Hearing Solutions

Cochlear Implants at UMTB Health

UTMB Health’s cochlear implant program is comprised of otolaryngologists, audiologists, speech-language pathologists, and various support staff. We will help you learn how cochlear implants work and provide the information you need to decide if a cochlear implant is the right choice for you and your family.

What is a Cochlear Implant and Who Can it Help?

A cochlear implant is a small electronic device that electrically stimulates the cochlear nerve (nerve for hearing). The implant has external and internal parts.

CochlearImplant

The external part sits behind the ear. It picks up sounds with a microphone. It then processes the sound and transmits it to the internal part of the implant.

The internal part is placed under the skin behind the ear during an outpatient surgery. A thin wire and small electrodes lead to the cochlea, which is part of the inner ear. The wire sends signals to the cochlear nerve, which sends sound information to the brain to produce a hearing sensation. Although normal hearing is not restored, with appropriate therapy and practice, the improved hearing experience can mean an increased awareness of sounds in the environment, as well as better communication through easier lip reading and listening.

A cochlear implant may help someone with hearing loss restore or improve the ability to hear and understand speech. A cochlear implant is different than a hearing aid. A hearing aid makes sounds louder but may not significantly improve speech understanding. When a person struggles to understand speech, even with appropriately fitted hearing aids, a cochlear implant should be considered. When the device is tuned appropriately and the recipient is committed to rehabilitation therapy, the -cochlear implant can significantly increase hearing in adults.  Cochlear implants in infants and toddlers may help them listen and learn to speak.

Information about getting a Cochlear Implant at UTMB Health

Cochlear Implant Surgeons

PROVIDERS

Cochlear Implant Audiologists

PROVIDERS

Cochlear Implant

cochlear implant web pic

A cochlear implant is a small electronic device that electrically stimulates the cochlear nerve (nerve for hearing). The implant has external and internal parts.

The external part sits behind the ear. It picks up sounds with a microphone. It then processes the sound and transmits it to the internal part of the implant.

The internal part is placed under the skin behind the ear during an outpatient surgery. A thin wire and small electrodes lead to the cochlea, which is part of the inner ear. The wire sends signals to the cochlear nerve, which sends sound information to the brain to produce a hearing sensation. Although normal hearing is not restored, with appropriate therapy and practice, the improved hearing experience can mean an increased awareness of sounds in the environment, as well as better communication through easier lip reading and listening.

A cochlear implant may help someone with hearing loss restore or improve the ability to hear and understand speech. A cochlear implant is different than a hearing aid. A hearing aid makes sounds louder but may not significantly improve speech understanding. When a person struggles to understand speech, even with appropriately fitted hearing aids, a cochlear implant should be considered. When the device is tuned appropriately and the recipient is committed to rehabilitation therapy, the -cochlear implant can significantly increase hearing in adults.  Cochlear implants in infants and toddlers may help them listen and learn to speak.

A hearing aid is a device which a person wears that sends amplified sound into the ear. A hearing aid uses whatever hearing the person has, and generally is a very good solution for most persons with a hearing loss.

A cochlear implant is a device which is surgically implanted into the inner ear to restore hearing function. The device generally includes an internal processor which is the part placed into the inner ear, and an external processor that is worn outside on the head or ear, supplies power to the internal processor, and sends sound information to the internal processor which then sends this information through the inner ear to the brain.

 

Cochlear implants are a treatment option when a person cannot obtain sufficient benefit from hearing aids to rely on listening for communication. Years of research and clinical experience have contributed to the development of guidelines for determining when a cochlear implant may be considered.

The Food and Drug Administration (FDA) approves the use of cochlear implants for individuals who meet the specified criteria. Insurance companies often follow these guidelines when determining if the cochlear implant is a covered expense, however some insurances use more stringent criteria.

FDA Pediatric Candidate Criteria:

Ages: 9 months to 24 months

  • Profound sensorineural hearing loss in both ears
  • Lack of progress in the development of auditory skills
  • No medical contraindications
  • High motivation and appropriate expectations from family

Ages: 25 months to 17 years, 11 months

  • Severe-to-profound sensorineural hearing loss in both ears
  • Lack of progress in the development of auditory skills
  • Poor or limited speech perception abilities
  • No medical contraindications
  • High motivation and appropriate expectations

FDA Adult Candidate Criteria:

Age: 18 years of age or older

  • Moderate-to-profound sensorineural hearing loss in both ears
  • No medical contraindications
  • Poor or limited speech perception abilities
  • A desire to utilize audition in communication
  • High motivation and appropriate expectations

Yes, cochlear implants and their surgery are covered by Medicaid and Medicare, as well as the majority of private health insurance companies.

