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Cochlear Implant Library

AB offers a variety of informative materials for recipients, parents, and anyone considering cochlear implants for themselves or a loved one. From research to articles, newsletters, and brochures, the Cochlear Implant Library helps you understand the journey to hearing with cochlear implants.

“What I value most about having AB as a partner on my journey to hearing is that information is always available — as well as help.”

Judi Axel, implanted at age 60, bilaterally implanted at age 61

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Advanced Bionics offers a variety of newsletters that provide support, tips, and news about AB’s cochlear implant systems, services, and technology breakthroughs.

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The Loud & Clear! newsletter is a complimentary periodical from Advanced Bionics that covers important listening improvement topics. Read our issues online for information on how to help promote language and listening skills in children with hearing loss.

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General Information Articles

These articles provide an overview of cochlear implants and hearing loss.

Cochlear Implant Overview

Cochlear implants are prosthetic devices designed to restore some hearing to adults and children with a severe-to-profound sensorineural hearing loss by converting the acoustic input signal into an electrical pattern that is interpreted as sound by the user. A cochlear implant consists of internal components that are surgically placed and external components that require fitting and programming. Cochlear implants are considered the only medical treatment for severe-to-profound hearing loss.

Cochlear Implant V. Hearing Aid

Cochlear implants are different from hearing aids. A hearing aid acoustically amplifies sound and relies on the responsiveness of healthy, inner ear sensory cells to receive that sound and send the message to the brain. In patients with severe-to-profound sensorineural hearing loss, the inner ear sensory cells are lost or damaged to the degree that a hearing aid is no longer beneficial for understanding speech because there are not enough healthy sensory cells to relay the message to the brain. A cochlear implant, however, bypasses the absent or damaged sensory cells and stimulates the hearing nerve directly by converting acoustic sound input into an electrical pattern that is recognizable to the hearing nerve for the transmission of sound information to the brain.

Cochlear Implant Components and Functions

The cochlear implant system consists of a microphone, sound processor, headpiece, cable and internal implant. The implanted part is surgically positioned beneath the muscle tissue and skin on the side of the head by a surgeon. The small implant electrode is threaded down into the hearing mechanism of the inner ear, the cochlea, during the surgery. The external component is a miniature computer sound processor that is worn on the outside of the body, either over the back of the ear (HarmonyTM Sound Processor), or at waist level (Platinum SeriesTM Sound Processor).

A microphone connected to the sound processor detects nearby sounds and the processor converts these sounds into digitally coded signals. The headpiece transmitter, magnetically aligned over the implant and connected to the sound processor, rapidly sends these signals as radio waves through the skin and to the implanted part.

The implant receives these digitally coded signals and interprets them using its sophisticated microelectronic architecture and multiple independent output circuits to send focused stimulation down the electrode to the inside of the cochlea. Multiple contact sites located along the length of the electrode emit focused stimulation pulses to the surrounding hearing nerve receptors inside the cochlea. Nerve fibers send this information to the brain for central processing, interpretation, hearing perception and developmental recognition of the incoming sounds.

Cochlear Implant Surgery

Adults
and children 12 months of age and older, with severe-to-profound sensorineural hearing loss, may be candidates for a cochlear implant. Typically candidates will have been fitted with hearing aids but receive minimal benefit. Benefit with hearing aids is determined by standard diagnostic tests administered by audiologists as well as parent and teacher/therapist questionnaires, which measure a child's response to sound and development of speech with hearing aids.

Once a child or an adult is determined to be a candidate for a cochlear implant, has completed the evaluation process, and insurance approval has been received, surgery will be scheduled. The surgical placement of the internal portion of the device is performed under general anesthesia and takes approximately two hours. Typically, this surgery is done on an outpatient basis in which the adult or child would arrive in the morning and go home in the late afternoon. Occasionally, an overnight stay may be necessary.

Following a 3–6 week recovery period, the recipient will return to the audiologist for the fitting of the external components. This first fitting is often referred to as the "initial stimulation" or "hook up". An audiologist programs the device during the fitting process. Programming involves setting specific parameters of stimulation for the recipient, particularly the levels perceived as soft and comfortable. Special programming software (SoundWaveTM Professional Suite) is used by the cochlear implant audiologist to create, adjust, fine-tune and optimize sound processing programs on the sound processor computing system, to best fit individual hearing needs.

Following the initial stimulation, the recipient will require frequent adjustments or "fine tuning" as they adapt to the device. While some recipients adjust very quickly, others require several weeks or months. How much sound is understood by the recipient depends on several factors, including age at implantation, length of deafness, previous experience with sound, and access to aural rehabilitation and therapy services.

