Georgia State University Georgia State University SeriesSeries

Cochlear ImplantsCochlear Implants

Part 2, Presentation 1Part 2, Presentation 1

July 2001July 2001

Cochlear ImplantsCochlear ImplantsDr. EasterbrooksDr. Easterbrooks

What is a Cochlear What is a Cochlear Implant?Implant?

The cochlear implant (CI) is a The cochlear implant (CI) is a prosthetic replacement for the prosthetic replacement for the inner ear (cochlea) and is only inner ear (cochlea) and is only appropriate for people who appropriate for people who receive minimal or no benefit receive minimal or no benefit from a conventional hearing aid.from a conventional hearing aid.

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The cochlear implant The cochlear implant bypasses damaged bypasses damaged parts of the parts of the inner earinner ear and electronically and electronically stimulates the nerve stimulates the nerve of hearing. Part of the of hearing. Part of the device is surgically device is surgically implanted in the skull implanted in the skull behind the ear and behind the ear and tiny wires are inserted tiny wires are inserted into the cochlea. into the cochlea.

http://www.listen-up.org

Cochlear Implant HistoryCochlear Implant HistoryPre-1960’sPre-1960’s

- beginning studies of - beginning studies of electrical stimulation on electrical stimulation on humans humans 1960’s1960’s

- active research of - active research of electrical stimulation in electrical stimulation in human human earsears1970’s1970’s

- first wearable implants - first wearable implants designed for long-term designed for long-term

stimulationstimulation1980’s1980’s

- commercial - commercial development of the development of the cochlear implant device cochlear implant device beganbegan

……continuedcontinued 19851985

- United States Food & - United States Food & Drug Administration Drug Administration (FDA) granted the first (FDA) granted the first approval for approval for

implantation implantation in adultsin adults 19901990

- FDA granted - FDA granted approval approval for cochlear for cochlear implants in implants in childrenchildren

Today Today - cochlear implantation - cochlear implantation

is is a safe and effective a safe and effective medical procedure for medical procedure for individuals who are individuals who are severely to profoundly severely to profoundly deaf with minimal deaf with minimal

benefits benefits from from conventional hearing conventional hearing aidsaids

http://216.133.14.145/gettingstarted/history.htmhttp://216.133.14.145/gettingstarted/history.htm

Who is a Candidate?Who is a Candidate?

Candidates for implants are Candidates for implants are adults or children (two adults or children (two years or older) with all of years or older) with all of the following:the following:

Profound or severe hearing Profound or severe hearing loss in both ears (this includes loss in both ears (this includes people with so-called "nerve" people with so-called "nerve" deafness). deafness). Hearing aids but receive little Hearing aids but receive little or no benefit from them in or no benefit from them in understanding speech by understanding speech by listening alone. listening alone.

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No medical reason to No medical reason to avoid surgery. avoid surgery. A desire to interact with A desire to interact with the hearing world and to the hearing world and to communicate with spoken communicate with spoken language. language. Realistic expectations Realistic expectations about results.about results.

http://text.nlm.nih.cdc/www/100txt.htmlhttp://text.nlm.nih.cdc/www/100txt.html

Four Basic Parts of a Cochlear Four Basic Parts of a Cochlear ImplantImplant

A A microphonemicrophone, which picks up , which picks up sound from the environment; sound from the environment;

A A speech processorspeech processor, which , which selects and arranges sounds selects and arranges sounds picked up by the microphone; picked up by the microphone;

Continued…Continued…

A A transmittertransmitter and and receiver/ stimulatorreceiver/ stimulator, , which receive signals from the speech which receive signals from the speech processor and convert them into electric processor and convert them into electric impulses; impulses; And And electrodeselectrodes, which collect the impulses , which collect the impulses from the stimulator and send them to the from the stimulator and send them to the brain. brain.

www.nidcd.nih.gov/health/pubs_hb/coch.htmwww.nidcd.nih.gov/health/pubs_hb/coch.htm

How Does a CI Work?How Does a CI Work? Sound is received by an Sound is received by an

microphone that rests over the microphone that rests over the ear like a behind-the-ear hearing ear like a behind-the-ear hearing aid. aid.

Sound is sent from the Sound is sent from the microphone to the signal microphone to the signal processor by a thin cable. processor by a thin cable.

Signal processor translates the Signal processor translates the sound into electrical codes. sound into electrical codes.

Codes are sent by a thin cable Codes are sent by a thin cable to the transmitter held to the to the transmitter held to the scalp by its attraction to a scalp by its attraction to a magnet implanted beneath the magnet implanted beneath the skin. skin.

……continuedcontinued Transmitter sends codes across Transmitter sends codes across

the skin to a receiver/stimulator the skin to a receiver/stimulator implanted in the mastoid bone. implanted in the mastoid bone.

