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Implant cochléaire

Assessment for a Cochlear Implant

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"cochlear implant assessment", "Evaluation for a cochlear implant", "How to get a cochlear implant", "selection process"

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To obtain an assessment for a cochlear implant, it is best to be referred by an ENT doctor, audiologist or hearing care professional.

 

Selection Criteria

The selection criteria for a cochlear implant evolve according to technological developments and results observed among cochlear implant users. The following are general criteria that may change over time.  It is the selection committee, under the authority of the Centre québécois d’expertise en implant cochléaire, who will make the final decision following assessment of all factors.  
 

State of the Internal Ear (cochlea)

The cochlea must be without obstruction or serious malformation to enable the insertion of electrodes.  


Functional Hearing

Deafness must be permanent; usually its degree must be minimally severe in the best ear. The ability to recognize words and sentences (without lipreading) must be limited with optimal hearing aid fitting.  

 

Age / Communication : 


Among Children : 

The communication’s criteria are directly related to age and hearing profile presented by each child.

  • There is no age restriction for children with acquired or progressive deafness (deafness of a lesser degree that has become more severe over time).  

  • There is no age restriction for children with congenital deafness with a certain amount of hearing experience and functional oral language*.

  • The age limit is 7 years old for children with congenital deafness without hearing experience and/or without functional oral language*.

Among children older than 7 years of age, the communication mode is an important factor, as a child older than 7 who mainly uses sign language and benefits very little from his or her hearing aids, is likely to obtain very limited performance with the implant.  


Among adults :
  • There is no age limit for adults as long as they have a functional oral language*.

Communication mode is an important factor, as a person who mainly uses sign language and benefits very little from his or her hearing aids, is likely to obtain very limited performance with the implant.

 *Functional oral language is assessed during a meeting with the Speech Therapist.  The language will be considered functional if the person has the potential to understand and express herself in an oral mode with both familiar and unfamiliar communication partners.  The person must be able to follow a conversation (understand the questions and maintain the exchange) only through the oral mode with the support of the lipreading. Intelligibility of speech is one of the important factors taken into consideration. The fact of uttering unintelligible vocalizations on signs or natural gestures is not enough to consider that the oral language is functional.

 

Psychological State :


Among children and adults :

The potential recipient of a cochlear implant must be in good mental health and not present a serious problem likely to hinder efficient use of the implant. This person must also demonstrate a willingness to participate in each step of the process : surgery, implant programming and intensive functional rehabilitation. 

 

Support from Family and/or Friends :

It is important for the potential recipient and his/her close relatives to have realistic expectations with regard to the cochlear implant. Strong motivation is also necessary. For children, teenagers and elders, family involvement is essential throughout the process.  


Selection Process

At the CHU de Québec-UL, L'Hôtel-Dieu de Québec 

 

Appointment with the Ear/Nose/Throat Specialist (ENT) :
  • Assessment of the patient’s general state of health. 

  • Complete ENT examination including an ear exam. 

  • Request for examination of the ears in radiology (CT scan and, if required, an  MRI : Magnetic Resonance Imaging), which is essential to the planning of surgery.  These exams can be done in your area.

  • Request assessment in other disciplines, if required. 

 

Appointment with the Audiologist :
  • Gather information on the potential recipient’s auditory history.

  • Re-assess, if needed, the potential recipient’s hearing level.
  • Request additional evaluations (eg, auditory brainstem auditory evoked potentials (ABR)).
  • Hand in, if needed, the “Request for Professional Opinion with regard to the Actual Hearing Aid” Form to ensure that optimal hearing aids fitting is provided.

  • Document the child’s overall status through clinical observation or by requesting a complementary assessment, if required.

  • Discuss the potential recipient’s (and/or parents’) expectations regarding the cochlear implant.

  • Explain how the implant functions and expected results.

  • Explain the steps of the process (decision, surgery, programming, rehabilitation).

  • Fill out the necessary authorization forms for the sharing of information (CIUSSS de la Capitale-Nationale, IRDPQ, referring agent, rehabilitation centre or supraregional rehabilitation centre).  

 

At the CIUSSS de la Capitale-Nationale-IRDPQ, St-Louis site


Don’t forget to bring your hearing aids, or those of your child, as well as batteries (make sure the hearing aids are properly adjusted and functional).


Appointment with the Audiologist :
  • Make sure that hearing aids are in good working order with best fitting.

  • Assess hearing abilities with hearing aids. 

  • Discuss results expected with a cochlear implant.

  • Assess motivation and expectations regarding the cochlear implant.

  • Assess attention, cooperation and the willingness to learn (especially with children). 

 

Appointment with the Psychologist :

Among children :
  • Search for symptoms of psychological, emotional or other problems that could limit the use of the implant.

  • Assess the motivation and expectations of the child (according to age) and his/her family. 

