What You Need to Know About Cochlear Implant Surgery

Is a Cochlear Implant Right for You?

Cochlear implant
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A cochlear implant can enable deaf or hard of hearing people to hear sounds. It replaces the function of the cochlea, the three small bones of the middle ear that turn vibrations into electrical signals to the auditory nerve. Cochlear implants may be used for people who can't benefit from hearing aids.

Today's cochlear implant surgery is a relatively minor operation that takes just a few hours. Your procedure may be an outpatient surgery and you will need to arrange for someone to drive you home (you should not drive or take public transportation the day you have anesthesia).

Or, you may spend the night at the hospital. 

There are many things to consider before you decide to have a cochlear implant. You'll also want to prepare yourself for what to expect the day of the surgery. We'll help guide you through all of this and give you a few tips for living with your new implant as well.

Do You Fit the Criteria?

First of all, it's important to understand that not everyone can qualify for a cochlear implant. Though advances in technology have expanded the number of people who can benefit from it, your doctor may have any variety of reasons for not recommending the surgery.

According to the U.S. Food & Drug Administration (FDA), the success of a cochlear implant relies on many factors, including how long you've been deaf and your age. For some people, the cochlea may not be healthy enough to accept the implant.

In addition, a cochlear implant is not something that works like magic—one day you can't hear and the next you can.

It requires work and a good support system to learn how to use it. The longer it's used, the easier it becomes.

Do you or your child meet the criteria for receiving a cochlear implant? These are the things that indicate that an implant may be something to consider:

  • You have a severe hearing loss.
  • You get little to no benefit from hearing aids.
  • You are willing to work hard to receive the maximum benefit from an implant (particularly for older children and adults).

Is It Right for You?

When considering an implant, it's important to learn the basics, including how an implant works and an understanding of all the costs involved. You may even wish to learn about the history of the cochlear implant

Know the Financial Costs

Check with your insurance company to see if they offer coverage of implants and post-implant therapy. If there is no coverage, you can try to convince them to cover it. Implant manufacturers or implant teams may be able to help with this.

According to the Centers for Medicare & Medicaid Services (CMS), cochlear implants may be covered by Medicare if you meet certain criteria. Additionally, there may be restrictions regarding the medical facilities where you can have the procedure done.

If there is no insurance coverage and all efforts to obtain coverage have failed, you can follow the lead of some parents and raise funds to cover the cost. In that case, you will need to research fund-raising opportunities and available sources of help.

In addition, you can prepare for the financial cost of maintaining an implant.

Begin by learning where to buy batteries for the cochlear implant if they are not provided by your insurance.

Know Why Implants Are Controversial

For many years, the Deaf community has debated the value of cochlear implants. Many feel that there is nothing wrong with being deaf, so correcting for it has been controversial.

Although opposition to implants in Deaf culture is less than it once was, it is important to listen to the viewpoints of both sides. This will give you a better understanding of the concerns, especially when it comes to children.

Know Your Implant Options

There is not a single cochlear implant device available.

It's important to discuss all of your options with your doctor and research each carefully. For instance, you will want to investigate the benefits of a single implant versus a bilateral implant, particularly for a child.

You can also research implant manufacturers such as Cochlear, Advanced Bionics, and Med-El. The FDA offers useful information regarding FDA-Approved cochlear implants. You can check on recalls, safety, and the device's rate of malfunction.

Another consideration is to research the individual implant programs at implant centers. You might find that one is a better fit for you.

If you have time, read books on cochlear implants. There are reference books, books about people's experiences with implants, and even children's books available.

Know What to Expect

The experience of others is valuable because a cochlear implant is a life-changing experience. Talk to others who have had implants, or to parents of children with implants. You can also research the outcome for implantees with similar conditions to yours.

Make sure your expectations are realistic based on the age of the implant recipient and other factors involved. Keep in mind that implant recipients are still deaf and you will not be able to hear when the implant is turned off.

It's a good idea to have an idea of what to expect when it's time to actually activate the implant. For instance, it is normal for a young baby to react by crying or be upset somehow because of the strange noises in their heads. Young children may also be in shock and it can be disconcerting for teens or adults as well.

Know the Risks

The surgery has the same risks associated with any surgery, though serious complications are rare. It's always a good idea to familiarize yourself with all the risks, no matter how small, as well as the possible side effects and post-surgical care.

Meningitis is one of the known risks and patients should take steps to reduce that and consider being vaccinated. The Centers for Disease Control and Prevention (CDC) offers suggestions for reducing the risk of meningitis.

Additionally, there is a possibility that your implant may not be a success, such as in the cases of extrusion or infection. It may be necessary to remove the implant.

Prepare for Surgery

You will be working with an otolaryngologist, a doctor specializing in treating the ears, nose, and throat. He will want to ensure that you are ready for the cochlear implant.

