The Surgical team of Adventis ENT Services works very closely with our team of Audiologists and Therapists at SpHear Speech and Hearing Clinics, to ensure you or your family member get the best possible advice and care in the management for any type of hearing loss – in children or adults.
Benefit from our vast experience in the cutting edge technology of Hearing (Auditory) Implants.
How Do We Hear
Types Of Hearing Loss
Hearing Loss In Adults
Hearing Loss In Children
Newborn Hearing Screening
Comprehensive Hearing Assessment
Early Intervention For Children With Hearing Loss
What Are Cochlear Implants
Benefits Of Cochlear Implants & Is It Right For Me
The Process Of Getting A Cochlear Implant
Bilateral Cochlear Implants
Hybrid (Eas) Cochlear Implant
Bone Conduction Implants (Baha & Bonebridge)
Vibrant Soundbridge Middle Ear Implant
Auditory Brainstem Implant
Welcome To Our Centre for Hearing & Auditory Implants
Your ability to communicate is a priceless gift. Hearing loss isolates you from contact with other people and is generally most noticed by others around you. Detecting and treating hearing loss early is a significant step towards improving the quality of life.
We are committed to helping you understand your hearing loss and to prescribing and maintaining the best solution for your needs and lifestyle.
At our Centre, we offer patients the most advanced management options for any type of hearing loss. Our team has a cumulative experience of approximately 1000 cochlear implant recipients. We are one of the few centres in the country with an Auditory Brainstem Implant Programme. We can help you decide on Hearing Aids, Middle Ear Impalnts, Bone Conduction hearing devices and Hybrid Hearing Implants.
We believe in a multidisciplinary team approach, bringing all of the experts that you need together under one roof. Our experienced team works closely together and helps develop an individualized plan to best meet your needs. Our team of hearing specialists includes clinical audiologists, otolaryngologists, neuro-otologists and auditory-verbal therapists who offer a patient-centered approach to hearing healthcare.
How Do We Hear ?
The ear is an amazingly complex but efficient hearing system.
Sound waves a guided down your ear canal by the pinna.
The sound waves hit your ear drum and it vibrates.
The small ossicles vibrate with the ear drum, transferring the sound across the middle ear to the cochlea.
The fluid inside the cochlea picks up the vibrations and carries them to the thousands of tiny hair cells. These hair cells change the movement into electrical impulses which are sent along the auditory nerve to the brain. The hearing centre of the brain interprets the impulses as sound.
Different Types Of Hearing Loss
There are three basic types of hearing loss:
Sensorineural Hearing Loss
Sensorineural hearing loss is often called 'nerve deafness'. It's caused by damage to the cochlea, or the nerve pathways between the cochlea and the brain. Sensorineural hearing loss can be mild, moderate, severe, or profound. It can affect one or both ears, and is usually permanent.
Mild - to moderately severe sensorineural hearing loss can usually be helped with hearing aids or a middle ear implant. Moderately severe to profound hearing loss can usually be helped with a cochlear implant.
Conductive Hearing Loss
Conductive hearing loss occurs when there is a problem with the outer or middle ear. This means that sound is unable to travel or 'conduct' from the outer ear to the eardrum and the tiny bones, or ossicles, of the middle ear. A conductive hearing loss may occur in both ears or just one and can often be helped by medical or surgical treatment.
Mixed Hearing Loss
Mixed hearing loss combines problems with the conductive pathway (outer and middle ear) and the cochlea or auditory nerve (the inner ear).
Hearing Loss In Adults
Hearing Loss is more common than you might think. One out of twelve (1/12) persons in India has hearing loss. Usually hearing loss is first noticed by others around you. People may not be aware of the problem until it is severe enough to cause communication difficulties.
Detecting and treating hearing loss early is a significant step towards improving the quality of your life.
Why is it difficult to hear?
In 90% of all cases, hearing loss occurs because the delicate hair cells in the inner ear become weak. This means that the brain does not receive all the sounds and frequencies it needs in order for, for example, speech to be understandable.
Untreated hearing loss has many consequences
Living with untreated hearing loss means difficulties in social gatherings, lost performance at work, as well as a hindrance to enjoy many cultural sides of life. Many decide to stay at home and avoid situations that demand their attention and social contribution. It is also exhausting to deal with hearing loss as you need to concentrate far more in order to keep up with life around you.
There is no good reason to wait
Most people typically disregard their hearing loss, but this is a bad decision. Your brain gets used to not hearing everyday sounds and the longer you live without sounds, the harder it is for the brain to get used to comprehending them again. Regular hearing instrument use can prevent deteriorating of your brain's ability to interpret sounds.
The hearing test and an interview will tell
A simple hearing test can determine if you have a hearing loss. It is recommended to get a routine hearing screening minimally every decade until age 50, and at least every three years thereafter.
Where do I go from here?
The first step is to see our ENT doctor and hearing care professional for a consultation and a hearing test. Depending on your test result and the nature of your hearing loss, you'll be advised on which kind of treatment, surgery or hearing instrument best suits your needs.
A hearing instrument is more discreet than hearing loss
The technology and cosmetics of modern hearing instruments makes a hearing instrument far more discreet than having to ask another person to repeat their question, accidentally ignoring them or acting as if you have heard them and maybe giving the wrong answer.
