is not doing well with hearing aids or “they just don’t work like they use
to,” a cochlear implant may be an option.
How can I tell if I or someone I know is
candidate?
If you or someone you know is using a hearing aid but it just does not seem to be
enough then you may want to consider cochlear implantation.
Below are some common questions that indicate a cochlear implant might be an
option:

1. Do you or someone you know have to ask people to repeat themselves in

one-on-one conversations, even in a quiet room?
2. Do you or someone you know only understand close relatives or friends on
the phone?
3. Do you or someone you know depend on lip-reading to understand
conversations?
4. Do you or someone you know watch only closed captioned television
programs?
5. Do you or someone you know have difficulty following conversations in
restaurants or other crowded places?
6. Do you or someone you know avoid social activities out of fear of not
hearing what is going on around you?
7. Do you or someone you know become exhausted by the end of the day
because it takes so much energy and concentration to communicate?

If the answer is yes to two or more of these questions, you may be a cochlear
implant candidate.
What is involved?
The process varies depending on the individual’s age and health considerations.

For adults, the initial step is usually a thorough audiologic evaluation (hearing
test). This is followed by a physical examination and radiologic imaging. Other
medical tests may be necessary depending on the circumstances. Once the
candidacy has been determined, there is an additional meeting with both the
surgical and audiology team members to review the expectations, long term goals
with the implant, as well as the risks and benefits of the surgery.

The surgery is usually performed in an outpatient or overnight observation basis.

The surgery is similar to other otologic (ear surgeries) procedures which include a
mastoidectomy. An incision is made behind the ear and in the scalp. The
electrode is inserted into the cochlea and the magnet/processor is carefully
positioned on the skull behind the ear. After the operation, the patient can
usually resume normal activity within a week.

The incision must be well healed before the implant can be used. Healing time for
the incision usually takes about four to six weeks.

The implant can then be activated. The cochlear implant requires programming
or mapping. This is accomplished on an outpatient basis with our audiologist. The
mapping is away to “fine tune” the implant to the needs of the individual.
Implant Team Members
Andrew de Jong, M.D. – Implant Surgeon
Kirsta Herder, Au.D. – Implant Audiologist
Lori Benn, SLP – Speech Therapist
Natalie Smith, Cochlear Implant Coordinator