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Cochlear Implants in Adults - Follow-up and Training

What will I look like after a cochlear implant?

The internal part of the implant is not visible after surgery. The bandage that is placed over the incision at the end of surgery will remain on your head for several days. After the incision behind the ear heals, a slight bump may remain; this is covered by your skin and hair.

Depending on the length of your hair, more or less of the external portion of the device will be visible. Both the internal and external parts of the device contain magnets. Magnetic force keeps the external part in place over the implanted part. This arrangement allows a radio frequency code for the electrical impulses to pass through the skin from the external portion to the internal portion. You can remove and reattach the external portion yourself.

What kind of follow-up occurs after surgery?

Two to four weeks after surgery, you will receive the external portion of the implant. It is during this appointment that you will hear with the implant for the first time. The audiologist will conduct comprehensive procedures using a computer to adjust the speech processor to enable you to achieve the maximum benefits. The process takes place over a two-day period. During this time, the audiologist determines the optimal settings for each of the electrodes in the implant.

This information is used to create a unique "MAP" or program for each patient. The MAP is programmed into the speech processor and adjusted as necessary for a custom fit. You will return weekly for adjustments of the MAP and for communication training.

The training focuses on auditory training, listening to environmental sounds and music, telephone use and communication strategies. Our experience has shown that our intensive, comprehensive post-operative program plays a significant part in our patients' success and satisfaction with their cochlear implants. What can I expect to be able to hear?
A major goal of cochlear implantation is to increase your ability to recognize speech. A cochlear implant never re-establishes normal hearing. Almost all patients are able to hear a range of loud to soft sounds and can differentiate between many (but not all) environmental sounds.

Most patients show an improvement in face-to-face communication because additional auditory clues enhance their ability to lipread. Those who had normal hearing at one time are able to understand some speech when listening through the implant alone without speech reading clues. Regaining use of the telephone is a very real possibility.

What about hearing in more difficult situations?

Hearing in noisy situations like groups or parties is more difficult than in one-to-one communication. To make it less difficult, we teach our patients strategies to help compensate for competing messages that get in the way of speech.

Listening to music at home or in a concert hall are also challenging situations. However, while many patients do not enjoy hearing music through the cochlear implant, some patients report great satisfaction.

How long does it take to adjust?

In general, patients report that it takes about six months to one year to feel really comfortable with the auditory input from a cochlear implant. Some adapt more quickly while others require longer to learn how to listen and to understand speech and other sounds.

Do I need more surgery? How long does the implant last? What about new technology making my device obsolete?

The internal portion of the devices currently in use are intended to last a lifetime. Any adjustments and improvements are made to the external portion or the speech processor which has been designed to be expandable for the future enhancements.

Although the reliability of the internal devices is outstanding (98 to 99% cumulative survival percentage), removal of a device that has failed and reimplantation with a new one has been done with no decrease in benefit.

The speech processor, an external component, is designed to incorporate advances in technology. Much of the research done by the Adult Cochlear Implant Team at Washington University focuses on understanding and evaluating those changes in technology. We are in the forefront of investigating new procedures and incorporating them into our clinical care of the cochlear implant patients.

Should I get an implant in both ears?

Clinical research studies have shown that there are advantages to listening with cochlear implants in both ears. The benefits are primarily for listening in noisy situations, listening to soft inputs and for sound localization. Most adult patients with two cochlear implants, received them sequentially. Patients wearing a cochlear implant in one ear are highly encouraged to wear a hearing aid in the opposite ear.

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Copyright 2014 Washington University School of Medicine
Copyright 2014 Washington University School of Medicine