1. Are both adults and children suitable for cochlear implants? Which patients with neurological deafness are not suitable for cochlear implants?
Cochlear implants can be considered for both children and adults (including the elderly) as long as their condition requires it. The basic indications for cochlear implantation are: severe or profound sensorineural deafness in both ears caused by cochlear pathology, hearing loss of more than 3 months, normal psycho-intellectual development, correct understanding and appropriate expectations of the cochlear implant by the family and/or the implant recipient, and conditions for hearing and speech rehabilitation education. However, for adults and children, there are also different ranges of adaptation.
(1) For children under the age of 5: surgery should be considered as long as the above conditions are met.
(2) For children between the ages of 5 and 12: In addition to the above conditions, it is advisable to have some language foundation, otherwise the rehabilitation effect will receive some impact.
(2) For those who are over 12 years old: those who have a language basis, active surgical treatment, the efficacy is mostly better; those who do not have a language basis, the efficacy will be greatly affected.
(3) Patients whose hearing loss is not severe enough for severe or profound deafness in the first place, or whose hearing loss is severe enough only in one ear and not in the other, generally do not require cochlear implantation.
(4) In patients with severe hearing loss in both ears, there are also some cases that are not suitable for cochlear implantation: cases with severe malformation of the inner ear, auditory nerve deficiency, severe mental illness or uncontrollable epilepsy, patients with uncontrolled septic inflammation of the middle ear mastoid, or other diseases that cause poor general condition of the body and cannot tolerate surgery.
2.What items should be checked before cochlear implantation?
(1) Otological and audiological examinations: specialist examination, directional condition audiometry (or pure tone audiometry), acoustic impedance, otoacoustic emissions, ABR latency and threshold, and multi-frequency steady-state audiometry.
(2) Imaging examinations: high-resolution CT examination of the temporal bone, cranial MRI examination, MRI inner ear water imaging examination.
(3) Other examinations of the whole body: examination of heart, lung, liver, kidney function, electrolytes, nutrition and other conditions; psychological, intellectual and spiritual condition assessment.
3.What aspects of assessment should be performed before surgery?
The assessment mainly includes three aspects.
(1) Medical evaluation: The main purpose is to examine the patient’s general health, history of hearing loss, etiology, as well as the condition of the cochlea and the outer and middle ears. This includes etiological assessment, history of hearing loss assessment, radiological examination, etc.
(2) Audiological evaluation: The main purpose is to quantify the patient’s preoperative hearing, communication ability, and the effectiveness of using hearing compensation devices. (2) Audiological evaluation: The main purpose is to quantify the patient’s preoperative hearing and communication abilities and the effectiveness of the hearing compensation devices.
(3) Psychological/rehabilitation assessment: reasonable understanding of the effects of cochlear implant hearing assistance and appropriate expectations; postoperative conditions for hearing speech rehabilitation training, etc.
4. How does a cochlear implant help patients recover their hearing?
The cochlear implant system is divided into two components: the in vitro machine (including the speech processor, coupling coil, power supply system and wires) and the implant (mainly including electrodes and receiving stimulator).
(1) Sound is transmitted through a microphone, encoded on the speech processor, and converted into a special form of digital information.
(2) This information is sent to a coil, which is then transmitted wirelessly to the implant in the body, which decodes the digital information and generates corresponding electrical impulses that are sent to electrodes in the cochlea, where the electrical impulse signals are directly stimulated to the auditory nerve.
(3) The auditory nerve receives the signals and transmits them to the auditory center of the brain, which recognizes these electrical signals as sound.
5. Is cochlear implant surgery minimally invasive? Will it leave scars on the head and neck and affect the aesthetics?
The current cochlear implant surgeries at 301 Hainan are minimally invasive, with small incisions (incision length of about 2.5-3.5 cm) and a layered suture technique that heals well with little skin tension and few post-operative complications, and the wounds are basically invisible without careful identification. (Traditional cochlear implant surgery is a large incision of 6-10 cm, which will leave a longer scar behind the large ear after surgery, unsightly, poor patient acceptance, and high risk of scalp ischemic necrosis)
6. What complications can arise from cochlear implant surgery?
Major complications include: flap infection and necrosis, meningitis due to severe infection, implant silicone allergy, facial nerve injury, etc.
