FAQs

Here are the benefits of joining the CICADA club:

• Opportunities to socialise and meet new people who have a cochlear implant.
• Participate in CICADA Australia's activities.
• Receive CICADA's Buzz Newsletter via email, post and / or website.
• Access to past and upcoming CICADA presentations. If you can't get to a presentation you can watch it online.
• Discounts, raffle tickets or other offers may be available from time to time.
• Vote about matters.
• Membership app for your smart device (Apple and Android), with access to Events, News, Membership Details and your very own CICADA Digital Membership card.
• Prior notifications via email and the CICADA membership app of all CICADA functions. 

Joining Fee: $25.00 AUD

1. How can I watch the CICADA Presentations & the AGMs through the Internet?
   On the day just click on this link: https://ccicaaa.memberjungle.com/scheduled-live-webinars
   Try it now to make sure it works. You should see the video screen. But remember it won’t be live until the presentation starts.
2. Will the live stream have captions?
   Yes. We have captions produced by the streaming platform. Accuracy of captions may vary.

Any questions please email support@pascoeberry.zendesk.com

Please remember that support may not be available after the event has started, because we will be working hard to keep the video streaming.

All passwords are encrypted and the website and administration area of CICADAS storage are all encrypted by SSL in data transit. Your data is stored in a secured database which is physically separated from the web-server to further protect your data. Our provider has for over 15+ years hosted systems for Australian government and non-government organisations. Access to specific member data is controlled by the site administrators who can allow (and restrict) individual access and privileges for additional website or system editors. Our provider uses an Australian-based hosting facility with redundant data-centres to ensure complete availability in case of any hardware or bandwidth failure with our own technical support team to manage the servers.

We do not share your personal data with other organisations.

CICADA Aust Inc is the short spoken and written version of the organisation's full name:

Cochlear Implant Club and ADvisory Association Australia Incorporated.

Donations and member involvement are gratefully accepted. Please contact us to:

Volunteer: 

• Set up tables and chairs, signage, equipment or other items, complete other tasks before events start and / or pack up and other tasks after events conclude.
• Bring food / drinks to morning teas, BBQs etc.
• Cook food on the BBQ during events.
• Serve food / drinks during events.
• Assist with administration (copying, folding, addressing envelopes, mail-outs).
• Co-ordinate raffles.
• Welcome people to events.
• Give presentations at / for events.
• Submit items (articles, photos etc) for CICADA Buzz newsletter.

Donate leadership:

• Serve in committee(s). Elections for committee are held during Annual General Meetings and subcommittees may be set up and closed when required.
• Co-ordinate a CICADA support group in your local area.
• Conduct peer mentoring.

Donate Equipment / Services:

• Fully working technology (e.g. computer, video equipment).
• Captioning service.
• Auslan interpreting service.
• Audiobooks (with / without paper version).
• Indoor / outdoor spaces and / or equipment for events.

Donate cochlear implant equipment no longer being used:

• Sound processors
• Batteries
• Spare parts
• Peripheral devices that pair / stream to sound processors (e.g. mini-mic, phone clip, TV streamer, waterproof kits)
• Manuals / instructions

Donate financially via:

• Cash into donation boxes at events.
• Electronic funds transfer/ direct deposit through our website.

Please note that we are a registered charity and financial donations of $2 or more are tax-deductible.

CICADA Australia Inc is an incorporated association, registered in NSW. We provide advice and assistance to CICADA associations, both incorporated and unincorporated, in various states and/or territories within Australia. These affiliated associations may have their own support groups and / or procedures. The associations can be contacted via CICADA Australia Inc.

People can be members of both CICADA Australia Inc and a local association and / or support group.

A list of CICADA associations can be found on our website.

CICADA Australia Inc provides advice and assistance to CICADA Support Groups. These operate in various states and/or territories within Australia and may be metropolitan or regional. Some may have their own procedures and may host events in or close to a local area, such as morning teas, BBQs, social catchups, events with presentations, or other activities.

A list of CICADA support groups can be found on our website.

Question: Is it possible that my cochlear implant is still affecting my inner ear balance after 20 months? I have to be very careful moving as I easily lose my balance.

Answer: Melville da Cruz – Ear, Nose & Throat Surgeon

Our inner ear balance system and hearing mechanisms are very closely linked. This is because they share common inner ear fluids called perilymph and endolymph.

When a cochlear implant electrode is inserted into the cochlea, it usually disturbs the balance system. Usually, this disturbance is short-lived before returning to normal. A few days at most.

The balance system in the opposite ear, as well as your sense of vision, both have a strong role in taking over to return your overall balance to a new equilibrium.

Occasionally, the balance system doesn’t fully recover following inner ear surgery. This is because the remaining balance in the other ear and sense of vision doesn’t have enough reserve function to take over fully.

You’re more likely to experience this if you’re older or have a cochlear implant in your better balancing ear.

What to do when your balance is still not better?

There is no easy solution to this problem. The best advice is to maintain a vigorous (daily) exercise program. Also, avoid medications that may further suppress the balance functions (e.g. Stemetil). Take extra care in the dark (reduced vision) or in unfamiliar or dangerous situations (heights or near moving machinery).

This FAQ originally appeared in Hearing HQ Magazine.

Question: Would I be eligible for a middle ear implant? I have total hearing loss in the left ear due to an immune response after I had a stapedectomy and have partial hearing loss (mixed, I think) in the right ear. 

