All About Cochlear Implants

• What is a Cochlear Implant?
• How does a Cochlear Implant Work?
• Who Might Benefit?
• What Might I Hear?
• What Results are Typical?
• Medical Exclusion Factors
• The Implant Operation
• Costs
• Initial Cochlear Implant Evaluation
• Resource Support from the Manufacturers

What is a Cochlear Implant?

A cochlear implant is an electronic device that provides sound to individuals with severe-to-profound hearing loss. A cochlear implant bypasses damaged structures of the inner ear and directly stimulates the auditory nerve.

How does a Cochlear Implant Work?

1. Sounds are picked up by a microphone and turned into an electrical signal.
2. The electrical signal is sent to a speech processor (worn either on the body or the ear) where it is "coded" or turned into a special pattern of electrical pulses.
3. Electrical pulses are sent to the coil or headpiece where they are transmitted across the skin by radio waves to the cochlear implant.
4. The cochlear implant sends a pattern of electrical pulses to the electrodes, which are found on the electrode array, which has been implanted in the cochlea.
5. The auditory nerve picks up the tiny electrical pulses and sends them to the brain.
6. The brain recognizes these signals as sound.

Detailed information about specific brand-name cochlear implants is available from the manufacturers Web sites (Advanced Bionics, Cochlear Corporation, Med-El Corporation and others operating primarily in Europe).

Who Might Benefit From a Cochlear Implant?

• Adults and children with severe to profound sensorineural hearing loss in both ears
• Children who are 12 months (younger in some cases) to 18 years of age and adults of any age
• Individuals who receive insufficient benefit from hearing aids
• Children who can receive family and educational support
• Individuals and families with appropriate expectations and an understanding of the necessary follow-up
• Individuals who are willing to wear the external apparatus

Parents of children who receive cochlear implants must appreciate the considerable time commitment involved in the process of cochlear implantation and the ongoing educational process. They must agree to return with the child to the implant center for follow-up testing and monitoring of the cochlear implant. The parents also must be willing to cooperate and work with the child's educators to provide appropriate habilitation.

What Might I Hear Through a Cochlear Implant?

Patients have described the initial sounds of speech through a cochlear implant as:

• "Computer," "fax machine," or "Mickey Mouse" speech
• "Beeps" or "noise"
• A radio not quite tuned in

Generally, over time the brain becomes accustomed to this new sound and starts to view it as "normal."

What Results are Typical of a Cochlear Implant?

The cochlear implant will provide the ability to hear sound. The degree to which a person can understand speech varies greatly. Some individuals are unable to understand speech without visual cues, while others can easily use the telephone. We continue to conduct research focused on understanding why there is such great variability in performance post-implantation.

General trends observed in the pediatric cochlear implant population:

• Children who use their cochlear implants on a full-time basis tend to understand more speech than those who do not
• Children born deaf who are implanted at a younger age tend to understand more speech post-implantation

General trends observed in speech and language development of pediatric cochlear implant users:

• Speech production skills mirror listening skills
• Speech production skills can continue to improve after an extended period of time
• Language skills seem to improve at a faster rate than children with profound hearing loss who do not wear cochlear implants
• Reading skills of cochlear implant users appear to surpass what has been historically reported in deaf children in that cochlear implant users tend to track more closely to their hearing peers than do their peers with profound hearing loss who use hearing aids

Medical Factors That Might Exclude You from Implantation

Contraindications include deafness due to lesions of the acoustic nerve or central auditory pathway, active middle ear infections, absence of development of the cochlea. In addition, health issues that would not allow a candidate to undergo surgery also apply.

The Implant Operation

The operation for a cochlear implant takes about 3-4 hours and is done under general anesthesia. Patients should expect to spend 1- 2 nights in the hospital. Typically, patients check in on the day of surgery, stay overnight in the hospital, and are discharged the next day. The hair around the ear will be shaved, but grows back in its normal manner.

