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Cochlear Implantation Surgery
(CI Surgery)

     
     

Cochlear Implants have helped a large number of people around the world who are profoundly deaf. A Cochlear Implant is different from a hearing aid device. Unlike hearing aid device, which make sounds louder, a cochlear implant does the work of damaged parts of the inner ear (which is known as cochlea) to provide sound signals to the brain. A cochlear implant is a small electronic device that replaces the function of a damaged ear and help people with profound deafness to lead a better quality of life. A cochlear implant is put by doing a major surgery.

Understanding how Hearing Works

When a sound is produced, it enters the ear canal and moves through the ear canal and strike the eardrum. These sound waves cause the eardrum, and the three bones (called as ossicles) within the middle ear, to vibrate. The vibrations move through the fluid in the spiral shaped inner ear - known as the cochlea - and cause the tiny hair cells in the cochlea to move. The hair cells detect the movement and change it into the chemical signals for the hearing nerve. The hearing nerve then sends the information to the brain with electrical impulses, where they are interpreted as sound.

Hearing Loss

One of the most common reasons for hearing loss is the damage that is caused in the inner ear - The Cochlea. Some of the conditions that may lead to hearing loss are as follows :

  • Noise induced hearing loss

  • Sensorineural hearing loss

  • Congenital sensorineural hearing loss

  • Genetic hearing loss

  • Superficial siderosis

  • Inner ear malformations

  • Meniere's disease

  • Limited benefit from hearing aid as determined by specialized audiological testing

  • Acoustic neuroma

  • Auditory neuropathy

  • Familial hearing loss

  • Meningitis

  • Otosclerosis

  • Enlarged vestibular aqueduct syndrome

  • Neurofibromatosis Type 2

Hearing Loss Treatment Options

There are various treatment options available to treat hearing loss or deafness. The ENT specialist or surgeon will tell the most suitable option for the patient based on the severity and type of hearing loss. Some of the treatment options available for treating hearing loss or deafness are as follows :

  • Cochlear Implantation Surgery : As mentioned earlier a cochlear implant is an electronic medical device that is surgically implanted. The cochlear implant replaces the function of the damaged inner ear (which is called as cochlea). A cochlear implant is suitable for patients with a severe to profound sensorineural hearing loss or deafness and who receive little or no benefit from hearing aids.

  • Bone Conduction Implants : Bone conduction implants are suitable for people with outer or middle ear trouble, or who are deaf in one ear. A bone conduction implant such as Baha, is the most effective way to provide hearing. Instead of trying to send sound through the damaged part of the ear, a bone conduction implant uses the body's natural ability to send sound through bone, bypassing the outer and middle ear completely. The result is a clean, clear sound without the distortion or feedback often associated with standard hearing aids.

  • Hearing Aids : The main function of a hearing aid is to capture the sound and make it louder. Hearing aids function by capturing sound, making it louder then sending it down the ear canal, through the middle ear to the inner ear where the hearing nerves are. Hearing aids are very helpful for those children who have mild to moderate hearing loss that may have been caused by damage to the inner ear, exposure to loud noise, reactions to certain medications, head injury and genetic factors

Cochlear Implantation Surgery for Treating Profound Hearing Loss or Deafness

Cochlea is that part of inner ear which is essential for hearing. Cochlea is actually a spiral-shaped cavity containing nerve endings essential to hearing. In case of impaired hearing which may be attributed to various reasons, patients are advised to undergo cochlear implantation surgery.

Diagnosis & Preparation

Before the surgery, a series of OPD tests are performed on the patient for assessment. The following are some of the tests which the patient might have to undergo before the cochlear implantation surgery.

  • Hearing test

  • Speech understanding with appropriate hearing aids

  • MRI scan

  • Audiologic consultation

  • Speech pathology consultation

  • Hearing aid evaluation

  • Balance assessment

  • Medical evaluation

  • Psychology consultation

1. In order to evaluate cochlear function, a complete ENT, neurologic and audiological work-up, including transiently evoked otoacoustic emissions, is performed in all patients.

