General Information about Cochlear Implants
A cochlear implant is a small electronic device (which is surgically implanted into the inner ear) that provides sound to children and adults who have a severe to profound hearing loss (70dB or more) and who do not benefit from hearing aids. Cochlear implants enable sound to reach the brain, effectively skipping the part of the ear that is damaged. The device converts sounds we hear to electrical impulses and directly stimulates the cochlear nerve.

Parts of the Device
A Cochlear Implant has Three Parts:
1) Receiver: The receiver is surgically implanted under the skin behind the ear. A wire extends from the receiver to the electrode array which is inserted in the cochlea. Surgery is usually performed on an outpatient basis by our neurotologists.

2) Microphone: Picks up sound in the environment and transmits it to the speech processor.

3) Speech processor: A microcomputer is worn behind the ear (it's appearance is similar to a hearing aid) or as a body unit (which is worn on a belt or in a pocket). The speech processor interfaces between sound in the environment and the internal implant electronics in order to send information to the hearing nerve. This process occurs in milliseconds, enabling the listener to hear sound as it occurs.
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About the Device
The cochlear implant can increase the awareness of sound in children, improve the ability to lip read, and enhance communication skills. Many recipients of the device have gone on to enter mainstream school environments, talk on the phone, and communicate verbally. Following surgery, rehabilitation is necessary, as the recipient must learn to associate the sound signals with normal sounds.

Adults who have lost their hearing later in life can be excellent candidates for cochlear implantation. Because of previous exposure to sound, they retain auditory memory which enables greater speech comprehension. Many adults report a better quality of life after receiving an implant. They also report improved communication with family and friends as well as with the world at large.

To determine suitability for this device in a profoundly deaf child, a careful examination is required. The evaluation is performed to determine whether or not the child can receive adequate information from a powerful hearing aid, and whether or not the procedure can be performed and give expected improvement. Children who have heard and developed communication before losing their hearing historically do the best with implantation. The earlier the implantation is completed, the greater the expectations for benefit from the device.
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Candidacy Qualifications
Young children (12 months to 2 years):
1) Profound sensorineural hearing loss in both ears
2) Lack of progress in development of auditory skills with hearing aids or other amplification devices
3) High motivation and realistic expectations from family
4) Other medical conditions, if present, which do not interfere with cochlear implant procedure

Children (2 to 7 years):
1) Severe-to-profound sensorineural hearing loss (nerve deafness) in both ears (90 dB).
2) Receive little or no benefit from hearing aids after a 3 to 6 month evaluation. 3) Lack of progress in the development of auditory skills.
4) Have no medical contraindications.
5) High motivation and realistic expectations from family

Adults (18 years and over):
1) Severe-to-profound sensorineural hearing loss in both ears (greater than 70dB)
2) Receive little or no useful benefit from hearing aids
3) Qualified candidates are those scoring, with use of hearing aids, 50 percent or less on sentence recognition tests in the ear to be implanted and 60 percent or less in the non-implanted ear or bilaterally
4) Have no medical contraindications
5) Possess a strong desire to hear
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When a Cochlear Implant might NOT be Suitable
1) Hearing is “too good”:
If a person is able to achieve good speech understanding with hearing aids, then hearing aids are likely a better option than a cochlear implant system.

2) Profound hearing loss for a very long time:
If the auditory nerve and hearing centers in the brain have never been stimulated or have not been stimulated for a very long time, they may not be able to interpret sound information very well.

3) The cochlea is not the main cause of hearing loss:
A cochlear implant cannot help if the main cause of hearing loss lies elsewhere than in the inner ear.

4)Surgery is not likely to be successful:
If the cochlea is in poor condition and cannot receive the electrode, or the auditory nerve is damaged or absent, a cochlear implant is unlikely to provide benefit.  For example, in meningitis, bone growth can occur in the cochlea making implantation very difficulty unless performed soon after the occurrence of meningitis.

5) Medical problems:
Patients need to be healthy enough to tolerate the anesthetic, recover from surgery, and participate in follow-up & rehabilitation programs.

6) Inappropriate expectations:
It is essential for the patients and their families to have realistic expectations of the likely benefit of the cochlear implant system.

7) Inadequate support from family or care-givers:
Support from family and care-givers is a very important factor in the success of cochlear implant use.  In the case of children with cochlear implants, such support is vital.
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Facts about Cochlear Implants

• Cochlear implants can help an estimated 200,000 children in the United States who do not benefit from hearing aids.
• The earlier after birth or after the onset of hearing loss someone is implanted, the better a person performs and benefits from a cochlear implant.
• Approximately 70,000 people worldwide have received cochlear implants.
• Approximately 25,000 people in the United States have cochlear implants.
• Nearly half of all cochlear implant recipients are children.
• The demand for cochlear implants is increasing annually by 20%.
• Approximately 250 hospitals across the country perform cochlear implant procedures.
• A recent study on cochlear implants demonstrated that special education in elementary school is less necessary when children have had "greater than two years of implant experience" before starting school.  These children are mainstreamed at least double the rate of age-matched children with profound hearing loss who do not have implants.
• The benefits of a cochlear implant to society amount to a lifetime savings of $53,198 per child. (Cheng, Rubin, Powe, Mellon, Francis, Niparko, 2000, JAMA)
• By the time a child with hearing loss graduates from high school, as much as $420,000 can be saved in special education costs if the child is identified and given appropriate early intervention.
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For more information, visit the following sites:
1) The CochlearTM web site to learn more about their cochlear implant, Nucleus Freedom:www.cochlearamericas.com
2) The Advanced Bionics web site to learn more about their cochlear implant, Harmony: www.bionicear.com
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