Dr Melville da Cruz

Answer: Melville da Cruz – Ear, Nose & Throat Surgeon

Stapedectomy Surgery

Stapedectomy surgery, for conductive or mixed hearing loss due to otosclerosis, usually has wonderful results. The hearing threshold improves and the quality of sound is very natural. However, there is a risk of a dead ear in 0.5-1.0% of surgeries despite the surgery being carried out competently.

In this situation, it would leave only one hearing ear on the opposite side. So it is strongly advised not to undergo surgery on the opposite side because of the small risk of a second dead ear.

Bone anchored hearing implant

Fortunately, there are several options for rehabilitating hearing in this situation with hearing aids of various kinds. A bone-anchored hearing (BAHA) implant is one such device that can help. Inserted under the skin in the mastoid bone behind the ear, it works by bypassing the middle ear and stimulating the cochlea directly through the bone of the skull. Bone anchored hearing implants have predictable hearing outcomes in conductive hearing losses.

You can trial the hearing experience of a bone-anchored hearing implant before surgery. The surgery to implant a bone-anchored hearing implant is simple and carries no risk to the underlying hearing. An external speech processor held on by a magnet or small clip generates sound vibration to be transmitted to the implant under the skin.

Middle ear implant devices

There are several other kinds of middle ear implant devices that can also work in this situation. The Bonebridge, for example, is an active middle ear implant that has the source producing the sound vibrations implanted within the mastoid bone behind the ear. Rather than externally in the speech processor as with the bone-anchored hearing implants.

Many other implantable devices are in development. Some are active devices that attach to the middle ear bones such as the Vibrant Soundbridge. However, these devices require more complex surgery than the Bonebridge or bone-anchored hearing implant for placement. They also require manipulation of the middle ear bones and hence carry a risk to the underlying hearing. These devices would not be suitable for surgery on the side of an only hearing ear.

This FAQ originally appeared in Hearing HQ Magazine

Question: I have severe to profound hearing loss and need a cochlear implant. Will I be able to have MRI scans after I receive an implant?

Roberta Marino

Answer: Roberta Marino, Audiologist

Your ability to undergo MRI (Magnetic Resonance Imaging), depends on the type of implant you receive. It also depends on the strength of the machine.

It is good to discuss your MRI options with your Ear, Nose and Throat surgeon, so you understand what scanning limitations may be present after cochlear implantation.

MRI is an important medical test that most of us will need at some time in our life. It is popular as it allows good visualisation of internal body structures with no adverse effects.

If a cochlear implant is not MRI-compatible or only compatible at a certain strength of machine, undergoing this scan of any body part (not just the head) can cause:

• De-magnetisation of the internal implant magnet,
• Displacement or turning off the magnet,
• Heating and/or vibration of the implant.

If you have a middle ear or bone conduction implant you may hear loud noises during the MRI imaging.

Magnetic Resonance Imaging Strength

The strength of MRI is measured in Tesla (T). The higher the T-rating, the higher the image quality and the faster the scanning times. However, a higher rating results in a greater risk of interaction with an implant. This includes cochlear implants, middle ear and bone conduction implants. Typically, MRI scans are measured at 1.5T however there are MRI machines that can measure at the higher strength of 3T and even 7T.

Most implantable devices are now able to undergo MRI imaging of 1.5T without removal of the internal implant magnet. Newer implants can undergo imaging of up to 3.0T.

Hearing implants can create a blurring effect on the image making it difficult for doctors to pick up fine details, particularly on the implanted side. And in some cases, the magnet may need to be removed prior to the scan and replaced afterwards with minor surgery.

What you need to do

Always advise your doctor and radiologist that you wear an implanted device. It is also advisable to carry a patient identification card with your important contact information and your implant make and model. This way, if necessary, the implant manufacturer can be contacted. A Medic Alert necklace or bracelet telling people you wear an implant is also useful.

People wearing bone conduction implants and middle ear implants also need to be aware of MRI compatibility before undergoing any scans. Some older middle ear implants such as the Vibrant Soundbridge are not MRI-compatible. The newer model implants are safe to use in MRIs up to 1.5T.

This FAQ originally appeared in Hearing HQ Magazine

Question: I am considering a cochlear implant and feel I should be asking my surgeon questions but just don’t know what to ask. Can you help?

Sarah McCullough

Answer: Sarah McCullough, Audiologist

The decision to get a cochlear implant can be quite daunting. Knowing what to ask your surgeon can help you to move forward with more confidence.

The first step is to find out if a cochlear implant is the best choice for you. To determine this ask “Am I likely to obtain more benefit from a cochlear implant compared with my hearing aids?”

If you are likely to benefit, and you feel it is the right time for you, there are some specific questions about the surgery you might want to ask:

• Will I lose the hearing I currently have?
• Are some implants better for keeping my remaining hearing?
• What does the surgery involve?
• Is there anything I can’t do after surgery?
• Will the surgery affect my balance or tinnitus (sounds in the ear)?
• How long will I be in the hospital?
• How long does it take until I can hear with the cochlear implant?

The answers to these questions will help you prepare for the surgery and understand what to expect.

When you’ve decided to go ahead

You will need to decide which cochlear implant is the right one for you and your lifestyle. You could ask ‘What implants are available and what are their differences?’

If you are receiving only one implant, ask if there is an implant compatible with your other hearing aid so that they can work together post-surgery. It is also important to consider what you enjoy in life and compare your needs to the options that each implant can provide.

If hearing in water is important, you might ask about the options for swimming and bathing. Consider asking about phone use, connecting to your television or music and the ability of the implant to be upgraded for use with future technologies. It can also be important to ask about how the implants themselves work on the inside to replicate hearing. If choosing for your child, ask about wearing options, ease of use and monitoring and availability of accessories for listening in school.

