Cochlear Implantation: Breaking the boundaries of Silence

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Cochlear Implantation Breaking the boundaries of
Silence
Cochlear Implants Cochlear Implants are medical
devices that enable hearing in people with severe
or profound loss of hearing, especially in cases
where hearing aids offer very little to no
benefits. In recent years, the cochlear implant
industry has made significant progress with
technological advancements abound, such as
improved sound quality, effective sound
processing even in loud or noisy environments,
minimally invasive and safer options, etc. The
implants can enable the users to carry out
activities of a wide range, from watching
television to understanding conversations with
much more ease and even participating in them,
amongst others.
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How do they work Unlike hearing aids which
amplify the sound signals, cochlear implants
bypass the damaged portion of the ear and access
the auditory nerve directly, enabling direct
sound processing by the brain. Cochlear implants
consist of an external component and an internal
component. The external component is a sound
processor for processing the incoming sound
waves, that is fit close to the ear and the
internal component, implanted surgically beneath
the skin behind the ear, is an array of
electrodes that transmits the processed sound
signals into the auditory nerve. The signals
then reach the brain and are therein processed as
sound. Although cochlear implants enable
hearing, the sound generated might not be exactly
the same as the original, that is, an individual
using a cochlear implant would perceive sound
differently from an individual without any
hearing difficulties. Thus, the sound generated
from the implant would require relearning sound
perception and getting used to it. Before the
Surgery The patients are assessed pre-surgery to
determine if they are suitable candidates for
cochlear implantation. The tests include ear
examination for infections or any other
abnormalities, hearing tests such as audiogram
assessments, speech, and language assessment with
hearing aid trial to determine its potential
use/benefit. Apart from these, a CT scan and/or
MRI scan of the ear and brain is performed to
check for abnormalities, if any. CT scan is
generally employed in patients with a history of
middle ear disease or meningitis. MRI is usually
the preferred mode of imaging, as it detects all
abnormalities crucial for patient management.
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During the Surgery Cochlear implant surgery is
performed after anesthetizing the patient with
general anesthesia. The area adjacent to the
site of implantation is shaven and an incision is
made behind the ear. The cochlea (a bone in the
inner ear responsible for auditory transduction)
is accessed, and the implant electrodes are
inserted into the cochlea. A device called the
receiver is placed right under the skin behind
the ear and it is secured to the skull. The
incision is closed, and the patient is moved to
the recovery area for the effect of anesthesia
to wear off. As the anesthesia wears off, the
patient may experience discomfort or pressure
around the implanted area and might feel dizzy in
some cases, but these effects dont last very
long.
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After the Surgery Post-surgery, the patient
would be under observation for a short while,
followed by a hospital stay, that could range
between a few hours to two days, depending on the
necessity. The patient would be given
instructions on post-surgery care, including
dressing change, handling stitches and other dos
and donts, prior to discharge. Implant
Activation The implant needs to be activated for
it to start functioning however, the activation
does not take place immediately after the
surgery. Usually, a healing period of around 3-6
weeks is allowed after the surgery, where the
incision heals completely and the swelling
reduces. Once the incision is healed completely,
the external component a sound processor will be
added. The sound processor is programmed/mapped
and activated, thus activating the internal
device to stimulate the cochlear nerve, which
will, in turn, commence responding to sounds
thereafter. Time to hear Over the next few
months, programming sessions are conducted, where
the processor is fine- tuned for optimum sound
output. The sound processor is adjusted to suit
the needs of the patient with testing and
fine-tuning, followed by assessing the sounds
heard by the patient. In the meantime, the
patient gets familiarized with the functioning of
the implant and the sound generated, as it would
require some time to get used to hearing with the
implant.

• References
• Cochlear Implant Surgery. Published 2021.
  https//www.hopkinsmedicine.org/health/treatment-t
  ests-and-therapies/cochlear- implant-surgery
• Cochlear implants - Mayo Clinic. Mayoclinic.org.
  Published 2020.

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• https//www.mayoclinic.org/tests-procedures/cochle
  ar-implants/about/pac-20385021
• Center for Devices and Radiological Health.
  Before, During, After Cochlear Implant
  Surgery. U.S. Food and Drug Administration.
  Published 2018. https//www.fda.gov/medical-devic
  es/cochlear-implants/during-after-implant-surgery
• Best Cochlear Implant Surgery Hospital in Delhi
  NCR, India Indraprastha Apollo Hospitals.
  Apollohospitals.com. Published 2016.
  https//delhi.apollohospitals.com/procedures/cochl
  ear-hearing-implant-service

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