What do people with cochlear implants need

Things to know about a cochlear implant (CI)
for those affected and their relatives



Hearing is a vital part of our life, it means quality of life, creates and maintains relationships, promotes development, favors activity and allows people to mature as partners and personality through listening, listening and being spoken to.

But hearing loss is increasing worldwide:
For many severely hard of hearing people or people who are almost deaf and have no or only a poor understanding of speech with hearing aids, or are even completely deaf, questions inevitably arise in the direction of new hearing possibilities.

A Cochlear implant gives many hearing impaired people a legitimate way of doing things hope. Sometimes the cochlear implant is touted as a “miracle” in articles and press reports and the impression arises that after such an operation all problems are solved and the hearing impairment finally defeated. Here, for the sake of honesty, one should differentiate a little better.

With the following information we would like to contribute a little to objectivity, point out the background and offer criteria for a personal decision:

I. What is a cochlear implant (short: CI) and how does it work:

historical overview
Cochlear implant technology was introduced in 1978 by Professor Graeme Clark of the University of Melbourne - a breakthrough in medical technology. With this, Clark realized his childhood dream of enabling deaf people, like his father, to hear. As the inventor and developer of the world's first multi-channel implant, Clark is also known as the father of cochlear implants.
A cochlear implant is a high-tech medical device, a multi-part "inner ear prosthesis", it takes over the failed functions of the inner ear by bringing electrical stimuli directly to the auditory nerve and thus bridging the disruption or interruption of transmission perceive.
A cochlear implant system consists of the following components:

a) External parts: Speech and ambient noise are picked up by the microphone and processed in the speech processor (mostly similar to a BTE device). The speech processor filters, analyzes and digitizes the sound and generates coded signals. These are transmitted by the speech processor via the transmitter coil (a magnet ensures that it is correctly positioned) as a high-frequency signal to the cochlear implant under the skin.

b) Internal parts: The implant usually has a flexible silicone cap with a titanium housing (there are minor differences depending on the manufacturer) and is surgically anchored at the back of the head in the skull bone. It stimulates the various areas of the auditory nerve in the cochlea via current impulses on its electrodes and thus creates an auditory impression. The electrodes are distributed over the length of the cochlea (inner ear).

c) Speech coding strategies: These control the digital processing of ambient noise and speech. Different strategies emphasize different pitches, volumes, and the passage of time. CI users show an improved understanding of speech and welcome the high sound quality when using a speech coding strategy tailored to their respective needs.

Had Speech processors (SP for short) used to be in the format of a cigarette packet and were worn on the body, so today these behind-the-ear devices are much smaller and resemble a somewhat larger hearing aid. The SP can be operated either with 675 batteries (zinc-air) or with rechargeable batteries (lithium-ion).


II. There are different manufacturers, products and CI systems

In the clinics known to us, cochlear implant systems from the following three manufacturers are used (in alphabetical order):

The decision for a certain product is difficult, because as a layperson you can hardly understand the real technical differences between the products used.
The research is concerned with the determination of criteria for which patients which implants or speech coding strategies are suitable. The results are not always comprehensible and it is therefore recommended, in case of doubt, to seek advice from several clinics, each of which uses certain implants (see companies).

The following criteria can also be essential for a decision:

  • Are there comprehensive explanations in the respective clinic about the functions and use of a CI and a sufficient range of rehabilitation measures (speech therapy, etc.). Is a rehabilitation stay of several weeks advocated by the medical profession?
  • Is optimal follow-up care, e.g. accessibility of the respective clinic guaranteed because of the necessary readjustments?
  • Who (company, dealer, head office ...) is responsible for a quick repair and replacement of the speech processors, coils and cables in the event of failures, etc.?
  • Are the speech processors equipped with additional aids, such as the use of an induction coil or an external microphone? Can various additional devices (for telephone, mobile phone, television, lectures, etc.) be used with attachable adapters (wireless) or with cables?
  • How easy is it to operate the speech processor (plugs, switches, buttons, changing batteries and rechargeable batteries ..)?
  • What is the comfort and fit of the speech processor and the durability of the cables and connections?
  • What experiences do you have with battery consumption (but this is always to be seen in relation to the respective setting and usage time)? Is it possible to use rechargeable batteries? In Austria (in contrast to Germany), the costs for batteries are currently not covered by social insurance. (Additional information: A large part of the battery consumption - approx. 70% - is due to the sending of the coil through the scalp to the implant and this can be of different thicknesses)

These criteria should be used despite individual differences in conversations with CI carriers of the various systems to be discussed. Contact advice centers that will be happy to provide you with company-independent information or arrange various CI carriers and self-help groups.

