What is bionic ear (cochlear implant)?
Cochlear implant is an electronic device that is surgically implanted in inner ear and provides hearing in patients with highly severe hearing loss and or deafness. The cochlear implant is often referred to as a bionic ear. It may surgically be implanted in one or both ears.
What are the components of a cochlear implant? How does it function?
Cochlear implant consists of two components. These are internal and external components. The inner implant (also known as receiver or stimulator) is placed surgically under the skin behind the ear. It is made up of receiver and magnet components. In addition, a group of tiny cables (electrodes) are available. The external part consists of sound processor, cable and microphone. Sound processor analyzes the outside sound signals (ie. Speech, music etc.) and converts them into electrical current format. This electrical current is transferred by cable and transferred to implant which is placed under the skin via the radio waves. Receiver (internal part) carries these waves through the electrodes to the inner ear. Auditory nerve fibers are therefore stimulated and thereby providing hearing.
What are the differences between hearing devices and bionic ear?
Bionic ear is quite different from a hearing device. Hearing device increases the volume of sound to the ear like a loudspeaker. On the other hand, a bionic ear penetrates from the damaged cells in inner ear and directly stimulates the auditory nerve.
Bionic ear provides the social communication in the adults presenting with severe hearing loss or deafness by enabling the hearing. In addition to this, different from hearing devices, accurate hearing via bionic ear requires for a healing process.
Is bionic ear an experiment tool?
Bionic ear has been used since the 1970’s. Approximately 200.000 persons have been implanted bionic ear throughout the world so far. Nearly 3000 persons have bionic ears in both ears. Of these persons 1600 are babies. It was reported in 1984 that the bionic ear implantation threshold age was 18 months for children, and this threshold was decreased to 12 months in the year 2002.
Who uses bionic ear?
Bionic ear is placed in those with severe hearing loss and who may not sufficiently benefit from hearing devices. Bionic ear implantation may be planned to be inserted in persons between 3 months and 100 years. Bionic ear provides the maximum contribution to those who have recently lost their hearing sensation. However, bionic ears for those who are congenitally deaf should be planned to be implanted during the early stage. Therefore, such children are stimulated by the sound and initiate to speak when they are 2 – 3 years old.
Compared to those children who are implanted bionic ear in later stages, operations in congenitally deaf children and to whom bionic ear is surgically implanted before they are 2 years old are more successful. Those children who are implanted bionic ear when they are between 2 – 4 years old present with speech disorder. If the bionic ear is implanted after 9 years old, the possibility of speech of the child is almost not available. Therefore, it is of great importance that the bionic ear be implanted in the early age.
What are the hearing losses that may be treated with bionic ear?
Bionic ear is employed in the inner ear hearing loss cases, not sufficiently treated with standard hearing devices. Normally sound waves are perceived by the tympanic membrane when they reach to the ear, and directed to the inner ear via the ossicles of the middle ear. Sound waves are affect liquids in the cochlea and sensorial cells in the inner ear respond to this move of liquids. This converts the sound waves to the electrical signal. This electrical signal is directed to brain by auditory nerve. In many cases vitality of these sensorial cells in the inner ear lead to hearing loss. However, some of these cells may often survive. Because the bionic ear directly stimulates the auditory nerve, it penetrates from the damaged site and delivers sound signals to the brain.
May all the patients with severe hearing loss benefit from bionic ear?
Unfortunately, not all the patients may use bionic ear. Some of hearing losses arise from the disease of the auditory cell. If there are not any auditory nerves, no structures through which bionic ear transfer electrical signals to the brain are available. In some persons, inner ear physical condition is abnormal. In such cases, there may not be appropriate space to place the cables of bionic ear.
Just after the operation, what should I expect?
A large ear dressing (bandage) should be expected. This bandage may be tight. Slight imbalance may be felt. Sensation of dryness and burning in throat may be seen (due to anesthesia). Do not expect to hear thanks to implant just after the operation. Many patients have reported that bionic ear operations are easier than they assumed.
When may I use my implant?
3 – 4 weeks after operation, external component of the implant is placed. Implant programming is carried out by an audiologist. First programming may last for hours. During this process, patient and audiologist make their decisions for a mapping. This mapping method enables the most appropriate settings that the patient may hear. Signal levels in the electrodes improve with visits of the patient to the audiologist in the next months. The most appropriate settings are applied. Sounds initially are more different than those before hearing loss. Firstly, the patient should adapt at the surrounding sounds. With trials and errors, adaptation at sounds is available.
