Cochlear Implant Center

Cochlear implants are devices that can allow individuals with moderate to severe hearing loss to reintegrate with the hearing world. Unlike hearing aids, which merely amplify sounds, cochlear implants convert received sounds into a series of electrical impulses, which are delivered to the auditory nerve elements within the cochlea by means of an implanted electrode array. An internal receiver-stimulator contains circuitry designed to convert the coded information received from the externally worn speech processor to electrical impulses and governs the activation of specific electrodes. The externally worn components of these devices combine a microphone and the speech processor technology into one unit that is comfortably worn on the head and is held in place by a small magnet.

1. The microphone picks up a sound.
2. The signal is then "coded" (turned into a special pattern of electrical pulses).
3. These pulses are sent to the coil and are then transmitted across the skin to the implant.
4. The implant sends a pattern of electrical pulses to the electrodes in the cochlea.
5. The auditory nerve picks up these electrical pulses and sends them to the brain. The brain recognizes these signals as sound.

The current technological sophistication of today's cochlear implant systems can restore hearing in adults to a functional level and provide young children with auditory stimulation that benefits them in developing, comprehending and producing spoken communication as well as recognizing and understanding sounds in their environment. These advantages have important implications especially for young children relative to communication acquisition, cognitive development, education, social well being, family relationships, daily life activities and in their future, vocational options. Learn more at Children's Hospital of Richmond at VCU.

Likewise, emerging evidence supports the role of cochlear implants (and any hearing restoration) in the arrest and even reversal of cognitive decline in older individuals.

We currently offer all cochlear implant devices manufactured by the three FDA-approved makers: Cochlear Corporation, MED-EL and Advanced Bionics.

We provide audiological, medical, otological and radiological examinations as well as patient/family counseling, including, but not limited to:

• Hearing evaluations (with and without hearing aids)
• Speech perception testing (listening and understanding speech sounds, words, sentences) in quiet and with background noise
• Developmental and educational evaluation (children only)
• Speech evaluation (optional for adults)
• Medical/surgical evaluation (hearing history and health)
• CT and/or MRI radiographic studies
• Review of immunizations

Some individuals may require:

• Balance evaluation
• Other medical clearance, depending on specific health or medical issues

Learn more at Children's Hospital of Richmond at VCU.

The surgery is performed under general anesthesia on most patients. Only a very small amount of hair is shaved, if any. A minimally invasive incision measuring approximately 2.5 inches is made behind the ear. The mastoid bone is removed and small opening is made in the cochlea prior to insertion of the electrode array. The entire surgery typically lasts 1.25 hours.
The surgical team is experienced with the implantation of malformed or ossified cochleae. Likewise, our surgeons have extensive experience with hearing-preservation (electroacoustic) surgery. When this occurs, a variety of alternative surgical techniques and/or electrode arrays may be used.
The vast majority of patients go home the same day. Pain is typically minimal and most patients are able to resume their normal activity with a few days. The team will see patients frequently in the post-operative period. The device is typically activated three to four weeks following surgery.

The importance of vaccinations in cochlear implant users

To our cochlear implant patients and families:

As you know, cochlear implant surgery is a safe and effective way to restore hearing for infants, children, and adults with severe to profound hearing loss. However, there is a small risk of meningitis that can occur following cochlear implant surgery, especially in patients who have abnormal inner ears, a cerebrospinal fluid (CSF) leak during implant surgery, or a history of meningitis.

The Centers for Disease Control (CDC) recommends that all patients with cochlear implants receive PNEUMOCOCCAL (not meningococcal) vaccination and we congratulate all of you who are up to date with your vaccinations.

However, recently the CDC has updated its recommendations for safest coverage of cochlear implant recipients. (The CDC guidelines are listed below and can also be found on the Internet at: http://www.cdc.gov/vaccines/pubs/acip-list-sup/acip-sup-pneumo.htm). Please read the guidelines below and understand which applies. Proper vaccinations can literally mean the difference between life and death.

All implant candidates and patients who already have one or two cochlear implants must be vaccinated to decrease the risk of meningitis following surgery.

Note: The terminology can be confusing. There are two different pneumococcal vaccinations, PCV13 (Prevnar®) - traditionally given to children, and PPSV23 (Pneumovax® 23 - traditionally given to adults).

Children (18 years old or younger)

Infants with cochlear implants who are younger than age 2 should complete the Prevnar® series (part of the routine vaccination schedule for virtually all infants).

Children with cochlear implants aged 2 years and older who have completed the Prevnar® series should receive one dose of Pneumovax® 23. They should wait at least 2 months after the last dose of Prevnar® before receiving Pneumovax® 23.

Children with cochlear implants who are between 24 and 59 months of age who have never received either Prevnar® or Pneumovax® 23 should receive two doses of Prevnar® two or more months apart and then receive one dose of Pneumovax® 23 at least two months after that.

Children aged 5 years and older with cochlear who never received either vaccination, should receive a single dose of Prevnar® followed by one dose of Pneumovax® 23 two months after that.

Learn more at Children's Hospital of Richmond at VCU.

Adults (over age 19)

If you have never received either Prevnar® or Pneumovax® 23, you should receive a dose of Prevnar® first, followed by a dose of Pneumovax® 23 at least two months later.

Adults with cochlear implants who previously have received at least one dose of Pneumovax® 23 should be given a Prevnar® dose 1 year or more after the last Pneumovax® 23 dose was received. Adults who are now over age 65 should also consider receiving a booster Pneumovax® 23 vaccination.

Please note that if you are going to have cochlear implantation (or re-implantation), do not get a vaccination within 2 weeks prior to your surgery. If you have not completed the recommendations, don't worry - surgery won't have to be delayed. Just stay on schedule with your vaccinations.

Please bring this letter to your next appointment with your primary care doctor or pediatrician so that you can discuss this issue and assure that the correct pneumococcal vaccine(s) will be given.

We will need you or your doctor to send or fax us written verification that the correct pneumococcal vaccine was given.

Our fax number is: (804) 628-0950.

We appreciate your help in keeping cochlear implant surgery safe for all of our patients!

An additional consideration is learning to interpret the sounds created by an implant. This process takes time, though not much active participation for adults. Speech-language pathologists and audiologists are the professionals frequently involved in this learning process. Not everyone performs at the same level with a cochlear implant. Prior to implantation, all of these factors will to be discussed so that reasonable expectations for performance can be established.

Initial stimulation and programming takes two days and usually occurs three to four weeks following surgery. Follow-up visits begin on a weekly then monthly basis for the first six months. Bimonthly visits are scheduled up until one year following initial programming. Follow up after the first year of cochlear implant use in 3 to 4 times each year. Children may require more frequent programming than adult cochlear implant recipients. Learn more at Children's Hospital of Richmond at VCU.

All follow-up programming is provided by VCUHS cochlear implant team or its affiliates.

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