FAQ
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Deafness/Hearing Impairment and Remedial Alternatives?
Hearing problems can arise at birth, childhood, adult life and/or
in older age groups. They may be hereditary (often reflected in the family
history), a consequence of infection (eg Meningitis, Rubella, Mumps, Meniere's
disease), due to accumulated exposure to noise, deterioration due to aging, or
some combination of these factors, and sometimes may have unknown causes.
There are various medical categories of deafness or hearing impairment. The severity
may range from mild hearing loss in one ear across part of the audio frequency
range, to a total hearing loss in both ears.
Other symptoms can precede or
accompany hearing loss, such as balance problems and tinnitus – head noises or
ringing in the ears.
There are a wide variety of hearing aids ranging from
simple amplifiers to sophisticated devices with computer programs that help
reduce the effect of background noise. There are also bone conduction types of
hearing aids.
The cochlear implant is one of several different “solutions” for different
situations. Cochlear implants are now highly advanced and widely applied.
There are numerous types of accessories for connecting outputs from television,
radio, DVD and CD players, personal audio devices and the like to hearing aids
and cochlear implants. Aids and implants also have T (telecoil) switches which
allow coupling to the signal from an inductive loop rather than (or in addition
to) voice input. Many home telephones and mobile phones have the inductive
coupling option, as do some public venues such as lecture halls, cinemas etc.
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What is a Cochlear Implant?
A Cochlear Implant is an electronic biomedical device, the first ever designed to
replace one of the five senses. This is achieved by direct electrical
stimulation of the hearing nerves, resulting in nerve impulses to the brain
that the brain interprets, or learns to interpret, as sound. The device
comprises:
• a small implant – a receiver, microchip, electrical lead and magnet –
that is surgically embedded behind the ear; the lead containing tiny
electrode wires is threaded into the inner ear (cochlea)
• an external sound processor housing the transmitter with advanced
software, the microphones, batteries, and controls including accessory ports
and T switch
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What does the cochlear implant do?
Many people with hearing loss can use hearing aids to amplify sounds and help
them hear. For some people with severe or profound sensor neural deafness
hearing aids do not help. These people may make use of the cochlear implant.
The cochlear implant replaces the function of the entire ear. It directly
stimulates any remaining hearing nerves using electrical impulses
to enable the brain to perceive sound.
How the cochlea works
The cochlea is arranged so that different sound frequencies stimulate different
hair cells and nerve fibers. Stimulating hair cells at the base of the cochlea
produces perceptions of high pitched sounds. Stimulating hair cells at the apex
of the cochlea produces low pitched sounds. The cochlear implant is designed
with electrodes at different positions so as to stimulate the appropriate hair
cells and improve the perception of sound.
There are no implanted batteries or moveable parts. The implants have
long lifetimes and very low failure rates, and are compatible with ongoing
technological developments and upgrades in the sound processor. The
implant is activated and controlled via the external processor. The
latter can be a small self-contained behind-the-ear (BTE) unit like a hearing
aid, or a smaller BTE unit accompanied by larger batteries and controls in a
body-worn package. Some makes offer a remote control with BTE
devices. Refer to manufacturers for details, schematic diagrams,
photographs and technical information on implants, processors, speech
recognition and noise control programs such as SmartSound, and for batteries,
accessories, care and maintenance procedures and the like.
view animation of a Cochlear implant in action- windows media player required. (supplied by Cochlear Pty Ltd)
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What is Involved - Surgery and Before/After?
Before
There are various prior audiological and associated assessments, as outlined at
www.scic.nsw.gov.au
These are followed by medical tests often at a public or Private hospital facility such as
Royal Prince Alfred.
Assessments preformed include:
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promontory stimulation
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CAT scans
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MRI scans
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Balance tests
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The Surgery
The surgery is relatively minor, 1-3 hours under general anaesthetic,
and only one day/night in a public or private hospital.
After a day or two
resting at home, most people can manage without assistance.
After
Within a week, most are back to near-normal routine, while after two weeks
return to full physical work and exercise are OK.
The switch-on
The implant is activated (“switched-on”) 2-3 weeks
after surgery, at specialist clinics such as SCIC. The external processor
component is fitted and connected to the computer.
The audiologist programs the implant
according to the person’s response to varying levels of electrical stimuli.
These are applied in sequence to the electrodes located at different parts of
the cochlea, that correspond to different frequency regions of the audio
spectrum. The implantee advises when they can just hear a sensation (their
threshold level) and describes increased electrical stimuli in terms of
loudness until the maximum comfortable sound level (“nice and loud but not too
loud”) is reached.