Two ears are better than one
We have two ears for a very good reason. They work together!
We need two ears to locate the source of sound.
Two ears help us hear clearly in background noise.
Listening with two ears is better than listening with one.
How to conserve your hearing
It is important to recognize that if you lose your hearing it won't come back. It is therefore important that you protect your hearing as much as a person with normal hearing. You should always wear hearing protection when engaged in noisy activities.
In particular listening to very loud music and using power tools are quite harmful to your ears. Take extra care when exposed to these types of noise. If you find your ears are ringing after engagement in a noisy activity this is a sign you may have caused some temporary damage. Make sure you protect your ears when doing this activity again in the future.
Please read our leaflet on ear care LINK.
Hearing aids are complex technical instruments that are tailored to the individual client's need. There are many different types and styles of hearing aids available today due to rapid advances in technology. Our Audiologist will discuss the choices available in your specific situation. The following section summarises the main aspects of the various styles in hearing aids.
What to consider when choosing a hearing instrument
What is your lifestyle? In what ways are you most affected by hearing loss? Is there anything you can't do because of hearing loss?
Type of hearing instrument
RIC, BTE, ITE, ITC or CIC? Do you prioritize appearance, durability or ease of handling? What is the degree of your hearing loss?
The shape and size of the outer ear and ear canal may determine which type you can use.
What technological features with benefit your particular hearing loss? How advanced does your hearing instrument need to be?
Some instruments adjust automatically and some have a manual volume control. Which do you prefer?
One or two?
If you have hearing loss in both ears, you'll get the most benefit by wearing two instruments.
What are the benefits of a modern hearing instruments?
New hearing instruments offer a number of high - tech features that amongst other things provide better speech understanding in noisy environments by for example turning down the unwanted nose and turning up the speech. They are also programmed to compensate for your specific hearing needs. A modern hearing instrument doesn't make everything louder - it makes sound more distinct!
What happens next?
The road to better hearing begins with an Ear and Audiological evaluation for diagnosis. This is followed by the selection and fitting of hearing instruments, and finally a period of adjustment.
We have a highly qualified team of professional audiologists, with extensive experience in all areas of hearing loss, including rehabilitation, hearing loss prevention and the latest hearing instrument fitting technologies. We use the latest and state of the art audiology equipment in diagnosing hearing loss and for the fitting of hearing devices. This ensures we provide you with the most professional expertise and an excellent on - going hearing care program.
Hearing Loss In Children
Does Someone You Know Have A Hearing Loss?
Baby - Does not respond or startle to loud noises?
Baby - Does not turn to the source of a sound after 6 months of age?
Child - Has delayed speech development?
Child or older - Has difficulty understanding what people say?
Child or older - Turns the TV or radio volume up too high?
If the answer to any of the above questions is "yes", the individual in question may be experiencing a hearing loss. Please contact our specialist hearing clinic capable of carrying out diagnostic tests.
Why hearing is so important:
We start to develop languages from the moment we are born.
If a child has a hearing loss the basic development of language will often by delayed.
Many children with a profound hearing loss also can learn to speak if they are diagnosed and treated relatively early.
So the earlier the hearing loss is detected, and the earlier it is treated the better. With today's technology, children can be fitted with hearing aids within the first few months after birth.
Firstly, they need to be fitted with the right kind of hearing aid. Then, when the time is right, the can get special speech and language therapy.
If the hearing loss is so extreme that even very powerful hearing aids don't help, your child can still learn to communicate using cochlear implants.
Signs of hearing difficulties
You should always be aware when your child does not respond appropriately to sounds. Sometimes a lack of response if attributed to inattention, but it is important to determine if inconsistent or no responses actually stem from an inability to hear.
What to watch for in your baby's hearing...
Birth to three months...
?Startles to sudden loud noises
Stirs, wakes up, or cries to loud sounds
Soothes or calms to your voice
Makes cooing sounds
Three to six months...
?Begins to turn eyes or head to sounds
Stops crying when spoken to
Awakens easily to sounds
Begins making vowel sounds such as "ah" and "ou"
Six to nine months...
?Looks for family members when named
Turns head towards sounds
Will respond to own name
Responds to simple requests with gestures
Begins babbling, such as "baba" and "mamama"
Uses voice to get your attention
Nine to twelve months...
?Understands "No", "Bye bye"
Responds to soft sounds
Looks at pictures when named
Repeats simple sounds that you make
Uses voice when playing alone
Common signs that children may not be hearing normally.
Not aware someone who is out of view is talking, especially when distractions are minimal.
Using "what?" or "Huh?" frequently.
Intently watching the faces of speaker.
Sitting close to the television set when the volume is sufficient for other family members.
Increasing the volume of the TV or stereo to unreasonably loud levels.
Not responding to voices over the telephone and / or switching ears continually.
Not reacting to intense, loud sounds.
The single most important signs of possible hearing loss, however, is a lack or delayed development of speech and language.
What to do if you think your child may have a hearing loss :
If you think a hearing loss may be present the first step is to ask your doctor to refer your child to us for an audiological assessment. This assessment will determine whether a hearing impairment exists and to what degree. No child is too young to receive a complete hearing evaluation. Today's technology even allows newborns to be tested for hearing loss.
