COCHLEAR IMPLANT

INTRODUCTION

Cochlear implants are first true bionic sense organs

Like human inner ear hair cells they convert mechanical sound energy into electrical impulses.
Cochlear implants are not hearing aids which merely amplify mechanical sound waves and increase
their energy content
Otter et al have shown that in the normal auditory nerve in young people there are approximately
35,000 nerve fibres; they concluded that a minimum of 10,000 spiral ganglion cells (SGC) are
required for preservation of speech recognition.
In most pathologies hair cells are damaged but ganglionic cells are intact which can be
electrically stimulated using cochlear implant.

PREOPERATIVE EVALUATION

Postlingually deafened adults tested using first PTA and speech discrimination testing.
Otological assessment for candidature should exclude active otological disease.
As in the medical domain the most important criterion should be the absence of major psychological
or psychiatric disorder.
HEARING TESTS
HINT (Hearing In Noise Test) and CNC word testing (Consonant Nucleus Consonant)
Other test includes ESP i.e. Early speech perception test
RADIOLOGICAL EVALUATION for any contraindications for implant procedure.

CT IS BEST FOR

Anatomy of facial nerve and facial canal

Enlarged Cochlear aqueduct
Defects of cribriform area of Cochlea
Presence of round and oval window

MRI BEST FOR

Morphology of cochlea and semicircular canals

Patency of cochlear duct
Status of cochlear nerve
Defect of modiolus
CNS Abnormalities
Most sensitive to identify early labrynthitis ossificans (before complete ossification) as fluid changes
within cochlea can be picked up by MRI early.

ASSOCIATED DEFECTS
 CHARGE syndrome, (coloboma of iris, Heart defects, Coanal atresia, Retardation, Genital defects,
Ear anomalies), Pendred’s syndrome, Ushers syndrome

CANDIDATURE :

Individuals with < 50% HINT score and average PTA of 70 dB or greater are considered ideal
candidates for cochlear implant
It is widely accepted among all CI professionals (surgeons, audiologists and rehabilitation
professionals) that a period of trial of use of appropriate and well-fitted hearing aids should be given
before embarking on CI.

WHICH EAR TO IMPLANT :

Better hearing ear as ganglionic cell density is more and more chances of postop hearing
improvement (it is said implantation itself might damage residual hearing of poorer ear)
Least obstructed labyrinth if labrynthitis ossificans is there.
If any previous ear surgery, then the unoperated ear preferred eg canal wall down mastoidectomy in
one ear would make the C/L side more appealing as procedure wont require modification.

AGE OF IMPLANTATION

Now 1yr. Earlier thought that if implant placed early, electrodes might get displaced or implant
spontaneously extruded due to growth of skull which has been proved wrong.
Elderly are as likely to benefit from implants as young patients.

BILATERAL IMPLANTATION

Bilateral implantation benefits from “Head Shadow Effect” i.e. in normal listening environment
each ear receives different SNR (Signal to noise ratio)
Bilateral listeners can pick best SNR and enhance ability to speech understanding
Unilateral hearing makes sound localization almost impossible.

BENEFIT OF IMPLANTS IN AUDITORY NEUROPATHY

Auditory neuropathy is a condition in which Otoacoustic emissions are produced but BER waveforms
are absent as cochlear hair cells discharge dyssynchronously and thus are unable to generate action
potential.
Hearing loss in this condition is variable perhaps due to variable degree of dyssynchrony.
Cochlear implant bypasses dyssynchronous emissions and thus improves hearing.

ELECTROACOUSTIC or HYBRID IMPLANTS

Both cochlear implants and hearing aids.

For patients who retain hearing in lower frequencies but profound loss for higher frequencies.

DEVICE SELECTION

External and Internal Hardware

External Microphone, Speech processor, Transmission system.