The theme of the “Ear Care Day” on March 3 is “Cochlear Implant DD: Hope for Rebuilding Hearing”. This fully reflects our government’s determination and awareness to further increase public awareness that cochlear implants can rebuild hearing and effectively improve the rehabilitation of children with severe hearing impairment. As an otolaryngologist, it is my duty to popularize the knowledge of hearing impairment prevention and rehabilitation and to promote the sustainable and healthy development of hearing impairment prevention and rehabilitation in China. I will not repeat the information about the principle and superiority of cochlear implantation, which has been introduced in the related media. A hearing aid, as the name implies, is a device that amplifies sound to help deaf patients hear it, and it achieves the role of an amplifier. However, because some patients with severe or profound deafness have more severe hearing loss, the average hearing threshold in the speech frequency area is often more than 90 decibels, so it is difficult to hear even after amplification, and the effect is still poor after wearing hearing aids. The fundamental difference between a cochlear implant and a hearing aid is that a cochlear implant can bypass the damaged inner ear and directly stimulate the auditory nerve fibers to enable the patient to regain hearing, whereas a hearing aid cannot. What is the best age for cochlear implantation? There is no strict age limit for cochlear implantation. However, due to problems with the language center, if the patient is too old, he or she will miss the language development period. Generally speaking, the best age is between 12 months and 5 years of age. The best time to have an implant is before the deaf child is 5 years old, because the child’s most active hearing development is between 12 months and about 5 years of age, which is the peak of receptive language development, and the ability to receive language decreases significantly after this stage. If the patient can wear hearing aids for 3 to 6 months before surgery and conduct hearing rehabilitation training, it will help a lot to improve the speech ability after surgery. 6-12 years old belongs to the second stage, which requires a period of speech rehabilitation training to reach the parents’ expectation level; for children over 12 years old, parents should have reasonable expectations because they have missed the speech development period. Therefore, it is recommended that parents who have been diagnosed with a cochlear implant to restore hearing should choose a cochlear implant for their child as soon as possible, so as not to miss the best speech development period for their child! How long does a cochlear implant take? The cochlear implant consists of two parts: the inner ear and the outer ear. The inner ear is surgically implanted into the cochlea and between the muscles of the head and the skull. The surgery usually takes 2-3 hours. The post-operative wound healing time takes 7-10 days. One month after the wound has healed, the patient returns to the hospital to be fitted with an external device and to be adjusted. Specialists and audiologists will activate the computer program in the speech processor and adjust the program in the speech processor according to the patient’s comfort level with the sound, so that the patient can hear the sound more comfortably. The patient needs to come to the hospital regularly to have the speech processor tuned, as the patient needs a period of adjustment to the sounds he or she will hear after the implant. At the same time, the patient has to undergo hearing and speech rehabilitation. For post-speech deaf patients, training usually takes a few months, while for pre-speech deaf patients, it takes 2-3 years to achieve the desired results. What are the contraindications to cochlear implantation? Not all deaf patients can undergo cochlear implantation. There are two types of contraindications: one is absolute contraindication, including severe malformation in the ear, no cochlear malformation, severe mental retardation, children with mental retardation or other conditions that prevent them from cooperating with language training, and inflammation of the middle ear mastoid that has not yet cleared. Second, relative contraindications: those with poor physical condition; uncontrollable epilepsy; and those with insufficient conditions for rehabilitation training. V. What are the complications of cochlear implant surgery? Complications of cochlear implant surgery have a lot to do with the surgical operation, such as the smoothness of implantation, the depth and location of electrode implantation, etc.: 1. postoperative wound non-healing or hematoma formation; 2. facial paralysis, the incidence of which is about 2%. Most of them are transient and can be treated conservatively; 3. Non-auditory stimulation, including facial nerve stimulation, pain, vestibular spinal nerve reflex, etc.; 4. Electrode dislocation or folding, which often occurs in the mastoid rhizotomy cavity and requires re-surgical implantation. Therefore, attention should be paid to the intraoperative electrode fixation; 5. The implant malfunctions and needs to be replaced. According to European statistics, 95 percent of cochlear implants are still in use after ten years. The main reasons for replacing the cochlear implant are: trauma, mechanical failure, and the