Newborn Hearing Screening
The neonatal department of our hospitals have a programme of universal newborn hearing screening, on the basis of which all babies have their hearing tested prior to discharge. We recommend that your baby has his/her hearing tested.
What is the purpose of Universal Newborn Hearing Screening (UNHS)?
Good hearing is important for your child to learn speech and language. Because a hearing loss can prevent your baby from learning speech and language, it is important to diagnose hearing problems early, which is why we recommend your baby's hearing to be tested.
The purpose of newborn screening is to identify children who are at greater riskfor hearing loss so that they may receive timely diagnostic and interventionservices. Hearing screenings are NOT diagnostic evaluations. Screening testsidentify a need for further diagnostic hearing evaluations.
What is the incidence of hearing loss in newborns?
Approximately 3 in 1000 babies are born with a hearing loss. 1 in 1000 babies are born deaf. 90% of children with hearing loss are born to hearing parents. Some babies may be at a higher risk of developing a hearing loss. Theearlier that the hearing loss is identified, the sooner that intervention may begin.
What is the youngest age that a child's hearing can effectively be tested?
Hearing can be assessed at any age, even the day that a child is born.
Brainstem Evoked Response Audiometery (BERA) and Evoked OtoacousticEmissions (EOAE) evaluations are an effective and efficient means foridentifying and quantifying hearing loss. Both tests are effective for newbornhearing screening.
How will the babies hearing be tested ?
The hearing test will be primarily carried out using EAOE. The EOAE evaluation is performed by placing a small earphone into the child's ear. Clicking sounds are introduced into the child's ear. Echo responses, or emissions, are measured in healthy ears. EOAEs are acoustic signals generated by the cochlea, specifically, outer hair cells, in response to auditory stimulation. In response to click stimuli, EOAEs provide information over a broad frequency range (~500-6000Hz). Present EOAEs indicate that a child has normal/near normal hearing.
At the end of the test you will be given a report of the outcome, as well as a "Hearing Checklist' which allows you to monitor the Hearing Milestones of your baby.
What if the EOAE is not conclusive ?
If the EOAE screen is not conclusive, the child is 'referred' for the Hearing Screen to be repeated. This must be done within 30 days. If the second EOAE screen is also not conclusive, the baby is 'referred' for further definitive hearing tests using a battery of detailed hearing tests. A referral does not necessarily mean that the baby has a hearing loss, but suggests that the test was inconclusive and further testing is indicated. The Comprehensive Hearing Assessment (CHA) battery includes these tests: ABR., ASSR, OAE, Impedence, BOA. This should ideally be carried out before the baby is 3 months of age.
Comprehensive Hearing Assessment (CHA)
This is a test battery of a complete assessment of hearing in a child and is completed by our trained paediatric audiologists.
The purpose of the comprehensive hearing assessment (CHA) is to determine if a hearing loss exists, to what degree, and to help discover what type.
Types of audiological evaluations in the test battery :
Various different hearing tests can be utilised for differing ages of children. The type of tests used will depend upon the age, level of understanding and cooperation of the child.
Behavioural hearing tests :
The tests usually require the child to respond to soft sounds in some way (verbally, by picture pointing, raising the hand or through a game"). These tests can be fun and for infants and toddlers, a head - turn response to a test signal is usually and the best and most reliable testing method. In slightly older children Distraction testing, Visual reinforced audiometry and play / conditioned audiometry are used.
Auditory brainstem response (ABR / BERA)
For newborns or infants and children who cannot reliably perform the behavioral test procedures, other more objective tests, such as ABR, can help determine hearing abilities.
Clicks or tonal ''pips'' are sounded in an infant's ears through earphones. The ABR provides information about the function of the auditory pathway to the level of the brainstem. The response of the clicks or tones are recorded, providing an estimate of hearing sensitivity.
Auditory Steady State Response (ASSR)
This is a modified form of ABR where frequency specific information can be obtained to plot an audiogram of hearing thresholds.
Otoacoustic emissions (OAEs).
These tests provide a unique way to examine the function of the cochlea. Sounds are sent to the child's ear with a small loudspeaker. A microphone records the response to the sound from the cochlea (known as an emission). This offers valuable information about the sensory hair cells in the cochlea.
Tympanometry (Impedence testing)
This test helps determine how well the eardrum and middle ear are working. A gentle puff of air is delivered into the child's ear and the amount the eardrum moves in response to change in air pressure is recorded. If the eardrum does not move, for examination, it could mean there is fluid behind the eardrum and otitis media with effusion may be present. If there is negative pressure it could mean that the child is at risk for developing an ear infection.
Pure Tone Audiograms
This can be used in older children. The child wears headphones / ear inserts so each ear can be tested individually. Each ear is presented with pure tones at different frequencies. If a hearing loss is identified bone conduction can also be assessed as part of this test to identify if the loss is sensorineural or conductive.
Early Intervention For Hearing Loss In Children
Learning that your child suffers from a severe hearing loss is a difficult experience. Our job is to ensure that your child receives the very best technology and professional care available.
Early Intervention First Steps To Success
A child's hearing develops from the third month of pregnancy. Children communicate from the moment they are born. They are constantly listening and are able to recognize the voices of their mother and father very soon. They learn to talk by imitating the sounds they hear. Children with a severe hearing loss are deprived of hearing environmental sounds around them. Today's modern technology can help children hear again, giving them access to oral communication and a wealth of sounds.