This process results in a MAP with minimum and maximum electrical/auditory
levels across the frequency range. Such MAPS are unique to each person.
This switch-on is followed by hearing rehabilitation. Monitoring and adjustment
of the MAP and stimulus parameters is carried out regularly over the first few
months, as the implantee adjusts to the new sound sensations. Speech
discrimation and general sound perception is enhanced over time, and fine
tuning continues through less frequent sessions at the clinic. The hearing
rehabilitation process varies significantly among individuals.
CICADA meetings and social functions allow recent implantees and
prospective implantees to meet and observe other CI recipients in everyday situations, and how
they cope with unfamiliar voices, distractions, background noise etc. Partners,
family and friends can also learn from the experiences of those who support the
recipients. Any unfavourable comparisons with other recipients are discouraged
because each person’s outcome is unique and dependent on many factors. CICADA
aims to assist recipients achieve their own personal best.
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Who Does a Cochlear Implant (CI) Help?
The cochlear implant is one of several different “solutions” for different
situations. Hearing problems can arise at birth, childhood, adult life and/or
in older age groups. They may be hereditary (often reflected in the family
history), a consequence of infection (eg Meningitis, Rubella, Mumps, Meniere's disease), due to accumulated exposure to noise, deterioration due to aging, or
some combination of these factors, and sometimes may have unknown causes.
There
are various medical categories of deafness or hearing impairment. The severity
may range from mild hearing loss in one ear across part of the audio frequency
range, to a total hearing loss in both ears. Other symptoms can precede or
accompany hearing loss, such as balance problems and tinnitus – head noises or
ringing in the ears.
There are a wide variety of hearing aids ranging from
simple amplifiers to sophisticated devices with computer programs that help
reduce the effect of background noise. There are also bone conduction types of
hearing aids. Cochlear implants are now highly advanced and widely applied.
There are numerous types of accessories for connecting outputs from television,
radio, DVD and CD players, personal audio devices and the like to hearing aids
and cochlear implants. Aids and implants also have T (telecoil) switches which
allow coupling to the signal from an inductive loop rather than (or in addition
to) voice input. Many home telephones and mobile phones have the inductive
coupling option, as do some public venues such as lecture halls, cinemas etc.
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What Does It Cost?
The audiology clinic assessments and medical tests before and after surgery are
fully covered by the scheduled Medicare fee, while some clinics charge higher fees.
The cochlear implant system, spares, batteries and accessories cost around $25,000.
As an implantable prosthesis, it is included in the hospital procedure, which is
reimbursed by private health insurance for those with 12 months prior
membership. The candidate should check with the particular hospital, surgeon and anesthetist
what the gap fees are, if any. The hospital stay and any gap charges may be partly or fully
covered depending on the particular health fund plan and the excess involved - again one should check in advance.
The public hospital procedure for public patients is free. The NSW Health Dept and equivalent
bodies in other States have limited funding allocated via Sydney Health and
similar regional bodies. Funding also comes from various charities, especially
for children.
Veteran Affairs Dept Gold card holders are fully covered.
Further
detail on costs is available in an article in the CICADA National Newsletter March 2006, and from the
Secretary.
The implanted
device carries a 10 year manufacturer’s warranty from Cochlear Ltd, while the
external processor and associated components are covered for 3 years.
Batteries, spare parts, and repairs are fully covered for eligible members of
Australian Hearing Services, including children and young adults up to 21 years
of age. Otherwise, implantees purchase ancillaries from the manufacturer,
battery or accessory suppliers.
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Where to Go for Information, Advice, Assessment?
There is considerable information in published form and on the internet.
One
recent book for (potential) implantees is found among the vast number of
health-related books of the Icon Group:
“The Official Patients Sourcebook on Cochlear
Implants” – A Reference Manual for Self-Directed Patient Research 276pp 2004.
Some websites like http://www.listen-up.org/ci/ci-infromation.html
also have a lot of information.
CICADA can assist such "Self-Directed Patient Research" especially in the Australian content,
by personal contact, through this website, and via the LINKS.
The first step before or after informing yourself is usually to consult the
family doctor/GP who can refer you (or your child) to an ENT (Ear, Nose,
Throat) specialist and/or to an audiologist in public or private practice.
If
you are at the stage where a cochlear implant appears a likely option, the
doctor can refer you direct to specialist cochlear implant clinics.
The last step is a referral to one of the
implant surgeons. Note that some doctors/GPs remain relatively uninformed about
cochlear implants and unaware of the specialist clinics or surgeons involved.
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