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Types of Hearing Implants

Which hearing implant could be right for you?

There are more than 15,000 Cochlear™ hearing implant recipients in Australia and Cochlear Ltd have provided more than 550,000 implantable devices worldwide.

 

What exactly is a Cochlear Implant (CI)?

The cochlear implant first came into being in Melbourne, Australia in 1982. A collaboration between an audiologist, a professor and two surgeons resulted in the world’s first multichannel cochlear implant. This life-altering technology would go on to become a worldwide solution for those suffering moderately severe to profound hearing loss.

This remarkable device is discretely implanted inside the cochlear and works with a highly compact external speech processor that transmits the sound to the cochlear.

Unlike hearing aids, which amplify sound, a cochlear implant bypasses damaged hair cells in the cochlear and stimulates the hearing nerve directly. A cochlear implant can also be used for patients with acquired single-sided deafness.

There are two main components to a cochlear implant; the implant itself, which is inside the cochlear organ and the highly compact external processor, which can be worn on or off the ear. This processor is connected to the head through a tiny magnet. These tiny processors are technological powerhouses and provide features including Bluetooth connection providing direct and easy access to your mobile phone or iPad any time.

The device is small, compact and technologically savvy, although you don’t need to be technologically savvy to wear it.

 

Are there any age limits?

Provided your general health is good, you meet the criteria, have a good support network and are motivated, age is no barrier for receiving a cochlear implant.

 

Why would I need a Cochlear Implant (CI)?

While the majority of people with hearing loss can be helped with hearing aids, for some, hearing aids are not enough due to the extent of cochlear damage. For these people, simple everyday situations become stressful and challenging; crossing the street, speaking to co-workers, friends and family, going for a walk outside, speaking on the phone and going to the shops. In many cases, all of this leads you to experiencing regular anxiety and exclusion. The things you love doing in life can become difficult and unfulfilling.

A cochlear implant has the ability to change this.

A cochlear implant can be the extraordinary alternative that changes your life and alters your state of mind. In many cases, it allows you to get back to doing what you love, for some, even allows them to start doing things they’ve never done before.

 

How does a Cochlear Implant work?

How the ear hears with a cochlear implant:

  1. Speech Processor:An external speech processor is connected to the head by a tiny magnet, which captures sound and converts it into digital signals.
  2. Digital Signals:The processor transmits the digital signals to an internal implant that is intricately inserted through the tiny cochlear spiral in the middle ear.
  3. Electrode Array:The internal implant converts the signals into electrical energy, sending it to an electrode array inside the cochlear
  4. Hearing Nerve: Electrodes stimulate the hearing nerve, by passing damaged hair cells, and the brain perceives the signals as sound

 

Benefits of a Cochlear Implant

  • Ability to understand speech in one-on-one and group conversations with less dependence on lip reading
  • Identify sounds in the home and outside environment – these might include the telephone ringing, leaves rustling in the wind or a dog barking
  • Follow the topic of conversation and join in on discussions
  • Speak to loved ones on the telephone and understand what they’re saying
  • Listen to music
  • May assist in your professional life – communicate easier with co-workers and work more efficiently
  • Go to events in the evening and be able to converse more easily even though darkness has fallen

The benefits depend on the recipient and their lifestyle but regardless of anything, a cochlear implant has the ability to greatly improve your overall wellbeing and quality of life.

 

What is the process for receiving a Cochlear Implant?

Step 1: The Cochlear Implant Candidacy Questionnaire

To ensure that cochlear implants are fitted to the right candidates at the right time, the Attune cochlear implant team will need to obtain information about your hearing history, the devices you are using to assist your hearing, and to understand your current hearing difficulties. Attune uses this information to advise you and your loved ones of your suitability for a cochlear implant assessment.

Step 2: Referral to Implant Surgeon

Ask your GP for a referral to an Attune cochlear implant surgeon. Cochlear implant surgery is performed by Ear, Nose and Throat (ENT) surgeons with specialist implant training. Your surgeon will advise your medical suitability for implantation.

Step 3: Evaluation and Information Session

When you visit the Attune Cochlear Implant Centre, your audiologist will:

  • Perform a hearing assessment in a purpose-built, soundproof room to identify your level of hearing loss
  • Show you the implanted device, how it works and discuss the potential outcomes specific to you
  • Explain the remaining assessments and what they entail.
  • Explain the post-operative program of training and support we provide
  • Provide information about potential sources of assistance such as phone relay and captions.

*We recommend you bring a family member of loved one to this appointment as a second person can go through the process with you and learn how they can assist you with your implant.

Step 4: Specialist Tests and Investigations

Attune works closely with a team of Ear, Nose and Throat surgeons, audiologists and psychologists with a wealth of experience in this field so you and your loved ones can have peace of mind knowing you are receiving expert care.