  • Assess the level of collaboration across the different steps of the process. 

  • Assess parents’ process of adjustment to having a child with a hearing impairment. 

  • Assess the child’s adaptation to his/her hearing impairment. 

  • Assess the functional organization for the next steps of the process.     

 

Among adults :

  • Assess motivation and expectations regarding the implant. 

  • Observe the potential recipient’s personality : capacity to invest him/herself as well as his/her capabilities with regard to learning and adaptation.

  • Assess external stressors.

  • Examine the social network and support the person can rely on. 

  • Assess the functional organization for the next steps of the process.

 

Appointment with the Speech Therapist :


Among children :

  • Conduct a brief assessment of the language level (comprehension and expression). 

  • Assess the child’s and parents’ communication aptitudes.

  • Assess attention, cooperation and the willingness to learn.

  • Discuss results expected with a cochlear implant. 

 


Among adults (if needed) :

  • Assess competence with regard to communication. 

  • Assess level of language comprehension and functional oral      
     language. 

  • Assess expectations regarding the implant and the improvement of   speech. 

  • Discuss results expected with a cochlear implant. 

 
In order to complete the observations gathered during assessment, the team may contact clinicians in your area to obtain more information. Additional assessments may be required.


Decision

The decision regarding the application for an implant will be made by the Selection Committee of the Centre québécois d’expertise en implant cochleaire.


There are three possible outcomes :


Acceptance :

The team considers that the cochlear implant is an appropriate course of action for the potential recipient. 

 

Deferral of decision :

The team is unable to come to a decision, either because it needs additional information or because certain issues need to be addressed. Objectives may then be transmitted to the potential recipient and attending clinicians in his/her area. After a certain amount of time, the team may meet again with the potential recipient for re-assessment or ask him/her to contact them.   

 

Refusal :

The team considers that the cochlear implant is not the appropriate course of action for the potential recipient.  

 

The decision is communicated by mail, occasionnally by phone, in the 2 weeks following the meeting of the Selection Committee. Committee meetings take place every 4 to 6 weeks.

In the case of a positive answer, we may confirm the date of surgery with you; this confirmation may be sent later but with enough time to organize your stay in Quebec City. With your acceptance letter, you will receive information with regard to required vaccines, as well as a pre-surgery health questionnaire that you will need to fill out.


Following an Acceptance

  • Required vaccination. You will receive a detailed letter with a questionnaire to be completed. The questionnaire must be returned to L’Hôtel-Dieu de Québec.
  • Surgery (about 2 hours) and activation of the cochlear implant at L’Hôtel-Dieu de Québec. Preoperative visit the day before. Day surgery (no hospitalization). Consultation with the ENT doctor and activation of the implant by the audiologist the day after the surgery.
  • Convalescence (about 2 weeks). Return home. During convalescence, it is essential that you wear your processor. Young children need to return to the rehabilitation center of their area in order to prepare for the initial programming.
  • Intensive Initial Programming at L’Hôtel-Dieu de Québec (3 days).
    During the first 2 days, 2 appointments per day are planned : in the morning, at the IRDPQ, site St-Louis and in the afternoon, at L'Hôtel-Dieu de Québec.  Think about your travel between the 2 institutions for these visits. 
  • Intensive Functional Rehabilitation (RFI) in the designated center (12 weeks for children and 8-10 weeks or less for adults).


Questions et réponses

Will a cochlear implant enable me to regain normal hearing ?

A person wearing a cochlear implant continues to have restricted hearing. The cochlear implant may improve the perception of speech and sounds, but some very soft sounds remain inaudible. The cochlear implant makes it possible to hear soft sounds, but analysis of these is not the same as with normal hearing. Therefore, a person wearing a cochlear implant has more difficulty understanding speech than a person with normal hearing. In fact, understanding speech in a noisy environment remains difficult even with the cochlear implant and the perception of music is altered.

Does a cochlear implant allow me to hear as with a hearing aid ?

The perception of sounds with a cochlear implant differs from a hearing aid (more acute, echo, muffed, metallic).
The hearing aid amplifies sounds while the cochlear implant codes them (like a computer) and transmits electrical impulses to the auditory nerve. This is why the brain needs time and auditory training to interpret this new auditory information.

 

Is the cochlear implant only for people who have profound deafness ?

Selection criteria evolve according to technological developments and results obtained by cochlear implant users. A cochlear implant can now become an option for individuals who are not completely deaf but whose understanding of speech is significantly affected. An assessment of hearing abilities is essential in determining if a cochlear implant will be of greater benefit to a person than his/her hearing aid.

Am I too old to receive a cochlear implant ?

One can receive a cochlear implant at any age, if the person has a functional oral language . Most importantly, the person must meet the eligibility criteria with regard to receiving a cochlear implant and must be able to undergo surgery.
 

