Cochlear Implant is best for children having severe hearing loss. It's beneficial for early intervention of HI

1. COCHLEAR IMPLANT
IMRANA SHAKOOR-SLP

2. HUMAN HEARING MECHANISM
IMRANA SHAKOOR-SLP
•Step 1: Sound waves enter the ear. When a sound occurs, it
enters the outer ear, also referred to as the pinna or auricle.
...
•Step 2: Sound moves through the middle ear. Behind the
eardrum is the middle ear. ...
•Step 3: Sound moves through the inner ear (the cochlea) ...
•Step 4: Your brain interprets the signal.

3. Cochlear Implant & Speech Acquisition
■ Cochlear implanted children will have the benefit of
having a device that allows them to “tune into” speech
sounds more easily and monitor their own speech..
■ After cochlear implantation, the patient will receive aural
(re)habilitation services by an audiologist and/or an SLP
to build auditory skills to learn how to listen to,
discriminate between, and understand the range of
sounds (e.g., environmental sounds, spoken language,
music) conveyed via the device
IMRANA SHAKOOR-SLP

4. WHAT IS COCHLEAR IMPLANT?
❖ Biomedical device / Bionic Ear
❖ Surgically implanted
❖ Bypasses the damaged part of the inner ear &
stimulates the electrical activity in the remaining
neural fibers of the auditory nerve & generate
sensations of hearing.
IMRANA SHAKOOR-SLP

5. Three manufacturers of implants commonly used in
1. portion (Nucleus)
Advanced Bionics- (Clarion)
Med-El
2. Surgically implanted components
Receiver coil
Electrode array
3. External components
Microphone
Speech Processor
Transmitter with a magnet
COMPONENTS OF CI
IMRANA SHAKOOR-SLP

6. Normal Inner Ear Damaged Ear
HAIR CELLS
IMRANA SHAKOOR-SLP

7. Deafness: Normally functioning hair cells not
present; some atrophy of 8th N fibers.
IMRANA SHAKOOR-SLP

8. Hearing Aid:
- acoustically amplify the sounds.
- rely on the responsiveness of surviving hair cells.
Cochlear Implant:
- bypass the damage hair cells
- convert the acoustic input signals into electrical
energy used to stimulate the surviving auditory
nerve fibers in the inner ear.
DIFFERENCE B/W H.AID & C.IMPLANT
IMRANA SHAKOOR-SLP

9. COCHLEAR IMPLANT
IMRANA SHAKOOR-SLP

11. Sound is received by
the microphone
Microphone

12. Sound is sent
from
microphone to
speech
processor
cable
Speech
processor
IMRANA SHAKOOR-SLP

13. Speech processor
analyzes and
digitizes the sound
into coded signals
Speech
Processor
IMRANA SHAKOOR-SLP

14. Coded signals are
sent to the
transmitting coil Transmitting coil
Cables
IMRANA SHAKOOR-SLP

15. Transmitting
coil sends the
code across
the skin to the
receiver/
stimulator of
internal
implant
Transmitting coil
Receiver/ stimulator

16. Signals are
sent to the
electrodes to
stimulate the
remaining
nerve fibres
electrode

17. Signals are
recognized as
sounds by the
brain
producing a
hearing
sensation
IMRANA SHAKOOR-SLP

18. COCHLEAR IMPLANT
SURGERY
IMRANA SHAKOOR-SLP

19. ➢ Medical Evaluation.
➢ ENT examines the outer, middle and inner ear
➢ Physical examination
➢ Imagery Evaluation: x-ray, CT scans, MRI
➢ Audiological evaluation: Audiologist tests hearing.
➢ Speech and Language Testing
➢ Psychological examination
PRE-IMPLANTATION PROCESS
IMRANA SHAKOOR-SLP

20. CANDIDACY
Age: most important criteria
➢ Maximum Benefit in speech & language: in children
born with bilateral sensorineural hearing loss is to
be carried out before age of 3 years.
➢ Up to the age of 6 years good benefit
➢ Above 6 years limited benefit
IMRANA SHAKOOR-SLP

