Ear Center: Cochlear Implants

Cochlear Implant Overview
History
Candidacy
Cochlear Implant Evaluations at the Ear Center
Evaluation
Diagnostic Imaging
Costs & Insurance
Neptune Waterproof CI Sound Processor by Advanced Bionics Corporation
Recommended Vaccinations 
CI References
Cochlear Implant Animation

Cochlear Implant Overview 

Cochlear implants are electronic devices that are implanted under the skin behind the ear consisting of an internal receiver and an electrode array that is placed within the inner ear (cochlea) to help restore some hearing for patients with severe to profound deafness. An external processor is worn behind the ear or on a belt and contains a microphone and transmission system (telemetry). The external processor picks up environmental sound, processes the signal, and transmits it to the implanted internal receiver. The internal receiver is attached to an electrode array that is implanted within the cochlea.  the electrodes transmit the sound as an electrical signal to the inner ear. Remaining inner ear nerve cells transmits the sound signal to the brain which must interpret the signals as sound and words. The signals are not sounds as they are heard by normally hearing individuals but are signals that deaf or profoundly hearing impaired people must learn how to interpret into words.

Some brains are able to interpret the signals very well and others struggle to make sense of the signals. This results in 1/3 of patients being low, medium, and high cochlear implant performers respectively. After a cochlear implant is performed, there is a one to two year period needed for practice and brain training. The most important determiner of success with a cochlear implant is the length of time of deafness prior to implantation.

Video - How Cochlear Implants Work

History

Cochlear implants were started in 1960 by Dr. William House of the House Ear Institute. The first human patient was implanted in 1973. Currently, there are three approved multi-electrode cochlear implants available - Cochlear Americas, Advanced Bionics, and MedEl.

To date, approximately 100,000 people worldwide have been implanted with cochlear implants. In the United States, 22,000 adults and 15,000 children have been implanted. Dr. Kraus has been implanting cochlear implants in adults and children since 1986. He was one of the original co-investigators working with Cochlear Corporation during the Pediatric Cochlear Implant investigational trials. Along with 14 other co-investigators, it was their results that help lead to FDA approval for cochlear implants in children 2 years or older in 1990.

Candidacy

Patients who are considering a cochlear implant receive special counseling and require a standardized evaluation to determine candidacy. It must be determined that the patient is anticipated to perform better with a cochlear implant that with hearing aids that are optimally fit. Discrimination scores (understanding ability) must be 40% or less in the best aided condition. CT and MRI scans of the head are necessary in order to determine candidacy. The patient must be healthy enough to have a 3 hour general anesthetic, have no bleeding problems, and be of sound mind enough for postoperative computer mapping to adjust the device. A Pneumovax® vaccine is required for adults. Children are required to have Prevnar®, Pneumovax®, and HIB vaccines along with their standard pediatric immunizations. The cochlear implant operation is performed under general anesthesia and requires an overnight stay. CI processor fitting is performed approximately 3 weeks after implantation depending on healing and other individual factors. At least 1-2 years of cochlear implant computer mapping and auditory habilitation therapy is required to maximize hearing potential.

Older Patients: Cochlear implantation can be safely performed in patients over 70 years of age who cannot be helped by conventional hearing aids. Usually, their duration of hearing loss is longer than in younger patients. Decreased performance correlates with duration of deafness rather than with age. Profound hearing loss can have adverse effects on social isolation, depression, cognition function, and quality of life. Older patients must be able to undergo a 3 hour anesthesia and are usually required to have a complete history and physical examination, including a chest x-ray, EKG, and blood tests, performed by their primary care physician prior to determining candidacy.

Cochlear Implant Evaluations at The Ear Center

Thank you for choosing our center for your cochlear implant evaluation. As you know, cochlear implants represent the cutting edge of sophisticated medical technology. In many cases, multi-circuit cochlear implants can help to restore useful hearing to children and adults who have:

  • severe to profound hearing loss in both ears with less than 40% word recognition scores,
  • who derive little or no benefit from conventional hearing aids.

Evaluation

In order for our cochlear implant team to properly evaluate you or your loved one for a cochlear implant, it will be necessary for you to spend several hours or longer with us in the office. During your visit, your hearing will be tested by our audiologists and our cochlear implant surgeon will perform a complete medical evaluation. You or your child may also require a complete physical examination by your family doctor/pediatrician depending on individual circumstances.

During the hearing evaluation, which may be lengthy, our audiologists will perform many tests of your hearing ability with and without your hearing aids. In order to facilitate the testing, it is essential that you bring your most recent hearing aid(s), ear molds, etc. with you to your visit even if your hearing aids are not working or if you do not wear them regularly. In addition, please remember to bring all of your past medical records, including previous hearing tests (audiograms), to help us better understand your health history. Literature and DVD's concerning cochlear implantation are available to help you understand the science and process of cochlear implantation. By the end of your visit, a member of our staff will attempt to answer all of your questions.

Diagnostic Imaging

If it is felt that you would benefit from a cochlear implant, it will be necessary for you to have a special x-ray and/or diagnostic test(s) of your ears (CT scan of your ears and an MRI head scan). These studies are necessary in order to properly assess the anatomy of your inner ears (cochleas) and for preoperative planning. Simply stated, there must be an open channel within the cochlea (patent cochlea) present in which to place the active cochlear implant electrodes. You must have an intact hearing nerve to carrier the hearing signals. These tests will be arranged for you by our medical staff. The imaging tests are not performed in our office and are scheduled on another day. Because they are special tests, they are usually performed in our local hospital (Moses Cone Hospital) or a free-standing radiology imaging center (such as Triad Imaging, Greensboro Imaging, etc.