Costs

The costs of the cochlear implant device, operation and first three months of post-operative audiology visits may total $60,000 to $65,000, depending on a number of medical and nonmedical factors. These costs are the responsibility of the patient's family and their health insurance plan or other third party payor. Cochlear implant devices are typically warranted for a period of three years, but thereafter maintenance of the device is the responsibility of the user. Purchase of maintenance contracts from the manufacturer is strongly advised (currently these contracts are priced at around $300-400/year). Some insurance contracts will cover a majority of the costs of implantation. Medicaid may cover a smaller portion; but in both cases it is necessary to obtain prior approval of benefits. Medicare will cover a portion of the costs and supplementary contracts, an additional portion beyond Medicare payments. Once cochlear implant candidacy is established, our patient coordinator will assist in acquiring prior approval from a patient's insurance company for the procedure. It is each patient's own responsibility to work with his or her insurance company in determining what the patient's "out-of-pocket" costs will be.

What Happens at the Initial Cochlear Implant Evaluation?

Below is an outline of what patients can expect at their initial cochlear implant evaluation. The initial evaluation is a cooperative procedure. Patients should expect a full day of diagnostic testing and counseling, which will be provided by many different individuals within our department.

1. Audiology. A complete diagnostic audiological evaluation will be completed to determine the type and degree of hearing loss.
2. Hearing Aid Clinic. An audiologist in the hearing aid clinic will first assess the benefit (if any) that you receive from properly fit hearing aids. You will be tested with the hearing aid(s) you are currently wearing. If you do not currently wear hearing aids, you will be temporarily fit with hearing aids just for the duration of this test. It is important that you bring your own hearing aids and earmolds to this evaluation even if you have not been wearing them.
3. Examination by an Implant Audiologist and other Research Personnel. Aided speech perception testing will be administered to determine if you are audiologically an implant candidate. The audiologist will discuss the implant in detail and review what patients gain from its use. Pediatric patients will be evaluated audiologically and by caregiver report.
4. Examination by an Otologist (Ear Doctor). The otologist will examine and question you to determine the cause of your hearing loss and to determine if you are medically an implant candidate.
5. Computerized Tomography (CT) Scan. An x-ray technician will position you inside the scanner. As the equipment rotates, it will photograph successive one-millimeter layers of the inner ear. This will determine if the anatomy of your inner ear is adequate for placing a cochlear implant. Contrast dye will not be used, therefore you can eat regular meals prior to this test.

Meeting with the Otologist/Patient Coordinator. The otologist will review the CT scan results and make a recommendation regarding implantation. If you meet cochlear implant criteria and have chosen to receive the implant, the otologist will answer any further questions you may have regarding the surgery. The Patient Coordinator will review the costs of the implant procedure and discuss insurance coverage and requirements for follow-up visits. Surgery will then be scheduled pending insurance authorization.

Remember Your Cochlear Implant Manufacturer

We would like to remind all of our patients that your cochlear implant company can be a great source of information.  Cochlear implant companies provide not only 24 hour audiological support and assistance when troubleshooting your equipment, but are also there to answer all of your questions and can provide such information as how to optimize your telephone use, which cell phones are the best for your device and how to use hearing accessories.

Please visit your cochlear implant website to become familiar with the plthethora of wonderful information that is available.

Cochlear Americas

400 Inverness Parkway
Suite 400
Englewood Colorado 80112
USA
Toll Free: 1 800 523 5798
Telephone: 1 303 790 9010
Fax: 1 303 792 9025

www.cochlearamericas.com

Customer Service
1-877-883-3101
Available for any questions you may have

myCochlear.com    
Online ordering system                          

Hear Always
1-800-483-3123
Recipients support and troubleshooting

OMS Insurance Support         
1-800-663-4667
Reimbursement experts 

Reimbursement
1-800-663-4667
Medicare and Medicaid billing

Advanced Bionics Corporation

25129 Rye Canyon Loop
Valencia, CA 91355
1-800-678-2575
www.bionicear.com

Customer Care (Customer Service)      
1-877-829-0026  
1-800-678-3575 TTY
CustomerService@advancedbionics.com

Insurance Services
1-877-779-0229                     
1-800-678-3575 TTY            
insurance@advancedbionics.com                                                       

Bionic Ear Association (BEA)

1-800-678-2575
(661) 362-1400
hear@advancedbionics.com
A cochlear implant community offering dynamic programs to assist CI candidates and recipients in building their knowledge base and understanding of CI technology, use of accessories, assistive-listening devices, and other cutting-edge technology.

Check out Advanced Bionics NEW Online Community and the Listening Room: www.HearingJourney.com