What is a cochlear implant

A cochlea implant is an electronic medical device that replaces the function of the damaged inner ear. Unlike hearing aids, which make sounds louder, cochlea implants do the work of damaged parts of the inner ear (cochlea) to provide sound signals to the brain.

A cochlear implant is made up of 2 parts:

  • An outer part collects sound and processes it into electrical information, which is then transferred through the skin, usually via a cable and coil to the implant itself
  • The inner part is implanted during an operation and has a receiver/ stimulator which then sends the information along an electrode implanted into the cochlea itself, stimulating the tine nerves of the inner ear direct

Who is a good candidate for a cochlear implant?

When the natural cochlea either does not work from birth or gradually deteriorates in function over time in adults, environmental sounds can be amplified by using conventional hearing aids.

When the sounds can no longer be made loud enough to be useful to hear speech clearly, a cochlear implant may become a consideration

Adults can either suddenly or gradually become aware of their decreasing ability to hear clearly, especially in acoustically challenging environments like restaurants.

How do I know if my child has a hearing loss?

Children are a little more difficult to diagnose and symptoms of hearing loss vary according to age:

  • A newborn baby may not startle to loud noise
  • Older infants may not respond to being spoken to
  • Children should be using single words by 12-15m and combining 2 words by 18-24m and if not, this might be due to an underlying hearing loss

Due to the inaccuracy of subjective hearing assessments in the first 2 years of life, objective testing should be used whenever possible.

The international standard is universal neonatal or infant hearing screening by testing the middle ear (Tympanogram), cochlea (Oto-acoustic emissions or OAE) and hearing nerve that carries the sound information to the brain (Automated auditory brain stem response or AABR)

Should screening tests indicate a possible problem, your child should ideally be referred to an audiologist from the DCIP, trained in special tests like ABR and behavioural audiometry to assess if a cochlea implant may be necessary

What is the ideal age to perform a cochlea implantation?

The most important reason to identify an underlying hearing loss as early as possible is so that the baby can receive help as soon as possible.

Hearing aids can be fitted almost immediately and if needed, a cochlear implant should be performed before the age of 1 year.

There is no upper age limit to implantation in adults but patients older than 70 years of age may take up to 12 months to get used to the electronic sound to gain near-normal speech understanding

How successful are cochlea implants?

Children born deaf who receive a cochlea implant before the age of 2 years have a good chance to enter grade 1 with spoken language skills that closely match those of their normal hearing peers.

This is providing that there are no other factors influencing the child’s speech and language development such as a central processing disorder and that he or she continues to receive the required audiological and speech and language therapy.

Children that have not had adequate access to sound will have a decreasing chance of developing spoken language as they get older with outcomes much more limited after the age of 3.

Every child is unique in that there may also be additional challenges to speech and language development such as central auditory processing difficulties or additional disabilities not yet diagnosed by the time of implantation

There is therefore no guarantee that a cochlear implant will result in spoken language

Most adults that had previously developed speech and then later in life acquired significant hearing loss will be able to use a telephone after cochlea implantation. Again, the sooner the implantation after hearing loss the better with periods of more than 10 years of significant hearing loss also associated with a poorer outcome

What is the process once I have been referred to the cochlear implant team?

Please see the attached PDF:

Assessment process DCIP

 

Once I have been accepted, what next?

Please see the attached PDF:

Approved- Next DCIP

What are considered realistic expectations?

Please see the attached PDF:

Expectations DCIP

What are the possible complications from cochlear implantation surgery?

All cochlear implant surgeons in South Africa have to undergo a mandatory period of observation, product specific surgical training and supervised surgery to ensure safe surgery. Complications from cochlear implant surgery are rare but it is suggested that you discuss the specific risks with your surgeon personally.

What are the costs involved?

The costs of cochlea implantation are significant and unfortunately may be prohibitive. Unfortunately, most medical aids do not contribute significantly to the device cost and our provincial government does not as yet provide this service as a part of state health care.

A summary table of the potential costs are presented below and all prospective patients or their caregivers are encourage to discuss these with their medical aid and or ‘gap’ cover providers accordingly.

Gears for ears is a non-profit entity that may be approached for assistance in trying to cover the cost shortfall between device cost and medical aid contribution

The DCIP is also a non-profit company and we try to assist where possible with school fees where therapy is included. Applications are considered on an individual basis, are subject to funds available and will be limited to a fixed amount per patient per year.

Download the table here.

DCIP-Cost-table

NOTES:
(*) Discovery Health for example will currently contribute R187 000 per year towards the device and pay for a processor upgrade every 3 – 5 years

(?) Please check with your medical aid or gap company to be sure

Therapy will have to be individualized according to patient needs. Adults would require less input and younger children perhaps much more than the average but your child’s treatment plan will be tailored to their needs and be discussed every step along the way

Your choice of schooling depends again on your child’s needs but you may decide on Livingstone school for example, which being semi-private and geared towards on-site therapy, may cost more.

*Estimates correct as of August 2015