An intro to a cochlear implant
When any part of normal hearing no longer functions properly, then for some users, a Cochlear Implant can be considered. Some say that this is the recommended route and some deaf people decide that this is not for them. A cochlear implant is typically considered when hearing aids provide little to no benefit to the user. During the implant surgery, these hairs are typically damaged making it impossible to return back to hearing aids- so careful consideration should be made by the surgeon, audiologist, and user as to which route would provide the best benefit. A normal ear hears with about 18,000+ hair cells that are so tiny they could all fit on the tip of a pen. When one is considering an implant, they are reducing this to the number of electrodes that are in each implant and how that implant functions. Implants range from 12-24 electrodes depending on the company that one decides to go with. One cannot switch companies without revision surgery, so this is a huge decision! Meningitis is a possible risk that one needs to be warned about. Proper immunization is recommended to prevent unnecessary complications. While there are risks to this procedure, many users and parents have chosen this surgical procedure to possibly improve their life.
– How it works and ManufacturesCurrently to this date there are only 3 companies for users to choose from. Each company has its own set of ways to tackle the problem of hearing the loss in the way they felt it would give them the most gain. The three companies are Advanced Bionics, Cochlear, and Med-El. Each company makes its own line of products that line up with its specific implantable device. You cannot switch companies unless you undergo another surgical procedure. Some have switched companies with another surgery and have said that they had better results with a specific one, but this could be caused by the surgical procedure or the placement or the advancements and not the specific company itself. When someone gets an implant, because it is bypassing the damaged part of the ear, the users’ level of amplification needs can change. Because of this at activation, the Audiologist will go through each part of the electrode to give enough stimulation for the person. This can take some time, so be sure to be patient. I am told to expect this to take up to 3 hours. It is important here to recognize that the implant will convert all sounds into a stimulation that is sent directly to the cochlea. It is not sent as a sound. The brain will have to work hard to convert it into a sound. Some people will get frustrated with family, friends, and loved ones for not understanding that this process for the brain to relearn all of this can take a considerable amount of time. Sometimes it’s a matter of a few hours, but it seems to be more commonly over a few months’ time. Each user has their own results which can result from multiple issues. There are users that can understand speech from leaving activation, but understand that this is not always possible. Each implant has a warranty of 10 years and the device is expected to last up to without defects. Premature failure of this has happened but this is not very common. Surgery costs could be an issue for the patient for a new/replacement implant. Even with proper insertion and the device working fine, any part of the electrode failing could cause the need for revision surgery to replace the electrode failure. The surgeon may suggest a specific type of implant based on several factors but the user seems to have their pick of which company. It is best to talk to your surgical team about which might be best for you and openly discuss all three companies.
The Cochlear Implant Surgery
The surgery seems like what should be rather simple to perform, however, if any step is not performed correctly or if there is an unknown problem that is not seen prior to surgery on the scans it can complicate this procedure. The facial nerve or Taste nerves can be damaged or injured in the process. Sometimes this fades over a few days to a few weeks and rarely does it seem to be a long-term complication. There is a smaller drill bit that some surgeons are able to use if the distance between those two nerves is close together. Some surgeons will choose to do less drilling and not create a ‘bed’ for the implant to rest into. Each surgeon will make sure that the implant is secure and that it will be safe for the user. If you have any questions on how your surgeon does this, it is okay to ask them. My surgeon will drill a recess for the electrode but has no plans on drilling a ‘bed’ for the implant unless he feels that it is slipping out of place. He will make sure that it has a tight fit. He is confident that this is all I should need unless he notices something during the placement process that he will take care of at that time. This may be called a pocket procedure but this term seems to not be correct as it is just referencing that the skin around the implant is a snug fit to hold the implant in place. Implants that do not have the drilling at the part of the magnet part – may notice that the implant can be seen easier as it could tend to stick out more. I do not care about this part much. However, any unusual swelling or abnormalities should prompt medical attention from your surgical care team. It may be best to consider your outfit for going home. Many say to bring a shirt that can be buttoned up the front so it’s easy to put on. One could be too sore to lift their arms and may not feel well.
So now that you understand the surgical procedure and the implant itself, let’s talk about the part that sits on the outside of the body. This has 3 main parts to its makeup. There is the battery, coil, and processor. There are off-the-ear solutions for those users that need that as an option. Each company has its own way of resolving waterproofing issues and features it thought were beneficial to people who use its products. The coil sits on the outside of the head, just above the ear. Some coils are waterproof and some do not seem to be. The coils come in a variety of specific lengths based on what fits the person’s need. This coil sends the signal from the processor to the implant. The implant portion changes that into an electrode stimulation signal that the brain has to convert into sound. The processor is the ‘ears’ of this whole thing that typically receives the sounds. It collects the sounds and converts that into a specific signal that can tell the implant which Hertz the sound is. This is sent through the coil which is sent to the implant. The processor has a few different wearing options – such as on the ear like a typical hearing aid, clipped onto something, or an all-in-one processor that does not use a separate coil. There are waterproof cases offered by each company that needs a specific battery size to use with their case system to properly fit. The cases are also rated for only so many times of submersion, so this would be a reoccurring cost for the user. There is a completely waterproof solution from Advanced Bionics called the Neptune, which requires no special case. Insurance may help pay for another processor after it is no longer under warranty and or device failure. With some insurances, they will not cover a new processor until the other one is no longer functional or in need of replacement and is out of the warranty period. When any part of this device fails to work properly – no sound is delivered- making it non-functional. Do not expect the users to hear from you. Yelling will not aid the user in this time frame and in fact when one yells it is impossible to lip-read. Also, for the user that needs to lipread – try your best to not over pronounce your words, this is not only annoying but makes the task of figuring out what you are saying even harder – if not totally impossible.