This will involve an examination of your ear and a general physical exam. You will receive a hearing evaluation, X-rays, and may need to go through other imaging procedures. It is also possible that you will be asked to take psychological tests to see if you are likely to cope with the implant.

Beyond getting necessary vaccinations and following all of the recommendations of your doctor, you can do other things to prepare for your surgery.

If your child is going to have the cochlear implant surgery, make sure to discuss everything with them. Helping them prepare may take some of the fear out of the procedure and aid them in understanding what is going to happen and why.

Whether you're a parent or the implant recipient, prepare yourself mentally and emotionally as well. Understand the possible complications or side effects such as headaches and nausea. Realize that the transition may not be smooth, but that hard work and therapy will make it easier.

The Day of the Surgery

The day of any surgery can make anyone nervous, so it's a good idea to know what to expect when you get to the hospital.

The Procedure

Before surgery, nurses will shave a small patch of hair behind your ear where the surgery will take place. You will also be administered anesthesia.

The surgeon will make an incision and the skin and tissue flap is lifted so he can drill into the skull bone behind the ear. A receiver is placed into this area and an electrode array is inserted into the cochlea. The surgical area is closed up with stitches (a small permanent scar may result) and your head will be bandaged.

After Surgery

Depending on the length of the surgery and other factors, you may be sent home shortly after surgery or have to stay in the hospital for a short while. You'll feel the effects of coming out of anesthesia and experience some discomfort in your implanted ear.

You'll have to keep the bandages on for awhile and take care of the stitches, following all the instructions given to you at the hospital. In about a week, you will return to have the stitches removed and the site examined.

Recovery Period

During the recuperation from the surgery, there may be minimal side effects, which are generally temporary. These may include minor swelling, pain, changes in taste, dizziness, inflammation, bleeding, etc. If you have any questions or concerns, call your doctor.

It's recommended to keep children out of daycare and school for a week after surgery and limit physical activity for three weeks. Adults should be able to return to work in one to two weeks after surgery. It's a good idea to walk and do other light activities each day, but avoid strenuous activity such as running or weight lifting for four to six weeks.

After Implantation

The implant doesn't work immediately after the operation. You will return in three to six weeks to have the external transmitter attached and the implant activated.

The sound processor, microphone, and implant transmitter will be fitted and programmed and the audiologist will determine what sounds you are hearing. You will learn more about how to care for and use the device as well.

You will then work with therapists to learn to associate the signals from the implant with sounds. Commit yourself to working hard with the post-implant therapy. This auditory training is essential for maximizing the benefit from the implant. 

Do be aware that some insurance companies will not pay for therapy. Others will provide only limited therapy coverage.

Learning to Hear

The process of recognizing sounds after receiving your cochlear implant takes time. Progress will come and it's important for everyone to remain relaxed and patient as you learn to hear. Older adults may have more difficulty with this because you want an immediate result, so try to control your frustrations.

After your child has had their implant for awhile, it may become clear what type of educational services are needed. Perhaps an oral deaf education program will meet your child's needs. You may also need to look into a complete communication program in a school or program for the deaf.

Be aware that if you choose a mainstream program, your child's teacher may not be familiar with deafness and cochlear implants. 

If you don't know sign language, consider learning it. Even though you can now hear well with an implant, when it's turned off, you will still be deaf and need to be able to communicate.

Living With an Implant

Your life with a cochlear implant will be different and there are a few things you should know. For instance, implantees can play sports, with a few restrictions. When traveling, you can ask to be wanded by security instead of going through the scanning machines.

You might also consider joining the Cochlear Implant Awareness Foundation or want to start a chapter in your area. This can be an excellent source of support. You can also share your experience with others online by starting a website or joining a group on social media.

Upgrading the Device

A cochlear implant may need to be maintained, updated, or you might need more surgeries. As an implantee, it's important to prepare yourself for these possibilities.

You may need surgeries in the future if there is a problem or if the technology changes. You may need or decide that you want an upgraded version of your implant's internal parts.

It's also possible that the maps for the implant's speech processor may need to be changed. The processors may need to be upgraded or even replaced as well.

Eventually, the cochlear implant itself may need to be replaced. Cochlear implants, like any prosthetic device, have a limited lifespan.

A Word From Verywell

The decision to go ahead with a cochlear implant is not one to take lightly. However, with a good understanding of everything involved, it may be right for you. Try to keep in touch with your medical team and be sure to ask any new questions that come to mind throughout the process. For many implantees, it's a rewarding experience and the hard work pays off.

Source:

Centers for Disease Control and Prevention. Use of Vaccines to Prevent Meningitis in Persons With Cochlear Implants. 2017.

Centers for Medicare & Medicaid Service. Medicare: Coverage With Evidence Development: Cochlear Implantation. 2015.

Denworth L. Science Gave My Son the Gift of Sound. Time Magazine. 2014.

Mayo Clinic Staff. Cochlear Implants: Overview. 2017.

U.S. Food & Drug Administration. What Is a Cochlear Implant? 2014.

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