As more and more bilateral cochlear implant surgeries are being performed, the understanding of bilateral simultaneous and staged implantation is becoming deeper and deeper.
How much of a difference is there in hearing improvement with bilateral implants compared to unilateral implants?
According to the available literature on bilateral implantation, objective audiological findings show that
1. The hearing threshold of bilateral implantation is lower than that of unilateral implantation, and lower means more sensitive hearing.
2. Speech recognition in a quiet environment is about 18.7% higher in bilateral implants than in unilateral implants, which means that in the same environment, bilateral implants can understand 18-19 words more than unilateral implants out of 100 words.
3. Sentence recognition in a noisy environment: when noise and speech came from the same ear, sentence recognition was 31.1% higher with bilateral implants than with unilateral implants, and when noise and speech came from different ears, sentence recognition was 10.7% higher with bilateral implants than with unilateral implants. This means that bilateral implants allow for truly free communication when in a noisy environment.
Does bilateral implantation mean that future technology updates will not be available?
In the early days, it was advocated to implant one side first and leave the other side to enjoy the new technology in the future. This was a very reasonable proposition at the time. However, as things stand now, it seems that new technologies such as gene therapy still require a wait of at least 10 years, after which the neurological function of the side without sound stimulation will deteriorate significantly. Therefore, the notion of leaving one ear uninterrupted for new technologies is unrealistic (statistically, less than 10% of unilateral implant recipients wear hearing aids on the opposite side for long periods of time).
The latest cochlear implants are designed with soft electrodes and ultra-soft electrodes that are softer, slimmer and thinner, specifically designed to protect the microstructure of the cochlea, and now the clinical minimally invasive implantation techniques are very mature and can be done with a round window approach. The minimally invasive surgery itself has no direct impact on the basilar membrane and the hearing structures such as hair cells.)
And, only now the activity of the auditory nerve and center can be maintained by sound stimulation, which is meaningful for the future application of the technology.
Is there much damage and surgical risk to the child with bilateral simultaneous implants?
Cochlear implantation is a small to medium invasive surgery with little tissue damage, minimal bleeding and short anesthesia time. The latest cochlear implants can be well implanted with a small incision of 3-4 cm. There is no particular damage to the child, whether the implant is bilateral or unilateral. The surgical risks are also effectively controlled by the delicate operation (Soft surgical protocols), so the surgical technique has developed to a point where it is controllable and safe.
Is it possible to match the hearing of two sides with a long interval between implantations? Does it make sense?
Bilateral implantation with a longer interval requires a process to match both sides compared to simultaneous bilateral implantation. After all, the posterior implant has not been heard for a longer period of time. How long does it take for the posterior implant side to match the previously implanted side? This has to do with the tuning of the second side. The tuning allows both sides to be tuned to the maximum range of loudness tolerated by the patient, and both sides will have equal loudness levels, with an average adaptation time of 3-6 months to reach the desired hearing level.
Bilateral implantation brings greater benefits to the user’s life and work, whether it is a noisy environment or a quiet environment, speech communication ability and tone recognition, and music appreciation.
Is it ugly to wear both sides of the cochlear implant after bilateral implantation?
Cochlear implant in vitro units have also been designed to be smaller and more aesthetically pleasing. The latest cochlear implant processors are very small and a variety of user-friendly wearing styles allow the processor to be worn in other positions, such as hairpin style for girls and cap style for boys, both of which can conceal the processor well. There are two directions for the future development of in vitro machines: all-in-one machines and in-the-ear machines. It will be just in time to catch up with these technologies when the child is a little older and has a stronger need for aesthetics and image. Bilateral implantation emphasizes early implantation to achieve the best match and best results on both sides.
Besides better hearing, are there other benefits of bilateral implantation for the child?
Research has proven that in addition to superior hearing and speech skills for children with bilateral hearing compared to those with unilateral hearing
They also have better social, psychological, emotional, and success patterns than children with unilateral hearing. Data show that more than 35% of children with unilateral hearing (where one ear is completely normal and the other is deaf) repeat at least one year of school, and more than 60% require additional assistance in learning. In addition, with no sound stimulation on one side of the brain and uneven development of the left and right brains, the overall intelligence level of this population is poorer than that of children with binaural hearing.
The resulting social-psychological-emotional impairment and the difference in the pattern of success cannot be ignored. Bilateral implantation restores the hearing of both ears of the child and makes learning and work communication much easier compared to unilateral. If parents and friends have high orientation and requirements for their children, timely bilateral implantation can be a definite benefit to the child’s development.
Are there any special considerations for bilateral implantation in daily life after implantation?
In daily life, there are two precautions for children with bilateral implantation: the program of the processor on both sides cannot be used alternately, and parents should mark both sides of the processor to be worn properly, so that they do not wear the wrong one. Bilateral wearing try to place in bilateral direction or bilateral ear, so that it is more beneficial for the child to hear the sound and direction discrimination in all directions.
Is there any special attention when tuning a child with bilateral implants?
When tuning, parents should reflect to the tuner the auditory performance of both sides, such as speech recognition and hearing sensitivity in one ear, as well as the child’s daily sound localization. To assist the tuner in adjusting the program.