Audiology Testing:
I will start our journey together with a discussion on the hearing assessment performed prior to cochlear implantation. Those of you who are currently going through this process are most welcome to join me as well as CI users who have already experienced the routine hearing follow-ups after implantation.
The cochlear implant candidacy process includes a medical examination, auditory assessment, and sometimes a psychological evaluation. The goal is to obtain information to provide reliable answers to two key questions:
(1) Is a cochlear implant the most appropriate hearing assistive device?
(2) Are there any medical restrictions for the surgery?
Candidacy Evaluation:
Cochlear implantation has been proven a safe and effective means of restoring auditory skills in people with severe, profound, and total hearing losses. Modern implant systems are generally similar in design, consisting of an intracochlear electrode array, implanted electronics, and an external signal processor. Although signal processing parameters vary across manufacturers, the major cochlear implant (CI) systems all present a representation of the spectrum of acoustic signals along with the electrode array following the assumed tonotopic arrangement within the cochlea.
Counseling Cochlear Implants
Back in the 1960s, when I was a diagnostic audiologist, the patient I most dreaded seeing was a young child with a profound hearing loss. Despite our best efforts, this was a child we could not help a great deal. The best I could do at the time was prescribe two rather clunky and limited binaural body hearing aids and provide a visual-based (speechreading) treatment program. The result was usually a child who was eventually educated within a school for the deaf and who had limited oral communication skills and severely impaired English language skills.
With the advent of somewhat earlier detection and improved amplification in the 1970s, this child was later able to wear powerful binaural behind-the-ear hearing aids. We could provide more aural-based treatment, which yielded a child with improved communication skills; however, the child still had speech, language, and educational limitations. Although more of these children entered the educational mainstream, it was not always with success. In many cases, the child was able to compete academically with normal-hearing children but failed socially. The strain of constantly having to be alert to speech read and to hear took a toll. Many of these “successful” orally educated children rebelled and eventually became leaders in the 1990s movement to reinstate American Sign Language into the education of children who are deaf. This movement flowered mightily during this decade but now seems to be subsiding with the advent of newborn hearing screening and cochlear implants.
Surgery
You, your health care provider, and an audiologist may consider a cochlear implant if you are experiencing hearing loss and continue to rely heavily on lip-reading. Candidates for cochlear implant surgery include individuals who:
- Are experiencing hearing loss and are not helped by hearing aids
- Have hearing in both ears but with poor clarity
- Miss half or more of spoken words, without lip reading, even when wearing hearing aids
- Rely heavily on lip reading, despite wearing hearing aids
In cases of more moderate hearing loss, a partially inserted cochlear implant is used to preserve hearing so that both a hearing aid and the cochlear implant may be used simultaneously in the same ear. In more severe cases of hearing loss, however, a fully inserted cochlear implant is needed to achieve the full benefit of an electrical hearing.
How much cochlear implants help varies from person to person. Most individuals note a significant growth in their awareness of sounds within days after their cochlear implant is turned on, which is about four to six weeks after surgery. Speech understanding improves more gradually, with most individuals experiencing the largest improvement within the first six months. The size of this improvement varies considerably between people. Improvements in speech understanding can be aided with auditory, or hearing, therapy after surgery.
Post-Op Management
After having cochlear implant surgery, your child:
- will wear a dressing over the implant area
- may be off-balance or dizzy
- may have ringing in the ear
- may experience mild to moderate pain
- won’t have to have the stitches removed—they’re absorbable and dissolve on their own
It is normal for the ear to stand out from the head due to swelling. It will return to its normal position within a few weeks after surgery. Your child may also have swelling spread into the temple or around the eye on the side of surgery.
It is also normal to have blood come out the nose and down the throat. This comes from the ear and will resolve in 1 to 2 weeks.
Moderate dizziness lasts for a few days. The imbalance can take a few weeks to completely resolve.
Dressing Care
A dressing called a mastoid dressing will be placed at the end of surgery. This dressing is white and held in place with a special stretchy tape. The dressing will be removed the day after surgery and will be replaced with a neoprene headband that will be given to you in the recovery area. The dressing should remain in place for a total of 5 days, removing briefly twice daily to place ointment on the incision.
Bathing
Bathing: The incision should be kept dry for 1 week after surgery. It is OK to shower as long as the incision is kept dry.