Cochlear Nucleus

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What makes the Cochlear^TM Nucleus^® different to other products?

• Water resistant – The Nucleus^® 5 Sound Processor (CP810) is the world’s 1st water resistant and only submergible sound processor. Swim, knowing there is no need change accessories (using rechargeable battery configuration)
• MRI compatibility – Cochlear’s Nucleus^® 24 range is approved for MRI scans at 1.5 Tesla with the internal magnet in place, and 3.0 Tesla with the magnet removed.
• Industry’s smallest sound processor
• Most reliable implant system. 7 out of 10 people worldwide select Cochlear^TM when selecting a cochlear implant.
• Microphone technology that gives superior hearing performance in noisy settings.

Introduction

The latest Cochlear^TM Nucleus^® system is designed to offer people with severe to profound hearing loss the best in hearing performance. It features the industry’s smallest sound processor (CP810), a two-way remote assistant (CR110) to wirelessly monitor and manage your hearing, and the Nucleus^® CI24RE Cochlear Implant. The Nucleus^® CI24RE Cochlear^TM Implant has a solid reputation as being the most reliable and best performing implant. Featuring sophisticated electronics and the award winning Contour Advance electrode, the Freedom Cochlear^TM Implant delivers leading performance for today, and the flexibility and power needed for tomorrow’s breakthroughs. Together these components set a new benchmark in hearing performance.

What is a cochlear implant?

A cochlear implant is a tested and proven medical intervention to connect clinically approved hearing impaired people to sound, providing that the hearing nerve between the brain and cochlea still works. It restores hearing levels to between 20 and 30 dB, which is normal hearing thresholds. Unlike hearing aids, which make sounds louder, it replaces the function of the damaged inner ear (cochlea).

Who qualifies?

Early implantation is of utmost importance as it influences a child’s ability to develop spoken language. Cochlear implants are routinely implanted in children from 12 months of age. The youngest person in South Africa to receive a cochlear implant is 7 months. Cochlear^TM implants can help adults who:

• have moderate to profound hearing loss in both ears
• receive little or no benefit from hearing aids
• score 50% or less on sentence recognition tests in the ear to be implanted
• score 60% or less on sentence recognition tests in the non-implanted ear or in both ears with hearing aids

and children who:

• have severe to profound sensorineural (inner ear) hearing loss in both ears and
• receive no real hearing benefit from hearing aids and
• are not making progress in developing speech and
• have parents and families dedicated to their child learning speech and being part of the hearing world

See referral criteria for professionals under ‘downloadable content’ on the PROFESSIONALS page.

Where do I start?

It is crucial to visit an Audiologist or Ear Nose and Throat specialist when you, or your child, experience a hearing loss. Potential candidates can be referred to, or contact Southern ENT to connect you with your nearest Cochlear^TM implant or Baha^® clinic. It is crucial that people considering a cochlear implant be evaluated by a specialised and experienced cochlear implant team.

How does a Cochlear^TM implant work?

1. A receiver-stimulator is placed just under the skin, behind the ear
2. An electrode array is implanted surgically into the cochlea
3. An external sound processor transmits digitally-coded sound to the cochlea
4. The recipient manages his/her hearing with a hand held remote assistant

What are the benefits of a cochlear implant?

Children: Cochlear^TM implants for children
Adults: Cochlear^TM Implants for adults
Electrodes designed with the patient and surgeon in mind: Cochlear’s electrode portfolio is dedicated to a range of patient needs and surgical techniques. We believe ‘one size does not fit all’ but rather depends on the patient’s residual hearing and anatomy, and the surgeon’s preference. MRI compatibility: Many people will have at least one MRI scan during their lifetime. The magnet in a cochlear implant can cause complications for a cochlear implant recipient needing an MRI and the compatibility of cochlear implants with MRI is therefore an important lifetime decision. Cochlear’s Nucleus^® 24 range is approved for MRI scans at 1.5 Tesla with the internal magnet in place, and 3.0 Tesla with the magnet removed. To date, no other implant manufacturer can offer this level of MRI compatibility. The magnet can be removed in a simple outpatient procedure before the MRI takes place.

Clinical information

Frequently asked questions

We asked a few cochlear implant units to answer some of the questions they often get:

What symptoms are there for a child who is having trouble with hearing at infancy?

Symptoms vary by age:

• A newborn baby may not startle when a loud noise sounds nearby.
• Older infants may show no reaction when spoken to.
• Children should be using single words by 15 months, and simple 2-word sentences by age 2. If they do not reach these milestones, they might experience hearing loss.
• Some children may not be diagnosed until they are in school. This is true even if they were born with hearing loss.
• Inattention and falling behind in class work may be the result of an undiagnosed hearing loss problem. Children learn to communicate by imitating the sounds they hear. Untreated hearing loss results in delayed speech/language development, social problems and academic difficulties. (Johannesburg Cochlear Implant Clinic)

What is the ideal age to implant a young child?

The ideal age for a child to be implanted if the child is born with bilateral severe to profound hearing loss is before the age of one year. The research comparing age at implantation and outcomes is clear that the earlier a child is implanted the better the outcome. The reason for this is that in children with normal hearing the brain is learning all about sound even in utero, so the longer the delay in providing the child with meaningful sound the bigger the delay will be in the acquisition of spoken language. Outcomes can still be good if the child is implanted before the age of two years, but if the child has no language by the age of 3 years and then receives a cochlear implant it will be difficult to overcome that delay. Rehabilitative intervention is critical in a better outcome. (Tygerberg Hospital Cochlear Implant Unit)

Do you ever put the implants in both ears? Why or why not?