21. • Inpatient procedure
• Requires general anaesthesia
• Duration ~ 3-4 hours
IMRANA SHAKOOR-SLP

22. The Behind-the-Ear/Device Marking Template is used to
allow adequate clearance between the pinna, the
speech processor and the headpiece.
STEP-1: Behind-The-Ear/Device Marking Template
IMRANA SHAKOOR-SLP

23. After placing the Device Coil Gauge, an
outline is drawn around the template.
STEP-2: Device Coil Guage
IMRANA SHAKOOR-SLP

24. Note: The surgeon will determine the length of the
incision line.
A conventional postauricular-scalp incision
approximately 5.0-6.0cm in length for children may
be used.
The incision may be longer in adults if the scalp
needs to be thinned.
STEP-3: Incision (surgicl cut) Line
IMRANA SHAKOOR-SLP

25. The Recess Marking Template is
used to determine the location of
the recess bed and channel for
the electrode lead.
STEP-4: Recess Marking Template
IMRANA SHAKOOR-SLP

26. After completion of a mastoidectomy-facial recess
approach, the implant-receiver well/recess bed and
electrode lead channel are drilled.
Suture tie-down holes to stabilize the implant are
placed.
A standard cochleostomy is used.
STEP-5: Mastoidectomy-Facial Recess Approach
IMRANA SHAKOOR-SLP

27. The insertion tool is used to insert the electrode array in the
usual fashion.
The Insertion Tube is placed just inside the cochlea toward the
basal turn of the scala tympani, with the insertion tube slot
directed toward the modiolar (or inner) wall.
STEP-6: Insertion of Electrode
IMRANA SHAKOOR-SLP

28. The skin incision is closed in
layers.
STEP-6: Closure
IMRANA SHAKOOR-SLP

29. • Impedance check on all electrodes
• Neural response testing to help estimate required le
Audiological Testing in Operation Room
IMRANA SHAKOOR-SLP

30. POST OPERATION X-RAY
To confirm position of internal device
IMRANA SHAKOOR-SLP

31. •Rehabilitation to meet specific patient needs
•Regular follow-up appointments
POST SURGERY MEASURES
•Initial stimulation:
4-6 weeks post surgery
•Adjustments made regularly
based on feedback from patients,
parents, therapists and educators
IMRANA SHAKOOR-SLP

32. ✓ Facial nerve injury (less than 1/300 to 1/500)
✓ Small possibility of infection
✓ The small amount of hearing in the operated ear
will be lost.
✓ Some discomfort or numbness around the
implanted ear after the surgery
✓ Temporary dizziness, tinnitus or taste
disturbance
✓ MRI precautions after surgery
SURGERY RISKS / ADVERSE EFFECTS
IMRANA SHAKOOR-SLP

33. 1. Better speech understanding compared to a hearing aid
2. Awareness and responsiveness to environmental sounds
3. Less dependence on family members for day to day living
4. Reconnection with the world of sound
5. Facilitation of communication with family and loved ones
6. Ability to talk on the phone
7. Better appreciation of music
POTENTIA L BENIFITS OF COCHLEAR IMPLANT
IMRANA SHAKOOR-SLP

34. POSITIVE PSYCHOLOGICAL & SOCIAL BENIFITS
OF COCHLEAR IMPLANT
• Decline in:
-Loneliness
-Depression
-Social isolation
• Increase in:
– Self-esteem
– Independence
– Social integration
– Vocational prospect
IMRANA SHAKOOR-SLP

35. ➢ Compulsory therapy for 1 year
➢ However speech benefits go on for 4
years post implant
➢ Involvement of family-most crucial
DURATIN OF AVT & BENIFITS IN SPEECH
IMRANA SHAKOOR-SLP

36. References
ttps://www.asha.org/practice-portal/professional-issues/cochlear-
mplants/#:~:text=After%20cochlear%20implantation%2C%20the%20patient,music
%20conveyed%20via%20the%20device.
ttps://www.aussiedeafkids.org.au/communication-and-habilitation-for-wearers-of-
ochlear-
mplants.html#:~:text=Cochlear%20implanted%20children%20will%20have,they%2
can%20develop%20speech%20sounds.
ttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057214/