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Deafness in paediatric age can adversely impact language acquisition as well as educational and social-emotional development. Once diagnosed, hearing loss should be rehabilitated early; the goal is to provide the child with maximum access to the acoustic features of speech within a listening range that is safe and comfortable. In presence of severe to profound deafness, benefit from auditory amplification cannot be enough to allow a proper language development. Cochlear implants are partially implantable electronic devices designed to provide profoundly deafened patients with hearing sensitivity within the speech range.
it has been recognized that implantation at a very early age (12–18 months) provides children with the best outcomes, taking advantage of sensitive periods of auditory development. Bilateral implantation offers a better sound localization, as well as a superior ability to understand speech in noisy environments than unilateral cochlear implant.
Benefits from cochlear implantation include not only better abilities to hear and to develop speech and language skills, but also improved academic attainment, improved quality of life, and better employment status.
When the hearing loss is severe to a profound degree and the patients (children / adults) are not getting benefit with hearing aid fitting, Cochlear implantation will help them to develop good listening capability and speech and language development.
A cochlear implant or bionic ear is a device that is surgically implanted in the cochlea. The implant bypasses the inner hair cells and stimulates the 8th nerve endings electrically. Due to the invasive nature of the implant, the considerable variability of performance of recipients and the high cost of the device, selection criteria for the cochlear implant are designed to identify or predict those that would benefit to have favourable outcomes. Over the years, improvements in implant technology, surgical techniques and re/habilitation methods coupled with a greater understanding of hearing loss and related issues have led to an increase in recommendation of bilateral implantation and inclusion of those with multiple handicaps for implantation.
Appropriate selection is half the battle won, and thus all candidates must be carefully selected. A child or adult with hearing loss has other conditions related to structure and function- example Cochlear anomalies, facial paresis, visual impairments, sensory integration issues, autism, and related issues such as poor family support that impact outcomes. Hence all assessments are done by a team of professionals
Audiological assessment forms the basis to determine candidacy. The aim is to obtain a profile of peripheral and central abilities. Behavioural, physiological and electrophysiological tests are carried out to do the same. This information along with radiological evaluation helps to select the ear to be implanted (in case of unilateral implantation).
Cochlear Implant Near Me
All children should undergo Complete Ear, Nose and Throat examination to identify any debris or wax in the external ear and middle ear infection. If present Ears have to be cleaned and middle ear infections to be treated before submitting the child for further audiological evaluations. Medical assessment by the Paediatrician or Physician is typically carried out for other disorders based on signs and symptoms.
The following evaluations have to be done before taking a decision for implantation.
- Behavioural observation audiometry / Pure tone audiometry to assess the degree of hearing loss
- Impedance audiometry to assess the middle ear condition
- Oto-acoustic emission studies (OAE) to assess the inner ear function
- Brain stem evoked response audiometry to assess the cochlear nerve function
- High resolution computerized tomography (HRCT)of the temporal bones to assess the condition of the middle ear structures and the inner ear (Cochlea)
- Magnetic resonance imaging (MRI) of Brain, Cochlea and internal auditory canal to assess the Cochlea and Cochlear nerve
- Hearing aid trial and fitting
- Auditory training (Listening training) & Speech therapy
- Unaided & Aided audiometry to assess the benefit of training with hearing aids
- Speech & Language evaluation
With all the above mentioned evaluations if we find that the patient has severe to profound degree of sensorineural hearing loss and is not getting sufficient benefit with hearing aids and there is delay in development of speech, then a decision to do Cochlear implantation is made. The radiological evaluations will guide us in selecting the type of Cochlear implant
During counselling, parents get an understanding of the overall issues assessed. Now they must assimilate complex information regarding surgery, technology, and training. There are several other contentions like does the child need Cochlear Implant or will he/she do well with hearing aids? How early can it be done for the child? Whether unilateral or bilateral implantation? Which system, Cost factor? Here information counselling becomes very significant to make an informed decision. Some children derive more benefit from a cochlear implant than other children do. The team members must assess the abilities, motivation, and involvement of the family and child, including whether the family has a realistic view of the child’s potential to benefit from a cochlear implant. These families will be encouraged to meet the other cochlear implant recipients who have undergone Cochlear implantation and habilitation/rehabilitation program. The family and caregivers need to understand the importance of therapy & mapping post-implantation.
PARTS OF A COCHLEAR IMPLANT
The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin (see figure). An implant has the following parts:
A microphone, which picks up sound from the environment.
A speech processor, which selects and arranges sounds picked up by the microphone.
A transmitter and receiver/stimulator, which receive signals from the speech processor and convert them into electric impulses.
An electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve.
An implant does not restore normal hearing. Instead, it can give a deaf person a useful representation of sounds in the environment and help him or her to understand speech.
Cochlear implants replace the function of hair cells that are no longer able to generate electrical impulses in response to sound. Therefore, these devices may provide a viable alternative to hearing aids among adults with sensorineural hearing loss because they bypass damaged hair cells by transmitting the electrical impulses directly to the acoustic nerve.
WHAT ARE THE TYPES OF COCHLEAR IMPLANTS AVAILABLE IN INDIA?
