Coming to My Senses: One Woman's Cochlear Implant Journey

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147 Appendix An Audiologist Explains the Cochlear Implant Jeanne Coburn, Au.D. I believe my very first cochlear implant recipient best summed up the impact of getting a cochlear implant: “It’s the closest thing to a miracle that I’ve ever experienced.” The technology is truly incredible, and many cochlear implant recipients are able to hear sound and understand speech amazingly well, but it’s not the same as normal hearing. It has been a blessing to be able to work with cochlear implants over the last ten years and share the lives of over 250 individuals as they underwent this transformative procedure. As an audiologist, I explain cochlear implants to potential cochlear implant recipients and their families. I will try to walk you through the process that they experience. Qualifying for an Implant There are many aspects of cochlear implant candidacy, including a person’s medical history and current medical status, hearing history, age of onset of hearing loss, duration of deafness, use of hearing aids, psychological readiness, support of family and friends, and their understanding of realistic expectations for the process and possible outcomes for how they will hear with the implant. Some patients have already seen the cochlear imDr . Coburn is board certified in audiology with a specialty in cochlear implants. 148 Appendix plant surgeon and may have an idea of whether or not they are a candidate. Others are referred by their audiologist, primary care physician, family members, or friends. Often, I am the first stop in the cochlear implant candidacy process. Many potential candidates have some degree of nervousness about learning the results of their cochlear implant evaluation, which includes a regular hearing test in the sound booth while wearing headphones as well as special testing while using their hearing aids. A typical cochlear implant candidate has severe to profound hearing loss and no longer receives (or never did receive) sufficient benefit from hearing aids during their daily life. Technically, “insufficient benefit,” as defined by the FDA, means that an adult candidate scored below 60 percent when repeating sentences heard while wearing one or two hearing aids. In everyday life, insufficient benefit means that a person is no longer or never was able to understand speech when listening on the telephone, when someone is talking from a distance, or when the person talking is not facing the listener. In general, for cochlear implant candidates, understanding daily conversation through listening alone is a struggle. Many rely on their vision for speechreading to supplement their hearing in understanding spoken language. Some patients with profound hearing loss come to my office with only a whiteboard and marker or pen and paper as their mode of communication. How the Implant Works A cochlear implant is composed of an internal device, which is the actual “implant,” and an external device called the sound processor. The sound processor sits behind the recipient’s ear and looks like a large hearing aid. The processor has a short wire coming off it that connects to a small round disc called Appendix 149 the headpiece or transmitting coil. The headpiece has a magnet in it. The magnet is used to hold the circular headpiece onto the scalp in the correct position over the internal device. The sound processor has one or more microphones that pick up the sound. The sound is then transmitted to a computer chip that codes the sound for the internal device. The coded sound travels down a short wire to the headpiece with the magnet and then is transmitted to the internal device (see figure 1). The actual cochlear implant has a receiver/stimulator component implanted underneath the scalp behind and slightly above the ear. An electrode array with 16 to 22 electrodes comes out of the receiver/stimulator and is surgically placed into the cochlea. The receiver/stimulator is composed of a magnet, an antenna, and a computer chip. The internal implant receives the sound coded by the processor and transmits the coded sound and the necessary power to the electrode array in the cochlea. The electrode array directly stimulates the auditory nerve, which then conducts the signal up to the brain for decoding into sound. Figure 1. How a cochlear implant works. Courtesy of Med-El. 150 Appendix The cochlea has truly magnificent architecture. It is a long tube coiled up into a snail-shaped structure that takes two and a half turns. It is...