Cochlear Implant Program
Getting a Cochlear Implant
What is a cochlear implant?
A cochlear implant is an electronic device that provides a sensation of hearing to individuals who are deaf. It does not provide "normal" hearing, but the device can allow children to detect and differentiate among sounds.
It consists of two main parts: an external part worn somewhat like a hearing aid, and an internal part which must be implanted by a surgeon.
The external part of a cochlear implant is the speech processor. It has a "microphone" worn over or behind the ear. The microphone feeds the sound to the speech processor in the form of electricity. The speech processor codes the sound input into electrical signals which are sent back through a cord to the “transmitting coil,” a thin plastic piece about one inch in diameter containing a magnet placed on the side of the head behind and slightly above the ear.
The transmitter sends the signals across the skin to the internal part of the implant (the "receiver/stimulator"), which is under the skin.
The receiver/stimulator sends the signals into the electrode array, which is a one-inch long wire surgically inserted into the inner ear. The electrode array consists of several electrode bands, each of which can provide a tiny current to the inner ear, to replace the function of the damaged or missing hair cells of the cochlea which ordinarily would stimulate the nerve endings of the auditory nerve.
Implants from different manufacturers differ in the number of channels, programming strategy, and appearance of the externally worn device. Behind-the-ear processors are available to eliminate the need for a body pack for many cochlear implant users.
Does a cochlear implant provide normal hearing?
No. A cochlear implant provides a limited sense of hearing in the implanted ear. However, most individuals with good language abilities can learn to use this sound to understand spoken language. Many cochlear implant users can learn to understand spoken sentences without looking at the person who is talking, particularly if there is no background noise. Many can also learn to use the telephone.
Who can benefit from a cochlear implant?
Children who were born without hearing, and children who lose their hearing can benefit from an implant. Adults and children who once had enough hearing to perceive the sounds of speech have an easier time learning to use the new sound through an implant, but many children who never heard sounds before can learn to understand speech using the implant, if they have good cognitive (learning) abilities.
What factors might favor or limit my child's benefit from a cochlear implant?
Most children who are implanted receive some degree of benefit. Goals and expectations for the outcome of cochlear implantation vary for different children, and are reviewed thoroughly with the family before the surgery. Factors which favor a beneficial outcome from a cochlear implant are:
- favorable cochlear anatomy;
- surgery at a young age;
- a solid base of language development prior to surgery (age-appropriate);
- a high level of motivation and commitment on the part of the family to keep frequent appointments, maintain the device, and encourage listening skills;
- an appropriate educational program which incorporates listening activities into the curriculum;
- regular speech/language therapy given by a clinician with specific expertise and experience in the area of spoken language development in deaf children using cochlear implants.
The benefit from a cochlear implant may be limited by a child's previous language deprivation or by a particular child's disorder in language acquisition skills. The anatomy of the child's ear and auditory nerve also may limit sound reception and clarity with an implant. Illnesses such as meningitis may also limit outcomes.
At what age should a child receive a cochlear implant?
Children may be considered for a cochlear implant as young as 10 months. A congenitally deaf child who is going to have a cochlear implant should have the surgery before the age of four years, or earlier if possible. This early implantation gives the child the best chance to learn to use sound while language skills are developing.
Some congenitally or prelinguistically deaf children who receive cochlear implants when they are older do not develop the ability to recognize speech with the implant, and ultimately may reject its use. However, a school-age deaf child who makes maximal use of hearing aids and who already uses spoken language may benefit from a cochlear implant.
Children who once had normal hearing or partial hearing, and then became deaf, may be implanted as soon as it is clear that the child’s hearing is not going to recover and that there is little or no benefit from a hearing aid. A period of observation and training may be advisable after a seemingly total loss of hearing, to observe any recovery and to determine whether a hearing aid will help before the final decision is made to have an implant. Older children and teenagers who lose their hearing should participate in the decision whether to have a cochlear implant.
Should my child receive one cochlear implant or two?
Depending on your child's hearing, our team may recommend receiving two implants at the same time, or we may recommend starting with one implant. This determination is made based on many things, and will be decided in conjunction with the parents (and child when appropriate). One cochlear implant provides greatly improved access to sound for most candidates with severe to profound hearing loss. Some implant users benefit from continuing to use a hearing aid in the other ear. If a hearing aid provides no benefit, the child may be considered for candidacy to receive a second implant, to have access to sound in both ears. Bilateral cochlear implant use improves the ability to hear speech in noisy places and some ability to determine the direction a sound is coming from.
Should my child use sign language with an implant?
The option of a cochlear implant usually is chosen for the purpose of providing access to spoken language acquisition. After implantation, every effort should be made to give the child reasons to listen, hear, and learn to speak. However, every child’s language abilities and preferences are individual. Some parents of children with cochlear implants choose to use only spoken language to teach their child to communicate. Other children who have cochlear implants use both sign language and spoken language to communicate. If a child deaf from birth has a hearing loss so profound as to be a candidate for a cochlear implant, then the use of sign language prior to implantation provides full access to language.
Following the implant, some children (particularly those who were older than preschool age at the time of surgery) remain primarily users of sign language, and many children gradually make a transition from using sign language to using spoken language. However, sign language should not be withdrawn from everyday life to “force” the child to learn to speak. During auditory learning therapy sessions when the child is playing listening games, spoken language is often presented without sign to encourage listening. Both the home and school environment should provide the child who has a cochlear implant with plenty of meaningful spoken language input and with reasons to want to listen and hear. However, even children who become primary users of spoken language with their implants can still benefit from the use of sign language in less-than-optimal listening conditions, for learning new concepts, and when their speech processor is turned off or not being worn. The commitment of the family to provide full access to language is a requirement for the emotional well-being of any deaf child, including the child with a cochlear implant.
How is the cost of a cochlear implant paid for?
Most health insurance plans cover the pre-implant candidacy evaluation, the cochlear implant device, hospitalization and surgery, and follow-up visits at the hospital. The family is responsible for yearly theft/loss insurance after the first three years, and usually must pay for a service contract for the processor after the initial three-year warranty expires. The early intervention program or school district is responsible to provide ongoing speech and language therapy, with consultations provided by the hospital staff. The family plays a strong role in advocating and arranging for speech and language therapy, provided by a clinician with specific expertise and experience in cochlear implant habilitation, to be coordinated with the educational program.