COCHLEAR

IMPLANT

DEFINITION

A cochlear implant is a small, complex electronic device that provides direct electrical stimulation

to the auditory nerve in the inner ear .

The cochlear implant does not result in “restored” or “cured” hearing. It allows for the perception of

the sensation of sound.

Unlike a hearing aid, it does not make sound louder or clearer. Instead, the CI

device converts acoustic sound into electrical and bypasses damaged parts of the auditory system (cochlea) and directly

stimulates the auditory nerve.

EXTERNAL PARTSReceiving microphone:  Picks up sound from the environment and send it to the speech processor.  Speech Processing Analyzes the sound and converts it into an electrical signal.  Transmission LinkSends the signal to the internal part, where it's decoded.  Battery Provide the power to the electronic device.

INTERNAL PARTSReceiving MicrophoneThe receiver is just under the skin behind the ear. The receiver takes the coded electrical signals from the transmitter and delivers them to the array of electrodes that have been surgically inserted in the cochlea.

Electrode ArrayThe electrodes stimulate the fibers of the auditory nerve, and sound sensations are perceived.

COCHLEAR IMPLANT COMPONENTS

EXTERNAL PART Internal part

Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve.

Signals generated by the implant are sent by way of the auditory nerve to the brain.

The brain recognizes the signals as sound.

Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn.

It allows many people to recognize warning signals, understand other sounds in the environment, and enjoy a conversation in person or by telephone.

HOW IT WORKS!?

WHO IS BEST SUITED!?It is generally agreed that the best adult candidates are those who:

Have severe to profound hearing loss in both ears

Have had limited benefit from hearing aids

Have no other medical problems that would make the surgery risky

Have a strong desire to be part of the hearing world and communicate through listening, speaking, and speech reading

Have lost their hearing after speech and language development

WHO IS BEST SUITED!?It is generally agreed that the best child candidates are those who:

Have profound hearing loss in both ears.

Have had limited benefit from hearing aids.

Are healthy and have no medical conditions that would make the surgery risky.

Are involved (when able), along with their parents, in all the steps in the process.

Understand (when able), along with their parents, their role in the successful use of cochlear implants.

Have (when able), along with their parents, realistic expectations for cochlear implant use.

Are willing to be actively involved in their habilitation/rehabilitation.

Have support from their educational program to emphasize the development of auditory skills.

Predicting successAdult considerationsPediatric considerationsOnset of deafness. Duration of deafness. Mode of communication.Commitment.Motivation.

Age at implantation.Aural (re)habilitation.Family commitment.

PRE-OPERATION Examination of external, middle, and inner ear for signs

of infection or abnormality.

Various tests of hearing.

A trial of hearing aid use to assess its potential benefit.

Exams to evaluate middle and inner ear structures.

CT (computerized tomography) scan.

MRI (magnetic resonance imaging) scan.

Psychological examination to see if the patient can cope with the implant.

Physical exam 

THE OPERATION It is done under a general anesthesia.

The operation usually takes from 1½ to 5 hours.

The patient usually goes home the same day, some of them may stay in

the hospital for one or tow days.

An incision is made in the skin behind the ear.

The surgeon drills into the mastoid bone, creating a pocket for the receiver/stimulator, and then into the inner ear where the electrode array is inserted into the cochlea.

Skin infection.Onset of tinnitus.Damage to the vestibular system. Damage to facial nerve.Device failure.

After the surgery by almost four weeks the implant is "activated" by connecting anexternal sound processor tothe internal device by a magnet

The CI has been effective for the large majority of people.

However, its effectivity depends on numerous variables.

The younger a person receives their implant.

The shorter duration of deafness.

The level of expectations and motivations of the patient and parents.

Good medical professionals are essential for both the surgery and rehabilitation

A large number of adults who are deaf and have cochlear implants

derive substantial benefit from them when they are used in conjunction with speech reading.

Effectiveness of cochlear implant

The implant is by no means a cure for deafness and will not restore normal hearing.

It will take time to be effective

There will be no success with a cochlear implant without follow-up and rehabilitation services.

Having a cochlear implant does not guarantee the ability to speak.

1-The health and structure of the person's cochlea: The number of nerve cells the person has is important.

2-Implantation variables:These variables include the depth and type of implanted electrode and signal processing technique.

3- Learnability: How rapidly the person learns to use the implant.

4- The communicativeness and intelligence of the person.

5-The length of time the person has used the implantation.

6-The quality and dedication of the person's learning support structure

number of different things determines the effectiveness

of cochlear implant

Increase the level of hearing, which makes it easier for themto communicate and function in mainstream society.

Children with cochlear implant are often able to function inmainstream schools rather than special schools for the deaf.

Safety. Such as the ability to hear ambulance sirens orsomeone yelling. Can improve safety and security. The restoration of some auditory perception.

The cost is very high. It costs almost 150,000 to 200,000 riyals in non-governmental hospitals.

The brain may have difficulties translating the electronic pulses into understandable language.

The natural sounds and the way sounds are transmitted through a cochlear implant are different.

There is a risk associated with the surgery (damage to the auditory nerve or facial nerve).

The cochlear implanted should immunize for bacterial meningitis due to its higher incidence.

The patient may be prohibited from certain activities that could damage the cochlear implant such as

swimming.

There will be future limitations on medical testing which can be done after surgery as the device

contains magnets to connect the outer portion to the surgically implanted base.

There are certain criteria to implant two cochlear including;

Children (under 18):

1. If they have at least 90 decibels of hearing loss.2. Don't benefit enough from hearing aids.3. A hearing aid trial has not worked.

For adults:1. A 70 decibel or greater hearing loss.2. Limited or no benefit from hearing aids.

Both ears should also be in good physical condition for implantation.

BILATERAL COCHLEAR IMPLANTS

Having two "ears" is better than having only one "ear“.

A person with only one implant is similar to someone with a unilateral hearing loss.

bilateral implants overcome noisy environments

it can help filter sounds and making easier to hear speech.

Cochlear implants may destroy residual hearing.

They may not be able to benefit from the future improvements in hearing technology.

There is an increase in surgical risks.

Deaf community which consists of pre-lingual deaf people, is strongly against cochlear implant. Some of them consider Cochlear implant as an offence to their culture.

The problem emerged in the18th century with the argument of manualism vs. oralism. This is consistent with medicalisation and the standardisation of the normal body in the 19th century, when differences between normal and abnormal began to be argued about.

Criticism and Controversy

It is important to consider the sociocultural context, especially in the deaf community, which considers itself to possess its own unique language and culture.

Many do not believe that deafness is something that needs to be cured.

The cochlear implant can act as a tool deaf people can use to access the hearing world without losing their deaf identity.

Cochlear implants for congenitally deaf children are considered to be most effective when implanted at a young age, during the critical period in which the brain is still learning to interpret sound. Hence they are implanted before they can decide for themselves.

Children with cochlear implants are more likely to be educated orally without using sign language. They are often isolated from other deaf children and from sign language.

As cochlear implants for children grows, some schools

now are integrating cochlear implants with sign language in their educational programs.

COST

In U.S.A. the cost is from US$45,000 to US$125,000In K.S.A. the cost if from SA 150.000 to SA 200,000

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Done by:

Asma AlfassamMaram AbuassafMawahib AlnafeaSarah AlmohannaWejdan Alweheby