Once your child is diagnosed with a severe hearing loss, it is important to act immediately. The sooner a hearing loss is identified, the better the chances of successful rehabilitation. Early diagnosis and treatment of severe hearing loss is the first step toward successful hearing rehabilitation.
Early intervention means acting without delay to treat your child's hearing loss. If your child has an irreversible hearing loss that cannot be otherwise remedied, it is vital to get hearing instrumentation as soon as possible
Advantages Of Early Intervention
If the brain has never processed auditory information, it loses the ability to do so after only a few years. As the brain of a child more easily adapts to and learns from new auditory input, early cochlear implantation is a key factor in providing your child with crucial acoustic information. Research has shown that children receiving hearing device prior to age two achieve open - set speech perception equal to or faster than children implanted after age two.
It is also very important to assess how well the hearing instrument (s) work (s) for the child. If hearing aids are not going to be enough to help the child to develop spoken language, it is crucial to determine this as quickly as possible so that other alternatives can be evaluated while the child is still in the critical language learning phase.
For babies who have had hearing experiences and lost their hearing later, a similar rule applies: the shorter the duration of deafness, the greater the likely benefit from the cochlear implant.
What now ? Accepting Your Child's Hearing Loss
It takes time to understand and accept the fact that your child has a hearing loss. As soon as you are able to do this, you can begin to focus on how to cope with it. And when you're ready, you can gather more information that will help you deal with the practical side of things.
Talk to our ENT doctor and / or audiologist to get answers to all your questions. Do not hesitate to ask them for details. They know a lot about your situation. Remember that you are not alone. Hearing loss is more common than you think.
Knowing as much as possible about your child's hearing loss helps you to support your child's development of hearing and speech.
Families who went through the same experiences will understand your worries and can give you helpful advice. You will get to meet many families who attend our habilitation clinics.
Hearing Loss - What Are the Options?
If your child has been diagnosed with a hearing loss, your audiologist will discuss the options available for him/ her. Depending on the degree and the type of the hearing loss, your child may be a candidate for a hearing aid or a cochlear implant.
Hearing aids help your child to utilize the hearing abilities that he or she still has by amplifying sounds. If your child is a candidate for a hearing aid, your audiologists will advise you about the device that best suits your child's individual needs.
A cochlear implant is a hearing solution that takes over the function of damaged nerve cells in the inner ear. Unlike hearing aids, cochlear implants do not amplify sounds. Instead they process the sound signal electronically and use tiny electrical pulses to stimulate the hair cells in the inner ear.
What Are Cochlear Implants
While the majority of people who suffer from hearing loss may be helped with hearing aids, for some, hearing aids do not provide the benefits they need. Why is this?
Simply stated, hearing aids only amplify sounds. For people with a moderate - to - profound hearing loss, even the most advanced hearing aids may not work because making sounds louder does not make them clearer.
You may be able to hear sound with hearing aids, but understanding speech and other sounds may still be very difficult. Using a hearing aid with a moderate - to - profound hearing loss can be likened to listening to a loud, badly tuned radio program. And in some cases hearing aids may not provide audibility. In such cases, a cochlear implant may be the best option.
What is a cochlear implant ?
A cochlear implant is an electronic device that can restore useful hearing and provide improved communication abilities for persons who have severe to profound sensorineural hearing loss (nerve deafness) and who cannot benefit from hearing aids.
How is an implant different from a hearing aid?
Cochlear implants differ from hearing aids in two important ways:
Hearing aids simply amplify sounds. A cochlear implant, on the other hand, transforms speech and other sounds into electrical energy that is used to stimulate the hearing nerve in the inner ear
Unlike most hearing aids, cochlear implants have both internal and external components. The implant system consists of an external speech processor and headset (worn behind the ear) and an internal, surgically implanted receiver/stimulator package with an electrode array.
A cochlear implant does the job of the hair cells in the inner ear. As a result it restores your ability to perceive and understand sound. Unlike a hearing aid, a cochlear implant doesn't make sounds louder. Rather, it bypasses the damaged part of the ear and stimulates the auditory (hearing) nerve directly. This provides a clearer understanding of sound and speech.
Working of a cochlear implant:
Sound is picked up by a microphone placed on the ear.
The microphone converts the sound into electrical energy. This electrical signal is transmitted through a cable to the speech processor.
The speech processor is an ear level device. It analyses and digitises the sound into coded signals. This coding is done by the processor depending on how it is programmed.
The coded signal from the speech processor is sent to the transmitting coil worn on the head. This coil is held in place with a magnet. The transmitting coil sends the coded signal across the skin via radio frequency link, to the receiver stimulator package.
The receiver- stimulator package is surgically fitted in the mastoid bone of the skull just behind the ear. The receiver stimulator package contains a magnet so that the transmitting coil and receiver are aligned with each other without any direct contact through the skin.
The signal from the receiver stimulator package is sent to the electrode array which has been surgically put into the scala tympani of the cochlea.
Stimulation of the electrode array leads to stimulation of the nerve endings in the cochlea. This results in a sensation of sound.
What Are The Benefits Of A Cochlear Implant System?