There are four international companies of good repute who manufacture and supply cochlear implants in India.
- Cochlear (Australia )
- Advanced bionics (The United States of America)
- Me DEL (Austria)
- Neurilec (France)
All four companies have different models with different specifications suited for different situations. The cost of these implant models varies depending on the model and the company. Parents / Patients can take the guidance from the implant team for selecting a proper implant model depending on the findings of the candidacy evaluations and the financial status of the family.
WHAT IS THE COST OF COCHLEAR IMPLANTS IN INDIA?
The total cost of Cochlear implantation includes the cost of evaluations, implant, surgery and hospitalization, post implantation switch on, mapping and rehabilitation. It varies depending on the implant model selected, difficulties in surgery, duration of hospitalization, unilateral or bilateral (One vs both side) implantation, the number of mapping sessions and duration of rehabilitation. Hence, it is difficult to say how much it will cost. However, the surgeon will be able to tell you approximately how much it will cost at the time of counselling, looking at these various factors. Please visit us to have a case based discussion for further details.
WHAT ARE THE RISKS INVOLVED IN COCHLEAR IMPLANT SURGERY?
Cochlear implant surgery is generally safe. Risks of cochlear implantation can include:
- Loss of residual hearing. Implantation of the device can cause a loss of any remaining, unclear, natural hearing in the implanted ear in some people.
- Inflammation of the membranes surrounding the brain and spinal cord (meningitis) after cochlear implant surgery. Vaccinations to reduce the risk of meningitis are generally given to adults and children before implantation. The number of patients developing meningitis is very low thankfully. Maintaining the wound site sterile & avoiding visitors in the post operative period helps reduce the chances of meningitis.
- Failure of device. Surgery may sometimes be needed to repair or replace a faulty internal device. Unfortunately, this is not in the hands of the surgeon or the patient. Fortunately, this is quite rare.
- Complications are rare and can include:
- Facial paralysis
- Infection at the surgery site
- Device infection
- Balance problems
- Taste disturbance
- New or worsened ear noise (tinnitus)
- Cerebro-spinal fluid leak
The above mentioned complications are what have been reported in literature from across the world & are mentioned here for information for patients. In experienced hands, fortunately, these complications DO NOT OCCUR COMMONLY. The risk of any of the complications varies from case to case & depends on the complexity of the case, associated medical conditions, anatomical variation of the cochlea among many other factors. Please visit us for a case based discussion for further information.
IS THERE ANY SUPPORT FOR FUNDING FOR COCHLEAR IMPLANT SURGERY?
Funding for Cochlear implantation:
- ADIP Scheme: The central government under ADIP scheme is funding for Cochlear implantation for the hearing impaired up to a total cost of Rs.6 lakhs. There are recognised hospitals for conducting surgery and recognized therapy centers for rehabilitation of these children operated under the scheme. Parents can contact Medikeri super speciality ENT center for applying for assistance under this scheme.
- Karnataka state government scheme: The state government has also started funding for Cochlear implantation in some of the recognised government hospitals under SAST. Cochlear Implant Scheme of National Health Mission, Health and Family Welfare Department, Karnataka will be implemented through the Rashtriya Bal Swasthya Karyakrama (RBSK) and Suvarna Arogya Suraksha Trust (SAST). The scheme provides free treatment to children with severe deafness. The treatment consists of surgery for Cochlear Implantation and 1 year of rehabilitation therapy after surgery. The full package has been fixed as Rs 5.10 lakhs (at the time of writing this article) – including surgical and rehabilitation costs. Children between 8 months to 6 years having severe to profound sensori-neural hearing loss, not benefiting from a hearing aid trial, are eligible to obtain financial assistance through this scheme.
- Non-governmental organizations: Some of the Non-governmental organizations also fund for Cochlear implantation. Parents can take an estimate from the center and approach these NGOs for funding. For details please visit us at the hospital.
- Insurance companies: Some of the Insurance companies have provided funding for Cochlear implantation (partly / totally) depending on the insured amount by the parents working in multinational companies. Please contact your HR manager for the same.
AM I A CANDIDATE FOR A COCHLEAR IMPLANT?
To be eligible for a cochlear implant, you must have:
- Hearing loss that is so severe it interrupts spoken communication
- Limited benefit from hearing aids as determined by specialized hearing tests
- No medical conditions or factors that increase the risks associated with cochlear implants
- High motivation to participate in hearing rehabilitation and be part of the hearing world
- Realistic expectations of what cochlear implants can and can’t do for hearing
TO FIND OUT IF A COCHLEAR IMPLANT WOULD HELP YOU, PLEASE VISIT US FOR A DETAILED DISCUSSION.
CAN I HEAR IMMEDIATELY AFTER A COCHLEAR IMPLANT SURGERY?
Post implantation Switch on, mapping and auditory verbal therapy
Three to four weeks after surgery, the implant is switched on and the processor is fitted. The first mapping is done during the switch on and the patient has to attend the therapy sessions twice a week for a period of one to two years depending on the individual case. During the course of therapy, further mappings are done depending on the need for changing the map that will be decided by the therapist.