Frequently Asked Questions
Q1. What Is A cochlear implant?
A1. A cochlear implant is a device designed to help severe to profoundly deaf individuals who gain little or no benefit from hearing aids. With their cochlear implant they gain awareness of environmental sounds, some can understand speech without lip-reading and some can use the telephone. The cochlear implant system converts acoustic sound waves into weak electric currents, which are delivered to the immediate vicinity of the auditory nerve in the inner ear or cochlea. The auditory nerve is stimulated by these electric currents and transmits nerve impulses to the brain, where they are understood as acoustic sensations.
Q2. According To My Doctor, I Suffer From Nerve Deafness. Does This Mean That The Hearing Or Auditory Nerve Is Destroyed?
A2. No, the auditory nerve may still potentially function even in cases of nerve deafness; in most cases the auditory nerve is intact (or partially functional), but the hair cells in the cochlea are damaged or destroyed. Normally, when sound waves reach the ear they are converted into electric currents by tiny sensory hair cells. The auditory nerve responds to the electric current and passes it on to the brain. We experience this as “hearing”. If the hair cells are damaged, there is no mechanism to convert the sound waves into electric currents, and without electric current the nerve is not stimulated.
Q3. How Can The Cochlear Implant Help?
A3. The cochlear implant conveys weak electric stimuli to the vicinity of the auditory nerve. The electric stimulus activates the nerve, which then transmits a signal to the brain. The brain recognizes this signal and we experience this as “hearing”. The cochlear implant has the same function as the hair cells, in that it transforms sound into an electric current that stimulates the auditory nerve. Nevertheless, the result is not the same as normal hearing.
Q4. How Many Parts Are There To A Cochlear Implant System?
A4. A cochlear implant consists of two main components:
- The internal component, cochlear implant, which is implanted surgically, and
- The external components, Speech Processor, Microphone & Transmitter Coil, which are worn outside the body.
Q5. Can The Speech Processor Be Removed At Night?
A5. Yes, the speech processor can be removed at night. However, it should then be switched off, so as not to exhaust the battery. The speech processor may be worn through the night if desired – some users like to ‘keep in touch’ with the hearing world even when asleep.
Q6. Will An Implant Be A Hindrance In Activities Like Football, Swimming And Tennis, For Example?
A6. No, the implant itself is in no way restrictive. For some sports, such as swimming, the external part is usually removed beforehand, just as one would remove a hearing aid, although several companies now make waterproof versions. For other sports the use of a speech processor is even advantageous. Some active sports or pastimes can be dangerous to the implant or external parts however, so please ask your clinic for advice on activities where there is the possibility of blows to the head. Please also look at the BCIG Safety Guidelines.
Q7. Is It Possible That The Speech Processor May Need Repairing?
A7. As in any electronic device, sometimes faults do occur. The processor is usually sent back to the manufacturer for repairs, and the clinic will usually issue you with a replacement in the mean time. Do not attempt to make repairs yourself.
Q8. Does The User Have To Pay For The Repairs?
A8. In the UK, costs are covered by the NHS. In other countries, costs are covered by the user, health insurance, or government health care, as appropriate.
Q9. Is Hearing Absolutely Normal With A Cochlear Implant?
A9. No. From individuals who could hear before they were deafened we know that the sound of a cochlear implant differs from “normal hearing”. Users initially describe the sound characteristics with words like “mechanical”, “technical”, and “synthetic”. This perception changes over time, most users do not notice this artificial sound quality after a few weeks.
Q10. How Long Does It Take Before The User Derives The Maximum Benefit From A Cochlear Implant?
A10. From research we know that the performance of individuals can be quite different. However, benefit usually starts immediately and for adults reaches a plateau at about 3 months after the initial tuning sessions. Although performance continues to improve, after this time the improvements are at a slower rate. It is fair to say that for many users performance continues to improve for several years. In children improvement is at a slower pace. A lot of training is needed after implantation to help the child use the new ‘hearing’ he/she now has.
Q11. What Acoustic Signals Can Be Perceived With A Cochlear Implant?
A11. With a cochlear implant most acoustic signals of medium and high intensity can be perceived as well as quieter sounds. Patients report that they can perceive footsteps, slamming of doors, sounds of engines, ringing of the telephone, barking of dogs, whistling of the kettle, rustling of leaves, the sound of a light switch being switched on and off, and so on.
Q12. Are Users Able To Understand What Is Being Said Without Looking At The Speaker?
A12. A large number of users are able to understand speech without lip-reading. However, even in cases where this is not possible, there is some improvement in lip-reading with the implant.
Q13. Does The Cochlear Implant Facilitate Lip-Reading?
A13. Yes, users are able to perceive characteristic sound patterns of speech. The addition of these impressions to the observation of movements of the mouth and face facilitates lip-reading. The degree of help for lip-reading depends on the patient’s practice in dealing with acoustic signals and speech.
Q14. I Am Told Sometimes That My Voice Is Either Too Loud Or Too Quiet In Certain Situations. Does The Cochlear Implant Help In Controlling The Loudness Of One’s Own Voice?
A14. Yes. The cochlear implant enables the user to control the volume of the voice in two different ways:
- Since the user can now perceive their own voice, they are able to tell if they are speaking loudly or quietly.
- The cochlear implant allows background noise to be “heard”. Most patients learn to adjust the volume of their voice to the volume of the background noise.
Q15. Are Users Able To Make A Telephone Call?