Hearing is the basis on which we learn to speak and communicate with our friends and families in schools and communities. Cochlear implant systems can offer a wide range of benefits including hearing speech, environmental sounds and music.
Nearly all cochlear implant users hear environmental sounds, keeping them in touch with their surroundings - including traffic, sirens, alarms etc.
Virtually all recipients hear speech sounds through their cochlear implant. It usually takes some time to begin to understand these sounds especially for children.
Learning to understand speech and speech in difficult situations allows many adults to return to work or to continue a career which was interrupted by hearing loss.
Hearing the speech of others as well as their own voice helps CI recipients to tune their speaking abilities. Recipient s report that improved speech skills can open up new social, educational and career opportunities.
Many people are able to use the CI system so effectively that they can understand speech without lip - reading and can have interactive conversations over standard and mobile phones.
Infants and children
Children born with a profound hearing loss who received a cochlear implant at a young age may learn to listen and speak, going on to obtain age appropriate language skills. Your child may be able to attend a mainstream school and enjoy success in further education, employment and community life.
Studies have shown that children implanted before the age of two achieved spoken language skills equal to, or closely ranked with their hearing peers.
For many adults, suffering a hearing loss is just part of getting older. While hearing aids can be effective, there may come a time when a hearing aid just isn't enough.
Talking on the phone, reading to your grandchildren and taking part in community activities or social events may once again be possible with a cochlear implant.
Is A Cochlear Implant Right For Me?
Is your child a candidate?
Was your child born with a moderate - to - profound hearing loss in both ears?
Does your child fail to respond to your voice even while wearing hearing aids?
Has your child experienced a hearing loss after learning how to speak?
Is your child no longer progressing with speech and communication skills?
Does your child depend heavily on lip - reading?
Is your child exhausted at the end of the school day because communication requires such a high degree of concentration?
As parents, are you highly motivated to work with your child to help them develop age appropriate language and communication skills?
If you answered "yes" to several of these questions, you child may be a candidate for a cochlear implant. If you'd like to know more about the viability of a cochlear implant, you should discuss your child's options with a member of our cochlear implant team.
Adults and cochlear implant
An increasing number of adults are choosing to have cochlear implants as they realize that they no longer need to live in isolation caused by hearing loss. With a cochlear implant talking on the phone, participating in meetings, enjoying concerts and the cinema, and interacting with family and friends may once again become a reality.
Am I a candidate?
Do you have to ask people to repeat themselves in one - on - one conversations, even in a quiet room?
Do you only understand relatives and close friends on the telephone?
Do you depend on lip - reading to understand a conversation?
While dining with friends in a restaurant, do you have difficulty following the conversation?
Do you avoid social activities because you can't hear what is being discussed and are afraid you will not respond correctly?
Do you watch only captioned television programs?
Can you no longer hear birds singing?
If you answered "yes" to several of these questions, you may be a candidate for a cochlear implant. To find out more about the viability of a cochlear implant you should discuss your options with a member of our cochlear implant team
Getting A Cochlear Implant
Contacting our Cochlear Implant Team
Cochlear implant surgery and follow - up takes place at our cochlear implant centres. Cochlear implantation is a specialist procedure needing a team of experts. There aren't many centres that offer a CI Team approach , and you may need to travel some distance to meet us.
Cochlear implant candidates undergo a number of routine assessments prior to surgery. The information gathered enables the cochlear implant team to identify any additional conditions or needs and helps candidates establish appropriate expectations.It can sometimes take many weeks for the team to carry out all their assessments.
Hearing levels with and without hearing aids.
Speech understanding with hearing aids.
Auditory nerve function.
Evaluation of cause of hearing loss
CT and / or MRI studies.
Speech & Language
Assessment of stage of speech and language development.
Ability to cope with surgery.
Ability to participate in follow up programme.
Assessment of educational needs.
Making the decision
When our team has gathered all the information we need, they may decide either
-that an implant is unlikely to help you or your child, or
-that an implant might help you or your child.
Sometimes this is a complex decision. Parents are usually involved in discussion leading up to the decision.
Our cochlear implant team will put you in touch with adults and children with implants, and their families, and arrange to meet them. They can tell you what having a cochlear implant is really like.
Deciding the choice of implant - The team has expertise in implanting and fitting all makes and models of implants. There are at least three or four companies that manufacture cochlear implants.We will discuss the various brands and models available at the time.
Hospital stay is likely to be a maximum of two days. We would normally admit on the day of the operation provided all the preoperative tests are satisfactory
Cochlear implant surgery lasts about two hours and is performed while the patient is under general anaesthesia. The electrode array is inserted into the cochlea. The receiver/stimulator is secured to the skull. Typically, patients remain in the hospital for one or two nights. They have a bandage on their head which is removed after four days. Patients return to school or work as soon as they feel well enough to do so, usually within a week of surgery.
After the surgery, one has to wait for the scar to heal. This period is approximately 2 to 3 weeks. After this healing period is over, the implant and processor are programmed or mapped for the first time. This is called the 'switch on'.
Fitting the Speech Processor - The Switch On
You / Your child won't hear sound until the external parts of the device, the headpiece and speech processor, have been fitted. The speech processor is fitted 2 to 3 weeks after surgery, and is set up individually for each user. This is called the switch on.
