London Cochlear Implant Clinic

 

Getting an Implant

The full process can be split into fours parts:

The assessment

To determine an individuals suitability for a CI it is necessary to undertake a full assessment to determine:

  • The true level of hearing
  • The benefit obtained from hearing aids
  • The nature and history of the hearing loss
  • The anatomy of the ear
  • Mode of communication
  • Medical fitness
  • Expectation of result

This assessment can take a few weeks, particularly if hearing aids need to be adjusted and optimised and it is vital that the individual and family are aware of realistic expectations with regard to outcome, ongoing commitment to rehabilitation and future developments.

The operation

The surgical procedure itself is often regarded as the biggest obstacle whereas these days, in most cases, the operation is a relatively standard undertaking. Surgery to implant one ear can usually be undertaken as a day case and a bilateral implant is likely to result in just an overnight stay in hospital.

The incision is around 4-5cm long and is positioned directly behind the ear. The anatomy of the middle ear is relatively complicated and the risks of surgery are generally those of damage to the structures in the middle ear. These include the nerve that moves the face, the nerve that provides taste to half the tongue, the organs of balance and the jugular vain and carotid artery. Damage to any of these structures is incredibly rare.

Surgery takes about 1-1.5 hours for a single implant and 2-3 hours for a bilateral. At the end of the procedure, once the implant(s) is (are) in place it (they) can be tested by an audiological scientist to assess what responses can be obtained from the cochlear nerve. This helps when it comes to switching the implant(s) on later.

An x-ray may be taken to check the position of the implant.

After surgery a bandage is applied to the head. This is usually left in place for 24 hours. The stitches are under the skin and will dissolve however the wound will need to checked at one week and it is important to keep it absolutely dry until then.

The surgery is not particularly painful and most people find they need little in the way of pain killers afterwards.

It is common to feel a little bit dizzy especially with bilateral surgery but this should settle over the first few days.

Tinnitus in the operated ear can often be exacerbated in the early postoperative period. This usually settles, if not in the first few weeks almost certainly when the device is switched on.

The switch on

The external parts of the cochlear implant will not be fitted for 2 to 6 weeks after the surgery, to allow time for the scar to heal and the external magnet to remain secure. The patient will return to the implant centre for ‘switch on’ when the audiologist will begin to ‘map’ the external speech processor. The speech processor is ‘mapped’ by connecting it to the computer and sending signals via the cochlear implant to the auditory nerve in a series of beeps. Different maps (programmes) can be set for different listening situations (ie background noise, one to one etc.) The audiologist will spend some time tuning the speech processor to enable the patient to hear when ‘switched on’ this will happen during the first of a possible six sessions.

Once activated some time will be spent listening to simple sounds like clapping, running water, and traffic sounds. Speech will sound very different at this stage. It is often described as mechanical, robotic like Donald Duck, but this soon passes.
Every person reacts differently to the new sound, the strange effects quickly disappear as the brain adjusts to the new stimulation.
Adults who have a long duration of deafness e.g. 10 years will take longer to adjust to the new sounds than those who acquired their deafness relatively recently e.g. 2-3years.

Switch on requires several weeks of ‘tuning’. Appointments are often arranged on a weekly basis for 4-6 weeks. Each appointment is about 2 hours long. During this period of adjustment time is spent supporting the patient and discussing their experiences. It is hoped that at the end of this period patients will have a good understanding of speech, although lip reading may continue to be used.
In parallel the Speech and Language therapist will be assisting with rehabilitation.

There are many resources available on the internet, try the manufacturers websites.

Programming and rehab

As well as simply having the implant switched on and tuned in you may require input from speech and language therapists and teachers of the deaf. This is particularly the case for children. The precise programme of rehabilitation will depend on the team and what is best for you.