The Cochlear Implant Center at GBMC

How does an implant work?

• Processor (external device and microphone) captures sounds found in the environment.
• Converts the sound into an electrical energy
• Sent through the magnet into the internal implant device
• The information is converted into signals that are carried to the hearing nerve by electrodes placed along the implant.

What is the candidacy process?

Initial consultation

• Complete intake forms and questionnaires prior to appointment
• Adults 45+ will receive a brain health screening
• Check appropriate function of current hearing aids
• Assessment with and without current hearing aids will be conducted
• If necessary, we will assess the function of your ear drum mobility and muscles in the ear
• Assessment of your ability to understand speech in quiet and in noise will be completed. For children we will use picture pointing tasks and games
• Review all of the results and discuss cochlear implant technology and next steps

Medical evaluation (1-2 appointments)

• CT scan or MRI
• Initial medical/otological evaluation (please bring copy of scan with you to this appointment)

Psychological Evaluation (1 appointment: as necessary)

• Expectations
• Non-verbal cognitive evaluation

Speech-Language Evaluation/Rehabilitation

• Assess both expressive and receptive language skills
• Ensure understanding of how to use equipment for daily success
• Strategically assist in meeting goals from early detection of sound, differentiating sounds, understanding speech in quiet, then in noise, and music appreciation and telephone use

Surgery (Outpatient, same day surgery and release)

• Outpatient surgery located at the Women’s Surgical Center @ GBMC or Surgery Center of North Baltimore
• Surgery last approximately 90 minutes
• Return home the same day

Audiology

• Initial activation occurs 2 weeks following surgery. You will spend 1 hour with the audiologist setting the processor and 1 hour working with our CI Technician to ensure your understanding of your equipment.
• Follow up: 1, 3, and 12 months
• Annual follow-up visits may be performed in-person or via telehealth

Rehabilitation 

• The first appointment will be scheduled 2 weeks after activation
• Additional follow-up appointments will be scheduled on an individual basis

Who can be a cochlear implant candidate?

Children:

Ages 1 - 17 years:

• Severe to profound sensorineural hearing loss bilaterally
• Lack of progress in the development of auditory skills
• No medical contraindications
• High motivation and appropriate expectations of child and family members

Adults:

Ages 18 years or older:

• Moderate to profound sensorineural hearing loss
• In some cases, individuals with single sided deafness
• No medical contraindications
• Appropriate expectations regarding the outcomes and the personal commitment to follow up

What are the potential benefits?

Our team will work with you and/or your child to determine if more benefit would be received from use of the cochlear implant than from hearing aid use.  No one can predict the amount of benefit that a cochlear implant recipient can receive. There are several factors that influence patient performance: auditory memory, age of implantation, status of the inner ear, motivation and rehabilitation. Cochlear implant recipients should expect to make continual progress over time although final outcomes will differ based on the factors listed above.

Research shows that the most rapid progress occurs within the first several months of cochlear implant processor use. Consistent utilization of the processor (10+ hours per day) and engagement with an aural rehabilitation specialist is critical to ensure that you reach your optimal performance.

Does insurance cover an implant?

Most insurance companies cover cochlear implantation either fully or partially.  Following the candidacy evaluation, your cochlear implant team will submit documentation to indicate medical necessity for cochlear implantation to your insurance company. Preauthorization will be obtained to ensure coverage prior to surgery. In the case of partial coverage, the remaining charges would be billed to any secondary insurance or considered to be the patient's responsibility.

Surgery and risks

• Outpatient basis - takes approximately 90 minutes
• General anesthesia
• Incision behind the ear
• Electrodes inserted through inner ear
• Small depression in mastoid bone to secure device
• Incision closed, head bandaged
• 2 weeks for healing to occur
• Activation and follow-up

Activation and follow-up

• Issuance of personal processors, user manuals and accessories
• Counseling regarding care and maintenance
• Mapping - testing to set stimulation levels to processor

Activation Week:

• Activation will include up to 1 hour with the audiologist setting and assessing you with your cochlear implant
• CI Tech will introduce you to all your equipment and how to care for and maintain it
• You can expect to have sound awareness on this day
• Initial responses vary for each individual patient

Post-activation:

• Standard follow-up includes audiologic appointments at 1, 3, and 12 months
• Progress will be ongoing, but the biggest improvement is often seen in the 1st 3 months of daily use of the cochlear implant 10+ hours per day

Rehabilitation

Importance

• Essential for language development
• Increased Intelligibility
• Social Development
• Academic progress
• Self-esteem
• Quality of Life
• Independence

Pre-operatively

• Speech and/or Language Evaluations
• Functional Auditory Skills Assessment
• Discussion of Expectations
• Hearing History

Post-activation 

• Services provided in-person and/or via telehealth
• Frequency of therapy based on individual need
• Concentration of Levels of Auditory Skill development:
  • Sound detection (awareness)
  • Sound discrimination
  • Sound identification
  • Comprehension
• Listening in numerous settings
• Speech and Environmental sounds
• Articulation and Language addressed as needed
• Re-evaluations periodically to chart progress

Recommended vaccinations

The FDA has indicated that cochlear implant recipients may be at greater risk for meningitis and have recommended vaccinations. There are risks and benefits of cochlear implant surgery as it relates to the risks of meningitis. The U.S. Food and Drug Administration is recommending that, prior to implantation, cochlear implant candidates consider vaccination against organisms that commonly cause bacterial meningitis. These vaccinations include the pneumococcal vaccinations (23-valent and 13-valent) and haemophilus influeanzae. Your primary care physician can provide these vaccinations to you. Cochlear implant manufacturers are providing reimbursement for any vaccinations not covered by the patient's insurance.