What is Cochlear implant

                      Cochlear implant

Cochlear implant surgery is an operation of implanting a cochlear implant that enables the patient to hear nothing by electro-stimulating the remaining nerves in a patient who cannot hear at all due to a disease of the cochlea (cochlear). Cochlear implants are recognized as an effective method of rehabilitation by providing useful hearing to patients with bilateral altitude sensorineural hearing loss (who cannot hear at all) who are unable to receive help even with hearing aids. It is of great importance in that it is essential for the development of hyper-intelligence language and is a method that can be selected from patients who have senile hearing loss due to aging as a social problem and who do not benefit from hearing aids. 

Cochlear implant patients

If you can't hear both ears, and hearing rehabilitation for more than 3 months with a hearing aid is not effective, consider cochlear implantation.

There must be a functioning auditory nerve and no severe ear structure abnormalities on CT and MRI. In addition, the effect of transplantation is halved if there is a severe decline in intelligence.

There should be no medical, neurological, or psychiatric problems that will be contraindicated for general anesthesia or surgery because your body is healthy.

The shorter the duration of your hearing loss, the greater the benefit of cochlear implants. The cochlear implant benefits would be even greater if the previous verbal or verbal experiences remain in memory.

Congenital deaf children are most effective when they are treated before 5 years of age, especially before 3 years of age.

Not only is the support of family and society for rehabilitation important, but it is also the current performance of your surgery and requires strong motivation.

Cochlear Insurance Standards

Under 2 years old

Patients with hearing loss with a depth of both sides (90dB) or more, and if hearing aid development has not progressed even when wearing a hearing aid for at least 3 months

If you are between 2 and 19 years of age

Patients with hearing loss of more than 70dB in both sides, who have at least 3 months wearing hearing aids and have no progress in speech discrimination and language ability even in intensive education

19 years or older

Patients with hearing loss with altitude (70dB) or higher on both sides with a hearing aid of 50% or less

Cochlear implant

If you are under 19, cochlear implant insurance is available.

Preoperative examination

The pre-war evaluation of the cochlear implant determines whether it is a suitable subject or whether there is no problem after surgery. It consists of a general physical examination (blood test, electrocardiogram, etc.), hearing, language evaluation, imaging (temporal bone CT, temporal bone MRI), and equilibrium function tests, and includes genetic tests to identify the cause of hearing loss.

Surgery and hospitalization

Surgery usually takes 2 to 4 hours. Like other ear surgeries, cochlear implants have a very low risk of surgery.

General anesthesia is usually performed.

Shave the incision in the head.

After the incision, the skin and tissues are turned over and the skull is exposed.

Drill the bone behind the ear where the implant will be.

Make a hole in the cochlea.

Insert the electrode into the cochlea.

Hold the electrode and implant in place.

The skin and tissue are glued again and the incision is closed.

It takes some time for the patient to wake up from anesthesia and find the old body rhythm, and sometimes an analgesic is given if necessary.

Patients usually fast on the day of surgery and the length of hospital stay varies from hospital to hospital but usually lasts about 7 days.

Inner Cochlear Implant 

Mapping

If the swelling of the surgical site subsides about 3-4 weeks after surgery, an external device is worn and mapped. Mapping is a series of processes in which the sound signal is transmitted from the language processor to the body acceptor/stimulator, which is adjusted to the individual as best as possible to hear the best sound. It usually begins 4-6 weeks after surgery because the swelling after surgery decreases and the scalp thickness should be less than 6 mm.

A series of processes to determine the maximum sound stimulation level (C-level) while not increasing the size of the smallest sound stimulus (T-level) and the stimulus sound that the patient can sense sound stimulation. I will say

Children and adults have a different frequency of mapping, but they usually map every week to determine the appropriate intensity of the stimulus. After mapping 3 or 4 times, the appropriate sound level is determined, and then 3-4 times once a month. When the mapping is stable, it is checked once every 6 months-1 year. In addition to the regular mapping, if there is a change in the patient's hearing, an interim check is required.

Different Cochlear Devices

Speech therapy and language evaluation

After cochlear implants, some training is required to understand and speak the language. If you are a child who has not learned to speak, you need to receive regular hearing training and speech therapy after surgery to acquire language as if learning a word to your parents for the first time in your life. Even in adults who can speak, if you have surgery, the sounds you hear through the machine are different from the sounds you've heard before, so you have to train to hear them even after surgery. When an adult who already speaks well has hearing loss and undergoes surgery, it may sound different from the previous sound, but the brain quickly matches the old sound with the new sound, and after 3-6 months of daily conversation without much effort after surgery. Understand and start answering the phone. However, children who have not learned to speak must be trained to learn words one by one after surgery. Support from families with hearing loss is very important.

You may receive speech therapy at a location close to your home, but it is recommended that you receive it at a reliable speech therapy rehabilitation center where information is exchanged with the hospital where surgery is performed. Periodic language evaluation should be done at the hospital where surgery was performed.

Precautions after surgery

Be careful not to be impacted by the surgical site, and visit the hospital if the surgical site is swollen or the pain is severe. Since cochlear implants are sophisticated machines, they can be affected by magnetic fields, magnets, and electricity. If you are familiar with these precautions after use, you can safely use the cochlear implant.

Cochlear implant machines and surgical methods continue to evolve. With the release of fully waterproof products, swimming is possible, external devices are getting smaller, and hybrid cochlear implants that combine hearing aids and cochlear implants have been released to expand the scope of cochlear implants. Talk to an otolaryngologist to recover what you lost.