Receiver/stimulator converts the Receiver/stimulator converts the codes to electrical signals. codes to electrical signals.

Electrical signals are sent to the Electrical signals are sent to the specified electrodes in the array specified electrodes in the array within the cochlea to stimulate within the cochlea to stimulate neurons. neurons.

Neurons send messages along Neurons send messages along the auditory nerve to the central the auditory nerve to the central auditory system in the brain auditory system in the brain where they are interpreted as where they are interpreted as sound.sound.

hhttpttp://www.listen-up.org://www.listen-up.org

Subject factors that might affect Subject factors that might affect the performance of the performance of

the CI:the CI:EtiologyEtiologyAge and Onset of DeafnessAge and Onset of DeafnessAge at ImplantationAge at ImplantationResidual HearingResidual HearingFunctioning auditory nerve Functioning auditory nerve For adults: Good speech, For adults: Good speech, language, and language, and communication skills communication skills Good motivation Good motivation Support from family and Support from family and friendsfriends

http://text.nlm.nih.govhttp://text.nlm.nih.gov

What is involved in an evaluation?What is involved in an evaluation?

Ear examination to Ear examination to determine cause of determine cause of hearing loss and hearing loss and absence of infection. absence of infection. Medical examination Medical examination for eligibility for for eligibility for surgery and surgery and anesthesia. anesthesia. Hearing ability testing, Hearing ability testing, with and without best-with and without best-fit hearing aid. fit hearing aid.

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Evaluation of Evaluation of communication skills. communication skills. CT scan to determine CT scan to determine patency of the inner patency of the inner ear (cochlea). ear (cochlea). In adults - balance In adults - balance tests to determine the tests to determine the risk of postoperative risk of postoperative dizziness.dizziness.

http://depts.washington.edu/otoweb/http://depts.washington.edu/otoweb/cochlear_implants.htmlcochlear_implants.html

SurgerySurgeryRisks are the same for Risks are the same for any other ear surgeryany other ear surgery

Risks are considered Risks are considered minimalminimal

Procedure takes Procedure takes approximately 1-2 hoursapproximately 1-2 hours

Hospital stay is usually Hospital stay is usually one day for adults and 1 one day for adults and 1 to 2 days for childrento 2 days for children

http://depts.washington.edu/otoweb/http://depts.washington.edu/otoweb/

cochlear_implants.htmlcochlear_implants.html

What is involved in a What is involved in a CI follow-up?CI follow-up?

For Adults:For Adults:

* weekly adjustments of the * weekly adjustments of the MAP and communication MAP and communication

therapy for the first month.therapy for the first month.

* treatment focuses on * treatment focuses on auditory training, speech auditory training, speech reading, reading, music, telephone use music, telephone use & & communication strategies.communication strategies.

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For children:For children:

* after the initial 3 * after the initial 3 month period, children month period, children are usually seen every are usually seen every 3 months for the 3 months for the first first year and every 6 year and every 6 months months for the second for the second and and third years. third years. Thereafter, Thereafter, they they are seen annually.are seen annually.

* MAP is closely * MAP is closely monitored.monitored.

http://depts.washington.eduhttp://depts.washington.edu

MappingMapping

Programming Programming

StimulatingStimulating

Choosing frequenciesChoosing frequencies

Speech CodingSpeech Coding

http://www.listen-up.org “Mapping for Dummies”

Myths about Cochlear ImplantsMyths about Cochlear Implants

People with Cochlear People with Cochlear Implants are only able to Implants are only able to distinguish environmental distinguish environmental noises, not comprehend noises, not comprehend speech.speech.After someone gets a After someone gets a Cochlear Implant, they're Cochlear Implant, they're immediately able to hear immediately able to hear normally and talk on the normally and talk on the phone.phone.Cochlear Implants fix or Cochlear Implants fix or cure deafness.cure deafness.

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Cochlear Implants weaken the skull Cochlear Implants weaken the skull so if someone with a Cochlear so if someone with a Cochlear Implant gets hit in the head, they Implant gets hit in the head, they will fracture their skull.will fracture their skull.The electrodes in a Cochlear The electrodes in a Cochlear Implant go into the brain.Implant go into the brain.Cochlear Implant surgery is brain Cochlear Implant surgery is brain surgery.surgery.The cord for the Cochlear Implant The cord for the Cochlear Implant comes out of the neck.comes out of the neck.People with Cochlear Implants are People with Cochlear Implants are unable to go swimming.unable to go swimming.

The ControversyThe ControversyThere are two camps with There are two camps with very different opinions very different opinions about the Cochlear about the Cochlear Implant. Implant.

There are those who see There are those who see the CI as a gift and a the CI as a gift and a miracle that will enhance miracle that will enhance the quality of life for some the quality of life for some deaf and hard of hearing deaf and hard of hearing individuals.individuals.