A15. Many users are able to make telephone calls and understand familiar voices over the telephone. Some good performers are able to make normal telephone calls and even understand an unfamiliar speaker. However, not all users are able to use the phone.
Q16. Does The Cochlear Implant Help In Watching TV Or In Listening To The Radio?
A16. For many users the cochlear implant does make watching TV easier – especially when you can also see the speaker’s face. The radio is more difficult as there are no visual cues available.
Q17. Can A User Listen To Music?
A17. Some users are able to enjoy music. Some enjoy the sound of certain instruments (piano or guitar, for example) and certain voices. For others, the information transmitted by the implant may be insufficient to allow them to fully enjoy music.
Q18. Are There Any Unpleasant Sounds?
A18. During the speech processor tuning the clinician will perform certain tests to find out when a patient experiences acoustic signals as being unpleasantly loud. The speech processor is then adjusted so that no acoustic signal reaches this point. There may be other sounds that are not found to be ‘pleasant’ due to their nature (e.g. baby crying) but these should not be uncomfortably loud.
Q19. Does The Cochlear Implant Influence Tinnitus?
A19. Many users find that tinnitus decreases while their device is operating. Usually tinnitus decreases only on the implanted side, and for many users it remains reduced even when the speech processor is not switched on. Most users experience a lessening of tinnitus, in some cases it remains unchanged and there have been reports of rare cases where it is worse.
Q20. What Basic Risks Are Involved In Cochlear Implantation?
A20. Apart from the risk due to anaesthesia (as in every operation) the risks are the same as those connected with a middle ear operation as performed daily in an Ear, Nose and Throat clinic. Theoretically, the facial nerve might be damaged; given normal anatomical conditions, however, and with an experienced surgeon, this is highly improbable. Other conceivable risks are an intensification of tinnitus, disturbance of taste, and an enhanced feeling of dizziness.
Q21. Since When Have Cochlear Implants Been In Use?
A21. The first experiment with electrical stimulation was undertaken in France in 1950. From the late 1970’s there have been an increasing number of cochlear implantation’s each year. The first truly commercial devices were available from the early 1980’s.
Q22. Do Those Who Have An Implant System Use It?
A22. The great majority of implantees use their processor regularly from morning to night.
Q23. What Can Children receiving a Cochlear Implant be expected to Achieve?
A23. Since children are better able to utilize new information than adults, they can also be expected to benefit more from a cochlear implant. A very limited hearing can have a considerable influence on a child’s ability to learn to talk and on overall development. The speech of most children with cochlear implants is of better quality and more intelligible than their peers using acoustic hearing aids.
Q24. Are There Different Types Of Cochlear Implant?
A24. In Europe the majority of cochlear implants are supplied by four manufacturers; Advanced Bionics, Cochlear, MED-EL and Oticon Medical. Different implant programmes may work with different Cochlear manufacturers. Your local Implant programme is likely to have an array of information (brochures, booklets and videos) about the different types of implants available. If you use the internet you may wish to visit each manufacturers website:
Q25. Is There A Difference Between The Results Of Implantation In Adults And Children?
A25. Children who are implanted at a very young age or adults who became deaf after learning to talk – i.e. with postlingual deafness – respond better to the implant than adults with congenital deafness (born deaf) or prelingual deafness. Although we do not yet know the entire effects of a cochlear implantation on children who were born deaf and implanted later in life, it can be hoped that acoustic sensations will enable these children to incorporate sounds into their lives, and that will be of general benefit to them.
Q26. How Can I Help My Child To Use The Cochlear Implant Profitably?
A26. The best way of helping children to use their cochlear implant is to make hearing as interesting as possible for them. This requires a great deal of patience and training. They have to be shown how they can consciously use and evaluate the acoustic information that they receive from their cochlear implant.
Q27. What Other Requirements Have To Be Fulfilled Prior To An Implantation?
A27. A medical examination is necessary to ensure that the patient is appropriate to undergo surgery. The patient is likely to have scans of their head to ensure that the cochlear implant array can be inserted. Many Audiological tests are also required to rule out the possibility that the patient could not benefit from a change in hearing aids or additional counseling.
Q28. Can The Patient Hear Immediately After The Operation?
A28. No. Without the external coil and the speech processor the patient cannot hear. These components are fitted about a month after the operation, at the initial tuning session.
Q29. Why Is It Necessary To Wait 3 To 6 Weeks After The Operation Before Beginning The Training?
A29. A waiting period is necessary for the operative incision to heal completely. This usually takes 3 to 6 weeks. When the swelling has subsided, the initial fitting or programming of the processor can be done.
Q30. What Happens During The Basic Program?
A30. The basic program consists of 3 phases:
- Adjustment of the device – the device is adjusted until the patient experiences sounds as pleasant.
- Audiological tests are necessary to check whether the adjustment is correct and to find out what the patient perceives, before training is begun.
- Familiarization with the use of the device and aural training
Q31. How Important Is The Active Cooperation Of The Patient?
A31. The patient’s readiness to experience new and more detailed acoustic impressions and his active cooperation in the training program are of decisive importance for the degree of success. The extent and the duration of the training differ from patient to patient.
Q32. Is It Beneficial If Someone Who Is Close To The Patient Takes Part In The Training Program?
A32. If possible, yes. This person should be included in the training program so as to be able to help the patient with his exercises. Such a person should also know how to handle the processor.