These investigations include:

  • Testing your ability to understand speech through your hearing aids
  • CT scan of your ears
  • A balance function test
  • An opportunity for you to meet an implant recipient with a similar story to you – we do this so that you are able to learn from and ask questions of someone who has been in your current situation and experienced the cochlear implant journey with Attune. This is often a highly valuable and comforting process.
  • Discussion to set realistic goals and timeframes and choose the right implant system for you with your audiologist.

Step 5: Schedule of Surgery

If the investigations indicate you are eligible for an implant and it would be of benefit to you, and you decide to proceed, your implant surgeon will schedule your surgery.

Cochlear implantation is a routine procedure performed in a hospital by an Ear, Nose and Throat surgeon. The procedure generally takes one to two hours and most patients stay in hospital for one night.

What does implant surgery involve?

You are encouraged to discuss the surgery and any potential risks at the pre-operation appointment where they will provide you with all the information you need before proceeding.Candidates attend a pre-operative appointment before their implant surgery to ensure they are physically well, manage any medications such as blood thinners, and to explain the implant process and to allow you to ask any questions. The surgeon’s secretaries will notify you when to stop eating and drinking before surgery and when and where to present at the hospital.

Most patients are admitted on the day of surgery and the operations are done under general anaesthetic. The surgery takes between 1-2 hours on average and most patients stay one night in hospital. A head bandage is applied for the initial period after the surgery. You can continue to wear your hearing aid in the non-implanted ear during your recovery. A post-operative check with the implant surgeon typically occurs one week post-surgery.

Depending on the type of work you do, some patents return to work one to two weeks post-surgery: rest and avoidance of strenuous activities and sudden movement are important.

Credit: Dr. Andrew Lomas, Complete ENT / Attune Hearing Ear, Nose and Throat Surgeon

Step 6: Activation of your implant

About 10 to 14 days after your surgery, your speech processor will be turned on by your Attune audiologist. This is probably the most exciting and joyful moment of the whole process so we like to make sure you have your loved ones there to experience this with you!

At this appointment, your Attune audiologist will:

  • Program your speech processor and tailor it to your needs
  • Support and encourage you as you adjust to new sounds
  • Take you through how to operate and care for your device
  • Teach you valuable exercises and activities for you to do at home that will facilitate your adjustment to experiencing new sounds and sensations

Brain plasticity is a crucial part in maximising the incredible benefits a cochlear implant can provide. This is why we incorporate auditory and communication trainingas part of the rehabilitation program. This allows you to maximise your device’s potential and helps you adjust to your new implant at home.

 

What is auditory and communication training and why do we provide it?

Speech sounds very different when the cochlear implant is first activated. Structured listening practice helps you to learn to listen to the implant sound and become more proficient in hearing with your new device. A short period of daily training helps you to see that you are making progress and It helps your frequent communication partner (often a spouse or family member) to understand how to adjust their own speech to make it easier for you. Auditory Training helps recipients and their families to understand the limitations of the implant. For example, how far away can I talk with someone?, Many recipients report that listening practice helped to build their confidence with the new device, especially if they had not heard in the implanted ear for a long period of time.

Auditory training takes place at home usually and can take many forms. These include exercises given by the clinic to do at home with a family member, programs that can be down loaded on to their home computer or tablet, apps, recorded books and other sources that can be accessed by phones direct to the implant.

Communication training explores the broader context by answering questions such as the following:

  • What tools can I use when it’s noisy?
  • Where is the best place to sit in a restaurant if you have a cochlear implant?
  • How can I explain to my GP the best way to communicate with me?
  • What tips can I give my workmates when I return to work with my new CI?
  • What strategies can I use when phone calls don’t go well?

Your Attune audiologist will work through these with you and help you understand and establish tactics to feel as comfortable and confident as possible in every scenario.

 

Throughout the whole implant process, our implant audiologist works closely to support you and ensure your comfort and wellbeing every step of the way.

The Attune cochlear implant program has no waiting lists, giving you and your loved ones immediate access to expert help when you need it most.

 

Is a Cochlear Implant right for me?

If you have moderately severe to profound hearing loss and find hearing aids are not of great benefit, you could be a candidate for a cochlear implant. It is always best to seek advice from a medical professional who can assess your current hearing and advise whether a cochlear implant would be the best solution for you.

 

How do I know which type of Cochlear Implant system is best for me?

The choice of implant system is made collaboratively between the audiologist and the patient. This is dependent upon a number of factors including dexterity, familiarity and comfort with technology, medical status and work or social environment.

There are a wide range of features and benefits available in each type of implant system, which is why we like to get an understanding of your lifestyle so we are able to best advise you on which products and features would benefit you the most. Some of the available features include dual microphones, waterproof options, iPhone control, processor-off-the-ear, wireless accessories, dust and smash proof and disposable and rechargeable batteries. For example, if you are a professional who requires Bluetooth and relies heavily on their smartphone, we would ensure you get a product with a high level of connectivity. Following your investigation and assessment phase, your audiologist will go through the features and benefits of what is available to you and determine the best possible solution for you.