These questions will help you make a decision as to which implant might be best for you and why. It will also give you some information as to where to start if you want to do further research into your options. The choice of implant is a very personal decision. Explore all the options and choose what is right for you and your family. Whatever you decide, you will open up a whole new world of hearing.

This FAQ was originally published in Hearing HQ Magazine

What these common Cochlear Implant words and phrases mean:

• Activation: The post-operative process by which the external sound processor is linked with the internal implant.
• Bilateral: Both ears implanted.
• Bimodal: One implanted ear with a hearing aid other ear.
• Binaural: Hearing with both ears.
• Bluetooth: A form of wireless technology.
• BTE: Behind the ear sound processor.
• BWP: Body worn sound processor.
• CI: Cochlear implant; often used to describe the complete implant package, the internal implant and external sound processor.
• CT/CAT: Computed tomography or computed axial tomography. These medical scans are usually done as part of the assessment process before surgery to determine whether a cochlear implant may be suitable.
• dB: Decibels. This is the measurement of how loud a sound is.
• Electrode Array: The part of the implant inserted into the cochlear to stimulate the auditory nerve.
• ENT: An Ear, Nose and Throat specialist doctor (Otolaryngologist). 
• HA: Hearing aid.
• Magnet: Located in the centre of the RF coil providing adhesion to the head. Often used when referring to the RF coil or headpiece. See “RF Coil”.
• MAP/Mapping: A program adjustment made by an implant audiologist.
• MRI: Magnetic Resonance Imaging. These medical scans are usually done as part of the assessment process before surgery to determine whether a cochlear implant may be suitable.
• RF: Radio Frequency.
• RF Coil: The external transmitting RF coil used to power and send signal to the implant.
• Sound Processor: The external device that converts sound into electrical signal transmitted to the internal device (implant).
• Switch on: See “Activation.”
• T-Coil / T Switch: Telecoil. A very small wire coil that serves as an antenna built into BTE processors and used to receive input signal from telephones, FM systems, etc.
• Unilateral: One implanted ear.

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 (cochlear).

• An external sound processor housing the transmitter with advanced software, microphones, batteries, and other features including T switch and Bluetooth.

Many people with hearing loss can use hearing aids to amplify sounds and help them hear. For some people, 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.

The cochlear is arranged so that different sound frequencies stimulate different hair cells and nerve fibres. Stimulating hair cells at the base of the cochlear produces perceptions of high-pitched sounds. Stimulating hair cells at the apex of the cochlear produces low-pitched sounds.

The cochlear implant is designed with electrodes at different positions to stimulate the appropriate hair cells and improve the perception of sound.

There are no implanted batteries or movable parts.  The implants have long lifetimes, 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 sound processor. 

The sound processor can be a self-contained behind-the-ear (BTE) unit like a hearing aid, or an above-the-ear unit.  Some manufacturers offer a remote control or a smartphone app for some of their devices. 

Refer to manufacturers’ manuals for details, schematic diagrams, photographs and technical information on implants, processors, speech recognition and noise control programs, and for batteries, accessories, care and maintenance procedures.

Before Surgery

There are various audiological and associated assessments such as hearing tests, as outlined at 

https://www.nextsense.org.au/

These are followed by medical tests, often at a public or private hospital facility.
 

Assessments performed include:

• Promontory stimulation.
• Computerised Tomography (CT) scans.
• Magnetic Resonance Imaging (MRI) scans.
• Balance tests.

The Surgery

The surgery is relatively short, usually 1–3 hours under general anaesthetic, and there is only one day/night stay in a public or private hospital.

After Surgery

After a day or two resting at home, most people can manage without assistance.

Within a week, most recipients are back to near-normal routine. After two weeks return to full physical work and exercise are OK.

The Switch-On

The implant is activated (“switched-on”) within a few days or weeks after surgery, at specialist clinics such as NextSense. The external processor component is fitted and connected to a computer during the switch-on appointment.

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 or feel 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 ear’s implant for each person. For example, a MAP programmed in an external processor for the left ear will not work when attached to the right ear of the same person, and a MAP for one person will not work when the external processor is attached to another person.

At the end of the switch-on appointment, the external processor component is detached from a computer, and is then powered by portable batteries which are either rechargeable or disposable.

Implantees may or may not leave the switch-on appointment with a pack of equipment, accessories and/or manuals to use at home, work or other places, to care for the sound processor, and/or to use in conjunction with the sound processor.

After Switch-On

This switch-on is followed by hearing rehabilitation.

Monitoring and adjustment of the MAP and stimulus parameters are carried out regularly over the first few months, as the implantee adjusts to the new and / or different sound sensations. Speech discrimination 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 amongst individuals.

Attending CICADA Australia Inc meetings and events: Before and After Surgery and Switch-On

CICADA meetings and social events allow recent implantees and prospective implantees to meet and observe other CI recipients in everyday situations, and get answers about how they cope with unfamiliar voices, distractions, background noise etc. Partners, family and friends can also learn from the experiences of those who support 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, because "No-one can explain better what it is like to have a cochlear implant than a person who uses one". CICADA exists to make this happen.

Hearing problems can arise at birth, childhood, adult life and/or in older age groups. They may be hereditary (often reflected in family history), a consequence of infection (e.g. Meningitis, Rubella, Mumps, Meniere's Disease), due to accumulated exposure to noise, deterioration due to ageing, or some combination of these factors, or 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 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 wired and wireless accessories for connecting outputs from television, radio, DVD and CD players, personal audio devices, computers, mobile phones etc to hearing aids and cochlear implants. Aids and implants also have T Switch (telecoil) 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 and train stations.