There are those who see There are those who see the CI as a threat to Deaf the CI as a threat to Deaf Culture and as a tool that Culture and as a tool that considers Deafness as a considers Deafness as a disability.disability.

Opinions in Favor of the CIOpinions in Favor of the CIGives accessibility to language at Gives accessibility to language at the critical age for language the critical age for language acquisition, assuming the oral acquisition, assuming the oral method is used.method is used.The surgical procedure, while The surgical procedure, while invasive, is no more invasive invasive, is no more invasive than routine operations such as a than routine operations such as a tonsillectomy.tonsillectomy.Gives access to a world of Gives access to a world of education, social contacts, etc. education, social contacts, etc. as a hearing child.as a hearing child.Possible avoidance of being Possible avoidance of being labeled, teased, isolated, etc. as labeled, teased, isolated, etc. as a “disabled” child.a “disabled” child.Gives ability to be aware of Gives ability to be aware of sounds.sounds.Allows individuals to function Allows individuals to function more “normally” in a hearing more “normally” in a hearing world.world.http://www.listen-up.orghttp://www.listen-up.org

Opinions Against the CI Opinions Against the CI The CI is ethically wrong. Being Deaf The CI is ethically wrong. Being Deaf is a birth right and not a disability. is a birth right and not a disability. A large portion of the Deaf Community A large portion of the Deaf Community sees the CI as a threat to its very sees the CI as a threat to its very identity. identity. The implant perpetuates the idea that The implant perpetuates the idea that Deafness is a disability that should be Deafness is a disability that should be remediated.remediated.Invasive surgery should be reserved Invasive surgery should be reserved for life-threatening situations, not for life-threatening situations, not simple life enhancements.simple life enhancements.Offered the choice, many adults reject Offered the choice, many adults reject the implant.the implant.Decisions are made for children when Decisions are made for children when the long-term effects are still the long-term effects are still unknown.unknown.The surgery makes a life-time The surgery makes a life-time commitment for a child.commitment for a child.

The The CHOICE CHOICE is is

YOURSYOURS

ResourcesResourceshttp://216.133.14.145/gettingstarted/history.htmhttp://216.133.14.145/gettingstarted/history.htmhttp://text.nlm.nih.govhttp://text.nlm.nih.govhttp://depts.washington.edu/otoweb/cochlear_implants.htmlhttp://depts.washington.edu/otoweb/cochlear_implants.htmlhttp://www.listen-up.orghttp://www.listen-up.orghttp://www.rnid.org.uk/html/info_factsheets.htmhttp://www.rnid.org.uk/html/info_factsheets.htmhttp://deafness.about.com/health/deafness/gi/dynamichttp://deafness.about.com/health/deafness/gi/dynamichttp://www.entnet.org/cochlear-implant.htmlhttp://www.entnet.org/cochlear-implant.htmlhttp://www.pbs.org.wnet/soundandfury/cochlear/debate.htmhttp://www.pbs.org.wnet/soundandfury/cochlear/debate.htmhttp://www.nidcd.nih.gov/health/pubs_hb/coch.htmhttp://www.nidcd.nih.gov/health/pubs_hb/coch.htmhttp://www.dww.deafworldweb.org/pub/c/ci.htmlhttp://www.dww.deafworldweb.org/pub/c/ci.htmlwww.cochlear.comwww.cochlear.comwww.cochlearimplant.comwww.cochlearimplant.comwww.hei.org/htm/cocimqu.htmwww.hei.org/htm/cocimqu.htmhttp://www.awesome-ears.com/contro.htmlhttp://www.awesome-ears.com/contro.htmlwww.zak.co.il/deaf-info/old/ci-opinions.htmlwww.zak.co.il/deaf-info/old/ci-opinions.html

GlossaryGlossaryAuditory TrainingAuditory Training – instruction designed to maximize an individual’s use of residual hearing by – instruction designed to maximize an individual’s use of residual hearing by means of both formal and informal listening practicemeans of both formal and informal listening practice

EtiologyEtiology – physiological reason or cause for any anomaly – physiological reason or cause for any anomaly

MAPMAP – specifications of threshold, suprathreshold, and frequency by which the speech – specifications of threshold, suprathreshold, and frequency by which the speech processor of a cochlear implant processes the speech signal and delivers it in electrical form processor of a cochlear implant processes the speech signal and delivers it in electrical form to the electrodes in the electrode arrayto the electrodes in the electrode array

Residual HearingResidual Hearing – the hearing remaining in a person who has a hearing loss – the hearing remaining in a person who has a hearing loss

Speech ReadingSpeech Reading – speech recognition using auditory and visual cues – speech recognition using auditory and visual cues