Phone: 518-439-4326 Fax: 518-439-6143
Cochlear Implant Center
What is a Cochlear Implant?
A Cochlear implant (CI) is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing. The implant provides direct electrical stimulation to the hearing nerves. Unlike hearing aids or implanted hearing devices, the cochlear implant does not amplify sound, but works by directly stimulating any functioning auditory nerves inside the cochlea with electrical impulses. All current model cochlear implants are comprised of two parts: an external speech processor that resembles a standard behind the ear hearing aid and an internal stimulator that is surgically implanted under the skin behind the ear.
External:
- A microphone which picks up sound from the environment
- A speech processor which selectively filters sound to prioritize audible speech and sends the electrical sound signals through a thin cable to the transmitter,
- A transmitter, which is a coil held in position by a magnet placed behind the external ear, and transmits the processed sound signals to the internal device by electromagnetic induction,
Internal:
A receiver and stimulator secured in bone beneath the skin, which converts the signals into electric impulses and sends them through an internal cable to electrodes into the cochlea. The electrode array is comprised of up to 22 electrodes which wind through the cochlea, and send the impulses to the nerves in the scala tympani (ganglion cells) and then directly to the brain through the auditory nerve system.
As of 2007 approximately 100,000 people worldwide have received cochlear implants; roughly half are children and half are adults. Cochlear implants are considered a safe, reliable, and effective treatment for severe to profound hearing loss.
Results
Hearing results with the new generation implants can be very dramatic. Many patients become successful telephone users. Results are influenced by several factors including past hearing experience, status of the cochlea, motivation, and rehabilitation.
There are a number of factors that determine the degree of success to expect from the operation and the device itself. Our cochlear implant center determines implant candidacy on an individual basis and takes into account a person's hearing history, cause of hearing loss, amount of residual hearing, speech recognition ability, health status, and family commitment to aural habilitation/rehabilitation.
Post-lingually deaf adults and pre-lingually deaf children form two distinct groups of potential users of cochlear implants with different needs and outcomes. Those who have lost their hearing as adults (Post-lingually deaf adults) were the first group to receive FDA approval for implantation. These individuals have already had hearing experience in that their brains have the proper neural pathways to perceive sound and understand language. The risk of surgery in the older patient must be weighed against the improvement in quality of life. As the devices improve, particularly the sound processor hardware and software, the benefit is often judged to be worth the surgical risk, particularly for the newly deaf elderly patient. The oldest person implanted at The Institute was 93 years old.
The other group are children born deaf. Research shows that congenitally deaf children who receive cochlear implants at a young age (less than 3 years) have better success than congenitally deaf children who first receive the implants at a later age, though the critical period for utilizing auditory information does not close completely until adolescence. The earliest age that implants can or should be performed is controversial. The advantage in the long term for implantation prior to one year of age has not been proven. Most studies show that children implanted earlier than one year of age do not perform better than children implanted between one and three years when tested two years after implantation.
A prime candidate for cochlear implantation is described as:
- Having severe to profound sensorineural hearing impairment in both ears
- Having a functioning auditory nerve
- Having lived a short amount of time without hearing (approximately 70+ decibel loss, on average)
- Having good speech, language, and communication skills, or in the case of infants and young children, having a family willing to work toward speech and language skills with therapy
- Not benefitting enough from other kinds of hearing aid
- Having no medical reason to avoid surgery
- Living in or desiring to live in the "hearing world"
- Having realistic expectations about results
- Having the support of family and friends
- Having appropriate services set up for post-cochlear implant aural rehabilitation (through a speech language pathologist, deaf educator, or auditory verbal therapist).
Patients first undergo a candidacy evaluation at our cochlear implant center. This involves medical evaluation by one of our doctors, followed by extensive hearing and specialized testing by one of our audiologists. A trial of high performance hearing aids is mandatory. If this has not been done you will be referred to your audiologist for a hearing aid trial first. Where children are involved, extensive discussion and planning with parents, teachers and speech-language pathologists is done. As an integral part of the evaluation process patients undergo both MRI and ultra high resolution CT scanning of their inner ears.
The MRI scan is done to confirm the presence of a cochlear nerve and to ensure that the cochea has a patent lumen in which an implant electrode can be inserted. If a cochlear nerve is not found, the patient can be fit with an auditory brainstem implant. Sometimes the cochlear lumen has been obliterated with new bone formation. This is usually due to meningitis. Cochlear implantation can still be performed with specialized electrodes and procedures. The CT scan is done to confirm normal cochlear and inner ear anatomy prior to implantation.
Pioneering work at the Capital Region Ear Institute Implant Center
Recently two new surgical procedures for cochlear implantation and implatable hearing devices has been developed at the Institute:
The minimal access surgical technique for Vibrant Soundbridge implantation was developed in 2007 and published in The American Journal of Otology & Neurotology and also presented at the International Implant Symposium in Vienna by Dr. Rende. This allows the device to be implanted through a very small skin incision with much less trauma to the body than previous techniques.
The Bone Island Bridge Technique was published in the prestigious journal Laryngoscope in 2007 by Dr. Foyt. This technique improves the stability of the cochlear implant electrode as it courses from the receiver to the cochlea.
Our Implant Support Group
Cochlear implants are not for everyone and we are committed to helping you make the best decision for your self. We can put you in touch with people that have gone through our program. Our implant support group is a wonderful resource for you to gather information and to learn about other people’s experience firsthand.
If I am a candidate
If you are judged to be a candidate for a cochlear implant you will be extensively counseled. Surgery can then be scheduled at your convenience. The surgical procedure takes about 3 hours and is performed under general anesthesia.
Most people go home on the day of surgery with minimal to no discomfort. First activation of the implant occurs approximately 2 weeks after surgery. You will meet regularly with an audiologist for extensive personalized programming and rehabilitation.
Choice of implant
We offer full expert support for Advanced Bionics, Cochlear Americas, and Med-El Cochlear implants. Patients may choose from any of the available implant systems.
The Implant Surgery
Surgery is almost always performed as an outpatient and takes about one hour for the actual procedure. Patients can go home on the day of surgery. Using the minimal access technique which in the Capital Region was pioneered at the Capital region Ear Institute a small 3-4cm incision is made behind the ear. A Mastoidectomy (opening into the bone behind the ear) is performed. A small opening is then created into the cochlea called a cochleostomy. The receiver is placed into a prepared spot in the skull and the electrode array is inserted into the cochleostomy.
Bilateral Cochlear Implantation
Research has confirmed the bebefit of implanting both ears in patients with severe to profound hearing loss. The Northeast Ear Institute was one of the first centers in the country to provide bilateral cochlear implant services. Our extensive experience with both simultaneous and sequential bilateral cochlear implantation in children and adults ensures that patients receive the most advanced expert care available.
Insurance Coverage
The cochlear implant is recognized as a standard medical device and is generally covered by insurance. The center provides services to obtain authorization and reimbursement from insurance companies so that the patient is not subject to extraneous charges.
The Capital Region Children’s Hearing Foundation
The Capital Region Children’s Hearing Foundation is a nonprofit charity benefiting hearing impaired children in the Northeast. The foundation provides financial support for hearing aid and cochlear implant needs as well as group support activities such as summer camps and instructional and social programs.
For More Information
Initial consultation is done by appointment with a physician and an audiologist.