Our audiologist will set the speech processor so that it is comfortable for the child, with levels that are neither too loud nor too quiet. The levels must be measured very carefully for each child, because every child is different and has different needs. Sometimes, it takes several sessions to set the levels accurately.
The speech processor program, also known as a map, contains settings for pitch, loudness and timing. Programs are customized to meet each person's particular needs during "fitting sessions" with an audiologist.
First Sounds With a Cochlear Implant
When the initial mapping is complete, the speech processor can be switched on to real sound. Your child will hear lots of different sounds in the room, including your voice, his/her own voice, and a host of everyday sounds. Some children find all the new sounds exciting and rush off to explore them. Others can find the whole experience, and the sheer quantity of everyday sounds, rather overwhelming. A few children will take no notice of the new sounds.
Hearing lots of different sounds is not the same as being able to tell them apart. It may take your child a long time to work out that one set of sounds is your voice, and another is a bunch of keys rattling. It is important that you have realistic expectations. At this stage, just noticing that there are sounds is a vast step forwards, and one which your child will need time to get used to. It is too early for most children to start sorting the sounds out, let alone to make sense of them. In hearing terms, your child is like a new born body.
What to expect in the beginning
Just like a new baby, your child will need time to learn about sounds, before he or she can be expected to do anything with it. Try to avoid putting pressure on your child or "testing" your child, for example by standing behind him/her and making noises.
Don't expect too much. If your child is simply happy to wear the speech processor then you are making great progress.Keep usual routines going.
Encourage the child to wear the speech processor as part of everyday life, and to wear it as much as possible. Some children will need rewards or incentives at first. If your child is reluctant to wear the speech processor, ask members of the implant teams, or your child's school teacher, for advice.
Make sure the child is wearing the speech processor in a way that is comfortable and practical. If in doubt, ask the implant team, speech and language therapist or audiologist for advice.
Getting to know the Speech Processor
Before you return home after the initial tuning sessions, one of the cochlear implant team members will explain the controls on the speech processor, and show you how to check that it is working properly. You will also receive a user's Guide and a Troubleshooting sheet.
Let your audiologist know if your child known if your child consistently wants the speech processor turned up or down or off. This often a sign that it needs to be readjusted.
The more information that you give your audiologist about your child is or is not responding to sound in everyday situation, the better the audiologist will be able to program his/her device.
If you are not sure how something works, or how to check that it is working, ask a member of the implant team, and keep asking until you are sure.
Check that the speech processor, batteries , cables and headpiece are all working correctly every day, just as you would a regard hearing aid. When you are used to doing it, a full check any takes a few sounds.
Keep an eye on your child's responses and check the equipment even more carefully if there are any sudden changes. If in doubt, ask the implant team for advice. The speech processor may need to be readjusted.
Habilitation and Rehabilitation
In order to attain the greatest benefit from a cochlear implant, candidates should be fully committed to the follow - up programme designed by their cochlear implant team. Follow - up programmes vary according to local practice.
Learning to Listen
Learning to listen, and to make use of new listening skills, takes the average child a long time. Children who are born with good hearing, and who have already had months of listening practice in the womb, spend a long time just listening and working out what sounds are, and then, perhaps, playing with their voices, before they attempt to say their first word, let alone to put words together. Your child will take just as long or longer.
Some children learn relatively quickly, other need more time. Making sure that the device is working properly, encouraging your child to wear it as much as possible, and giving lots of support and good listening/talking opportunities in quiet surroundings, will help your child to make the most of what she or he can hear.
Constant background noise, such as the television or radio makes it harder for children to learn to listen.
Plan activities, the reading books, cooking or playing games, which you can share with your child, which are enjoyable and which give lots of space for 'talk'. Play listening games. Your therapist will help you plan activities.
Other factors affecting success
Age of implantation is only one factor influencing the benefit a child will receive from a cochlear implant. A rich communication environment, effective speech processor programming, motivation, rehabilitation and appropriate expectations are all important factors contributing to a child's overall success.
It is crucial to talk to your child, even though he or she may not fully understand what you are saying. Talking to your child is the best way to encourage the development of spoken language. Facial expression and body language emphasize the meaning of words and will help your child understand you better.
The speech processor of a cochlear implant system is programmed for each person individually. Setting up an ideal program, also known as a "map", requires regular fitting sessions to fine - tune settings. As the brain adjusts to auditory input, sounds that may have seemed loud at the first fitting can become too soft after a period of time. Regular fitting sessions are therefore an important factor for your child's success with the CI.
Success with a cochlear implant requires strong motivation and active participation from you as a parent. Even the best cochlear implant will not help your child if he or she does not wear it consistently. Periods of time without stimulation require your child's brain to readjust to incoming sounds from the cochlear implant, which can delay progress. Research has shown that wearing the speech processor for longer periods positively affects children's performance with their implant.
Structured auditory therapy is another key factor for successful cochlear implant use. For very young children, auditory therapy may initially involve structured listening activities to help your child detect and recognize sounds in the therapeutic setting. At a later stage, your child learns to apply these new listening skills in the real world, outside the therapeutic setting. Various pediatric rehabilitation materials are available for use at home, so you can help your child develop hearing skills in a playful way.
One Or Two ? - Bilateral Cochlear Implantation
What is Binaural Hearing?