The audiology clinic assessments and medical tests before and after surgery may be covered by the scheduled Medicare fee in NSW, while some private clinics may charge higher fees. 

Assessments and medical tests conducted in other States and Territories may have similar or different arrangements with Medicare, audiology clinics, hospitals etc.

In some circumstances all costs are paid directly through Medicare and / or private health insurance and the candidate / implantee does not have to pay money themselves.

In other circumstances, the candidate / implantee may need to pay some or all costs upfront and may or may not be fully or partially reimbursed later by Medicare and / or their private health insurance company.

As an implantable prosthesis, it is included in the hospital procedure, which may be paid for via private health insurance for those with at least 12 months prior membership.

The candidate should check with the particular hospital, surgeon and anaesthetist what the gap fees are, if any. The hospital stay and any gap charges may be partly or fully covered depending on the particular private health fund plan and the excess involved – the candidate should check, in advance, with their private health insurance company.

The public hospital surgery procedure for public patients is free in NSW. The NSW Health Dept and equivalent bodies in other states or territories have limited funding allocated via Sydney Health and similar regional bodies. Funding also comes from various charities, especially for children.

Candidates should check whether the surgery procedure for public patients in their State or Territory is free for one ear and / or for two ears.

Veteran Affairs Dept Gold cardholders are fully covered.

Some costs of implants, accessories etc may or may not be covered through the National Disability Insurance Scheme (NDIS) – candidates and implantees are advised to check eligibility and funding criteria.

Batteries, spare parts, and repairs are fully covered for eligible members of Australian Hearing Services, including children and young adults up to 26 years of age. Otherwise, implantees purchase ancillaries from the manufacturer, battery or accessory suppliers, or through their clinic where MAPs are programmed.

Further details about costs are available from implant manufacturers and / or clinics such as NextSense.

The Cochlear brand of implanted devices carry a 10-year manufacturer’s warranty from Cochlear Ltd, while the external sound processor and associated components are covered for up to 3 years (depending on the component or accessory).

The lifetime of a cochlear implant is expected to be for as long as a person lives. CICADA Australia Inc has members whose first implanted device is more than 35 years old and the device is still working.

The external sound processor can be upgraded. Newer models of external sound processors may have some or all of these features:

• Connectivity to other widely available communications technology or equipment e.g. Bluetooth, T Switch (telecoil), smartphones, computers.
• Updated software.
• Improvements in sound processor technology or parts.
• Improvements reported by implantees of sound perception or clarity.
• Improvements in look, feel and / or weight.

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. The ENT specialist and / or audiologist will conduct some tests or scans, and may refer you or your child elsewhere such as a hospital for tests or scans that require specialist equipment.

If you or your child are at the stage where a cochlear implant appears a likely option, the doctor or ENT specialist can refer you direct to specialist cochlear implant clinics.

It is a good idea to also attend CICADA meetings and social events. These allow recent implantees and prospective implantees to meet and observe other CI recipients in everyday situations, and get advice or information, and get answers to questions about experiences with surgery, coping with unfamiliar voices, distractions, background noise etc. Partners, family and friends can also learn from the experiences of those who support recipients. Any unfavourable comparisons with other recipients are discouraged because each person’s outcome is unique and dependent on many factors.

Once these steps have been completed, get a referral to a cochlear implant surgeon. The surgeon can answer questions about the medical aspect of cochlear implants and surgery, and give advice about which hospitals they may operate at, which devices they recommend for your or your child’s specific situation, what the possible costs may be and whether they use Medicare and/or private health insurance, etc.  

Note that although cochlear implants have been available in Australia for many years, some doctors/GPs remain relatively uninformed about cochlear implants, and they may be unaware of the specialist clinics or surgeons involved.

Yes, cochlear implant and BAHA sound processors can be used with mobile phones.

However, you should never hold the phone against a BAHA sound processor itself, as this could cause unwanted feedback.

The BAHA telecoil can be used to further improve the quality of sound from an ordinary phone. Some Cochlear BAHA sound processors are Bluetooth compatible.

Source: Cochlear Ltd

Children using cochlear implants or BAHA can be taught to look after and clean the sound processors, abutment or other equipment just as they are taught to clean their teeth.

Source: Cochlear Ltd

Yes, cochlear implant recipients can have x-rays, including at the dentist.

You can safely use these items as they have low magnetic strength.

Some bilateral cochlear implant recipients have both devices implanted during the same surgery.

Other bilateral recipients receive their second device later during different surgery.

There are a variety of reasons that can influence a recipient's decision. You should discuss your options with your audiologist and cochlear implant surgeon to find out which approach is right for you.

A second cochlear implant may improve hearing in difficult listening situations including classrooms, meetings, restaurants and other active, noisy places.

The benefits of bilateral cochlear implantation may include: improved localisation, always having one ear positioned near the sound source, better speech understanding in noisy environments, and subjective and qualitative benefits^3-4.

A second cochlear implant may improve your child's hearing in difficult listening situations.

Several studies suggest that children with unilateral hearing loss may have difficulty listening and learning in classroom environments, and often benefit academically and socially from binaural hearing^1-2.

