Cochlear Implant Surgery in Bangalore

When Is A Cochlear Implant Surgery Recommended?

Cochlear implant surgery is required for individuals with hearing loss in both ears and little to benefit from conventional hearing aids. The surgery is primarily recommended for the following conditions:

• Severe to profound hearing loss: Individuals with over 70% loss of cochlear hair cell function, inability to hear most sounds at any volume, and significantly poor understanding of speech might be candidates. 
• Limited benefits from hearing aids: Traditional hearing aids are tried on the patient before opting for the surgery.
• Post-lingual hearing loss: Cochlear implants specifically benefit those adults and children who lost hearing after acquiring language. However, pre-lingual deafness in children may also be treated with this surgery, ideally at a young age to support language development.
• Age and health considerations: Suitable candidates include infants as young as 6-12 months to elderly individuals. They should be in overall good health.
• Motivation and realistic expectations: The individual should be committed to rehabilitation post-surgery, including auditory training and speech therapy. Carrying realistic expectations by the patient and his/her family is also important.
• Support system: A support system including family and friends with educational and rehabilitation services should be there, especially in the case of children. 
• Bilateral implantation: Sometimes, implantation in both ears is recommended to improve one’s ability to localize sound and also understand speech in noisy environments.

The decision to undergo a cochlear implant surgery is taken after a thorough evaluation by qualified medical professionals such as audiologists, ENTs, and speech-language pathologists.

How Does A Cochlear Implant Surgery Work?

Here’s what happens before, during, and after a cochlear implant surgery:

Before the Surgery

Pre-surgical evaluation is important to ensure that the person is suitable for a cochlear implant surgery. Here is an overview of the typical evaluation:

• Hearing evaluation: The specialist examines your hearing ability and overall health to confirm your eligibility for the procedure.
• Medical examination: Your doctor will recommend certain tests such as blood and imaging tests to assess your general health. He/she will also explain the procedure in detail along with the expected outcomes.
• Pre-Surgery Instructions: Your healthcare provider will provide specific instructions to prepare for the surgery. This may include guidelines on eating and drinking before the procedure, medications to avoid, and any necessary preparations for aftercare.

During the Surgery

Here’s the step-by-step procedure:

• Anesthesia and preparation: General anesthesia is administered to the patient to ensure s/he’s asleep throughout the procedure. The area behind the ear may be shaved and cleaned.
• Incision: An incision is made behind the ear to access the mastoid bone, the size and shape of which varies but minimizes scarring and ensures optimal placement of the implant.
• Exposure of the Cochlea: After making the incision, the surgeon will gently move aside the skin and tissue to expose the cochlea, the spiral-shaped structure of the inner ear.
• Drilling the Opening: Using specialized surgical tools, the surgeon will create a small opening in the bone behind the ear to access the cochlea. This opening allows for the insertion of the electrode array, which will stimulate the auditory nerve.
• Insertion of an electrode array: Next, the electrode array (a thin wire with multiple electrodes) is carefully inserted into the cochlea through the round window (opening into the cochlea) or a tiny hole drilled in the cochlea. The electrodes on the array are designed to stimulate the auditory nerve fibers, allowing sound signals to be transmitted to the brain.
• Securing the implant: The receiver/stimulator is now secured in the well drilled in the skull bone, the incision is closed with staples or stitches and finally, it is bandaged to protect the surgical site.

The specific details of the procedure may vary depending on the patient’s individual needs and your surgeon’s preference. 

After the Surgery (Rehabilitation in both children and adults)

After a cochlear implant surgery, both children and adults undergo rehabilitation to maximize the benefits of the implant. The rehabilitation varies for varied individuals based on factors like their age and duration of deafness. 

For children:

• Initial activation and mapping: After a few weeks of surgery, the cochlear implant is activated, usually over several appointments. The settings of the speech processor are adjusted to fit the child’s hearing levels (mapping).
• Auditory-verbal therapy: Therapy involves developing the child’s listening and spoken language skills. The child is taught to listen to sounds, understand them, and use verbal language to communicate.
• Educational support: Many children need educational settings which may include systems that enhance the teacher’s voice, preferential seating in the class, and individualized education plans. 
• Parental and family involvement: Family involvement is crucial as the family members can engage the child in frequent and consistent communication requiring the use of spoken language in everyday activities to reinforce speech and listening skills. 
• Social integration: It encourages social skills and self-esteem. The children are encouraged to participate in group activities.

For adults:

• Initial activation and mapping: Similar to children, adults also undergo the sessions to fine-tune the settings of the cochlear implants for optimal hearing.
• Auditory training: Auditory training sessions with therapists and computer-based programs help learn/relearn interpret sounds, understand speech, and improve communication skills.
• Speechreading and communication strategies: They might be taught speechreading (lip-reading) and other communication strategies to enhance understanding and speaking. 
• Support groups and counseling: Sharing experiences and strategies with others with similar challenges can also help with emotional support and practical advice.
• Gradual integration into everyday life: Lastly, exposure to different listening environments (both quiet and noisy) helps adapt to various types of background noise and speech patterns.

Rehabilitation for both children and adults requires patience and persistence. Follow-ups must be attended sincerely and auditory input and practice should be consistent for the cochlear implants to show the improvements in communication and enhance the quality of life. 

Risks And Benefits Of Cochlear Implant Surgery

Understanding the risks and benefits of cochlear implant surgery is important for making informed decisions.

Risks:

• Surgical risks like infection, bleeding, and reactions to anesthesia.
• Malfunctioning of the device, requiring replacement surgery.
• Damage to the facial nerve, leading to temporary or permanent weakness or paralysis of the face.
• There is a risk of residual hearing loss in the implanted ear.
• Vertigo (dizziness), balance issues, and tinnitus (ringing in the ears) following implantation.

Benefits:

• Improved ability to hear and process sounds.
• Improved understanding of speech in both quiet and noisy environments for better communication.
• Enhanced social interactions, more independence, and a better quality of life.
• Improved educational and occupational opportunities, and social engagement.
• Increased safety as you are more aware of your surroundings.

For many patients, the benefits of cochlear implant surgery outweigh the risks and improve their hearing, speech understanding, and overall quality of life. The decision to undergo the surgery should align with one’s personal circumstances and health goals.