Hearing with two ears is called binaural hearing.It occurs naturally in someone with unimpaired hearing. But in the case of someone with a bilateral hearing loss, it may be achieved through the use of two hearing aids, two (bilateral) cochlear implantsor with a combination of implants and hearing aids.Binaural hearing is extremely important for everyday life and is critical in helping us determine the direction of a sound (sound localization) and better understand speech in noisy situations (speech understanding in noise).
The advantages of Binaural Hearing
The ability to localize from where a sound is coming. This is very important from a safety perspective.
A better understanding in noisy environments as selective listening is achieved more easily.
Better sound quality as you are hearing in both ears. This greater range provides a better sense of sound balance and quality.
An increased ability to distinguish between sounds.
Keeping both ears active. When the hearing nerve in one ear is not used for an extended period of time it tends to lose its ability to understand.
A less tiring and more enjoyable listening experience.
A sense of balance. When people hear from just one side they can feel that they have a 'dead side', which can be a strange sensation.
Bilaterally implanted users are able to process sound binaurally and enjoy many of the associated benefits, including improved speech understanding in difficult listening situation and sound localization. In children, stimulation by a cochlear implant has shown to lead to development in the central auditory system. This development occurs in the implanted ear, whether it is one ear or two.
Early bilateral implantation may be the best way to develop binaural auditory pathways. Results shows that the younger a child receives implants bilaterally, or the shorter the period between the two implantations, the better the results and the easier it will be for a child to adapt to the binaural hearing.
Richer, More Natural Sound
These individuals report that the second implant greatly enriched their total hearing experience. The addition of a second implant provides a greater amount of sound information, resulting in fuller, higher quality sound and easier, less demanding hearing. Individuals, who were formerly implanted in only one ear, describe the addition of the second implant as providing them with "3D hearing."
Bilateral users report the level of concentration needed to understand speech in noisy environments is greatly reduced with two implants.
Parents describe that their child often responds more easily and more quickly in group situations, is not as tired after school as they were with just one implant, and has more self confidence. Teacher and therapists observe that bilaterally implanted children acquire speech and language more easily on "on the go" in everyday life than unilaterally implanted children.
Acquiring Bilateral Implants
Bilateral cochlear implantation can take place during one surgery (called a simultaneous surgical procedure) or during two surgeries (called a sequential surgical procedure).
In the case of sequential procedures, an adjustment period typically exists while the later implanted ear catches up to the previously implanted ear for the two ears to work together optimally. The longer the interval between implantations, the more likely that training will be required to achieve optimal benefit from the two implants.
Bone Conduction Implants (BCI)
BCI include devices such as the BAHA and Bonebridge systems
Most of us receive sound in two ways. We hear by air conduction via the ear canal and middle ear to the inner ear (cochlea). And we hear through bone conduction, where vibrations bypass the outer and middle ear, traveling directly to the inner ear through the jaw and skull bone. This explains why you can still hear sound if you block your ears.
Hearing through Bone Conduction
Using bone conduction, sound is conduced naturally through the bone directly to the cochlea, independent of the outer and middle ear. A BCI system uses this natural process by amplifying sound signals, converting them into vibrations and transmitting them to an implant in the bone.
The bone then conducts the vibrations directly to the inner ear, which is embedded in bone. This is the reason why such implants are also called bone conduction implants.
In the inner ear, the mechanical vibrations are converted into nerve signals and transmitted to the brain via the auditory nerve and perceived as sound.
Implantable bone conduction is, therefore, an effective hearing solution for people with conductive or mixed hearing loss because it bypasses any problems associated with the outer or middle ear. The system can also help those who suffer from single sided sensorineural deafness by transmitting sound received on the deaf side directly to the hearing ear.
Is a BCI right for me?
Ask yourself the following questions:
Do you hear only from one side?
Do you or your child have malformed ears (microtia / atresia),
Do you have chronically draining ears?
When using hearing aids, do you have:
Problems getting sufficient loudness?
Trouble with feedback, squeal, whistles, or distorted sound quality?
Do you have sore or irritated ears due to wearing your ear moulds?
If you answered you to any of these questions, you may be a candidate for a BCI system. Talk to your hearing professional to learn more.
How does the Baha system work?
A small titanium implant is placed in the bone behind the ear where it osseointegrates with living bone. Put simply, it becomes 'one with the bone'. It's the same process that secures dental implants.
Osseointegration takes about three months for adults and six months for children. Once this has taken place an abutment is attached to the fixture and a sound processor is clipped on.
The Baha Attract System transmits sound vibrations to the inner ear through a magnetic connection between the sound processor and the implant under the skin. The benefit being that there is no skin penetrating abutment, providing a good aesthetic outcome with no need for daily care.
The Baha Connect System transmits vibrations through an abutment which connects the sound processor to the implant. Using the DermaLock TM technology the skin is left intact around the abutment. Here the major benefit is the efficient transmission of vibrations, providing maximum amplification.
How does a Bonebridge system work?
The Bonebridge is a bone conduction implant system, consisting of an external audio processor, worn behind the ear and an implant, positioned surgically under the skin.
Sound waves are recorded by the microphones of the audio processor. The audio processor converts the sound into electrical signals. These electrical signals are transferred through the intact skin to the implanted part of the Bonebridge system.