Recovery time recovery from surgery varies for each person. Some people are back on their feet to normal activities within a few days. Some, however, struggle with nausea, vertigo, and pain. Sometimes complications can signify a potential problem that needs to be addressed, and at other times it’s something that is expected to pass over time. Take in mind that ‘normal activities may not be your-normal… If you are very active you may have to cut back on what you are doing significantly for a few weeks until you get the go-ahead from your surgical team. Try not to overdo your support for someone as that might become a bit too intense when one is not feeling at their best. However, if they are struggling to go from room to room, then it might be best to offer some support or a cane to use for stability. Discuss with your medical team when it is best to notify them of difficulties that you or your loved one might be going through. Things that are said to help are elevated rest, meaning not laying flat, and avoiding laying on the surgical site. Some people also seem to suggest a neck pillow. I have purchased both of these for comfort. Jaw pain is also said to be common and could be caused by the breathing tube or the procedure itself. This can affect how much the person may want to eat or chew, but diet is very important to recovery from any surgery. Possibly consider getting nutritional shakes to aid in nutrition with the understanding that foods and drinks may not taste well to them. Soft foods can also help, but again try to understand that their favorite food may not taste the same and this can alter what they want to eat. Think about if someone had a medical procedure that made everything taste like rusted metal… How much would you want to try that? Just try to be patient with them even if you spent considerable time preparing that favorite meal. Perhaps freezing that meal or saving it for later would be ideal. Bruising, bleeding, swelling, redness, increased pain, dizziness, and discharge from the surgical site should be brought to the attention of the surgical team as soon as possible. The headwrap should be used for as long as the medical team advises one to keep it on. Follow your suggested care treatment. I will be allowed to take the head wrap off the next day and shower. I will not be allowed to scrub the site, but I would not want to do that anyway. My headwrap will be a soft bandage, but there are some versions of headwraps that are hard cups that cover the site. It is advised to be gentle with this location as it could be sore.
Activation of each electrode is tested and put at levels that the user reports to hearing sounds. The comfort level of sounds is also accommodated so that hopefully when leaving the office, things will not be too loud or uncomfortable. The person may hear chirps or beeps instead of sounds that are recognizable, which is said to clear up over time or with the other appointments that the user will have to adjust the tones. Each adjustment is called a Mapping. There will be several Mappings over the course of the year to ensure the user is hearing the best possible with their implant and processor. This cannot be done in one Mapping due to healing from surgery and the user getting accustomed to the level of sounds they are not used to hearing. The person may NOT immediately hear sounds! This is the most important thing to understand here. Activation varies from clinic to clinic, some activate the implant on day 1, some do not until days 7-10, and some do not until 2-4 weeks after surgery. My activation would have been 7 days, but we moved my surgery date so my activation will be 12 days after surgery. I like this extra time to heal up from being a type 1 diabetic so that possibly I will be less sore and more up for the long trip to their office. Due to this whole process, the user needs everyone’s patience during this time. The person needs time to understand the sounds that are being sent and possibly this will take several Mappings to make things understandable. Mappings are typically done several times in the first year, then once a year after that or as needed.I have my activation and then my first Mapping a week later. Then I will get one at the 2 months marker, at 3-4 months, at the 6 months, and we will then discuss what I need for the remainder of the year. Talking to the person with the understanding that they may need you to repeat what you are saying is vital. Understand that it may be too frustrating for them and that you may just need to give them time and space. Practice with them some basic words so they can relearn or figure out what it is you are saying. Over time this may improve, but it takes quite a bit of patience and understanding on all persons involved. This is NOT an overnight fix! It takes time. And like I said above, if any part of the procedure or equipment is not functioning properly, then understanding may not be achievable. Take into consideration too, how long the person has been deaf or not able to recognize sounds from that ear. The brain will be working very hard to remap the memories of sounds to make sense of what it is they are hearing.
This is what is called the Cochlear Implant.
This is the electrode
This is the Implant
The Sound processor
What you can expect from a Cochlear Implant
Credits Kimama Renar
Disclaimer: This Data is collected from various places and it’s not my words or creation. The full credits got to the one who made it. I am just rearranging it to a single place for easy access and understanding.