While cochlear implant surgery is safe when performed by a well-trained, experienced surgeon, the surgery is not simple, and requires a great deal of surgical skill. The procedure is performed from behind the ear, with a methodically and precisely created pathway for the electrode to be placed into the inner ear. Cochlear implant surgery, on average, takes 2.5 hours, and is performed as an outpatient surgery in both children and adults.

Your surgeon will discuss these risks with you in as much detail as you desire.

Risks associated with cochlear implant surgery:

  • Loss of residual hearing in the implanted ear
  • Meningitis
  • Facial nerve weakness or involuntary facial movement
  • Infection or extrusion of the implant
  • Soreness, redness or breakdown of skin in area around internal device, which may necessitate additional medical treatment, surgery and/or removal of device
  • Failure to place the implant or poor positioning of the implant
  • Failure of implanted components, possibly requiring removal and replacement
  • Component malfunction may decrease the number of available electrodes for programming purposes; may also result in perception of odd or uncomfortably loud sounds

Risks associated with any ear surgery:

  • Numbness/tenderness around implant site
  • Neck pain
  • Facial nerve paralysis
  • Taste disturbance
  • Spinal fluid leak
  • Dizziness (vertigo)
  • Tinnitus or “ringing in the ears”
  • Local complications such as bleeding, fluid collection or infection at the site or close to the site of surgery
  • Skin reactions (rashes)

General Risks:

  • Postoperative pain, scarring, bleeding and infection
  • Anesthetic risks associated with the heart, lungs, kidneys, liver and brain

If are interested in learning more, call to make an appointment with the UTMB cochlear implant team for assessment and discussion.

Currently cochlear implants last, on average, in excess of 20 years.

Cochlear implants do use batteries, either rechargeable or disposable. Rechargeable battery life varies, so often patient will use two rechargeable batteries during a day, with one charging to be available for use. Disposable battery life also varies, though generally the batteries in a cochlear implant need replacing 1-2 times a week, depending on level of usage.

The internal processor is waterproof, because it goes into the body; some external processors are also waterproof and others are not, depending on the manufacturer. Those manufacturers without a waterproof external processor typically have options to protect the processor during water use in the form of a case, or water-resistant wrap.

Like vision, which is designed to use two eyes, our hearing is designed for two ears, and when appropriate, patients with bilateral hard of hearing or deafness should consider bilateral cochlear implants. Sound is processed by both sides of the brain at the same tide, and when both ears are working, the ability to localize sound and comprehend sound is much better than in circumstances where only one ear hears. However, that being said, one good ear is better than none!

There are three companies that are approved to market cochlear implants in the United States. All three companies are used here at UTMB:

Cochlear implant systems are made up of internal and external components that work together. The design of the internal device and external components may look different, but they function very similarly. There is no definitive evidence that one implant system provides better results than another.

We will review each cochlear implant system during your appointments. Please consult the websites provided for more detailed information and respective warranties.

Before receiving a cochlear implant, you should verify which vaccines against pneumococcus you or your child have received and obtain additional doses if you are not fully immunized.

Bacterial meningitis is a serious infection of the lining around the brain and the fluid that surrounds the brain. Bacterial meningitis is a life-threatening infection. Individuals with hearing loss are at an increased risk of developing meningitis. Cochlear implant placement also increases the risk of developing meningitis. Although this risk is small, it is important for children and adults with a cochlear implant to be vaccinated against the bacteria that can gain entry into the brain and commonly cause bacterial meningitis. Two types of bacteria have produced the vast majority of cases of meningitis after cochlear implantation: Streptococcus pneumoniae (“Pneumococcus”) and Haemophilus influenzae type b (“Hib”).

Cochlear implant users and their families should be aware that vaccines against pneumococcus (“pneumo” vaccine) and Hib are widely available. These vaccines strengthen the body’s ability to protect against the common causes of bacterial meningitis. Some infections with pneumococcus may not treatable with routine either oral or intravenous antibiotics. Although vaccination does not prevent meningitis, it is the most effective way to avoid this potentially life-threatening infection.

“Pneumo” Vaccines There are multiple types of pneumococcal vaccine, Prevnar® for children being vaccinated when they are less than 2 years of age and Pneumovax® for those being vaccinated when they are over 2 years of age. Prevnar® is part of the routine infant immunization schedule in the United States; therefore, all children should have received this vaccine in infancy. It is important to verify that your child has received all doses of their Prevnar® series, and if not, to catch up. It is recommended that you or your child return to your primary care physician to follow current guidelines.