patient’s own desire to replace the product. VI. Does improper cochlear implantation increase the risk of meningitis? Dr. Wei and colleagues at the University of Melbourne, Australia, studied the risk of meningitis in rats that suffered inner ear damage during cochlear implantation and those that did not. They report in the journal Otolaryngology-Head and Neck Surgery that inner ear injury during cochlear implantation significantly increases the risk of meningitis. The researchers observed a high risk of meningitis for at least four weeks after the procedure. In contrast, cochlear implants without inner ear damage do not increase the risk of meningitis. Do children hear the same sounds as normal people after cochlear implantation? Children with cochlear implants are able to detect most medium and high intensity sound signals, as well as many weaker sounds. Some children report that they can hear footsteps, knocks on doors, engines, phone rings, dogs barking, kettles whistling, leaves rustling, lights switching on and off, and more. We have learned from patients who have learned to speak and are deaf for other reasons that the sounds heard through the cochlear implant are different from “normal sounds”. Users begin to describe the sounds they hear as “machine sounds”, “artificial sounds” or “synthetic sounds”. The patient’s speech understanding improved over time, and most users stopped noticing the difference after a few weeks. Because children can make better use of new information than adults, they can expect to get more help from cochlear implants. Severe hearing impairment can have a significant impact on a child’s ability to learn language and overall development. Most children with cochlear implants have higher levels of language skills and intelligence than children with hearing aids. Results from foreign studies show that the effects of cochlear implants vary greatly among individuals. However, most users have results from the time they are turned on, and generally reach stability after about three months. After that, hearing performance continues to improve, and the younger the age of the implant, the faster it progresses. Typically, many users experience sustained improvement in hearing performance over several years. Many users are able to make phone calls and understand acquaintances speaking on the phone. Some users with good results are able to make phone calls as well as normal people, and can even understand unfamiliar people. For many cochlear implant users, watching television is relatively easy, especially if the user can see the face of the speaker. Radio, on the other hand, is a little more difficult because there are no visual cues to help. Some users can enjoy music. They can enjoy musical instruments (such as piano or guitar) or songs. Many users can understand speech without relying on lip reading. And even when this is not possible, cochlear implants can be helpful for lip reading. What are the most common failures of cochlear implants? What are the long-term effects of cochlear implants? What are the common failures? To answer these questions, German audiologists such as Batemen meticulously and thoroughly analyzed their vast database of cochlear implant patients accumulated over 23 years. They analyzed the cumulative survival of 3,417 patients who received cochlear implants in Germany, including their survival rates with different models and brands of cochlear implants. The researchers found that cochlear failure was extremely rare and that isolated failures occurred almost exclusively in the pediatric population. The most common failure of cochlear implants was leakage of the ceramic and silicone shells, followed by failure due to external forces, with a 5.5% failure rate for all cochlear implants, i.e., only 173 out of 3417 cochlear implant cases. Why do I need speech training after cochlear implantation? Post-operative rehabilitation includes commissioning and comprehensive hearing and speech training. A child with prelingual deafness is just starting to hear sounds after the cochlear implant is turned on. His/her hearing age is only 0 years old and he/she needs to start from the beginning, hear sounds, gradually discriminate, understand and then start speaking. Therefore it takes longer than normal children to adapt to training. Do I need to wear a hearing aid in the other ear if I don’t have a cochlear implant? It is often recommended that parents wear a hearing aid in the other ear without a cochlear implant because the auditory nerve center will atrophy over time without acoustic stimulation. In a survey conducted by someone, patients who wore hearing aids on one side for a long period of time had little change in their pure tone threshold during a hearing test, but their language comprehension decreased significantly, indicating degenerative changes in the auditory center. Therefore, in order to avoid atrophy of the auditory center on the other side, it is theoretically possible to use a cochlear implant while wearing a hearing aid on the other side. However, the prerequisite for wearing a hearing aid is a certain number of hair cells. If too many hair cells are missing, the sound heard with the hearing aid is often distorted, and this can interfere with the use of the cochlear implant. Therefore, some children may be reluctant to use their hearing aids after the cochlear implant, so parents should do their best.