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Cochlear Implants - Uses and Innovations

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Cochlear Implants - Uses and Innovations

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Cochlear implants are devices that are implanted to aid in hearing for people with very severe hearing loss and who are not benefitted from hearing aids.

Written by

Dr. Bindia

Medically reviewed by

Dr. Sneha Kannan

Published At June 29, 2018
Reviewed AtAugust 1, 2023

Hearing loss can occur in both children and adults. It can be categorized into mild, moderate, moderately severe, severe and profound hearing loss. Profound hearing loss refers to a condition when a person cannot hear sounds softer than 90 dB.

Causes of Hearing Loss

There are various causes of hearing loss. They are:

  • Genetic conditions.
  • Viral infections.
  • Loud noise.
  • Head trauma.
  • Old age.

So, you have a hearing problem which does not improve with wearing hearing aids. Your doctor asks you to get a hearing test done and tells you that the hearing report says 'very severe or profound hearing loss' and you need to have a cochlear implant for this condition. Here, we discuss the cochlear implants, their uses, indications, contraindications, precautions, surgical procedure, and recent innovations.

A cochlear implant is an electronic device which is implanted in the cochlea and it directly stimulates the auditory nerve and aids hearing.

Parts of a Cochlear Implant

  1. Sound processor containing a microphone, battery, coil, and electronics which is fitted on the outer skin behind the ear.
  2. The implant, which is placed in the cochlea, houses a coil which receives signals and an array of electrodes for stimulation of the cochlear nerve.

Uses

Various conditions where cochlear implants are required include:

  1. Severe to profound sensorineural hearing loss.
  2. Patients not benefitted from hearing aids.
  3. Patients not preferring hearing aids.
  4. Can also be implanted in infants earlier for a better outcome, that is, better oral communication in later life.

CT or MRI imaging is done prior to implantation for evaluation of facial nerve, cochlea, cochleovestibular nerve, brain and brainstem as any aplasia/hypoplasia of cochlea, an absence of cochlear/auditory nerve or congenital malformations may alter the outcome.

Contraindications of Cochlear Implants

  1. An absence of cochlea.
  2. An absence of cochlear nerve.
  3. Active middle ear infection.

Get vaccinated with Prevnar or Pneumovax vaccine to prevent a risk of meningitis before cochlear implantation. The vaccines are available for both children and adults.

Complications

Complications are few:

  1. Risk of meningitis.
  2. Facial nerve paralysis 1 %.
  3. Device failure requiring reimplantation 2 to 6 %.
  4. Transient vertigo.
  5. CSF (cerebrospinal fluid) leak.

Precautions

  • Not MRI compatible. Recent innovations are compatible with MRI also.
  • Avoid head trauma. Children with implants should wear helmets while playing for implant protection.
  • X-ray and CT scan are to be done with caution, as it can affect the external processor.

Surgical Procedure

Surgical procedure for implantation is performed under general anesthesia. It involves making an incision behind the ear to create a well for placing the receiver and small cochleostomy for insertion of the electrode array.

Facial nerve monitoring is required during the procedure to prevent injury to the facial nerve.

In the case of bilateral hearing impairment, implantation is preferably done in the ear with better hearing.

Patients can be sent home one to two hours after surgery with dressing on the ear and follow up for seven days.

Preoperative and postoperative steroids are given.

Types

Various types of cochlear implant systems are available which includes Clarion, Med El, Nucleus systems. Various innovations in implant design are available.

MRI compatible implants are also available with a removable magnet, which can be replaced later on after the procedure.

Recent innovations include cochlear implants that use laser pulses to trigger auditory signals from hair cells into the inner ear.

Research is being carried out to design better implants for the best communication outcome.

Frequently Asked Questions

1.

What Is the Use of Cochlear Implants?

The cochlear implant is an electronic device that produces hearing sensations in people with severe hearing loss. It is especially useful for those who no longer benefit from hearing aids. It improves communication and quality of life.

2.

When and Why Was the Cochlear Implant Invented?

The original cochlear implant was invented by Andre Djourno and Charles Eyries in 1957. The first single-channel electrode cochlear implant was introduced in 1972. It was invented to help severely deaf children and adults. Over 1000 individuals, including children, were given cochlear implants from 1972 to the mid-1980s.

3.

How Does a Cochlear Implant Impact People’s Lives?

Cochlear implants improve the overall quality of life. Those with a cochlear implant can recognize speech more properly, which boosts their self-esteem. It also helps regain confidence in a social environment, rejoin family and friends, and have a fuller life.

4.

Who Can Benefit From Cochlear Implants?

People who are deaf or hard of hearing can benefit from cochlear implants. People with single-sided or bilateral hearing loss and who are unable to communicate properly with a hearing aid can benefit from these implants. Some adults who lost all or most of their hearing later in life can find cochlear implants useful.

5.

What Are the Advantages and Disadvantages of Cochlear Implants?

The advantages of having cochlear implants include:
- They allow deaf people to hear.
- It opens up new possibilities for deaf children.
  - It gives people their social lives back.
The disadvantages include:
- These implants are expensive.
- The procedure is invasive and might have potential side effects.
- It requires long-term investment for good results.
- The desired outcome is not guaranteed.

6.

Do Cochlear Implants Last a Lifetime?

Cochlear implants are implanted surgically to last a lifetime. However, there are situations where the implants fail and must be replaced. Also, the technology for external processing keeps evolving, and the internal technology needs to be updated to be compatible with external technology.

7.

How Is a Cochlear Implant Different From Hearing Aids, and Which Is Better?

Hearing aids amplify sound, whereas a cochlear implant stimulates the nerve electrically to activate hearing. The cochlear implant is designed to serve severe hearing loss and not partial hearing loss. Cochlear implants are a rarer choice, and hearing aids are the most commonly used treatment for hearing impairment.

8.

Who Are Not Eligible to Have Cochlear Implants?

The following individuals are not eligible to have cochlear implants:
- Children with inner ear abnormalities.
- People in whom deafness is caused by the injury or absence of the auditory nerve fibers. Cochlear implants can only work if the auditory nerves are intact.

9.

Are Cochlear Implants Waterproof?

The cochlear implant is surgically placed underneath the skin. Hence, it is waterproof. But the external processor is generally not waterproof. Well, with evolving technology, some external processors are also waterproof.

10.

Do Cochlear Implants Require Chargeable Batteries?

The cochlear implants use batteries to give power to the external processor. The external processor is the part that sits behind the ear and has a microphone to detect sound and a battery to power the system. The battery can be charged when needed. The battery life depends on the size of the battery. The minimum battery life is about 9 hours.

11.

Can Deaf People Be Considered Disabled?

Disability can be defined as a limitation of function because of an impairment. Deaf people are limited in performing some functions due to hearing loss. Hence, deaf people have a disability. However, some people feel that deaf people are not disabled because those who do not have other disabilities can function well with the help of modern technology, hearing aids, and cochlear implants.

12.

What Should Be the Sleeping Position With a Cochlear Implant?

After the cochlear implant surgery, sleep with your head elevated using several pillows for two weeks. After recovery, it is safe to sleep on the side of the operative ear. It is also recommended to remove the device before going to bed.

13.

Is There a Risk of Cochlear Implant Getting Infected?

Infection is a serious compilation of cochlear implants. The infection after cochlear implantation can cause hearing loss secondary to implant removal and meningitis. Acute infectious complications are generally resolved with appropriate antibiotic therapy.
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Dr. Bindia
Dr. Bindia

Otolaryngology (E.N.T)

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hearing aiddeafnesshearing losshearing problemscochlear implant
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