Cochlear Ltd

¹Litovsky, RY. Cochlear Whitepaper. Binaural Hearing.
²Litovsky, RY. Cochlear Whitepaper. Potential Advantages from Bilateral Cochlear Implants.
³Gantz, B.J., Tyler, R.S., Rubenstein, J.T., et al. (2002). Binaural cochlear implants placed during the same operation. Otol. Neurotol., 23(2): 169-180.
⁴Marvin, L., Chute, P.M., Rapoza, K. (2007) Speech Changes in Adults with bilateral and unilateral cochlear implants. Presented at 11th International Conference on Cochlear Implants in Children. April 2007 Charlotte, NC Clearer. Fuller.

Most people find the benefits of one implant so remarkable that they don't immediately think about having a second one.

However, when you receive two implants close together, or even at the same time (simultaneous), the brain adapts quickly. The tendency towards favouring one ear can be avoided and less auditory therapy may be needed.

For your child, allowing the two ears and hearing pathways to develop in tandem means the critical window time period can be used to it's full advantage¹

For some people, it may be possible to achieve binaural benefits using one cochlear implant and one hearing aid. However, with extended use of a cochlear implant, many people find that they no longer gain the binaural benefits they once did from the hearing aid in their non-implanted ear. This is when a second cochlear implant should be considered, even though it might be several years after the first implant.

Cochlear Ltd

¹Litovsky, RY. Cochlear Whitepaper. Binaural Hearing.

A BAHA is a Bone Anchored Hearing Aid. 

A BAHA is a surgically implantable device: a type of hearing aid that works via bone conduction. It is different to a cochlear implant.

Sounds are transferred through bone via vibration to the cochlear. It is used by people who cannot use conventional hearing aids.

Some recipients find their hearing performance improves immediately following switch-on of the first and / or second cochlear implant.

For other recipients, improvement is more gradual.

The experience for each ear in an individual person is unique, and may depend on factors such as the duration of hearing loss and how much experience the person has with a first cochlear implant or a hearing aid.

Choosing your second cochlear implant system is just like choosing your first - you want optimal hearing performance and peace of mind.

That comes from exceptional implant reliability and knowing that you will have access to the latest sound processing technology upgrades for life.

For example, you might want to upgrade the speech processor on your first ear to get the most from your hearing potential in both ears in the easiest possible way.

Source: Cochlear Ltd

It's very important for implanted children and adults to receive ongoing auditory, speech and language therapy, regardless of whether they have one implant or two.

With more access to sound, therapists may use different approaches to rehabilitation and incorporate practice in areas such as locating where sound is coming from, into your program.

To help you improve your listening skills, after regaining your hearing through a cochlear implant, it is best to practice with a partner, friend or anyone who can spend time with you on a daily basis.

However, there are many implant recipients who spend most of their time on their own, and for these people, listening practice may be virtually non-existent.

There are many ways to practice listening with your cochlear implant if you are on your own. 

Here are some ideas. Remember to start with a small goal that is easily achievable, and as you progress, choose goals that are a bit more challenging and / or take a bit longer to do.

• Tune in to the radio. Many radio stations allow people to listen via radio receivers and / or the internet. This can be for listening to people talk and / or for music.
• Have the television on. Even if you don't want to watch a program on a channel, you can listen to it. Some televisions also have radio channels available.
• If you want to listen to music, play a record, cassette tape, CD, DVD, internet-based YouTube / Spotify or similar channel, or listen to or play a physical musical instrument if you have access to one.
• Use audiobooks. Some audiobooks are accompanied by physical books you can read along to, and / or some may have internet-based e-books that you can read along to while you listen. Audiobooks can be borrowed in physical or digital formats from libraries.
• Use phones or computers to practice listening to sounds / words / sentences if your audiologist gives you these to listen to. 
• Go to a park, beach or other place to listen to different sounds of nature.
• Visit a shopping centre or other public place to talk with people, and / or attend theatre, musicals, etc.
• Use a phone or computer to make and / or receive audio or audiovisual calls.

Question: Why does the area under my transmitting coil feel hot and sore sometimes?

Answer: Sue Walters, Clinical Support Officer NextSense

At the time of your switch-on, the magnet holding the transmitting coil to your head will be fitted for comfort.

The magnet needs to hold firmly enough so the transmitting coil does not fall off easily but if it is too strong, it can cause a pressure sore over time. So, it is very important to have the correct strength magnet.

Does your magnet need to be changed?

You may need to change the strength of the magnet over time. Some situations requiring a change of magnet strength include if you

• put on weight or your hair grows thicker, you may need to change to a stronger magnet
• lose weight or your hair becomes thinner, you may need to change to a weaker strength magnet

What you can do to alleviate pain

If it does become sore, place a soft padded dressing under the coil to relieve the soreness and contact your clinic to order a weaker magnet. You should also ask someone to check the area under your magnet on a regular basis to make sure there is no inflammation. And, if the skin becomes broken, put a soft dressing under the coil, see your GP as soon as possible. Then contact your clinic or supplier regarding a weaker magnet.

Cochlear implant sound processors use rechargeable or disposable batteries. Battery size may vary depending on the sound processor model. 

BAHA sound processors use rechargeable or disposable batteries. Battery size may vary depending on the sound processor model.

How long batteries last may be dependent on the sound processor model, the amount of power needed for the MAP that is programmed, and whether any accessories for streaming are used, in addition to the battery type being used (rechargeable or disposable). 

Generally, if you are in noisy environments your speech processor works harder and therefore requires more battery power.

Your cochlear implant team will be able to suggest the best battery type(s) and how long the battery is likely to last.

