Cochlear Implants: 2010 and Beyond #3

[Guest guest]

NVRC News - May 27, 2010

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Cochlear Implants: 2010 and Beyond #3

By Cheryl Heppner, 5/27/10

Cochlear Implant Activation

At Virginia Commonwealth University, mapping of the cochlear implant

processor is done approximately three to four weeks after surgery by an

audiologist. Several follow-up visits are needed for mappings to fine tune

it. The VCU schedule usually has mappings at 3 months, 6 months, 9 months,

12 months, 18 months, 24 months and then yearly. Dr. Coelho stressed the

importance of these mappings being done by an audiologist who is very

experienced with cochlear implants. He finds that children generally reach

a maximum benefit from the mappings at about one year of age; with adults it

can be closer to two years.

Dr. Coelho showed a video demonstration of sound perception with the

channels of a cochlear implant. In answer to an audience question, he said

that having at least eight working channels in a implant allows for

understanding, and any additional channels add redundancy.

For individuals interested in videos about cochlear implants, he suggested

checking the websites of House Ear Institute and PBS as well as doing an

internet video search for " cochlear implant " . Today I did a Google search

of videos using " House Ear Institute cochlear implant " which turned up

mostly older videos. I watched three of them for a brief period. What fun

they were when I clicked on the red " cc " button and chose " Transcribe

Audio " ! Google's automatic captions can be great entertainment. I enjoyed

seeing Dr. Chorost's " Authors@Google " Talk from July 2008

(

).

A simple Google search of videos under the keyword " cochlea " gave more good

stuff. There's a captioned YouTube video of how a cochlear implant works at

and another of cochlear

animation at http://www.youtube.com/watch?v=dyenMluFaUw.

Cochlear Implant Outcomes

Dr. Coelho has found that individuals have a wide range of outcomes with

their cochlear implants. He has seen improvement long term, with people who

have had cochlear implants for 15 to 25 years still performing well.

He said that he believes that deciding to have surgery for a cochlear

implant is a very personal and private decision.

Research has shown cochlear implants to be cost effective. Research also is

helping to predict whether this technology will be successful. Duration of

deafness has been found to be the single most important factor. The longer

an individual has gone without sound, the harder it is to benefit from a

cochlear implant. Another important factor is experience with language

before having a cochlear implant.

Research shows that 90% of children implanted before the age of two were

integrated into mainstream education, compared to 20% to 30% of those

implanted after age four. Dr. Coelho noted that some people believe in

using both aural/oral education and American Sign Language. " I'm all for

whatever works, " he said, noting that whatever the choice, the child's

parents must be highly motivated.

Current Hot Topics

Dr. Coelho's list of current hot cochlear implant topics included:

- Bilateral implants. Among advantages reported by individuals who have a

cochlear implant in each ear are the ability to localize where sound is

coming from, elimination of " head shadow " , understanding speech in noise,

and improved speech perception. In addition, having two implants gives a

backup if one fails. Disadvantages are the need to have two separate

surgeries, the destruction of the remaining hair cells in both ears, and

denial of coverage for the second implant by some insurance companies.

- Implanting where a cochlea is malformed or scarred.

- Implanting children who are very young. Cochlear implant surgery before

12 months of age has been restricted due to concerns about the possibility

of post-implant meningitis. Children also may do well with hearing aids or

may have mental or physical conditions that could affect the audiological

performance of the implant. Surgery on babies, who have very little blood

compared to adults, is a risk. And with children at a young age, our

ability to measure hearing loss is not perfect.

- Implanting individuals who are elderly. Studies show many individuals who

are elderly get significant improvement from a cochlear implant. The

improvement may not be as great as that of a child or young adult, but it

tends to be significantly better than being without the cochlear implant.

Central auditory function declines as we age. There is decreased hearing

acuity in noise, decreased hearing acuity when someone is speaking fast, and

decreased memory of what is being spoken. All of these occur in individuals

who have normal audiograms, however they can decrease the performance of a

cochlear implant or hearing aid when compared to younger individuals.

A study has found that implanting the right ear gets better results for

speech understanding. Research has also shown that speech outcomes for

individuals who are elderly reach a plateau earlier when compared with

individuals who are younger.

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