Experience of cochlear implant users can vary. The best way to understand more about what a user experiences with a cochlear implant is to speak to a cochlear implant recipient. Through our Bionic Ear Association we can assist you throughout your journey to hearing by matching you with other recipients so that they may share their story and experience with you to help you better understand the benefits of a cochlear implant.

Understanding Hearing Loss

Hearing loss refers to a decrease in a person's sensitivity to sound and can range in degree from mild to profound depending on the extent of sensory cell loss or damage and can occur in one ear or both ears. Hearing loss is the third most common health-related problem in the United States. It is estimated that 28 million Americans have a hearing loss. Of those who have a hearing loss only six million have pursued hearing help and approximately 700,000 of those have a severe-to-profound hearing loss. Further, the incidence of hearing loss in newborns is approximately 1 in 1000 making hearing loss the number one congenital condition surpassing Down Syndrome and Spina Bifida. Hearing loss can be classified in three different ways: 1) based on location of the disease within the ear; 2) based on the onset of the hearing loss in relationship to speech and language development; 3) based on the cause of the disease within the ear.

Classification Based on the Location of the Disease within the Ear

There are three different types of hearing loss depending on the location of the disease within the ear. A conductive hearing loss results when a problem originates with the outer ear or middle ear and prevents or impedes sound from being conducted to the inner ear. A conductive hearing loss can stem from an abnormality of development, such as the absence or incomplete formation of a part of the external or middle ear system. The problem can also be caused by disease within the external ear or the middle ear such as severe and continuous otitis media (inflammation of the middle ear often accompanied by fluid buildup). This type of hearing loss can generally be corrected by medical or surgical means so that hearing is restored. A sensorineural hearing loss results from an abnormality of development or disease affecting the cochlea or auditory nerve. The cochlea is the organ that converts sound waves into electrical energy. The auditory nerve transmits the sound stimuli in the form of electrical impulses to the auditory center of the brain. In general, sensorineural hearing loss cannot be treated by current medical or surgical techniques because there is permanent damage to the inner or auditory nerve. A mixed hearing loss involves both a sensorineural and conductive component. The conductive part of a mixed loss may be treated by medical or surgical means, depending on the type of disease present and the percentage of the total hearing loss it may represent.

Classification Based on the Onset of Hearing Loss in Relation to Speech and Language Development

A prelingual hearing loss is one which is present prior to speech and language development. A postlingual hearing loss develops after speech and language development has begun or has been completed which could be between the second and sixth year. In general, the longer a person has experienced normal hearing, the better chance they have of maintaining that knowledge of the language developed.

Classification Based on the Cause of the Disease within the Ear

Hearing loss can also be classified as genetic or non-genetic. A genetic hearing loss is one caused by the presence of an abnormal gene within one of our forty-six chromosomes. Genes are the bits of chemical material that determine our physical, intellectual, and other traits including eye color, body build, and shape and function of ear structures. They are located on the chromosomes, rod-shaped bodies found in the nucleus of the cells in our body. Ordinarily, we have 46 chromosomes in every cell (23 inherited from each parent). A genetic hearing loss is one caused by the presence of an abnormal gene within one or more of our chromosomes. This abnormal gene may have been passed on by either one or both of the parents or it may have developed as the result of a spontaneous mutation or change during fetal development. About 30 percent of all children born with or who develop an early onset hearing loss have a genetic type of hearing loss.

A non-genetic hearing loss is one caused by an event resulting in incomplete or abnormal development of the ear structures prior to birth or producing damage to the fully developed ear structures during the immediate birth period or sometime after birth. There are no abnormal genes present, and, therefore, there is no chance of transmitting a non-genetic hearing loss to future generations. This type of hearing loss occurs in about 70 percent of those born with a hearing loss.

Regardless of the classification of hearing loss, there are many treatment options available for individuals who have a hearing impairment. Depending on the type and severity of hearing loss medical intervention or the use of assistive technologies such as hearing aids or cochlear implants may be appropriate. Should you suspect a hearing loss we recommend that you contact an audiologist to set up an appointment for a hearing evaluation to determine your hearing status.

