1. Cochlear Implantation Journey-
candidacy to communication
DR SHEELU SRINIVAS
CONSULTANT ENT SURGEON

2. Cochlear Implant
• Bionic ear
• Hearing is the only special sense which is
conquered
• Electronic device when implanted provides
sense of sound
• The cochlear implant is the most significant
technical advance in the treatment of hearing
impairment since the development of the
hearing aid around the turn of the century.

3. :

4. Normal Ear
Deafness: Normally
functioning hair cells
not present; some
atrophy of 8th N fibers.

5. What is the difference between CI &
Hearing Aid?
• HA simply amplify sounds.CI on the other
hand transforms speech sounds into
electrical energy used to stimulate the
surviving auditory nerve fibers in the inner
ear.
• CI have internal & external parts & a
surgical process is needed to place internal
processor components

6. Candidacy
• Age: most important criteria
• Maximum Benefit in speech & language: in
children born with bilateral sensorineural
hearing loss is to be carried out before age
of 3 years.
• Up to the age of 6 years good benefit
• Above 6 years limited benefit

7. 2 groups
Pre lingual Post lingual
• Lost hearing before • Lost hearing after
acquisition of speech acquisition of speech
• Implant before 3 years • Implant as soon as
• CEREBRAL PLASTICITY possible
• Any age 6 months to 100
yrs

8. Newborn hearing screening
• Two to four new-born's,
out of every 1,000, have
hearing deficiency
• among the high-risk
babies, the number of
hearing-impaired is 5 to 14
per cent.
• High-riskers include those
birth weight was
less than 1.5 kg;
jaundice, meningitis or
birth asphyxia;
ventilation after birth;
family history of hearing
loss

9. Do we need a test?
• Initially, babies who are born with hearing loss do
not look or behave any differently from babies
who are hearing.
• However, undetected and untreated hearing loss
has serious consequences on the acquisition of
language skills as well as cognition and emotional
and social development.
• The first 6 months of a baby’s life are very crucial
for the development of speech and language.

11. Results
• Given immediately
• Either Pass/Refer
• Even though child passes if he is a high
risker further assessment done
• Up to 3 years ,every 6 months

12. Audiological assessment
• OAE-oto acoustic emission
• ABR/BERA
• Play Audiometry
• Impedance audiometry

13. Audiological

14. Radiology absolute requirements
• Presence of cochlea(either normal or
malformed)
• Presence of auditory nerve
• Combination of CT/MRI is performed

15. Cochlear aplasia.

16. Absence of the cochlear nerve.

17. Speech & Language assessments

18. Psychological & IQ

19. Medical work up
• Pediatric
• Syndromes-Usher’s
• Ophthalmology
• Neurology
• Psychology
• Immunization:
Prevenar(pneumococcal),Hib

20. Counseling/Expectations
• Factors affecting the performance of
cochlear implantee
• Duration of deafness
• Age of onset of deafness
• Age at implantation
• Duration of hearing aid use
• Others: no. of surviving spiral ganglion cells,
electrode placemt,signal processing strategy

21. What is a cochlear implant system?
• Microphone
• Sound processor: is a tiny computer that takes
the sound captured by the microphone and
converts it into detailed digital information.
This digital information is sent to the magnetic
headpiece, transmitted to the implant, and then
sent to the hearing nerve, which in turn sends
electrical impulses to the brain, where they’re
interpreted as sound.

26. Surgery

27. Risks & complications of surgery
• Injury to facial nerve
• Meningitis
• CSF leak
• Skin infection
• Flap hematoma
• Extrusion of device
• Tinnitus
• Dizziness

28. Duration of AVT therapy & benefit in
speech
• Compulsory therapy for 1 year
• However speech benefits go on for 4 years
post implant
• Involvement of family-most crucial

29. Why are we not implanting all eligible
candidates?
• COST FACTOR
• LATE PRESENTATION
• COMMITMENT FOR AVT