Will a very young child who receives a cochlear implant have to replace it after a few years, since his/her cochlea has grown ?

The cochlea is fully formed at birth and does not grow. Nonetheless, the cochlear implant is an electronic device and as such, will need to be replaced at least once during a person’s lifetime.

What about cochlear implant surgery ?

This is a day surgery that requires general anesthesia. It lasts about 2 hours. 



Does the cochlear implant rust with the years ?

The internal components are covered with a bio-compatible material (which does not lead to rejection) and the electrodes are made with a special rust-proof metal.

 

Can cochlear implant users swim, shower or play sports ?

As long as they are not wearing the external device or as long as they are using a proper bathing accessory, cochlear implant users can take a shower, swim and practice most water sports (making sure to respect the time limits recommended by the surgeon following the surgery).  There are restrictions with regard to scuba diving due to variations in water pressure. Participation in all other sporting activities is permitted, although it may be necessary at times to wear a protective helmet.

Will I be able to hear with my cochlear implant the day after the surgery ?

As soon as the cochlear implant is activated the day after the surgery, the person can hear sounds. However, speech may remain unclear without lipreading. Speech comprehension will improve with the adjustments made during the intensive initial programming period, auditory training and time.

With a cochlear implant, will I be able to have a conversation over the phone ?

Most adults with a cochlear implant are able to follow a conversation over the phone with a person they are familiar with; but the ease with which they hear may vary. Some may understand a conversation with a stranger while for others, telephone conversations may be very limited, if not impossible. Telephone skills are directly related to the ability to understand speech through hearing only.

With a cochlear implant, will I finally understand people in a noisy environment (eg. restaurant, family meetings) ?

Certain limitations to one’s hearing remain, especially when it comes to understanding speech in a noisy environment. People report that they have more difficulty following a conversation in noisy situations than in silence. They must then use more visual cues (lipreading, natural gestures) and communication strategies to understand. The programming may be adjusted to facilitate hearing in a noisy situation; nonetheless, communication remains difficult.

With a cochlear implant, will I be able to watch my TV shows without the need for subtitles ?

Most cochlear implant users continue to rely on subtitles to complete auditory information. You must bear in mind that background noise or music broadcast during a show, as well as a lack of any possibility of lipreading, can interfere with the understanding of what is said. A sound transmission system may make listening to television easier.

With a cochlear implant, can I go to the movies ?

As with television, it may be difficult to understand what is said. Some movie theatres provide transmission systems than can be hooked up to the cochlear implant. 

With a cochlear implant, will I be able to speak more clearly ?

Even though the cochlear implant provides better hearing, adult speech patterns developed over the years remain hard to change.

If my cochlear implant does not work to my satisfaction, can I go back to wearing my hearing aid ?

The insertion of electrodes in the cochlea usually destroys any residual hearing. It is therefore usually no longer possible to use a hearing aid in the ear with a cochlear implant.

Does a cochlear implant make it possible to listen to music ?

Variances in cochlear implant performance were noted in this regard.  Some cochlear implant users enjoy listening to music, while for others the music appears as set of noises. On the other hand, some may identify musical instruments or keep pace, but are unable to recognize the lyrics of a song. Others may recognize words and/or complete sentences of a known and sometimes even unknown song.

Do cochlear implant users often have headaches ?

Cochlear implant users are no more susceptible to headaches than the rest of the population. However, they must pay a greater level of attention and concentration to auditory information; their level of fatigue may be greater at the end of the day and thus lead to more headaches.

With a cochlear implant, will I be able to go back to the theater ?

In this regard, one must take into account that these are typically difficult listening conditions : the presence of background noise, several actors who sometimes speak all at once, variable lighting and varying access to lipreading.

With a cochlear implant, will I be able to more actively participate in meetings at work ?

Even though the cochlear implant improves comprehension of speech, the environment in which meetings are held may become a hindrance to communication : people speaking all at once or jumping frequently from subject to another, lack of opportunities for lipreading, etc. Therefore, it is important to use appropriate communication strategies and foster good group management.

 

At family dinners, will I be able to follow all the table talk ?

The ease with which you will understand table talk may vary according to the number of diners, the lighting, the presence of background noise, the opportunities for lipreading and the flow of conversation (people not talking all at once). It is important for the cochlear implant user and his/her parties to adopt appropriate communication strategies.

With a cochlear implant, will it be necessary to use sign language with my child ?

It depends on the child’s overall development, the level of his/her hearing abilities and the progress of language acquisition. This aspect will be discussed with parents during speech therapy follow-up.

Do children who have received a cochlear implant go to regular school ?

Many factors come into play : the age when the cochlear implant was received, individual potential, the level of hearing and language abilities, and the educational environment. Children with a cochlear implant may have different needs with regard to their schooling (e.g. interpreter, academic advisor, etc.). Most will use an FM system in class.