Hearing Loss in a Child - There is Hope

Learning of severe-to-profound hearing loss in a child can be quite surprising news to many parents. The majority of children with hearing loss are born to parents with normal hearing. It is normal for parents to experience a broad range of emotions in the weeks and months following the initial diagnosis of hearing loss. David Luterman, Ph.D. has described a process of mourning "the lost normal child." Some hearing parents will react to the news initially with intense feelings of shock, denial, anger, grief, guilt, sadness, fear, anxiety and confusion when they first learn about their child's hearing loss. In summary, the mourning process moves through the stages of shock, recognition, denial, acknowledgement, and constructive action. Following diagnosis of hearing loss, one of the first constructive actions is obtaining appropriate hearing aids for their child. According to Dr. Luterman, "The key to successful integration of hearing loss into a family is the degree to which parents are able to integrate hearing loss into their lives. If hearing loss is seen as a tragedy and terrible loss, the family system will be continually assaulted by negative emotions. However, if it is treated as a teacher for everyone, and the positive aspects of hearing loss are seen and noted, then the family will flourish."

Choosing an audiologist with expertise in working with hearing loss in a child is a crucial consideration for success in fitting infants and young children. A pediatric audiologist will have expertise in using appropriate pediatric testing equipment and methods. The unique needs of infants and children will be taken into consideration when selecting and fitting earmolds and hearing aids for tiny ears. A pediatric audiologist should have flexibility in scheduling to allow plenty of time in counseling and teaching parents how to optimize the use of hearing aids for their child. During the counseling process, the audiologist will seek to understand where the family is in the process of acceptance of the child's hearing loss and individualize the early intervention plan accordingly. The audiologist should always be considerate of the amount of new information the family can handle during one session, and adapt their counseling style to the needs of the parents. Parents should be given clear and unbiased access to information about the options in amplification and communication styles available to children with hearing loss.

There Are More Resources Than Ever for Dealing with Hearing Loss in a Child

The encouraging news is that there has never been more hope for children with profound hearing loss. We live in an unprecedented time and there have never been more options in sophisticated hearing aid technologies to improve the hearing and quality of life for children with hearing loss. Superb advances in hearing aid technologies have been made in the past decade. Most children with hearing loss are fit with two hearing aids to give balanced hearing in both ears and to allow them to pinpoint the location of a sound or conversation. Wearing two hearing aids provides better sound clarity and word recognition in noisy listening environments.

Programmable digital hearing aids are available in high power models to allow the audiologist to give the child access to the wide range of sounds necessary to develop spoken language skills. Hearing aid programming software and real ear measurement equipment allow the hearing aids to be individually customized to optimize the hearing aid fitting for the child and to assure the speech signal is delivered at the most appropriate listening levels. The goal of digital hearing aids is to deliver soft sounds at an audible level, average speech at a comfortable level, and loud speech at louder (but not uncomfortable) levels. Some children with profound hearing loss use various forms of visual language (sign language or cued speech) while they are developing their spoken language skills. Most children with hearing aids can significantly benefit from an FM system. The FM system helps to overcome some of the challenges of listening in background noise, at distances, and rooms with poor acoustics.

After a three to six month trial with hearing aids, some children do not demonstrate expected gains in speech and/or hearing development milestones. In recent years, the criteria for cochlear implants in children with profound hearing loss has expanded and now this option is available to a wider range of children. An evaluation by a cochlear implant center team (cochlear implant surgeon, audiologist, speech-language pathologist, developmental psychologist, and other team members) can determine if this option is potentially beneficial.

The following websites provide useful educational resources for parents dealing with hearing loss in a child:

Alexander Graham Bell Association

The Listening Room
HearingJourney
Oral Deaf Education
John Tracy Clinic
Hands and Voices
Audiology Online
Healthy Hearing
American Academy of Audiology
American Speech, Language, and Hearing Association

Child Hearing Aids: Top Ten Tips for Very Young Children

Your child's first set of hearing aids represents a major milestone in the exciting journey of learning to hear, listen, and speak. Since the experience of using hearing aids is a new and important addition to your child's daily routine, it helps to have some tried and true tips from other parents and pediatric audiologists. Below are ten strategies for getting your child off to a successful start with wearing their new hearing aid.

