Friday, February 27, 2009

Cochlear Implants 101

"Can you tell he's hearing yet?"

"Is he turning to sounds?"

"Why did you get him implanted if hearing aids were providing him sound?"

"What is that poking from his head?"

We've had many questions like these since Aiden's surgery so I thought it'd be good to do a couple posts about cochlear implants, the activation a.k.a. mapping sessions a.k.a. "turning on his ears" and the therapy that must follow in order for Aiden to be successful with his implants.

Let me preface this all with I am not the expert. I will do my best (with the help of the Cochlear website and other references), to explain all this.

I'll start with the difference between a hearing aid and a cochlear implant.

Hearing aids amplify natural sounds. People who wear hearing aids (mechanically) hear the same way a hearing person does. But no matter how loud the sound the hearing aid produces, it will not provide the clarity needed to someone with Aiden's degree of hearing loss to understand all environmental and speech sounds. This is why he was a candidate for cochlear implants.

Cochlear implants don't make sounds louder. They work by bypassing the damaged part of the ear and sending DIGITAL sound directly to the auditory (hearing) nerves and then on to the auditory centers of the brain. This is a different type of sound Aiden will receive then he did from his hearing aids or that you and I hear everyday. We hear acoustically whereas Aiden will hear digitally.


There are three brands of implants we had to choose from, Cochlear, Advanced Bionics, and Med-El. We had a gut feeling of which brand we wanted right away. Yet still, I continued to research, and question, and doubt our first choice, all up to just days before we had to tell our audiologist which brand we wanted. This wasn't a choice we could change our mind about once done, this was a lifetime decision we were making for Aiden. I don't question our decision today and I believe it's important to feel good and secure with the brand chosen. I do believe though that all the brands are wonderful and in the end, with the proper therapy, do the same job.

Some things we looked at when making our choice was:
  • Asked our audiologist and surgeon what they worked with the most. We felt it was important since they would be working closely with us to surgically implant and map Aiden.
  • Talked with other parents and asked them pros and cons of their decisions. We also met kids with each of the three implants and saw the different wearing options.
  • Different wearing options for each brand for NOW and the near future. We're not worried about how Aiden will wear the equipment in 10 years from now, because by then, they'll most likely have new external equipment.
  • And because I am a little (ok a lot) OCD, I did put together a spreadsheet comparing every "engineering" aspect of the brands, but soon realized I'm not an engineer and it just got too technical ... (this is where my husband steps in and reminds me that we know what we want so just tell the audiologist).

Ultimately, all brands are amazing. The success lies in the auditory training after activation. If a child is not provided extensive language opportunities, it won't necessarily be the implant that's failing. So when you hear me talk about every little thing I do, know I already know I'm nuts, but know even more that I'm doing it to feed Aiden's auditory brain every little bit of language that I can! It's the key to his success.

The Equipment

We chose the Nucleus Freedom by Cochlear for Aiden. We like the different wearing options from toddler to preschooler. We like their reliability and success rates. We like their "splash-resistant" design. We like their technology upgrade capabilities. We like their battery options. We like their customer service reputation. They just felt right for us.

This is the internal and external pieces of the Cochlear product ... the "mechanics" to help Aiden hear. (This information is directly from the Cochlear website. My comments are in parentheses).

1) Earhook - sits on top of the ear to hold the sound processor securely in place.

2.) The Processing Unit - houses the main "computer" for the sound processing system. Features microphones that help to pick up sound from speech and the environment.

3) Behind the Ear (BTE) Controller Option - sits behind the ear and features buttons which allow for adjustment of volume, programs, and sensitivity. (Also holds the batteries).

4) Coil/Cable - connects the sound processing unit to the implanted "magnet" on the other side of the skin. It helps to transmit the electric impulses that enable hearing.

5) The Magnet - sits in the middle of the coil and connects with the magnet on the other side of the skin. This connection between the magnets helps conduct sounds to the hearing nerve.

6) Cochlear implant body - made up of titanium and silicone (this is what we see protruding from Aiden's head right now)

7) Electrode Array - extends from the main body of the implant into the Cochlea (it is the end of this piece that is inserted and wrapped around the Cochlea). This is the main piece of the implant that delivers sound to the hearing nerve.

Drew's dad, did an amazing job in this video explaining the Cochlear equipment too. I highly recommend checking this out! Very good!

So, as you can see, there are internal and external parts. Both must work together in order for Aiden to receive any type of sound (along with the activation/mapping sessions). He's all set with the internal parts and at activation on March 9th, we'll receive the external parts, and they'll "turn on his ears". This is why Aiden still cannot hear right now.

Here is what the external pieces look like on. At first, Aiden will have what is called a "Babyworn" setup (click to see a good picture of it on the Cochlear website). With this setup, the battery pack/controller is pinned to his shirt and he will just wear the processor on his ear. I am very excited about this wearing option! Once he gets older, and ears get bigger, he will be able to wear the whole thing on his ear as you see in this diagram.

I cannot stress enough that Aiden will ALWAYS be deaf. This is not a cure for deafness by any means ... it is a solution to help Aiden hear. If Aiden does not have the coils (the round piece) attached to his head on each side, he will not hear. If one side falls off, he will just hear from the side that is attached. He will (hopefully) NOT wear "his ears" when bathing, swimming, or sleeping. Other than that, Aiden will have on his "ears" at all waking moments. But when they are off, his world will be silent.

Coming up ... What is "activation/mapping" and what will Aiden hear once he's activated.


leah said...

What a great post! People sometimes ask us if Nolan can get an implant, and we have to explain that he gets tremendous help from his hearing aids so a CI isn't necessary. I wish I could have this available when people ask- you put that together pretty well!

Lucas'Mommy said...

Great post, Tammy! Love it! Very informative!

Kel said...

Awesome post! I really need to do something like this on my blog for everyone...

susannah said...

this is a great post! i was thinking of doing something similar for all of the many many questions...

Anonymous said...

That was a good post. It answered a lot of questions I had.


Julie said...

Wow! Great explanation :0)

Can't wait to hear about his reactions to activation day,