Will children who receive their cochlear implant at a very young age (before 2 years old) develop their language at the same rate as their normal hearing peers ?

Very young children with a cochlear implant have a very good chance of developping speech abilities.  They will however normally demonstrate a delay in language acquisition with varying degrees of severity.

What benefits can people with profound congenital deafness (since birth) and who have a functional oral language expect to gain ?

It is more difficult to predict the benefits of a cochlear implant for these users.  The results are likely to be more limited, notably because of the long duration of their deafness.  The lack of stimulation of the auditory nerve and brain is among the hypotheses that may explain the weaker implant performance observed in these individuals. 

In general, these adults have more difficulty understanding speech without lipreading.  After several weeks of rehabilitation, they can normally understand simple sentences if spoken slowly.  The use of the telephone may remain difficult or even impossible, and be limited to short conversations with a familiar person.  In exceptional cases, a person belonging to this category may experience hearing performance comparable to the ones experienced by adults who became deaf.

With regard to communication, it is important to point out that the use of a cochlear implant brings about little change to one’s level of speech and language.  Although the person benefits from improved access to speech sounds, articulation habits developed over several years are difficult and perhaps impossible to change.  Despite the motivation and determination observed among many adults, it is unfortunately rare to observe improvements in speech production.  For most people, the cochlear implant will facilitate conversation with the support of lipreading. 

Because accomodating to the new auditory information is often more difficult for this group of individuals, they often require more rehabilitation time.

Should a person refuse cochlear implantation for the hope of breakthroughts in hair cell regeneration ?

No one can predict when a revolutionary technique or drug may be discovered. However, current research suggests that it’s unlikely we’ll ever be able to sufficiently regrow the hair cells in the inner ear to restore functional hearing in cases of profound deafness. Moreover, not stimulating the central auditory pathways (brain) for several years will compromise the potential results expected following late cochlear implantation or any possible hair cell regeneration.

With a cochlear implant, will I be able to understand speech in all situations without lipreading ?

Following IFR, most adults are able to understand words and/or sentences with their hearing only (without seeing the lips of the people they are speaking with) in a calm environment. However, the percentage of words and/or sentences recognized, as well as the degree of ease with which they can do so varies from one person to another.  It is difficult to predict the maximal level that can be attained, as several factors must be considered (duration of deafness, pre-implant hearing abilities, etc.). 

It should be noted, however, that cochlear implant performance is influenced by the sound environment.  Indeed, when people find themselves in a noisy environment or in a group (ex: restaurant, family dinner ...), they often have more difficulty understanding speech.  

Will the cochlear implant help me understand a person who is talking to me and whose lips I can see ?

Most people who receive a cochlear implant experience a significant improvement in their ability to follow conversations with the support of lipreading.  Daily exchanges are also greatly facilitated as they require much less effort. 

Can one hear sounds from his/her environment with a cochlear implant ?

With a cochlear implant, people are able to hear (sometimes at the beginning without knowing what it is) low intensity sounds (ex. ticking of a clock, birds, refrigerator humming).  However, a few weeks may be necessary before being able to recognize sounds emanating from the environment (identify what was heard).  

What do sounds “sound” like with a cochlear implant ? Will I hear the same way as I do with my hearing aids ?

According to several adults, sound with a cochlear implant is different than that heard with a hearing aid or with a normal ear.  For some people, sounds may seem metallic, muffled or sharp, and for others, it comes close to the actual sound.  The appreciation of sounds will evolve over time.  At the beginning of the programming, some people may find sound to be unpleasant, but will get used to it afterwards. Children with a significant degree of deafness since birth have nothing to compare the sounds they are hearing with, as they only experienced limited benefits provided by hearing aids.  It will be for them their way of hearing.

 

Does the cochlear implant make it easier to watch television ?

Some people may understand words and/or sentences without lipreading or subtitles. However, as soon as there is background noise or music in a television program, speech becomes much more difficult to understand.  Moreover, it is very arduous to understand translated television programs because one cannot use lipreading.  Consequently, most people resort to assistive listening devices (system that sends television sounds directly to the implant) and/or close captioning (subtitling) to watch television. 

When will I benefit from my cochlear implant ?

Adjusting to the new auditory information provided by the cochlear implant requires work and perseverance.  However, the benefits gained vary greatly from one person to another and depend on certain characteristics (duration and degree of deafness, use of hearing aids, language level, etc.).  Generally, the more the profound deafness is of short duration, the more the results obtained with the cochlear implant are interesting and appear rapidly.  As such, a person with short duration deafness can refer more easily to his or her auditory memory to make sense of the new sounds heard with the cochlear implant.  

Dernière révision du contenu : le 28 novembre 2019

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