Hearing is believing - try the BCI system to see if it is right for you
One of the unique features of any of the BCI systems is that a prospective recipient can test it prior to implantation. Most are amazed. Not only by how much better they can hear, but the quality and clarity of sound provided. Speak to our clinician or surgeon to try a BCI.
Baha on Softband - gently introducing a new world.
Babies and young children have very thin bones and may not be ready for an implant. The Baha on softband is the ideal early intervention alternative. The softband allows the sound processor to be worn, without the implant. Easy to use and comfortable, providing infants and toddlers with the amplification they need to facilitate language development.
What Is The Vibrant Soundbridge ?
The vibrant soundbridge is a middle ear implant system. It directly stimulates middle ear structures in much the same way as normal sound moves them via the ear canal. This "direct drive" stimulation enables excellent sound quality without blocking the ear canal.
The Vibrant Soundbridge consists of an external and an internal part. The external part is an audio processor and is worn on the head, can be discretely covered by hair. This internal part is an implant which mechanically vibrates middle ear structures. These vibrations can be amplified and adjusted to optimally compensate for different types and degrees of hearing loss.
How Does The Vsb Work ?
Sounds are picked up by the microphone of the audio processor. The audio processor is held over the implant by magnetic attraction to a magnet in the implanted part.
The audio processor converts sounds into electrical signals.
These signals are transmitted across the skin to the implant.
The implant relays the signal further to the FMT (Floating Mass Transducer). The FMT is the core component of the system and is smaller than a grain of rice.
The FMT converts the signal into mechanical vibrations that directly drive a middle ear structure (e.g. the ossicular chain) and cause it to vibrate.
These vibrations then conduct sound to the inner ear and to the brain and are perceived as sound.
Vibrant Soundbridge Benefits
In contrast to a traditional hearing aid, which works by amplifying sound, the Vibrant Soundbridge directly stimulates the ossicular chain providing the most efficient transfer of sound called "direct drive". The many clinical results for the Vibrant Soundbridge conducted at numerous clinics and universities worldwide have repeatedly demonstrated that the Vibrant Soundbridge performs better than hearing aids in many environments. Patients implanted with the Vibrant Soundbridge receive the following benefits:
Improved sound clarity, quality and increased functional gain as compared to their hearing aids
Preference for the Vibrant Soundbridge in a variety of listening situations such as outdoors, in restaurants, and when listening to television and radio and in loud background noise
Virtual elimination of acoustic feedback problems
Improved comfort as the Vibrant Soundbridge was more comfortable to wear. Patients typically wear the Vibrant Soundbridge longer on a daily basis than they wear hearings aids
Improvement in gain and output particularly in the high frequencies above acoustic hearing aids
Improvement with occlusion due to completely open ear canal
Auditory Brainstem Implant
What is an Auditory Brainstem Implant (ABI) ?
An auditory brainstem implant (ABI) provides a sensation of hearing to deaf people by directly stimulating the cochlear nucleus in the brain. This implant uses similar technology as the cochlear implant, but instead of electrical stimulation being used to stimulate the cochlea, it is used to directly stimulate the cochlear nucleus in the brain stem of the recipient.
Because it bypasses the cochlear nerves, the device is most useful for people who have an absence or damage to the cochlea or cochlear nerves (which precludes the use of a cochlear implant).
How does an ABI work ?
The device comprises a processor positioned by the ear, a receiver/stimulator and an array of electrodes. The electrode array of the ABI connects directly to the brainstem, bypassing the damaged cochlea and cochlear nerves. The microphone in the processor picks up sounds from the environment and digitally transmits them to the receiver stimulator placed under the skin. The receiver/stimulator stimulates the brainstem electrodes, allowing the patient to hear a variety of sounds.
Who can benefit from an ABI ?
Any adult or child with bilateral (both ears) severe to profound sensorineural (nerve) hearing loss who might have been candidates for a cochlear implant but cannot receive a cochlear implant due to absence or damage to the cochlea or cochlear nerves would be a candidate for an ABI.
Such situations may occur due to trauma, illness(such as meningitis), tumours of the hearing nerve(acoustic neuromas) or may be a birth anomaly.
See the BBC telecast on the first Paediatric Nucleus ABI done in India. This was carried out by our team on a 4 year old child.
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My experience with cochlear implant My name is Gerald Andrew; I am 29 year old male Tanzanian. Last year (2009) was one of the most memorable for me. It’s when I received my cochlear implant at Apollo hospital in New Delhi after Read More »
I wanted to thank you immensely for the help that you provided to my father and thus to our family by giving him the gift of hearing. He is now recovering well and is able to hear all the conversations as normally as anyone else can.
My father, underwent a Stapedotomy ear surgery to correc ct his hearing problem, first in one ear and then 6 months later in the other. The result of the surgery was better than expected and post full recovery my father is able to hear very well. Read More »
My experience with cochlear implant My name is Gerald Andrew; I am 29 year old male Tanzanian. Last year (2009) was one of the most memorable for me. It’s when I received my cochlear implant at Apollo hospital in New Delhi after more than three years of hearing loss. Everyone’s experience with coch hlear implant is a bit different therefore, am happy to share mine with anybody out there, from the moment I lost my hearing, my experience during my stay at Apollo Hospital and one year later on, after cochlear implant. Read More »