New products for special forms of hearing loss:

Many people develop a form of hearing loss called partial hearing loss, which is mild to moderate hearing loss at low frequencies that drops off to total hearing loss at higher frequencies. For these people, hearing aids often give unsatisfactory results in understanding speech or listening to music. Conventional cochlear implant systems are also not the best solution, as those affected with CI have their natural residual hearing in the low frequency range
can not use.
Both that EAS ™ hearing implant system (Electrical acoustic stimulation, Duet device) from MED-EL as well as that Cochlear ™ Hybrid ™ System the company Cochlear offer new possibilities.
A cochlear implant with a shortened electrode to supply the high frequency range is used in the respective ear, combined with a hearing aid that amplifies the lower sounds accordingly.

The extent to which the affected person can use such devices should be discussed sufficiently with the respective clinic and the surgeon.
As far as we have been informed, these systems can also be used after a later loss of the low frequency range, in which case the electrodes of the implant will be reprogrammed accordingly.

III. When should the operation be performed?

A CI is recommended if there is a severe hearing loss (today already from 80 dB hearing loss) and the person affected with hearing aids insufficient understanding of language can achieve more, or the person affected is already unilateral or bilateral.

In these cases, the transmission of the sound stimuli to the auditory nerve is severely disturbed or interrupted and enormous communicative problems arise in professional and private respects, as well as in relation to one's own linguistic expression. Isolation begins.

At late deaf people The rule is that an improvement is more likely, the shorter the time between deafness (or hearing loss bordering on deafness) and implantation.


IV. Procedure

In order to basically determine the possibility and usefulness of an implantation, you should definitely contact one of the clinics in Austria after a conversation with the ENT doctor and request a preliminary examination:

  • AKH Vienna, ENT department
  • Graz: ENT clinic of the LKH
  • Graz: ENT department of the Elisabethinen
  • Salzburg: ENT department of the LKH
  • St. Pölten: ENT department at the LKH
  • Innsbruck: ENT department
  • Feldkirch / Vorarlberg: ENT department of the LKH
  • Klagenfurt: ENT department at the LKH
  • Wels: ENT clinic
  • Linz: ENT department at the AKH
  • Linz: ENT department of the KH Barmherzige Schwestern

This list corresponds to our current state of knowledge.

To a Preliminary examination include: thorough hearing tests (with and without hearing aids), medical examinations (to what extent the auditory nerve is intact), computed tomography, assessment of language ability. These examinations are carried out by audiologists, surgeons and speech therapists. Under certain circumstances, examinations by other experts, e.g. psychologists, radiologists, may be necessary, as well as medical professionals because of any operational risks. The main goal of a preliminary examination is to get as much information as possible for a personal decision, because this is the basic requirement for an operation.

again: Are useful before making a decision Conversations with those affectedwho have already had such an implantation, e.g. in existing CI self-help groups and advice centers. However, it should also be borne in mind that a CI implantation in different people does not always lead to the same result.

Vaccinations:

A number of clinics currently recommend the following vaccinations as part of a CI implantation:

- Streptococcus pneumoniae ("Pneumococci")
- Haemophilus influenza type B

Ask the respective clinic for detailed information on this, or discuss this with your surgeon or family doctor. Based on our previous experience, the costs for these vaccinations are partially covered by the social insurance. In any case, before the vaccination (on the part of the doctor), an application should be made to the chief physician regarding the assumption of costs, in which the need for the vaccination is pointed out. .


V. The operation

The The operation itself usually takes 2 to 3 hours under general anesthesia, on average another 3 - 4 days stay in the clinic is necessary.
The objection that such an operation can no longer be reversed must be countered by the fact that this is also not the case with many other operations. On the positive side, it can be said that complications have so far been extremely rare and that surgery is constantly improving with regard to surgical methods.

So far in adults only for the time being one-sided (one ear) operated on. As a result, spatial hearing, directional hearing and intelligibility in background noise cannot be optimally achieved. However, since every healthy person also needs two ears for adequate hearing, more and more people are now applying for an operation on the second ear after an initial period of familiarization. The experience with a bilateral (bilateral) CI supply with adults are generally extremely positive, very many can use them to work happily again, make phone calls and take part in group discussions.
With children, bilateral care is already carried out in an operation in order to optimize language acquisition.

What happens after a CI fitting?

After the wound has healed, the Initial adaptation of the speech processor by an audiologist from the respective clinic with concentrated participation of the person concerned. It is important to find out the best strategies for voice coding of the processor in extensive measurements and to program them. .
The first hearing impressions are different and everyone experiences new hearing differently, but it is always an exciting experience.

The first setting is not enough; the speech processor is adapted to the changes in hearing perception at intervals, since hearing with the CI always develops slowly. This means a lot of time and energy, but it is usually worthwhile in many improvements.
It is always up to the person affected to learn to interpret the new hearing perceptions and to use the new device. This is where it begins personal training.
A better hearing and understanding even after a successful operation, it largely depends on the person concerned. As a rule, a lot of effort and training is required in everyday life and, if necessary, with special exercises in order to develop an increasingly better understanding of speech and to process the multitude of hearing impressions.

