Cochlear implant surgery in India

Overview

Cochlear implant (bionic ear) is a small and complex electronic device that is surgically implanted in the inner ear to give the sense of sound in a person with severe to profound hearing loss.

The hearing loss are of two types;

Conductive hearing loss in which hearing is impaired due to disease or any obstruction in the ear canal, ear drum or middle ear which may be corrected or treated with the medical or surgical intervention or in some instances, it can be corrected using hearing aids. Cochlear implant is not indicated in such cases.
Sensorineural hearing loss occurs often due to problems in the inner ear, mostly due to damage to the hair cells. This results in making the auditory nerve unresponsive as it does not receive the sound signals which are normally transmitted through the hair cells. This can be corrected only with cochlear implant.

Cochlear implants are designed to aid children and adults with sensorineural hearing loss. This type of hearing loss typically involves damage to tiny hair cells in the cochlea. As a result, sound can't reach the auditory nerve, which usually receives information from hair cells. A cochlear implant bypasses the damaged hair cells to stimulate the auditory nerve directly.

The implant does not help to make the sound louder or clearer like other hearing aids do, instead it aids in bypassing the damaged area of the auditory system and stimulates the auditory nerve directly helping an individual to perceive sound.

Cochlear implants allow sufficient hearing which allows patient to have better understanding of speech. Although the quality of sound with cochlear implant is different from natural hearing, patients are able to well understand the speech and environmental sounds and cope better with their surroundings.

Cochlear implant has two parts:

External part that includes a microphone, speech processor and a transmitter
Internal part (surgically implanted) that includes a receiver- stimulating system fixed to the skull bone behind the ear and electrodes inserted in the cochlea.

Candidates

Cochlear implant surgery can be done in both children and adults.

In adults:

If they are having severe to profound hearing loss in both the ears and have not benefited from other hearing aids, are considered for cochlear implants. The hearing loss should be of sensorineural type which can occur due to injury, illness or ototoxicity.

In children:

Children who are congenitally deaf with speech disability, or have lost the sense of hearing after a head injury or illness, are candidates for cochlear implant surgery.

The best candidates are those who have no medical reasons which prohibit surgery, having a functional auditory nerve with a clear understanding about cochlear implant and have realistic expectations from the surgery.

Procedure

Evaluation and matching procedure:

Cochlear implant surgery begins with a thorough evaluation by a team of audiologist, ENT surgeon; physician, anesthetist etc. After it is decided that the patient needs the cochlear implant, the surgery is done.

The procedure is done under general anaesthesia and it takes around 2-3 hours to complete the whole procedure.

To start with the surgeon makes a small incision behind the ear and the bone is exposed anteriorly up to the level of ear canal and place is made in the bone posteriorly for inserting the receiver of the implant. The implant is secured in the position behind the skin ad muscles of the ear. The ear canal and ear drum are left undisturbed during the entire procedure.

Then a small incision is made in the cochlea and the electrode is inserted there through cochleostomy. After securing the insertion of the implant the incisions are closed and dressed.

Recovery

Recovery from the surgery is quite simple and doesn't take long. You would stay at the hospital for 1-2 days.

The real work begins after the cochlear implant is implanted. Rehabilitation is necessary to get maximum benefits from the implant surgery which starts with fitting the patient with external parts-speech processor, battery pack and transmitter.

Necessary adjustments and reprogramming is done to activate and programme the implant and its parts. Rehabilitation with speech language pathologist, audiologist, surgeon, psychologist, and teachers helps the patient understand how to listen to the implant and how to understand the speech.If the patient has had hearing aids in the past, the rehabilitation takes advantage of the developed auditory skills and builds on them, whereas in case of no previous sound exposure, the process starts from making the patient learn about the sound and how to respond to the sound.

Expected Results

With a cochlear implant, the recipients may experience wide range of outcomes. For individuals who lost hearing after learning to speak, perception of speech and sound after a cochlear implant may seem quite different initially from what they remember. Though after using it for several months, they would feel it to be more natural and familiar.

In children, who were born deaf, the benefits achieved are quite drastic. While in adults, if the length of time between deafness and cochlear implant is less, the better is the outcome and vice versa.

Time & Cost

You would need about 6 weeks in India for pre-operative evaluations, surgery and initial rehabilitation, which is then carried out by a rehab centre in your country for better progress.

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