Cochlear Implant

• Sound is picked up by a microphone
• Sound is sent from the microphone to the speech processor
• The speech processor analyses and digitises the sound into coded signals
• Coded signals are sent to the transmitter
• The transmitter sends the code across the skin to the internal implant
• The internal implant converts the code to the electric signals
• The signals are sent to the electrodes to stimulate the remaining nerve fibres
• The signals are recognised as sounds by the brain producing a hearing sensation

Cochlear implants provide a heightened sense of sound for adults and children with profound hearing loss. They are designed for people whose hearing does not improve with surgical correction or with use of a hearing aid. Cochlear implants will not restore or create normal hearing.

A Cochlear implant is a proven medical option designed to help your child with hearing loss communicate more easily and interact more comfortably with others. It's an alternative to the traditional attempts to improve hearing ability, such as powerful hearing aids, which in some cases provide little or no assistance.

Your doctor will likely do some or all of the following:

Ear (otologic) evaluation : The middle and inner ear are examined to check for infection or abnormalities.

Imaging : An MRI & CT scan is taken to evaluate the anatomy of your inner ear.

Physical examination : This includes a medical history and physical examination to insure that general anesthesia is safe.

Psychological evaluation : May be recommended to determine how well you are likely to cope with a cochlear implant.

Implantation : Surgery under general anesthesia is required to implant the internal components. The receiver / stimulator assembly is placed inside the temporal bone and the electrodes are inserted into the cochlea, which in turn directly stimulates the hearing nerve. The implantation procedure usually takes about one to two hours.

Mapping & switch on : After three to four weeks the incision should be healed. At this point, the programming of the speech processor will be carried out and the external parts of the implant will be hooked up. The implantee will begin to hear then.

Auditory Verbal Therapy : Children who are not exposed to the hearing world must undergo extensive habilitation to improve their speech, language and hearing skills.

Possible Complications You will have frequent follow-up visits for the following:

• Headpiece fitting, done 3-4 weeks after surgery
• Adjustments to the speech processor (mapping)
• Ongoing evaluation of hearing status
• Auditory Verbal Therapy

You'll have cochlear implant training to improve your ability to:

• Identify sounds
• Read lips
• Develop speech skills

Outcome

A cochlear implant should improve the ability to sense sound. Most people with cochlear implants can hear soft to loud sounds and recognize speech at normal decibel levels. The outcomes will vary depending on the age of initial deafness, period of effective hearing aid use, speech & language therapy during the early childhood days, mode of communication, motivation, condition of the nerve fibers, general health etc.

Call your Doctor if any of the following occurs

• Pain
• Dizziness or vomiting
• Facial paralysis
• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, bleeding, or discharge at the incision site
• Cough, shortness or breath, chest pain, or severe nausea or vomiting

Pediatric immunization schedule

Pneumococcal Conjugate vaccine( not available in India)
Age at first dose(months)	Primary series	Additional dose
2-6	3 doses, 2 months apart	1 dose at 12-15 months of age
7-11	2 doses, 2 months apart	1 dose at 12-15 months of age
12-23	2 doses, 2 months apart	Not indicated
24-59	2 doses, 2 months apart	Not indicated
60 months or older	Not indicated	Not indicated

Polysaccaride Pneumococcal vaccine
Age at first dose	Primary	Booster
< 2 years of age	Cannot be given	At 2 years
> 2 years of age	Immediate	Every 3-4 years

Hemophilus Influenza vaccine
Age at first dose(months)	Primary series	Additional dose
1 ½ - 3 ½	3 doses, 1 month apart	18 months
4 - 7	3 doses, 1 month apart	18 months
7 - 11	2 doses, 1 month apart	18 months
12 – 14	1 dose	1 month after
15- 59	1 dose	Not required

• Hearing Loss of Neural or Central Origin
• Absence of Cochlea
• Absence of VIIIth Nerve Development
• Active Middle Ear Infections
• Psychological contraindications
• Other contraindications to surgery