Cochlear Implant Surgery

COCHLEAR IMPLANT SURGERY

The ear is a remarkably complex and efficient hearing system. The whole process of hearing takes place in a fraction of a second.

When are cochlear implants indicated?

When hearing aids are not effective in people with severe-to-profound hearing loss, medical experts consider a cochlear implant to be a more effective long-term solution.

How are cochlear implants different from hearing aids?

Unlike hearing aids, cochlear implants don’t just increase sounds. They mimic the natural hearing function of the inner ear through electronic stimulation.

The system has two parts – an external sound processor and the actual cochlear implant. External sounds are received, processed into electrical signals, and then passed on directly to the hearing nerve (or auditory nerve), completely bypassing the injured parts of the inner ear.

You are a good candidate for a cochlear implant if you find the following when you use a hearing aid-

Do you have to ask people to repeatedly repeat themselves, even in quiet conversations?
Do you need lip-reading to help you comprehend what’s being said?
Do you avoid social activities as you don’t know what’s being said and are worried about responding mistakenly?
Are you tired in the end of the day because listening takes too much concentration?
Are you having a difficult time keeping up at work?
Is it difficult for you to talk on the phone, or is listening to music not anymore enjoyable?

The surgery for the cochlear implant procedure typically takes about 1 to 3 hours. Multiple cochlear implant surgeries are performed each year. The associated risks are small, and your ENT surgeon will talk about them with you.

A cochlear implant is a small electronic device that is surgically implanted to help profoundly deaf people hear. It can be used for people who are completely or almost completely deaf in both ears, and get almost no improvement with hearing aids. It has to be noted that a cochlear implant is not the same thing as a hearing aid because a cochlear implant is surgically implanted and works in a different way. A hearing aid just makes the sounds louder but a cochlear implant does the work of damaged parts of the inner ear (called cochlea) to send sound signals to the brain.

How is a cochlear implant different from a hearing aid?

A hearing aid simply amplifies sounds while a cochlear implant, on the other hand, transforms speech and other sounds into electrical energy that is used to stimulate the hearing nerve in the inner ear.
Unlike most hearing aids, cochlear implants have both internal and external components. The implant system consists of an external speech processor, a headset and an internal receiver/stimulator device with an electrode array that is surgically implanted.

Who should undergo cochlear implantation surgery?

You should understand that a cochlear implantation surgery is a major surgery and is very expensive procedure. Before undergoing cochlear implantation surgery, you need to understand the benefits of this surgery and know whether you are eligible to undergo this surgery. The following are the few important points that you should know before undergoing this procedure.

You should be completely or almost completely deaf in both ears and have not got any benefit from hearing aids. If you can hear well enough with hearing aids then you are not a good candidate for cochlear implantation surgery.
You need to be highly motivated since after the cochlear implant is placed, you must learn how to properly use the device.
You need to have reasonable expectations from cochlear implantation surgery. The device does not restore or create a very “normal’’ hearing.
Children who undergo cochlear implantation surgery need to be enrolled in programs that help them learn how to process sound.

5 Before undergoing cochlear implantation surgery, you must have a medical evaluation by an ENT specialist. This evaluation may include radiology tests like a CT scan or MRI scan of the brain and the middle and inner ear.

How does a Cochlear Implant Work?

The external sound processor captures sounds and then filters and processes it. The sound processor then translates the filtered sounds into digital information. The digital information is then transmitted to the internal part of the cochlear implant system. The internal implant of the cochlear implant system converts the digital information into electrical signals, and sends them to a tiny, delicate curl of electrodes that sits gently inside your cochlea. These electrical signals from the electrodes stimulate the hearing nerve bypassing the damaged hair cells that result in hearing loss. This allows the brain to perceive sound.

What happens during a cochlear implantation surgery?

There are various factors that need to be taken into consideration before you undergo cochlear implantation surgery.

Pre-surgery work up:

A cochlear implantation surgery is planned after you undergo a pre-surgery work up that may take 2 to 3 days. A Pre-surgery work up is carried on outpatient basis. You will meet an audiologist, the ENT (cochlear implant) Surgeon and the team for initial consultation and pre-surgery work up. In order to know the severity of your hearing loss, a complete audiological (Pure tone audiometry, BERA , Impedance Audiometry ) and speech assessment tests are done. It is followed by imaging tests like HRCT temporal Bones and MRI of the CP angle and inner ear. After this some routine preoperative blood tests are done. You would also be seen by a physician or a paediatrician (for children) in order to ensure that you are fit for general anaesthesia.

Surgery:

You may require a hospital stay of around 4 days for surgery. Cochlear implantation surgery lasts for about 2 hours and is performed under general anesthesia. The electrode array is inserted into the cochlea. The receiver/stimulator is secured to the skull. You will have a bandage on their head which is removed after 1 to 2 days. You may return to work usually within a week of surgery.

Switching on the implant :

Once implanted, the device has to be activated. Usually, the activation of the implant takes place two to three weeks after surgery or the implantation. This time gap allows enough time for the incisions made during the surgery to heal properly. The implant is then ‘programmed’ or ‘mapped’. Mapping is done on a regular basis during postoperative rehabilitation to fine-tune the processor and get the best performance as you get used to hearing with the implant.

Rehabilitation and follow up visit :

Our network hospitals in India have advanced rehabilitation therapy facilities for post-surgery rehabilitation. A good rehabilitation plan is necessary to maximize benefit from the cochlear implant. The rehabilitation includes Audiotory Verbal Therapy. In a Audiotory Verbal Therapy, you are taught how to listen with the help of the implant, how to understand speech and to talk. The emphasis is laid on making you listen and speak normally, rather than on lip reading and visual cues. Learning to listen takes time and requires concerted efforts from you, your family support and the person providing rehabilitation services to you. Even though the cochlear implant surgery just requires 4 days of hospitalization, the total number days of stay in India post surgery would be for at least 3 weeks. Hence the total number of days of stay in India would be around 1 month or so. The initial evaluation and the post-surgery rehabilitation would be done on outpatient basis during which you need to stay in a nearby hotel or a guest house. The cost of the hotel or guest house stay is not included in the cost of the surgery or the package. We will help you to find a suitable hotel or guest house nearby the hospital.

Cost of Cochlear Implant Surgery in India

A cochlear implant surgery is an expensive surgery. It is the cost of the implant that makes the surgery very expensive. The cochlear implant is a very sophisticated device and is manufactured by different companies under different brand names. Further there are different types of cochlear implants that have different features and specifications. The cost of cochlear Implant depends on make and specifications and hence you will find a huge variation in the cost of cochlear implant surgery package. There are different cochlear implant surgery packages (with different types of implants) and the cost varies depending upon the type of cochlear implant you choose.

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