Cochlear Implants

Cochlear Implant Procedure

Surgery

Cochlear Implant

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Surgery is performed while the patient is under general anesthesia and takes approximately one to three hours. The surgeon makes an incision behind the ear and forms a slight depression in the mastoid bone, where the internal device rests. The surgeon then creates a small hole in the cochlea and threads the electrode array of the internal device through this hole. The incision is closed so that the internal device is beneath the skin. Most patients feel well enough to return home the day of surgery.

Activation of the Cochlear Implant

Two to four weeks after surgery, after the incision has healed, the external components of the device can be programmed and activated. There is no hearing ability from the implant until this is done.
The activation includes:
Will insert pic of current headset when it is available

1. Fitting the headset
   After the incision has healed and swelling has subsided, an audiologist attaches a headset that consists of a transmitter and a microphone/speech processor. The transmitter contains an external magnet that is aligned with a magnet implanted inside the head during surgery. The transmitter sends sound signals across the skin to the internal receiver/stimulator.
2. Cochlear implant check
   The device is checked through a computer system, by communicating information between the cochlear implant and the external speech processor. Every component, including each electrode, is checked to make sure it is working properly.
3. Programming the speech processor
   An audiologist programs the speech processor using a special computer system.  Each electrode is fine-tuned for threshold (first hearing) and for comfortable listening levels. As each electrode is turned on, very small increases of electrical current are delivered to the hearing nerve until the patient hears a soft beep or tone. Once the softest hearing level is set, the patient listens for an increase in loudness until these beeps or tones become comfortable to hear. These steps are repeated until all electrodes are set for soft and comfortable levels. From these loudness judgments, a "hearing map" is created. The map is an individually designed set of instructions that tells each electrode how to stimulate the nerve endings in the cochlea.
4. Once a map is created and downloaded into the speech processor, the processor is turned on, and the patient hears through the cochlear implant for the first time. On this first day, speech usually sounds garbled or high-pitched. Environmental sounds may be difficult to identify. Over time, speech and environmental sounds become clearer and more natural. The audiologist will verify that the cochlear-implant recipient can tolerate a range of sounds, such as soft speech, conversational speech, loud speech, hand clapping, coughing, or doors shutting.
5. Using the external equipment
   The audiologist shows the cochlear implant recipient how to wear and operate the speech processor and its accessories and how to maintenance the device.
6. Programming sessions
   Several programming sessions are required to obtain and maintain optimal performance from the device. Patients return the day after activation for a recheck — and again generally after one month, three months, six months, nine months, and one year. After the first year, patients usually schedule annual appointments.

Rehabilitation after Cochlear Implant Surgery

Rehabilitation involves training the brain to understand sounds heard through the cochlear implant. The cochlear implant restores awareness of all sounds and patients sometimes are initially overwhelmed by the sounds. Speech and everyday environmental noises sound different from what they remember; the brain needs time to recognize what these sounds mean. This process is ongoing and is best achieved by wearing the speech processor continuously during waking hours.

Patients are given listening exercises to do at home. The difficulty level of these exercises varies. For some patients, weekly aural rehabilitation therapy may be necessary to help retrain the brain to hear. Speech therapy may be recommended for cochlear implant patients whose speech has been significantly affected by hearing loss.