What are the risks associated with bionic ear?
The risks of bionic ear solely include those related to surgery. These risks may be bleeding, infection, damage of facial nerve, delay of recovery from anesthesia, and imbalance. Direct risks of implant on the other hand may be mechanical or electrical, and extrusion of implant.
Will my scull be perforated during the operation?
No, not any holes are formed, nevertheless; a slot for the placement of the implant is done. This site is covered by scalp. Possible slight swelling recovers within a short time. Later on, it is possible to feel the implant under the scalp. Still, no components or cables are on the surface of the scull.
May surgery scar be seen outside?
Surgical scars after the recovery may hardly never be seen. Implant associated bulge that may be hidden by hairs is seen.
May more operations be required with developing technology?
The implant has been designed to function for life long. The sound processor which is on the surface may be changed with developing technology.
Will another implant be needed to be placed to my child when s/he grows?
No, in the time of birth inner ear is full and never needs to grow. Scull is complete as from 2 years. Electrodes are designed by considering the growth of the child.
Should I expect the improvement of cochlear implant technology?
No, the part of implant which is placed with surgical procedure has slightly been improved and evolved during the development of the bionic ear. Yet, sound coding systems are always improved. The part that employs these technologies are on the surface.
Is there a battery in the surgically placed part of the implant? Does this part need to be altered?
No, there is not any battery in the surgically implanted part of the implant. Energy is delivered to the part on the surface. Rechargeable batteries are used.
How long is the life of batteries?
BTE (behind – the – ear) batteries show performances for days. In noisy environments device functions frequently and life of battery shortens.
What kinds of batteries are used?
BTE devices use high energy zinc alloy batteries.
After the placement of bionic ear, may I undergo MRI?
Magnetic fields in the MRI devices apply pressure to the magnet of the device. In the recent implants, the lower effective MRI devices do not demonstrate any effects. If the high tesla devices are preferred for scanning, battery of the implant may be removed with a minor operation.
May I have normal x – rays?
Yes, it is possible to undergo normal x – rays and CT with cochlear implant
May I keep myself away from magnetic fields?
No problems occur in the low magnetic fields.
May I use mobile phone?
Yes, many persons with bionic ears use mobile phones together.
May bionic ear users swim, have shower? Do sports?
Bionic ear users may swim, have shower and do many sports. During these activities, the part on the surface should not be used. Helmet for head should be used during sports.
May I do diving?
The part on the surface should be removed when swimming. Inner part is not affected by water. Sports like boxing may not be done. Some implants are pressure resistant against 25 mt.
If I undergo implant operation today, and if the implants of the new technology are produced within two years, may I need to undergo operation again?
Most of the developments in the bionic ear technology are associated with the part on the surface.
If I had underwent operation 15 years ago and would like to use the new technology, would I need to undergo a new operation?
The first introduced implants were dependent upon analog technology, more operations could be needed. For example, if a single channel device were used in advance, and poly channel device is demanded, then new operation is required.
If I do not want to use the implant, may the implant be removed?
The part on the surface is always removed at nights. In order for removing the part implanted, a new surgical procedure is required.
If operation is demanded for recent technology, is this possible?
A little damage is developed in the inner ear due to trauma during the first placement, however recent implant may be placed. Therefore, it is determined that hearing in the persons with implants is as well as the first implant and even more than this.
Is our child not too young to undergo bionic ear operation?
It has been determined that those children undergoing implant surgery during early ages tend to hear and speak normally. Such children learn to speak faster.
I am 75 years old. Am I too old for cochlear implant?
No age limitation is available for bionic ear application. If you concern participating in the recovering programs, bionic ear operation may be done in every age.
I have lost my hearing in both ears. Should I have one or two implants placed?
One implant has mostly been placed so far. Two implants have advantages such as determination of the sound direction and well comprehension in noisy environments. Children with two implants may concentrate upon their classes well.
Is my implant affected by the detectors in airports and shopping malls?
Your implant is not affected in such environments. However, due to the fact that your device will lead to signals by the detectors, it is good for you to carry a special document for this.
First introduce of the device after implantation – Fitting