2. It is also determined prior to the procedure that there are no medical or radiological conditions or factors that increase the risks associated with cochlear implants.

3. The patient is also assessed on motivation level to participate in rehabilitation sessions and to be part of the hearing world.

It is always suggested that the patient should have realistic expectations and a clear understanding of what cochlear implants can and cannot do for hearing.

Description of a Cochlear Implant

An implant has four major parts :

  • Stimulator is an electrode array, which collects the impulses and sends them directly into the cochlea.

  • A headset microphone, which picks up sounds and amplifies them; these sounds go through a thin cable to a speech processor, This headset is worn on the ear like a hearing aid or on a belt or sometimes may be kept in a pocket.

  • Speech processor, which processes and arranges the sounds; these sounds are converted into an electrical code and sent back up the cable to the transmitter, which is fastened to the head.

  • A transmitter, which receives signals (sounds) from the processor and converts them to electrical impulses; these are sent across the skin to a stimulator, implanted in bone directly beneath the transmitter.

These days Bilateral Cochlear Implants (implant in both the ears) are more popular because they have been documented to provide increased satisfaction in treatment of severe-to-profound hearing loss. Evidence based studies have shown significant benefits of hearing restoration to both the ears.

Description of the Implant Procedure

  • This surgery is performed under general anesthesia and lasts about 2-3 hours.

  • An incision is made behind the ear, sometimes after shaving the hair behind the ear. This is then shaped into a slight depression in the mastoid bone. A microscope and bone drill is used for the same. The internal device rests in this depression.

  • A small hole is then created in the cochlea and the electrode array of the internal device is passed through this hole.

  • The electrode array is fitted into the cochlea while the receiver or stimulator is secured to the skull. This outside part is fixed after about 3-4 weeks to give the incision time to heal. Then; only when the devise is programmed and activated would the patient be able to use the device. There is no hearing ability from the implant until this is done.

  • x - Ray is taken after the surgery which ensures that the devise is positioned properly.

Recovery & Rehabilitation

  • Usually a patient is discharged within 2 days from the hospital following surgery.

  • Two to four weeks after surgery, after the incision has healed, the external components of the device can be programmed and activated.

  • Once the devise has been activated the understanding of the device is the most important part.

  • Rehabilitation is absolutely imperative for those who have undergone cochlear implants. There are auditory rehabilitation centers and this training can also be imparted at the hospital.

  • Rehabilitation involves training the brain to recognize and comprehend the signals generated through the implant.

  • As the hearing is quite different from a cochlear implant, a patient needs to know learning and relearning techniques.

  • The cochlear implants directly stimulate the auditory nerve; the patients sometimes are weighed down by speech and everyday environmental noises.

  • To achieve the best result it is recommended that the patient wears the speech processor continuously during waking hours.

  • Listening exercises are given to patients to do at home, with varying difficulty levels.

  • Speech therapy may also be recommended for cochlear implant patients.

Cochlear Implant Headset Activation includes

  • Fitting the headset: An audiologist attaches a headset, after the healing of the incision and once the swelling has subsided. This consists of a transmitter and a microphone/speech processor. An external magnet in the transmitter is aligned with a magnet implanted inside the head during surgery. Sound signals are sent by the transmitter across the skin to the internal receiver/stimulator.

  • Cochlear implant check: By communicating & exchanging information between the cochlear implant and the external speech processor, this device is checked. Every component, is checked to make sure it is working properly.

  • Programming the speech processor: The speech processor is programmed by an audiologist using a special computer system. Fine tuning of each electrode is done for threshold (first hearing) and for comfortable listening levels. On turning on of each electrode, very small increases of electrical current are delivered to the hearing nerve until the patient hears a soft beep or tone.

  • Once the softest hearing level is set, the beep level is set for an increase in loudness till these beeps or tones become comfortable to hear. These steps are repeated for all electrodes. From these loudness judgments, a "hearing map" is created. The map is an individually designed set of instructions that tells each electrode how to stimulate the nerve endings in the cochlear.