 

Bone Conduction Implants – BAHA and Bonebridge

 

What is a Bone Conduction Implant: BAHA and Bonebridge?

In bone conduction implants, such as the Bone Anchored hearing Aid (BAHA) and Bonebridge implants, external sounds are converted into mechanical vibrations which are sent to the inner ear through the bone.

 

How a BAHA Implant works

  • A titanium device is implanted behind the ear where it integrates with the bone
  • The sound processor attached to the head detects the sounds and coverts them into vibrations
  • An abutment connects the sound processor to the titanium implant
  • The implant then transfers the sounds directly to the cochlear
  • An alternative version using magnetic attachment across skin is also now available and can be discussed with your audiologist

 

How a Bonebridge Implant works

  • A compact and discreet external processor magnetically attached to the scalp collects sound
  • The energy to drive the implant is transferred via an inductive link to the internal coil
  • The signal is processed by a demodulator and relayed to the bone conduction device
  • The device then sends mechanical vibrations via screws to the bone and on to the cochlear

 

Who is suitable for a bone conduction implant?

Patients with the following health conditions may be assessed for a BAHA or Bonebridge implant.

  • Chronic external otitis, otitis media or myringitis
  • Atresia, microtia or stenosis of the external ear canal
  • Severe exostoses
  • Obliterative adhesions of the middle ear
  • Previous middle ear surgery eg. radical mastoidectomy
  • Irregular pinna that will not support a hearing aid eg. due to injury or cancer
  • Allergy to ear mould materials
  • Single sided deafness

 

What is the difference between a Cochlear Implant (CI) and a Bone Conduction Implant?

Which type of implant is recommended as the right solution for you is assessed based on your hearing condition. Cochlear implants are for severe to profound hearing loss, whereas bone conduction implants are for mild to severe hearing loss; conductive hearing loss, single sided deafnessor mixed hearing loss.

Those with mixed hearing loss and conductive hearing loss have a functioning cochlea. Due to a multitude of reasons, the middle ear is not functioning normally, which prevents sound travelling from the outer ear to the cochlear. The bone conduction implants are designed to help the external sounds travel to the cochlear through vibrations and are especially suitable for those who cannot tolerate conventional hearing aids for medical reasons.

Bone induction implants can also be fitted for single-sided deafness, provided that ear has had hearing in the past.

Those suffering from single-sided deafness typically have one ear with anormal hearing and one ‘dead ear’. These patients can wear an external sound processor on the side with hearing loss. This picks up the sound on the dead side and travels it to the side with a functioning cochlea, which allows them to hear sounds from both sides.

What is the process for the candidacy assessment?

  • Determining whether you have had middle ear surgery in the past
  • CT scan of middle ear
  • Audiogram and speech perception assessment
  • History of previous difficulties with hearing aids
  • Motivation and expectations of the outcome
  • Dexterity and overall health
  • Trial of a bone conduction device

 

How is a bone conduction implant managed?

Implant care and management is provided by a highly experienced team of Ear, Nose and Throat surgeons and Audiologists. The management program involves:

  • Periodic checks of the implant site
  • Periodic reviews of hearing levels
  • Regular programming of external sound processor
  • Resources, guidance and support counselling
  • Device management, care and maintenance
  • Most recipients are independent with their device in 1-2 months and after the first year an annual check is provided.

 

How a Bonebridge Implant works

  • An external processor magnetically attached to the scalp collects sound
  • The energy to drive the implant is transferred via an inductive link to the internal coil
  • The signal is processed by a demodulator and relayed to the bone conduction device
  • The device then sends mechanical vibrations via screws to the mastoid bone and then on to the cochlear.

 

Middle Ear Implant

 

What is a Middle Ear Implant?

In middle ear implants such as the Vibrant Soundbridge (VSB), the implant itself is used to convert external signals into vibrations, these vibrations are then picked up by the small bones in the middle ear.

 

How a Middle Ear Implant (VSB) works?

  • The small and discreet external audio processor magnetically attached to the head collects sounds
  • The signals are transmitted across the skin to the implant by radio frequency
  • A conductor link cable relays the signal from the implant to a miniature receiver attached to the small bones in the ear causing it to vibrate
  • These vibrations are then transmitted to the cochlea

 

What is the process for the candidacy assessment?

  • Determining whether you have had middle ear surgery in the past
  • CT scan of middle ear
  • Audiogram and speech perception assessment
  • History of previous difficulties with hearing aids
  • Motivation and expectations of the outcome
  • Dexterity and overall health

 

Footnotes:
https://www.cochlear.com/au/about/cochlear-30-anniversary
Cochlear Internal Data Dec. 2018
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782849/
https://academic.oup.com/jdsde/article/12/3/303/490386
https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/cochlearimplants/ucm062843.htm
https://www.karger.com/Article/Abstract/485586
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