Cochlear implant is a medical device with electronic infrastructure that can provide hearing for patients with severe and severe hearing loss. It has two main parts: the inner part, which we surgically placed, and the outer part, which adheres to the inner part with a magnet and transfers the sound perceived from the environment to the inner part. Simply, the working logic is to convert the sounds received from the environment into an electrical current with the microphone on the outer part, and to stimulate the auditory nerve with the inner part.
Which patients are used in the treatment, is there an age limit?
In general, all patients with a hearing loss that are so severe that they do not benefit from a hearing aid are candidates for a cochlear implant. We can divide the patients we use cochlear implants into two main groups. The first group is patients with congenital or early infancy hearing loss before speech development (prelingual hearing loss). The second group is the patients who have hearing and speech at a certain level with or without a hearing aid (Postlingual - post-speech hearing loss).
The lower limit for cochlear implants in our country is 12 months (1 year). has. In some centers abroad, this limit is reduced to 9 months. If the upper limit is the patient's general condition, we do not have any restrictions.
What tests are performed to detect hearing loss?
Exact detection and level of hearing loss Many tests are done to determine it. In our country, all babies have been screened in terms of hearing with newborn hearing screening throughout the country for about 25 years, and advanced tests have been performed on babies who did not pass the hearing screening test. The aim of hearing screening is to detect babies with suspected hearing loss and to determine the level of hearing loss up to the 3rd month and to ensure that these babies are introduced to the sound as soon as possible with appropriate methods until the 6th month. For this, we perform many tests such as clinical ABR (BERA), otoacoustic emission, and tympanometry for babies with suspected hearing loss during screening. We also perform the test, which we call pure tone audiometry, for adults and pediatric patients who can adapt to the test. The only reason we do this much testing is to test the level of hearing loss.
How is the operation process in cochlear implant?
We evaluate all patients' hearing tests and necessary radiological examinations before the surgery and examine whether they are a suitable candidate. If the patient is a suitable candidate, we make anesthesia preparation and surgery planning. We perform cochlear implant surgery with an incision made behind the ear under general anesthesia. In the surgery, we place the electrode part of the inner part to the cochlea (snail) within the ear bone, and the processor part to the back of the ear, under the skin. We check the operation of the electrode by making various measurements after the inner part is placed. We attach the external part after 3-4 patients after the operation, after the wound heals well and the edema decreases, and we make the necessary adjustments.
Does the patient begin to hear sounds after the external part is attached?
After the external part is attached, the implant starts to work and the auditory nerve is stimulated and the sound begins to be transmitted to the hearing center in the brain. However, the sound created by the implant is different from the sound structure we are used to. After a while, the brain re-codes the sound created by the implant and miraculously begins to perceive it as a normal sound. This period differs from person to person. Many factors affect this period, such as the patient's prelingual (pre-speech) or postlingual (post-speech) hearing loss, duration of hearing loss, and receiving special education.
Babies perceive sounds in the first nine months and then begin to speak. The situation is parallel to this with the cochlear implant. When we put on the outer part, we consider the baby as a newborn. After 6-9 months, it starts to make a sound. Especially, our patients who have had a cochlear implant up to the age of 2 can catch up with their peers and have a normal speech within 2 years.
Does the cochlear implant fit in one ear or both ears?
A normal person hears with both ears. Having two ears helps us to perceive the direction of the sound and to understand speech better in noisy environments. provides many factors. For this reason, it is ideal for a cochlear implant to be used on both sides. In our country, SSI covers the placement of bilateral cochlear implants up to 48 months (4 years) in babies with hearing loss. In older ages, special permission should be obtained for the second ear implant for the patient. After this permission is obtained, we can make the second implant.
Can a cochlear implant be placed in unilateral hearing loss?
There are many studies in our country and abroad on cochlear implant application in unilateral hearing loss. For this reason, we recommend cochlear implants to our patients in unilateral hearing loss.
In which hospitals are cochlear implants performed?
In order to perform cochlear implant surgery, first of all, correct diagnosis must be made and surgery must be performed. In order to make appropriate adjustments in the post-operative period, the hospital must have an appropriate audiology center. Standard and specific tests should be performed in this center. In addition, since cochlear implant surgery is a special operation, the experience of the surgical team is an important factor. For this reason, the standards of the hospital where cochlear implant application can be performed in our country have been determined and university hospitals (state/foundation) and training and research hospitals with these standards have been allowed.
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