An audiologist shared this experience, as described by a recipient and the audiologist:

"I think I'm going mad! When I walk towards my television the sound becomes softer, and when I walk away the sound becomes louder!"

A bit of detective work showed the microphone protector was the culprit. Sound processors have microphone entry ports - these are tiny areas in a row (front and back). All the sound in the environment has to enter through these tiny spaces to be processed for listening. If the front microphone is blocked (with perspiration or dust which is easy as it is facing up towards your scalp and hair), and the back microphone is not blocked, the sound coming in from the front will be softer compared to the back - therefore explaining the "crazy" experience above.

Lesson: It is important to keep the sound processors clean - particularly the microphones and their protective cover - to retain optimal sound clarity and volume.  To avoid a trip to your audiologist to 'do something about the background noise' make sure you change the microphone cover once a month so that you hear more speech and less background noise.

If living in or visiting a humid environment, or a wet or dirty environment, microphone covers may need to be replaced more often. Your cochlear implant audiologist can advise how often to replace the microphone covers for these situations.

If you are likely to forget this regular procedure, mark it in your calendar, diary and / or your phone.

A general guide is to dehumidify the sound processor every night while you sleep. If living in or visiting a humid environment or a wet environment, sound processors may need to be dehumidified more often. Your cochlear implant audiologist can advise how often to dehumidify your sound processor.

A general guide is to replace the dehumidifying desiccant every 2 months. If living in or visiting a humid environment or a wet environment, the desiccant may need to be replaced more often. Your cochlear implant audiologist can advise how often to replace your desiccant and which type to use.

This kind of sound usually does not come from inside the processor or the program, but is caused by a physical mechanism. The only moving part of your external processor is the coil cable, which is handled every single day, at least twice, morning and night. The plastic sheeting of the cord, which holds delicate wires connecting the processor with the transmitting coil, can suffer wear and over time can tear the wires sending sound intermittently, causing a sensation of static or crackling.

Talking about 'static' .....please be careful over winter when our synthetic jackets and jumpers, combined with wind and our rubber soled shoes, result in more static electricity being stored on our bodies than usual. Although the processors and the implants have clever electrostatic barriers, a strong static discharge directly on the processor or coil/cable can corrupt (disrupt or erase) a program. Instruct your family to touch your shoulder before touching the processor, and always remove the processor before removing clothing over your head.

You can wear a cochlear implant or BAHA for normal activities.

Special protection such as helmets for contact sports or vigorous sports may be used. Boxing and other aggressive sports are discouraged. 

For swimming and some other water activities, some sound processor models may have water accessories available. If water accessories are not available or you choose not to use water accessories, you will need to remove the external component when you swim, much like you would have to remove a hearing aid. The internal part of the cochlear implant is not affected by water.

For scuba diving, it is recommended that you check with your cochlear implant surgeon or clinician before participating in a dive, as there may be dive depth restrictions and / or other medical conditions that you will need to consider.

Question: I had a sudden unilateral deafness (hearing loss in my right ear) a few months ago (unilateral deafness). Although the other ear still functions well. What could have caused this and what can I do to hear with ‘two ears’ again?

Roberta Marino

Answer: Roberta Marino, Senior Audiologist

To help answer this question, I’ve enlisted the help of Dr Dayse Tavora-Vieira and Prof. Gunesh Rajan. They are from Perth’s Hearing Implant Research Unit, experts in implantable hearing devices and cochlear implants for deafness on one side (unilateral deafness).

About unilateral deafness

Around 0.8-2.7 per 1,000 people experience unilateral deafness (UD). And it increases substantially in school-aged children ranging from one to 56 per 1,000.

In the United States, 60,000 (est) people acquire UD each year. And in the United Kingdom, 9,000 (est) people develop profound UD each year.

Unilateral deafness can be present from birth or caused by conditions including;

• mumps,
• acoustic neuroma (a benign growth on the hearing/auditory nerve),
• viral infections,
• head trauma,
• Meniere’s disease, and
• genetic disorders.

But, sometimes there is no known reason for the loss of hearing which can occur suddenly.

Suffering from sudden unilateral deafness can be traumatic. Especially when accompanied by the onset of severe tinnitus (noises in the head/ears in the absence of external noise).

Adults with unilateral deafness find it difficult to detect the direction of incoming sounds, hear speech in background noise and hear when speech is presented to the ‘deaf’ ear. Indeed, twenty-six per cent of people with UD struggle with conversations in quiet and 73 per cent report some level of handicap.

What can you do about unilateral deafness?

Unfortunately, there is no cure for UD when the cochlea or hearing nerve is affected. However different hearing technologies can assist. These include

• the CROS (Contralateral Routing of Signal) hearing aid,
• bone conduction hearing aids,
• bone conduction hearing implants, and
• cochlear implants.

You can get a good idea of the potential benefits of a bone conduction implant by doing a trial of a bone conduction aid.

Alternatively, if your hearing nerve is viable, you could consider a cochlear implant for the ‘deaf’ ear.

You will need a full diagnostic evaluation to establish whether your hearing nerve is viable. So, you will need an audiologist specialising in this area who will consult with an ear, nose and throat specialist. However, it will be difficult to ascertain the potential listening benefits if there hasn’t ever been any auditory stimulation to the deaf ear throughout your life.

A cochlear implant is the only option if the deaf ear is directly stimulated. Research has shown this can also ease tinnitus.

Finally, all the other hearing solutions described work on delivering sound to the better hearing ear. If there is a viable auditory nerve and the system works well, the patient would need to participate in an intensive rehabilitation program.