Finally, we recommend that you review the terms of your current health insurance policy to check if cochlear implants are a covered service for you. Cochlear implantation is a well recognized technology, is the standard of care for the treatment of severe-to- profound hearing loss that cannot be treated with hearing aids, and is fully approved by the FDA for adults and children 12 months and older. Most health insurance carriers cover cochlear implants. However, some do not. If you have questions after reviewing the terms of your policy, we recommend that you contact your company's health care benefits department.

Cost & Insurance

Currently, the approximate cost for cochlear implantation is in the range of $40,000-$45,000 depending on the type of device implanted, length of hospital stay, etc. Please check with your insurance company concerning your individual benefits concerning cochlear implants.

We sincerely hope that this information concerning cochlear implant evaluations is helpful to you. Please remember to bring your hearing aid(s) and medical/hearing test records with you or arrange for them to be sent or faxed to us prior to your visit. Our fax number is (336) 273-9936.  Our cochlear implant team genuinely looks forward to meeting you and your family and introducing you to the world of cochlear implants - the cutting edge of medical technology.

Cochlear Implant Animation

 

**Nucleus 5 Cochlear Implant from Cochlear Americas

Cochlear Americas announced their newest cochlear implant, the Nucleus 5. It has a thin profile that will be useful for cochlear implants for young children.

**Beginning in October 2011, Cochlear Americas, the manufacturer of the Nucleus 5 (Nucleus CI512), has voluntarily recalled the implant due to moisture malfunction of one of four diodes. Currently, the Nucleus Freedom (CI24RE) with the Contour Advance Electrode is being implanted. The Nucleus Freedom device has not had the identified failure mode seen in the Nucleus 5 in any of the 62,000 registered Nucleus Freedom implants around the world. The Nucleus Freedom implant is now being used with the Nucleus 5 CP810 Sound Processor.

The new Nucleus 5 CI System.....

                 Nucleus_5_main_image

The Nucleus 5 has a thinner profile than previous cochlear implants....

Nucleus_5_lateral_image

 

Neptune Sound Processor by Advance Bionics - the World's First Waterproof CI Sound Processor

 

netune1_underwater neptune2_girl_in_water
Neptune CI Sound Processor worn on the right arm during swimming Neptune arm band during bath time

 

neptune3_sound_processors neptune4_sound_processors
Neptune CI Sound Processors Neptune with external transmitters

 

Advanced Bionics Corporation (ABC) has announced its newest cochlear implant sound processor, the Neptune. The Neptune is the world's first waterproof CI sound processor and has been approved by the U.S. FDA.

Now, patients being implanted with an ABC cochlear implant will have the choice of wearing either the Harmony (non-waterproof) or the Neptune (waterproof) sound processors. If hospital practices and insurance remimbursement is supportive, patients will have the opportunity to pruchase dual-sound processor systems i.e. two Harmony SP's, two Neptune SP's, or one of each.

Being waterproof, one can swim or bathe with the Neptune! Heairng is still delivered during these important times, especially for babies and young, active children.

The Neptune is a free-style design so that nothing is worn on the outer ear. The Neptune may be worn in the hair, on the arm, under their collar, or in their pocket without compromising hearing performance.

The Neptune design is tough and rugged. It carries an IP68 rating that offers maximum protection against solid particles and various forms of moisture. CI patients now have an opportunity to hear in all weather, all sports, and all terrain.

Neptune includes ABC's ClearVoice™, HiRes Fidelity 120™, and AutSound™ technologies.

Neptune's Features:

  • Swim with the Neptune
  • Bond during bath time
  • Freestyle Design
  • ClearVoice™, HiRes Fidelity 120™, and AutSound™ technologies
  • Removable controls
  • Flexible wearing options
  • Fashion-forward colors
  • Off-the-Shelf AAA battery
  • Convenient wearing accessories

 

Vaccination Recommendations for Patients Receiving Cochlear Implants

New recommendations have been issued by the Center for Disease Control:

  • Children should receive PCV13 vaccinations.
  • Older children (ages 2-5 yrs.) should receive two doses of PCV13 if they have not received any doses of PCV7 or PCV13. If they have completed the four doses of PCV7 series, they should receive one dose of PCV13 through age 71 months.
  • Children 6-8 yrs of age may receive a single dose of PCV13 regardless of whether they have previously received PCV7 or the pneumococcal polysaccharide vaccine (PPSV) (Pneumovax)
  • In addition to PCV13, children should receive one dose of PPSV at age 2 or older and after completing all recommended doses of PCV13.
  • Adults 19 yrs of age or older should receive a single dose of PPSV.
  • For both children and adults, the vaccination schedule should be completed at least two weeks before cochlear implant surgery.

 

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For addition website information concerning the various cochlear implant companies, please click on our "Links" section for their website addresses.

If you would like to learn more about cochlear implants for yourself or a loved one, please contact our office at (336) 273-9932 and ask for our Audiology Department.

Last revised April 21, 2012