It makes sense after the initial fitting of the speech processor the help of a Speech therapy to take advantage of, in addition, you can even with various Listening exercises Train your hearing and speaking skills using CDs. Various advice centers offer such help.

A several weeks of rehabilitation in one of the special clinics in Germany (there is no such in Austria) is generally recommended, even if this is still not considered necessary by some surgeons and clinics. The personal experience of many CI wearers, however, speaks a different language, especially since the best operation is one gradual habituation cannot replace this new hearing and acceptance of the permanent handicap.

Every CI wearer remains a hearing-impaired person to a certain extentBecause no technology, no matter how sophisticated, can replace healthy hearing, and this new type of hearing is only ensured by technology (speech processors are high-quality computers that you cannot change anything yourself). The implanted ear also has to do without a number of "built-in aids" - as with healthy hearing - for amplification and preselection. The transmission of sound waves into electrical stimuli that can be picked up by the auditory nerve and interpreted by the brain is and remains an exciting process.

The limits of a CI are experienced over time and each affected person will experience this differently. If, for example, the speech processor fails or the coil or the cable there is defective, the person concerned is deaf. Likewise, the speech processor cannot be used when swimming, showering or at the hairdresser's. This handling must therefore be learned.

At Weather sensitivity there may be slight pain in the implant area. However, this is only short-term and harmless.

The Implant in the head (embedded in the temporal bone behind the ear) can withstand even harder blows due to the nature of the material (although this hurts).

Additional resources, such as radio systems are also a valuable aid for CI wearers and facilitate understanding in many cases, e.g. when telephoning, watching TV, in groups and at lectures. Such systems can already be used without cables by means of an adapter on the CI. Before purchasing such aids, they should be adequately tested.

Final remark: The extent to which hearing can be improved after a CI implantation cannot be precisely predicted for the individual. Some CI wearers report a quick and very good open language understanding, even listening to music and making music themselves is made possible again, others have long-lasting difficulties and may be disappointed at first.
For most CI wearers, the truth is probably somewhere in the middle, a noticeable and significant improvement in speech understanding is achieved, but one still comes up against the limits of the existing hearing impairment. Because you no longer have to exert yourself so hard in everyday communication through better understanding with CI, the chronic overexertion of many hearing impaired people tends to decrease.
It is advisable not to go through either exaggerated praise (“I hear like a lynx again”) to be “persuaded” to a CI, nor to get through pessimistic reports (“Everything has gotten worse”) to be deterred. It is and remains a personal decision that depends on how the individual comes to terms with his current situation and what expectations he has. Only those who have made a decision will be able to achieve success for themselves through various rehabilitation efforts.
The question of whether an existing CI implantation Tinnitus improved, cannot be predicted. Some CI wearers report a decrease in tinnitus after the operation, especially after adjusting the speech processor. But there are also CI patients whose tinnitus only reappeared after the operation or who have subjectively worsened, at least for some time.

VI. The cost of an implant

The costs of a CI implantation (operation and initial equipment) are currently borne by a fund in Austria, so that there are currently no costs for the person concerned. As a result, there are certainly additional costs:

  • Trips to the respective clinic for settings and adjustments
  • Battery costs or costs of the rechargeable batteries
  • Speech therapy training
  • Insurance. This is strongly recommended, as the costs for a speech processor (between € 9,000 and € 12,000) in the event of loss, theft, breakage, etc. are not covered by social insurance. There have been countless such cases. The annual costs for such an insurance are usually around 3% of the new price. The contact person for this insurance in Austria is Allianz.
  • External accessories for television, radio, mobile devices, school training, etc.
  • Deductibles as part of the supply of spare parts or the renewal of a speech processor, speech therapy training, etc. may apply. These are heavily dependent on your health insurance company!

    All personal financial expenses in connection with a CI fitting and the associated costs can be claimed in full from the tax office as part of the extraordinary burden due to disability.

The durability of a cochlear implant

As a rule, the companies guarantee a very long shelf life (at least 20 to 30 years) for the implant implanted in the head. Knowing that just the technology unstoppable progresses, after many years it may well be possible that a reimplantation (replacement of the implant) is necessary, but this can usually be carried out in a clinic without complications and usually very quickly.
A Replacement of the implant could also be necessary if the speech processors improve their technical performance over the long term and can only implement this if the implant in the head also corresponds to this new technology.

The speech processor and the transmitter coil are of course subject to an aging process due to constant wear and can be replaced due to wear and tear. As a rule, social security pays these costs.

The Austrian Hard of Hearing Self-Help, other relevant associations, but also volunteer and self-affected employees try to offer independent advice and assistance to all interested parties in the sense of self-help. We are also happy to arrange self-help groups for the exchange of information and experience. At the same time, we strive to help with applications for rehabilitation measures and other aids.



Compilation and processing:
Harald Pachler, Liesbeth Hawle, Martin Schwarz and Hans Neuhold

Published in the ÖSSH magazine “Harmony”, June 2011

Austrian hearing impaired self-help ÖSSH
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