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What is a cochlear implant?
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How long have cochlear implants
been available? |
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Who is eligible to receive an
implant? |
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What is the surgery like? |
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What outcomes can be expected
from a cochlear implant? |
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What happens after surgery?
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What Risks and Complications
are Associated with Cochlear Implant surgery? |
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Is reimplantation possible for
upgrading to newer technology? |
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What else is important to ask
your implant team? |
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What is a cochlear
implant? |
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A cochlear implant is a
computerized device that provides hearing to people with
‘nerve deafness’ by stimulating the hearing
nerve with coded electrical signals. It by passes damaged
hair cells of the cochlea (the actual cause of ‘nerve
deafness’ in most people). Without a Cochlear Implant,
those damaged hair cells can prevent sound from normally
reaching the brain, even with the most powerful hearing
aids. |
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How long have cochlear
implants been available? |
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Please see the section on
history for more information. The U.S. Food and Drug Administration
(FDA) first approved cochlear implant devices for adults
in 1985 and for children in 1990. More than 40,000 individuals
have received cochlear implants worldwide, approximately
half children and half adults.
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Who is eligible
to receive an implant? |
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In general, adults who had
some degree of useful hearing before becoming severely
to profoundly hearing impaired and benefit minimally from
hearing aids may qualify as candidates for cochlear implantation.
Children as young as 12 months of age with profound hearing
loss in both ears and who demonstrate little progress
in the development of auditory skills may also be considered
candidates. It is very important that the implant recipient
(and the family, in the case of a young child) have an
understanding of cochlear implants and realistic expectations
regarding the use of the device. |
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What is the surgery
like? |
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Cochlear implant surgery
usually takes about 2 hours under general anesthesia.
Most patients are discharged the same day as the operation.
An incision is made behind the ear and a seat is made
in the bone to secure the implant package and to protect
it. The mastoid bone is opened, then the cochlea is identified
and a tiny opening made in it. The electrode array is
placed into the cochlea through that opening, called a
cochleostomy. A dressing is placed over the ear for 24
hours. The operation is minimally painful, requiring pain
relief only the day of surgery in many instances. |
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What outcomes can
be expected from a cochlear implant? |
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The vast majority of patients
receiving cochlear implants use them very successfully.
However, recipients may experience a wide range of outcomes.
For individuals who lost their hearing after learning
to speak, the average implant recipient will be able to
have a conversation without lipreading and to use the
telephone. However, the perception of sound after implantation
may initially seem different from what they remember.
After using the cochlear implant for a few months, these
individuals often report that they perceive speech to
be natural or closer to their memory of familiar sounds.
People can recognize familiar speakers but do best in
one-on-one conversation in quiet. A predictive factor
for implant performance for adults who are deaf is the
length of time between the onset of deafness and implantation;
those with duration of deafness of less than 20 years
tend to experience better outcomes. |
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While many factors affect
outcomes for children, in general, the younger a congenitally
deaf (born deaf) child is implanted, the greater is the
potential benefit to speech and language development.
The type of communication mode and educational setting
used with a child also contribute very significantly to
the outcome in a child, as does the degree of parental
involvement with the rehabilitation process. Children
who lost hearing after three or more years of hearing
should be implanted soon afterwards and results are routinely
excellent. |
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What happens after
surgery? |
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Many patients are discharged
from the hospital the same day as surgery. The surgical
site is checked in about 1 week and the patient is allowed
to shampoo at that time. The first programming and stimulation
occurs at 3 to 4 weeks. It is important to remember that
a number of programming sessions are necessary to fine
tune the hearing. While sounds will be audible immediately
at programming, understanding is likely to be very poor.
Rapid improvement in understanding speech and recognizing
environmental sounds can be expected over the first 3
months. While many individuals like to listen to music
with the cochlear implant, others find that they cannot
appreciate music as fully as experienced by normally hearing
persons. |
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Getting a cochlear implant
is a lifetime commitment. After surgery, it is necessary
to return to the center for a follow-up services, including
the fitting of the external components of the implant;
activating and programming of the implant and its microphone,
speech processor and transmitter; necessary adjustments
and reprogramming, and annual check-ups. Children who
are implanted often require years of extensive aural rehabilitation
whereas adults who have been implanted due to acquired
deafness usually do not need formal aural rehabilitation. |
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What Risks and Complications
are Associated with Cochlear Implant surgery? |
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During surgery remaining hearing in
the implanted ear may be permanently lost. |
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Because the surgery is done
in the vicinity of the nerve that moves the face, there
is a remote possibility that temporary or permanent facial
paralysis may occur after surgery. |
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There is a slight risk that
the patient may experience taste disturbances, such as
a metallic taste, following implant surgery. |
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There is the risk that the
surgical site may become infected, which might require
removal of the device. |
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The patient may experience
discomfort at the wound following surgery; this is usually
temporary. |
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Is reimplantation
possible for upgrading to newer technology?
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Yes, survival of ganglion
cells despite insertional trauma of the cochlea may in
part explain the overall good results of reimplantation.
Many reimplantations have involved upgrading a single
channel to a multichannel device and several authors have
commented on the safety of reimplantation of multichannel
devices. Hearing outcomes have been reported to be as
good as or better than with the initial CI with no significant
complication rate. Reimplantation success has potential
implications for device upgrade in future..
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What else is important
to ask your implant team? |
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How many implants has your center performed?
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Does your team recommend
a hearing aid trial prior to recommending a cochlear implant?
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Does the behavioral audiological assessment
include speech perception testing? |
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Does the evaluation include an assessment
of parental expectations? |
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What is the audiologist's
personal experience with cochlear implants? How many years
has he/she worked with implants? |
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Do your audiologists work
in cochlear implants at least 75% of the time? Do they
participate in research and teach other audiologists on
a national level? |
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How many cochlear implant
operations has the surgeon performed? How many on children?
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