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Cochlear Implants

  • A cochlear implant is an electronic device to provide a sensation of hearing to individuals who are deaf. It consists of two main parts: an external part worn somewhat like a hearing aid, and an internal part which must be implanted by a surgeon.

    How Boston Children's Hospital approaches cochlear implants

    The Cochlear Implant Program at Boston Children's Hospital is an interdisciplinary program within the Department of Otolaryngology and Communication Enhancement.

    • It provides a unique opportunity for children who are deaf and for their families.
    • The program, led by Greg Licameli, MD, is the largest and most comprehensive pediatric cochlear implant program in New England.
    • We offer advanced technology combined with unparalleled personal care, provided by a team of highly qualified clinicians.

    Boston Children's Hospital
    300 Longwood Ave
    Boston MA 02115
     fax: 781-216-2252

  • In-Depth

    How is a cochlear implant put together?

    The external part of a cochlear implant is the speech processor. It has a "microphone" worn over or behind the ear. A cord leads from the microphone to the speech processor. The speech processor codes the sound input into electrical signals which are sent back to the "transmitter," a thin plastic piece about one inch in diameter containing a magnet placed on the side of the head behind and slightly above the ear.

    In turn, the transmitter sends the signals across the skin to the internal part of the implant (the "receiver/stimulator"), which is under the skin. The receiver/stimulator sends the signals into the electrode array, which is a one-inch long wire surgically inserted into the inner ear. The electrode array consists of an array of electrode bands, each of which can provide a tiny current to the inner ear, to replace the function of the damaged or missing hair cells which ordinarily would stimulate the nerve endings of the auditory nerve.

    Will a cochlear implant provide normal hearing?

    A cochlear implant provides a limited sense of hearing. However, a cochlear implant combined with visual cues usually let most people understand spoken language.

    Who can benefit from a cochlear implant?

    Adults and children who used to have normal hearing or partial hearing—who learned to talk before they became deaf—often benefit from a cochlear implant.

    If your child was born deaf or became deaf before he or she learned to talk, cochlear implants can also help. It just might take longer for them to understand spoken language.

    What range of hearing loss must my child have to benefit from an implant?

    To be a candidate for a cochlear implant, your child must have a severe or profound sensorineural hearing loss in both ears.

    The average hearing level in the speech frequency range (500-2000Hz) must be poorer than 70 decibels in both ears without hearing aids, and with hearing aids your child must not be able to recognize single words clearly out of context without looking at the talker's face.

    If your child is younger than 2, her hearing loss must be 90 decibels or greater in both ears.

    At what age should my child receive a cochlear implant?

    The Food and Drug Administration allows cochlear implants for children beginning at age 12 months. A congenitally deaf child who is going to have a cochlear implant should have the surgery before the age of four years, earlier if possible. This early implantation gives your child the best chance to learn to use sound while language skills are developing.

    Children who once had normal hearing or partial hearing, and then became deaf, may be implanted as soon as it is clear that there's no benefit from a hearing aid.

    What factors might favor or limit my child's benefit from a cochlear implant?

    Ask yourself and your physician:

    • Does my child have good cochlear anatomy?
    • Does my child have good underlying language abilities?
    • Did she have a solid base of language development prior to surgery?
    • Will we participate in regular speech/language therapy given by a cochlear-trained clinician?
  • How is cochlear implant surgery performed?

    Implant surgery is performed under general anesthesia and takes three to six hours. Your child stays in the hospital one or two nights after the surgery. This can be a traumatic time, and you are encouraged to stay in your child's room during surgery and recovery.

    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. Your child's brain is not exposed or penetrated during the surgery.

    The electrode array is inserted into your child's 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 then surgically closed over the implant.

    What are the risks of cochlear implant 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 does destroy any ability the individual may have had to hear with a conventional hearing aid in that ear. Bear in mind that at some point, your child may need a replacement implant.

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