Most of the implantees at our clinic are young babies and children, and as such we see most children with bilateral profound hearing loss. Many times we recommend bilateral implants to:

• Ensure that the dominant pathway is being stimulated;
• Assist with binaural processing skills, which includes localization of sound as well as processing of speech in noise
• Difficulties to consider include financial constraints, traumatic histories or surgical risks. In Durban, we have recently successfully performed our first two bilateral simultaneous implants on two young children, and recently performed a bilateral sequential implant on an adult who was a long term hearing aid user. Many patients express the desire to implant the other ear to obtain better balance, and to not feel “lopsided”. (Durban Cochlear Implant Program)

What is the success rate of cochlear implants, and what is considered a success?

The selection criteria (see ‘who qualifies’ under the CLINICAL INFORMATION page) determines to a large extent the success that can be achieved with a cochlear implant. Pre-operative expectations determine post-operative outcomes.

The vast majority of recipients become successful users although a wide range of results occur and cannot be described by a single measure.

Adult with acquired hearing loss often benefit immediately after the activation of the electrodes and many understand speech without lip-reading on the first day already. More than 70% can be employed in an environment that requires the use of a telephone.

Children, born deaf, who received a cochlear implant before the age of 2 years, have the potential to enter grade 1 with spoken language skills that closely match those of their hearing peers – providing there are no other factors influencing the child’s progress and the child receives the required speech and language therapy. (Tygerberg Hospital Cochlear Implant Unit)

How effective is the implant in allowing a child to hear at normal levels?

Hearing is uniquely different for everyone, almost like a fingerprint. There are many factors that will influence how well a child will hear with a cochlear implant. These include aspects like the duration of hearing loss, condition of the inner ear and other medical conditions, rehabilitation and practicing hearing with the cochlear implant. Once the device has been fitted optimally, a child should be able to detect sound and speech between 20dB and 30dB. However, providing a cochlear implant does not imply that the child will automatically be able to perceive or interpret all the new sounds. Learning to listen with the cochlear implant is therefore of utmost importance to ensure a successful outcome. (University of Pretoria Cochlear Implant Unit)

The journey from here

Where do I start?

It is crucial to visit an Audiologist or Ear Nose and Throat specialist when you, or your child, experience a hearing loss. Potential candidates can be referred to, or contact Southern ENT to connect you with your nearest cochlear implant or Baha^® clinic. It is crucial that people considering a cochlear implant be evaluated by a specialised and experienced cochlear implant team.

What can I expect at a cochlear implant clinic?

Potential candidates have to undergo a series of medical tests to ensure they comply with the clinical criteria to benefit from an implant. The surgery is performed by only specialized Ear Nose and Throat Surgeons and is preceded by the intervention of a multi professional implant team that could include:

• Medical practitioners to evaluate the cause of hearing loss and general health
• Radiologists performing CT and MRI scans of the ears
• Audiologists to evaluate patients’ hearing, do the fitting and programming of the device after the implant and help with rehabilitation
• Speech and Language Therapists that also help with rehabilitation
• Psychologists to assess patients’ ability to cope with the surgery and participate in follow-up programs if needed
• Social Workers that guide and manage family and patient expectations
• Special education that helps with patients educational needs

Importance of early implantation

Early implantation is of utmost importance if somebody was born with a hearing disability as it influences the child’s ability to develop spoken language and adapt in a main stream school. There is nothing worse for a mother of a new born child than receiving confirmation that your child suffers from a disability. Hearing impairment is the largest, single disability; a silent killer as very often it goes undetected, ignored, or mistreated. If a child is congenitally deaf, and receives no hearing amplification he/she will hardly be able to develop spoken language after 3-4 years because the hearing pathway no longer activates the auditory cortex, but the visual cortex. This is largely due to the fact that these children have to rely solely on their vision to ‘hear’ and make sense of a very auditory world. It is therefore imperative that parents are guided into making the decision for the child to be a part of the hearing world or not, at the earliest time as possible. Cochlear implants are routinely implanted in children from 12 months of age. The youngest person in South Africa to receive a cochlear implant is 7 months.

First activation (switch-on):

The first activation is when the internal cochlear implant is connected to the external speech processor, i.e. when the patient is connected to sound for the first time. It usually takes place four weeks post-surgery and is just the beginning of a long process. The first activation is usually uneventful because the brain needs time and practice to adjust to the new sound. The results will emerge over time.

Post-surgery mapping sessions

Patients will have to attend a number of mapping sessions to (re) program the new implant during the first few months after the first activation. The map has to be changed according to the brain’s adjustment to sound. After the first year, an annual mapping appointment is usually sufficient.

Rehabilitation

Rehabilitation post cochlear implantation is an accepted part of the implant process since the brain needs auditory training and exercise to get used to the new sound. Read more on our PATIENTS page.

Auditory verbal rehabilitation

During 2010, Southern ENT sponsored thirteen professionals from around South Africa to complete a yearlong training programme in Auditory Verbal Practice (AVP) under Warren Estabrooks, President and CEO of WE Listen International. The aim of AVP is to enable children with hearing disabilities to communicate through speech. Contact us via our enquiry form for more information.

Never too old to be implanted

Never too old to be implanted: People who experience age induced hearing loss will be happy to know that there are no age restrictions on cochlear implants! If you are told that “hearing aids will no longer help/nothing more can be done”, a referral to a cochlear implant clinic might be that last resort. Contact us to connect you with your nearest cochlear implant team for an evaluation.