Cochlear Implant Program
What appointments are necessary prior to surgery?
Once your child has been approved to receive a cochlear implant, you will be given a pre-operative appointment ("pre-op"), as well as a surgery date. Pre-op typically takes place approximately 2-3 weeks prior to surgery, and typically includes a consultation with the anesthesiologist, and additional blood work.
Also, prior to surgery, your child will need to have updated immunizations, including one for meningitis. Our program coordinator will work with your family to ensure that your child has what is needed to proceed with surgery.
What happens during surgery?
The surgery is performed under general anesthesia and takes three to five hours. The child stays in the hospital one night after the surgery, or longer if needed. One parent may sleep in the child’s hospital room. During the surgery, the receiver/stimulator and electrode array are implanted. An incision is made behind the ear for the surgeon to expose the area of the round window, a tiny membrane at the separation between the middle ear and the inner ear. Then the surgeon places the receiver/stimulator in a small area on the side of the head where the bone has been drilled thinner to make a place for the receiver/stimulator to fit, outside the skull but under the skin. The brain is not exposed or penetrated during the surgery. The electrode array is inserted into the inner ear, and the receiver/stimulator is fixed in place over the bone. Electrical recordings are made to show that the electrodes are providing stimulation. The skin is surgically closed over the implant. An X-ray may be obtained to verify the placement of the device. When the external parts of the implant are not being worn, the implant is not typically visible from the outside.
What are the risks of surgery?
The risks of anesthesia are the same as for any surgery. Surgery to the inner ear also carries the risks (although uncommon) of facial nerve paralysis, loss of taste sensation, dizziness, or ringing in the ear. The surgery may destroy any ability the individual may have had to hear with a conventional hearing aid in that ear. It is possible that at some point in the future, the implant may stop working and may need to be replaced in another operation.
How can I help prepare my child for surgery?
A psychologist will meet with you and your child to help you find ways to feel comfortable and positive about the opportunity to have the surgery. For a young child, playing with dolls, head bandages, doctors’ masks and hospital vocabulary are ways to prepare for the surgery. Play dates or emails with other children who already have cochlear implants provide familiar role models. The cochlear implant team gives the child a backpack of age-appropriate items and games to take to the hospital. The child is encouraged to express questions and concerns. Brothers and sisters often have their own anxieties about the surgery, and their questions should be addressed so that they can feel positive and supportive about the implant.
How soon will my child be able to "hear"?
Three to four weeks after the surgery, your child comes in for the first “stimulation” using the speech processor. Activation of the speech processor requires two two-hour appointments within one week. During these appointments, your audiologist will assess your child's responses to help determine how much current to program each electrode to deliver. The audiologist may also use neural response recordings to program the device to give sound sensations that are audible and comfortable. The program produced is called a "map", and appointments such as these are called "mapping" appointments. After the initial mapping, the child is seen for re-mapping and fine-tuning at:
- one month post-activation;
- three months post-activation;
- six months post-activation (including hearing testing and a speech-language follow-along);
- then every three months, typically for the first year or two.
What will my child hear when the implant is activated?
Because only the recipient knows what they hear through a cochlear implant, we have to rely on what they tell us about what it sounds like. Most older children tell us it sounds like static, or buzzing, or high-pitched squeaky sounds. Regardless, in most cases your child may not understand speech when the processor is first turned on. Months to years of listening therapy is typically required to help your child's brain make sense of the sounds it is receiving. This is especially true for children who are implanted very young, and for children implanted later with limited spoken language abilities. Please refer to the "Additional Resources" page for simulations of what science tells us a cochlear implant might sound like.
