Pittsburgh Ear Associates is proud to offer multiple solutions for your hearing loss. Our office is fully equipped to determine the best solution for you whether it is traditional hearing aids or a surgically implanted device. The following is an overview of some implantable device options. To determine what is best for your loss a full examination and evaluation will be needed.
Cochlear Implant
How does a cochlear implant work?
A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds so they may be detected by damaged ears. 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 (hearing) nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn. However, it allows many people to recognize warning signals, understand other sounds in the environment, and enjoy a conversation in person or for some users, by telephone.
Who gets cochlear implants?
Children and adults who are deaf or severely hard-of-hearing may be candidates for cochlear implants. According to the Food and Drug Administration (FDA), through June 2010, more than 219,000 people worldwide had received implants. In the United States, roughly 42,600 adults and 28,400 children have received them.
Adults who have lost all or most of their hearing often can benefit from cochlear implants. Additionally, They learn to associate the signal provided by an implant with sounds they remember. This often provides recipients with the ability to understand speech solely by listening through the implant, without requiring any visual cues such as those provided by lipreading or sign language. Post-implantation aural rehabilitation may be necessary for the patient to receive the optimum benefit from the cochlear implant. Every person is different as are their results with a cochlear implant.
Cochlear implants, coupled with intensive post-implantation therapy, can help young children to acquire speech, language, and social skills. Most children who receive implants are between two and six years old, but older children can be candidates as well. Individual history plays a large role in the success of an individual with a cochlear implant. Early implantation provides exposure to sounds that can be helpful during the critical period when children learn speech and language skills. In 2000, the FDA lowered the age of eligibility to 12 months.
How does someone receive a cochlear implant?
To be considered for a cochlear implant, the patient will need to undergo a cochlear implant evaluation by a cochlear implant audiologist as well as a medical evaluation by the cochlear implant surgeon. This process usually takes 2-3 hours and any interested family members are encouraged to attend. The patient will be tested with his or her hearing aids on as well as without the hearing aids. The different cochlear implant manufacturer’s devices will be explained with a hands on counseling session. Realistic expectations and limitation of cochlear implants and any other appropriate options will be discussed. You will see the surgeon to discuss the surgery, possible risks and complications as well as outcomes. If you do decide to pursue a cochlear implant, you will need to have an MRI or CT of your head to determine if you are a cochlear implant candidate.
Use of a cochlear implant requires both a surgical procedure and significant therapy to learn or relearn the sense of hearing. Not everyone performs at the same level with this device. The decision to receive an implant should involve discussions with medical specialists, including an experienced cochlear-implant surgeon. The process can be expensive. For example, a person’s health insurance may cover the expense, but not always. Some individuals may choose not to have a cochlear implant for a variety of personal reasons. Surgical implantations are almost always safe, although complications are a risk factor, just as with any kind of surgery. An additional consideration is learning to interpret the sounds created by an implant. This process takes time and practice. Audiologists are involved in this learning process, and you may be referred to a Speech-language or an auditory-verbal therapist for aural rehabilitation. Prior to implantation, all of these factors need to be considered.
What does the future hold for cochlear implants?
With advancements in technology and continued follow-up studies with people who already have received implants, researchers are evaluating how cochlear implants might be used for other types of hearing loss.
NIDCD is supporting research to improve upon the benefits provided by cochlear implants. Research is currently be conducted looking at using a shortened electrode array, inserted into the beginning of the cochlea, for individuals whose hearing loss is limited to the higher frequencies. There are studies which explore ways to make a cochlear implant convey the sounds of speech more clearly. Other studies are looking at improving music appreciation for patients with a cochlear implant or a totally implantable cochlear implant. Bilateral cochlear implantation or bi-modal implantation (wearing a hearing aid on one ear and a cochlear implant on the other), is one topic that has much research supporting the use of both ears. This research has made insurance companies, surgeons, audiologists, teachers for the hard of hearing, rethink past beliefs, advancing the potential for individuals with hearing loss.
Other Implantables (Esteem, VSB, Maxum, BAHA):
What is an implantable hearing aid or device?
An implantable hearing aid or device is an alternative available to patients who cannot or will not wear traditional hearing aids. All implantable hearing aids or devices transmit and amplify sound in order that the patient may hear. A number of implantable hearing aids involve placing a magnet in the middle ear, on one of the bones in the middle ear or on the cochlea, the organ of hearing. The internal or external microphone picks up the sound, sends it to the magnet, which then vibrates the middle or inner ear, allowing the person to hear. Others involve placing an abutment or magnet on the skull and once healing has occurred, a processor is attached to the abutment or magnet which sends the sound to the better hearing nerve through vibrations across the skull.
There are two types of implantable hearing aids or devices: fully implantable hearing aids and partially implantable hearing aids or devices.
Fully implantable hearing aids or devices are devices that have an internal device that is implanted by the surgeon with nothing visible on the outside of the head. The device may have a remote control to adjust the volume or program on the hearing aid or device. They also may have an internal battery which is also implanted and may require additional surgery once the battery is no longer functioning. One example of a fully implantable hearing device is the Esteem by Envoy Medical. Further information is available at their website: www.envoymedical.com.
Partially implanted hearing aids or devices are hearing devices that have an internal device that is implanted by the surgeon along with an external device that is worn on the head, behind the ear or in the ear. One benefit of a partially implantable hearing aid or device is having the battery in the external device, which eliminates the need for additional surgery for replacement of the battery. This also allows for updates to the processor through programming software that would not require additional surgery.
There are several options available for a partially implanted device for persons who have a sensorineural hearing loss: the Vibrant SoundBridge by MedEl Corporation (www.medel.com) and the Maxum by Ototronix (www.MyMaxum.com). Both devices utilize an implanted magnet in the middle ear space with an external microphone worn either on the side of the head or in the ear canal. B oth are classified by the FDA as a Class III implantable device .
If you have a conductive or mixed hearing loss or a profound sensorineural hearing loss in one ear and normal hearing on the opposite side (also known as single sided deafness), you have options known as bone anchored hearing technology: the Baha System by Cochlear Americas (www.cochlearamericas.com), the Ponto and Ponto Pro by Oticon Medical (www.oticonmedical.com) and the Alpha 1 Hearing System by Sophono (www.sophono.com). The Baha System, Ponto and Ponto Pro are all categorized by the FDA as osseointegrated cochlear stimulators which consist of an abutment (a cone shaped screw that is implanted in the skull by the surgeon and a processor which picks up the sound and sends it to the better hearing nerve. The Baha System and the Ponto line both use a titanium abutment which is visible when the processor is not in use. The Alpha 1 Hearing System utilizes a surgically implanted magnet, which is not visible when the processor is not in use. Please see their websites for additional information.