Secondary complications include: subcutaneous hematoma, temporary facial paralysis, dizziness and balance disorders, external ear canal wall breakage and tympanic membrane perforation.
So far, 301 Hainan Branch has successfully performed more than 330 cochlear implant surgeries without major complications, with only three cases of temporary postoperative subcutaneous hematoma, rapid postoperative recovery, and high patient satisfaction.
7. Will hearing be restored after cochlear implantation? What other rehabilitation training is needed?
Hearing aid hearing can be restored to normal level after cochlear implantation. Theoretically, the average hearing threshold can be adjusted to 0dBnHL in a quiet environment, but in a noisy environment, the patient will feel uncomfortable, so in order to achieve a better level of speech recognition in various natural environments and to make the patient feel comfortable, the average hearing threshold is usually adjusted to about 25dBnHL.
Patients with prelingual deafness need to go to a professional rehabilitation training institution for training, including auditory training and speech training; patients with postlingual deafness can gradually adapt to the sound changes under cochlear implant hearing through extensive reading training, and they can generally adapt in about 3 months.
8. What should I do if my hearing is still poor after surgery, or if there is noise? How do I adjust the cochlear implant? How many times does it need to be adjusted?
If the hearing does not improve after the cochlear implant is turned on, first check whether the cochlear implant is in normal working condition to prevent the hearing effect from being affected by incorrect settings of the speech processor, lack of battery power or component failure.
In the case of other conditions such as noise, the first consideration is whether the microphone of the speech processor is working properly, whether the battery is loose, and whether the head piece is firmly connected. “This phenomenon can be quickly adapted to.
The commissioning of the cochlear implant is operated by a professional audiologist, who first selects the stimulation channel and chooses the appropriate stimulation intensity to determine the T and C values for that channel based on the patient’s response. The patient’s subjective experience of hearing sound shows a moderate level of loudness for normal speech, and the louder hearing is comfortable without producing side effects such as headaches, facial nerve twitches, facial muscle spasms, or frequent blinking. The number of channels measured varies with different cochlear brands, and the general tuning time is about 30 minutes.
In general, the machine is turned on 7 days after the surgery, and the first tuning is delayed by 1 month, then the second by 3 months, then by 6 months, and then every year thereafter. For patients with sensitive hearing or those who have repeatedly corrected poor vocalization, the frequency of tuning can be increased, while for patients with better recovery, the frequency of tuning can be reduced.
9.How much does it cost to install a cochlear implant? How much does a cochlear implant usually cost for commissioning?
The cost of cochlear implant installation is mainly divided into the cost of the cochlear implant, medical expenses during hospitalization, and the cost of rehabilitation training at a rehabilitation training institution.
(1) The cost of cochlear implants (unilateral implantation) varies greatly depending on the brand chosen and the combination of electrodes and speech processor chosen by the same brand.
(2) Medical expenses during hospitalization, which basically include hospitalization, medical treatment, surgery and related examination costs, generally range from 12,000 to 20,000 RMB, and the hospitalization period is about 10 days. In addition, there is a post-discharge transfer cost of 200-300 RMB per transfer.
(3) The cost of rehabilitation training at post-operative rehabilitation institutions may vary somewhat depending on the rehabilitation institution chosen and the patient’s speech foundation.
10. Can cochlear implants be used for life?
The cochlear implant is divided into two components: the implanted electrodes are designed for lifetime use and need to be re-implanted if they are damaged by force majeure; the in vitro part can be replaced with a new generation of processor according to individual needs in order to improve the hearing effect. Of course, if the cochlear implant is damaged due to human damage, loss, water ingress, etc., it will need to be repaired or purchased separately.
Other notes.
Documents to be brought to the clinic: identification documents (such as ID card, family register, etc.), previous medical records (including examination and test reports, CT and MRI imaging films, audiology-related examination reports, etc.).
Precautions during the clinic: cooperate with each examination room to complete relevant examinations according to the doctor’s instructions; please register in advance due to the large number of patients.