  1. Establish a routine time for putting the hearing aids on each day. It is helpful to spend some time holding, cuddling, smiling and talking with your child the first time you put their hearing aids on to develop a positive association with the hearing aids.
  2. Most babies and young children are curious about their hearing aids and will try to pull them off of their ears. When you notice the hearing aid has been removed, immediately place it back in your child's ears and be consistent in letting them know it needs to stay in their ear. The goal is consistent daily use for all of your child's waking hours.
  3. Some parents use a snug soft cap or bonnet to keep the child from pulling the hearing aids off. Soft cotton pilot caps to hold child hearing aids in place can be obtained from Hanna Anderson.
  4. Child hearing aids can be stabilized on the ears with Huggie AidsTM. A soft rubber ring circles around the child's ear and is attached to the hearing aids to secure them in place. Many parents have found Huggie Aids to be an ideal solution for hearing aid retention. Huggie Aids vary in size and will need to be changed as your child's ear grows.
  5. Toupee or wig tape can be attached to the hearing aids and used to keep the hearing aid stable and secure behind the child's ear. The tape should be changed often and the child's skin should be checked regularly for signs of redness or irritation.
  6. Your child's audiologist can experiment with using a smaller tone hook size to assure the fit is comfortable and stable. Also, the tubing and earmolds should be regularly checked to assure they are the proper size and length for rapidly growing ears. If the earmolds appear to be loose or are whistling, it is probably time for replacement. Young children may need new earmolds every three months.
  7. Child hearing aid clips with fun and whimsical designs can be clipped to your child's shirt and short string will attach to the hearing aid. If the hearing aid drops off, the hearing aid is safely attached to your child's clothing. Hearing aid clips in a variety of designs can be obtained from Westone.
  8. Hearing aids and earmolds can be obtained in a variety of colors. Allowing your child to participate in the selection process and to choose their favorite color is often very motivating for toddlers and pre-school-aged children.
  9. Demonstrate to all of your child's caregivers how to change the hearing aid batteries and adjust the volume to a comfortable listening level for your child. Make sure they understand how to insert and remove the hearing aids.
  10. Moisture in the hearing aids can affect sound quality and performance of the hearing aids. The battery doors of the hearing aids should be opened every night and the hearing aids should be placed in a Dri-AidTM kit to remove moisture.

Many parents find having the support and encouragement of other parents of children with hearing loss to be a valuable resource. Ask your audiologist to introduce you other families and for recommendations about local or state support groups for families of children with hearing loss.

Is a Cochlear Implant Right for Me or My Child?

Cochlear implants help people who simply are not getting enough benefit from hearing aids. The following statements can help determine if you are a cochlear implant candidate:

  1. I have difficulty following conversations without lip reading.
  2. I hear pretty well in quiet, but I struggle in groups or noisy places.
  3. I cannot follow most phone conversations; especially if I do not know the person calling.
  4. I feel isolated and limited both socially and occupationally due to my hearing loss.

If you answered “Yes” to any of these statements, you may benefit from a cochlear implant. This suggests that you should get an evaluation at a Cochlear Implant Clinic to determine if you are a candidate for a cochlear implant.

How Hearing Healthcare Professionals Determine Who May Benefit.

A team approach is often taken to determine candidacy for cochlear implantation. A surgeon rules out medical contraindications with a physical examination, an MRI or a CT scan, and medical record review.

An audiologist will evaluate the type and degree of hearing loss, assess the functional benefit received with hearing aids, and discuss the potential benefits to be gained from a cochlear implant.

One Cochlear Implant or Two?

The benefits of cochlear implantation have increased progressively with improvements in technology and clinical practice over the last two decades. Most of the 100,000 cochlear implant recipients worldwide have received substantial communication benefits from implantation in only one ear.

However, nature outfitted each of us with two ears. For people with normal hearing, two ears enhance hearing in noise and localization of sound. Therefore, it is only natural to consider the potential benefit of bilateral (both ears) cochlear implantation.

What are the potential benefits of implanting both ears?

  1. Hear better in noise
  2. Localize sound better
  3. Greater ease of listening - less effort required, less stressful, and less tiring
  4. Situational advantages - you don’t need to consider where to sit so that your implant ear is optimally positioned to capture sound (e.g., car, classrooms, theaters, etc.)
  5. Quality improvements - sound may be fuller, richer, and more natural1,2

Studies have documented some significant benefit in both adults and children with two implants. You should discuss your option to get two implants with your Cochlear Implant Team.

Whether you have chosen one Harmony or two, you are now ready for the next step of the journey to hearing: Getting cochlear implants.

Support Listening and Language Skills at Home

Listening practice is important in improving hearing and language performance. Access The Listening RoomTM for downloadable and interactive exercises designed to help you or your child hear life’s dynamic sounds.

The Listening Room is a free, one-of-a-kind website offering families and professionals activities that support the development of speech, language, and listening skills.

Tools for Toddlers

Tools for ToddlersTM is designed to help parents chronicle, support, and enhance their young child’s journey to hearing. Use these downloadable tools designed to help facilitate early language development:

References

1.

Dunn, C, et al. 2008. Comparison of Speech Recognition and Localization Performance in Bilateral and Unilateral Cochlear Implant Users Matched on Duration of Deafnessses at Age of Implantation. Ear and Hearing. 29 (3): 352–359

2.

Zeitler D, et al. 2008. Speech Perception Benefits of Sequential Bilateral Cochlear Implantation in Children and Adults: A Retrospective Analysis. Otology & Neurotology. 29 (3): 314–325.