This FAQ originally appeared in Hearing HQ Magazine

Question: After a stapedectomy two years ago my hearing is deteriorating slightly. I already have a powerful aid in that ear. And I had a sudden total hearing loss in it a couple of years ago. Hearing was partially restored with the help of steroids. Will the stapedectomy plus hearing aid see me out?

Answer: Melville da Cruz – Ear, Nose & Throat Surgeon

Otosclerosis is a hereditary disease affecting the hearing elements derived from the otic capsule (bony labyrinth). The otic capsule forms the complex inner ear (cochlear and balance organ) as well the stapes bone (the third of the three middle ear bones).

In individuals affected by otosclerosis both the cochlear and the stapes involvement contribute to the overall

Lateral view of the otic capsule also called the bony labyrinth by Henry Vandyke Carter et al Gray’s Anatomy, Plate 920

hearing loss. In cases where the conductive hearing loss is the greater component, due to involvement of the stapes bone, surgery in the form of stapedectomy (or stapedotomy) is a suitable treatment option. If the sensory-neural or cochlear component is the greater component, then stapedectomy will not be effective in reversing the hearing loss. A hearing aid is the best option.

In many cases of otosclerosis hearing loss is a mix of both cochlear and middle ear components. So, careful hearing testing will establish

• how much hearing surgery can restore, and
• how much will require sound amplification with a hearing aid.

However, over time the history of hearing loss due to otosclerosis (and other conditions such as aging and noise exposure) is for the hearing levels to slowly decline (over years to decades).

Monitoring changes

Monitoring hearing levels in both ears at regular intervals will help ensure optimum hearing outcomes. Decline in hearing following initially successful stapedectomy surgery also needs particularly careful testing to understand why the hearing is dropping. Generally, it is the sensory-neural or cochlear component of the hearing changes that declines with time. Which surgery cannot reverse. So, an adjustment of the current hearing aid or fitting a more powerful aid will be required.

If the hearing decline is due to a recurrence in the conductive component of the hearing loss then revision stapedectomy surgery may improve the hearing levels. Sometimes dramatically. Rarely, the hearing levels decline to a severe degree which responds poorly to even the most powerful hearing aids. In this situation a cochlear implant will be indicated, often improving the hearing to that experienced several decades before. Careful testing of hearing and consideration of the type of hearing loss will allow your ENT surgeon to advise which pathway is the best for you.

This FAQ originally appeared in Hearing HQ Magazine

Question: I have otosclerosis and I am considering stapedectomy surgery to improve my hearing. My surgeon has recommended stapedectomy surgery, but in my research I have read about stapedotomy surgery being better. What is the difference between the two operations? 

Answer: Melville da Cruz – Ear, Nose & Throat Surgeon

Otosclerosis is a hereditary disease resulting in progressive stiffness of the stapes bone; the third of the three middle ear bones.

As the stapes bone becomes progressively stiff it transmits sound energy less efficiently through the middle ear resulting in conductive hearing loss.

What is so exciting about otosclerosis is that the middle ear component of the hearing loss is treatable by surgery. Generally called stapedectomy.

Stapedectomy versus stapedotomy

This operation restores sound transmission to the inner ear bypassing the fixed stapes bone. This can be either by removing the entire stapes bone (stapedectomy) or drilling a very fine hole through it (stapedotomy) and replacing it with an artificial stapes bone.

When stapes operations were first developed in the 1950s, it was necessary to remove the whole stapes bone before introducing an artificial stapes replacement (generally made of fine stainless steel wire and fat taken from the ear lobe).

With micro drills and more recently lasers, it is possible to drill a fine hole (less than 1 mm in diameter) through the stapes footplate. A replacement stapes bone (made of titanium/platinum and Teflon) effectively bypasses the fixed bone, leaving the remaining footplate largely intact.

Both operations in skilled hands produce wonderful hearing results. And both operations still carry similar risks of permanent and severe hearing loss (dead ear, less than 0.5%).

However, the stapedotomy operation produces less trauma to the inner ear, preserving the higher hearing frequencies.

The modern stapedotomy replacement bones are also safer to revise if necessary. The replacement prosthesis is also compatible with MRI scanners if imaging of the region is required.

Because of these advantages, all modern stapes surgery for otosclerotic hearing loss is in the form of stapedotomy.

This FAQ was originally published in Hearing HQ Magazine

Question:  My child is due to have cochlear implant surgery soon. I’ve heard cochlear implant recipients have a higher risk of contracting meningitis. What precautions can we take?

Answer: Melville da Cruz – Ear, Nose & Throat Surgeon

Meningitis is a serious infection of the fluids and linings surrounding the brain and spinal cord, caused by a range of viruses or bacteria. The incidence of meningitis following cochlear implantation has been very low.

The report that caused concern

However, there was a concern about the risk of meningitis following a report in the US (1) in Sept 2003 of a cluster of bacterial meningitis cases in cochlear implant recipients.

The report investigated 118 cases of reported meningitis cases in implant recipients from 13 months to 81 years old. The onset of the infection ranged from less than 24 hours following implant surgery to more than 6 years after.

The most common infection was due to Streptococcus pneumonia. These cases suggested meningitis was more prevalent in implantees, however, these cases were over a 20 year period and approximately 60,000 implant surgeries. In the paediatric population, the incidence of implant-associated meningitis was higher than in non-implanted children indicating that cochlear implant surgery was an added risk factor for meningitis.

The real picture & causes

Follow up clinical and laboratory-based investigations suggested multiple factors lead to the ‘at risk’ profile. These risk factors included the presence of inner ear malformations, CSF leak (2) during or after implantation, history of VP shunt (2) (used for treating hydrocephalus) and recurrent otitis media (middle ear infection).