The purpose of the Cochlear Implant Evaluation is to:
  1. Determine if a cochlear implant is an appropriate treatment option
  2. Assess benefit of current hearing aids
  3. Provide information and answer questions about cochlear implants with the patient and family
  4. Make further recommendations regarding hearing aids, communication strategies, and aural rehabilitation

The evaluation process consists of:
Audiology consultation(s) to:
  • Obtain audiologic history
  • Determine hearing status with and without hearing aids
  • Determine ability to understand speech with hearing aids
  • Provide information about hearing, hearing loss and cochlear implants
  • Discuss expectations and goals of cochlear implant use
ENT Physician consultation(s) to:
  • Determine medical and surgical candidacy for a cochlear implant
  • Investigate possible cause of hearing loss
  • Discuss the surgical aspects and risks involved in surgery
Radiographic Testing:
  • Either magnetic resonance imaging (MRI) or computed tomography (CT) of the ear and brain
  • Determines whether the ear can receive a cochlear implant
  • Determines the presence of anatomic causes for hearing loss
Pediatric patients may also undergo a speech and language evaluation to:
  • Document child’s communication abilities
  • Provide information on speech and language development
  • Acquire information about child’s current education situation and offer support as needed
Pre-Surgical Information

Surgery scheduling and follow-up appointments with the ENT physician and audiologist will be handled by ENT office staff.

Please note a surgery date is typically not set until insurance approval is received. This process may take a few months, and you will be contacted promptly after insurance approval is received. A surgery scheduler will call you with your pre-op date and time; PLEASE make sure your contact and insurance information remain current in the UTMB Health hospital system.

Cochlear implant surgery can last from 1 to 4 hours. Patients are usually discharged the day of surgery but come prepared to stay overnight in the event that you are not discharged for unpredictable reasons.

You will see the surgeon for an examination following surgery. However, if you have any concerns about the incision, call the ENT office immediately at (281) 338-0829.

Initial stimulation of the device will take place approximately 2 to 5 weeks following surgery. You may continue to wear your hearing aid in the opposite ear if desired. Discuss this with your audiologist.

This visit is typically two hours in length and has the following goals:
  • Fit the sound processor, microphone, and coil
  • Create a “first-pass” map or program that is comfortable for the patient; additional maps will also be created to try prior to the next clinic visit
  • Counsel patient and family regarding device operation, troubleshooting, equipment care and maintenance
  • Complete Product Registration and Warranty paperwork
To achieve those goals for adult patients:
  • The session will begin with measurements of the integrity of the internal device (impedances)
  • Subjective measurements will be obtained by stimulating individual channels of the implant; the patient will first listen to tones to help determine appropriate program settings before the processor’s microphones are turned on to pick up speech sounds in the environment/room
To achieve those goals for pediatric patients:
  • The session will begin with measurements of the integrity of the internal device (impedances)
  • Depending on the child’s age and previous hearing experience, subjective or objective measurements will be used to create the maps
    • If subjective measurements are possible, individual channels will be stimulated until the child reacts or otherwise indicates that he or she has “heard” something
    • If objective measurements are necessary, the implant software is used to measure the auditory nerve’s response to stimulation; the child need not actively participate in this process.

Once the processor has been programmed and the patient becomes accustomed to wearing the device, information will be provided regarding the use, care and maintenance of the device.

Follow-up appointments

Because of the rapid adaptation of the auditory system, numerous mapping changes are necessary in the first year of cochlear implant use. For this reason, we have established the following schedule after surgery:  

Adult-CochlearImplant
Adult Schedule:
  • Initial stimulation of the cochlear implant speech processor – appointment will occur 3 – 5 weeks following surgery
    • Your implant will be turned on that day and basic fine tuning will be done; you will also receive detailed information on how your implant works, accessory usage, battery information, and proper care
  • 2 and 4-week follow-up appointment
  • 1, 3, 6, 9 and 12-month follow-up appointments
  • Annual appointments
Pedi-CochlearImplant
Pediatric Schedule:
  • Initial stimulation of the cochlear implant speech processor – appointment will occur 3 – 5 weeks following surgery
    • Your implant will be turned on that day and basic fine tuning will be done; you will also receive detailed information on how your implant works, accessory usage, battery information, and proper care
  • Bi-weekly appointments for 1 month
  • 1, 3, 6, 9 and 12-month follow-up appointments
  • Bi-annual appointments

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