  • This map is finally downloaded into the speech processor, and on turning on of the processor the patient hears through the cochlear implant for the first time. Initially speech usually sounds mangled or high-pitched. Identifying environmental sounds may be difficult. Over time, speech and environmental sounds become clearer and more natural.

  • Verification of the tolerance level of a range of sounds by the cochlear-implant recipient is ensured. Sounds, such as soft speech, conversational speech, loud speech, hand clapping, coughing, or doors shutting. This is done by an audiologist.

  • Using the external equipment: The cochlear implant recipient is shown and explained how to wear and operate the speech processor and its accessories. The audiologist also trains the patient on maintenance the device.

  • Programming sessions: To maintain optimal performance from the device several programming sessions are required. One mandatory check is done a day after activation followed by a month and then the recheck visits are tapered depending upon the requirement of the patient and the progress made by the patient. After the first year, patients usually schedule annual appointments.

Risks Of Surgery

As with all surgeries, there are possible risks, though a cochlear implant is a relatively safe surgery.

  • Wound healing problem: This is one of the most common complications. This includes

  • Problems such as skin breakdown over the implanted device

  • Infection where the surgical cut was made

  • The device coming out

  • Damage to the nerve that moves the face on the side of the operation

  • Leakage of the fluid around the brain (cerebrospinal fluid)

  • Infection of the fluid around the brain (meningitis)

  • Temporary dizziness (vertigo)

  • Failure of the device to work

Benefits of Cochlear Implants

Patients who are highly motivated and committed and follow the rehabilitation regime strictly benefit much more

  • The level of useful hearing achieved by recipients-cochlear-implant varies from one individual to another. Many patients do develop the ability to recognize speech without looking at the speaker. While some patients to clearly understand what's said still must rely on speech reading (or lip reading). All cochlear implant patients usually are benefited with Improved voice monitoring , Improved ability to recognize normal, everyday environmental sounds, Improved speech-reading and the ability to hear soft sounds .

  • Benefits from the surgery are much more enhanced, if the Auditory memory of the patient serves him well and he has had some exposure to sound before hearing was lost, also if the deafness period was short before implantation.

  • The status of the cochlea also is important. Patients who have a greater number of functioning auditory nerve fibers in the cochlea usually have better outcomes.

  • A patient should make daily use of the implant during all waking hours. He should also do listening practice with books on tape and other aural rehabilitation materials. Parents/guardians should make consistent use of strategies to develop listening skills and speaking skills throughout each day for children.

  • Cochlear Implantation procedure has several benefits. However these benefits may vary from person to person depending upon some factors such as condition of Cochlea, severity of hearing loss, how long the person was suffering with hearing loss, other medical conditions and the practice that they do using their .

  • Much better hearing than hearing aids.

  • Hearing in noisy environments.

  • Hear small sounds that you missed.

  • Will be able to hear alarms, people calling etc making you to feel safer.

  • You can talk on the phone.

  • You can enjoy music.

Cochlear Implantation Surgery in India

Mentors Ethicare Pvt. Ltd. has formed a network of some of the best cochlear implantation centers and cochlear implantation specialists in India. The cost of a cochlear implant surgery may vary depending upon the type of implant that is used and whether the surgery is for one ear or for both the years. If you want to know the cost of cochlear implantation surgery, cochlear implant specialists in India, cochlear implantation centers in India or anything related to cochlear implant surgery in India, you can write to us or call us anytime.

How to get started?

If you want to come to India for cochlear implantation surgery and want to know more details then please send the following details to us by email at info@mentorsethicare.com.

  • Age of the patient

  • Audiology Reports

  • CT scan images and reports (if available)

Once we get the medical reports, one of our patient service associates will contact you and guide you through the entire process step by step.

For more information on high quality and low cost cochlear implant surgery in India, you can write to us at info@mentorsethicare.com or call us anytime at 0091 9611 231 188

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