In addition, an electrode with a positioner was used in a high proportion of the cases of meningitis. The positioner involved a small wedge to place the electrode closer to the auditory nerve endings. Withdrawn from the market, subsequent modified electrode designs minimise this risk.

Minimising risk of meningitis

Several strategies minimise the risk of post-implantation meningitis. The adoption of a range of strategies is up to the protocols in various implant clinics, individual surgeons, implant recipients and their families.

Antibiotics

Antibiotics are standard during implant surgery and continued for several days after. Similarly, the insertion of a grommet in both the implanted and non-implanted ears is also common. This helps reduce the incidence of recurrent acute otitis media in infection-prone children.

Immunisation

Immunisation against a range of bacteria for all implant recipients is important. Particularly those with inner ear malformations, CSF leak at the time of implantation or with VP shunts to optimise their immunisation status.

In Australia, the national immunisation program ensures children and adults have access to a range of bacterial vaccines to minimise the chances of infection. Particularly Streptococcus pneumonia, Haemophilus influenza type B (HIB) and meningococcus, from a young age.

Streptococcus pneumonia is the most common bacterium in post-implant meningitis. So, immunisation is strongly recommended for all ages. The immunisation schedule is widely practised (2) and updated as new knowledge and more effective vaccines are available.

Hopefully, these measures will see a further reduction in the already low incidence of bacterial meningitis in cochlear implant recipients over time.

References:

(1) Cochlear implants. Bethesda, Md.: National Institute on Deafness and Other Communication Disorders, 2003. (Accessed 1 July 1 2003, at www.nidcd.nih.gov/health/hearing/coch.asp.)

(2) www.health.gov.au/internet /immunise/publishing.nsf.

A ventriculoperitoneal (VP) shunt relieves pressure from the brain caused by fluid accumulation. VP shunting is a surgical procedure primarily to treat hydrocephalus. Hydrocephalus occurs when excess cerebrospinal fluid (CSF) collects in the brain’s ventricles. CSF cushions your brain and protects it from injury inside your skull.

The fluid acts as a delivery system for nutrients that your brain needs, and also takes away waste products. Normally, CSF flows through these ventricles to the base of the brain. The fluid bathes the brain and spinal cord then is reabsorbed into the blood. When this normal flow is disrupted, the build-up of fluid can create harmful pressure on the brain’s tissues. This can damage the brain. VP shunts surgically placed inside one of the brain’s ventricles diverts fluid away from the brain. This restores the normal flow and absorption of CSF.

This FAQ originally appeared in Hearing HQ Magazine

Question: I have had outer ear infections with blocked hearing after swimming. My doctor has told me they are due to swimmer’s ear and exostosis. Do I need surgery?

Answer: Melville da Cruz – Ear, Nose & Throat Surgeon

Swimmer’s ear and exostosis are common in people who swim a lot. The repeated exposure to cold water over many years produces a mild inflammation of the lining of the bony external ear canal on both sides, stimulating bone growth – a little like growth rings on a tree trunk.

Exostosis progression

As the bone growth slowly progresses it produces three visible swellings in the ear canal (exostosis) which eventually constrict the canal leading to blockage. While the swellings are small, there may be minimal symptoms. As they grow however you may find water gets trapped after swimming. This can cause your hearing levels to fluctuate but can improve spontaneously after a day or two. In time, trapped water, wax and debris lead to recurrent infections which are difficult to clear.

Eventually, with large exostosis, there is near complete blockage of the ear canal and long periods of reduced hearing

Exostosis – CC BY-SA 3.0 by Welleschik

which can be disabling if they involve both sides. At this stage, using ear drops and clinical ear cleaning is not enough.

There are few symptoms when exostoses are small. They are often found during an ear examination for unrelated symptoms. As they enlarge, symptoms of blockage and hearing loss become more troublesome, especially for those who swim daily. While being diligent with your water precautions, such as wearing earplugs and drying well after swimming can be, at this stage, you should consider whether surgery is an option. Patients with larger occluding exostoses, who wish to continue swimming, will need to consider surgery as the painful infections are almost impossible to treat without a general anaesthetic for ear canal cleaning.

Surgery for exostosis

Surgery involves “drilling out” the exostosis to widen the bony ear canal back to its usual dimensions, under a general anaesthetic. It takes up to two hours depending on the size of the bony swellings and requires an overnight stay in hospital.

It can take several weeks for the skin to grow over the widened canal. While healing you will need to follow strict water precautions and have repeated dressings. In time, the second side will require surgery. It is rare, once the exostoses have been surgically corrected and the area has healed, that any further treatment is needed.

This FAQ originally appeared in Hearing HQ Magazine

Before you can fully understand how cochlear implants work, it’s helpful to first have a basic understanding of how normal hearing works:

1. The outer ear collects sound waves that pass through the air.
2. The sound waves vibrate the eardrum and the three tiny bones (hammer, anvil, and stirrup) in the middle ear.
3. This vibration moves the tiny hairs of the sensory cells in the inner ear or cochlea; sensory cells convert the vibrations to an electrical signal that is sent to the hearing nerve.
4. The signal travels up the nerve and into the brain, where it is interpreted as sound.

When any part of this delicate system is damaged, hearing loss can result. For those with severe to profound hearing loss, AB’s cochlear implant system is designed to restore the rich world of sound and improve the quality of you or your child's life.

Source: Advanced Bionics