Sir Ganga Ram Hospital

Hello,

I am Dr. Shalabh Sharma. The topic for today is the Cochlear implant, what are they and for whom are they used. So let’s start with what is a cochlear implant? This is an electronic device that can give a person who does not have hearing or has severe hearing impairment is the sensation of sound and these are indicated in children and adults. Indications are that a person or child with a hearing loss of more than 70 decibels is indicated for a cochlear implant, that means these are the people for whom the hearing aids are not good enough to provide them with the adequate hearing sensation which can go on to have them develop normal hearing normal language normal speech. How does this work? The cochlear implant is an electronic device it directly has electrodes that are inserted in the inner ear and these stimulate the hearing needs which carry the sensation of sound with the brain, this is not a neural, neurosurgical or a brain procedure, it is basically an ear procedure.

What are the indications in children? In children, the indications are a child born with the hearing loss or a child who develops a hearing loss as they grow older in indicated for an implant if they have a hearing loss of greater than 70 decibels and when we find that even with the hearing aid or with well-fitted hearing aid they are not able to develop normal hearing normal language and normal speech. And adults, in adults the indications for implants are usually people who have had their hearing, who are normal hearing but for some reason, in adult life, they go on to lose their hearing this could be because of an accident, because of some infection, viral infection, like mounts, rubella, missiles or trauma to the head, meningitis which is infection of the covering of the layer of the brain all of these can lead to the hearing loss or any ear disease also which could lead to a hearing loss. So once the hearing loss reaches greater than 70 decibels, usually these adults are not able to hear with the help of hearing aids, and in this case, we directly advise them to have cochlear implant surgery. The cochlear implant surgery is a short procedure it takes about one and a half hour to two hours per ear if both ears then you can say it will be around 3,5 hours for both ears and it’s a simple procedure, very effective and the postoperative, aftercare, there is a bandage behind the ear for about 5-6 days, the single stitch which is removed after 5-6 days after the procedure and in a day or two after the surgery, the child or adult wears the processor which looks like a hearing aid behind the ear and as soon as they put it on, it’s called switch on, they start hearing the sound. The audiologist and the therapists are then required, especially in children, to sort of tune of the device so that they start hearing as well as with the device and also to teach them some verbal therapy basically listening therapy we teach the children who have never heard before to start to listen to the sound so that they can go on to develop good hearing skils and with because of development of good hearing skills they go on to develop good speech, good language. Thank you so much, I hope this has been helpful.

Thank You!

Hello,

I am Dr. Shalabh Sharma. The topic for today is how do you approach a child with hearing impairment or hearing loss. Let’s start by talking about a child, when a child comes to me in the clinic with the hearing loss or suspected hearing loss, the child who is not either responding to sound or not starting to speak and learn language, then we suspect that there may be hearing loss, once a child has come, we have to send the child for some hearing tests to confirm that there is hearing impairment. There are many tests and they are done in small children as young as 3 months of age or 6 months of age, or one year of age, 6 tests are done in all to confirm and be sure about what is the level of hearing impairment and how much of hearing impairment is there? The tests are, for example, aided audiometry, unaided audiometry, BERA, ASSR, impedance audiometry and OAE. these tests, once they are done, confirm that a child has a hearing impairment and to what level of hearing or how much of hearing impairment is there. Suppose a child has come with low hearing impairment tests and the tests are showing that child has normal hearing, then what is the reason. In such children, there is usually a psychological issue or something related to the brain wherein it could low IQ attention deficit disorder, or some sort of autism spectrum disorder, wherein a child can hear but he is not able to accumulate that information and learn to produce to speak a language. On the other hand, if the hearing tests show that there is hearing impairment, then we have to see how much of hearing impairment is there to decide what has to be done, in some children it could be just simple thing like there could be fluid behind eardrums in such case some medicine is required and usually that care of it, if it doesn't then some may have to undergo some adenoid surgery or some incision in the eardrum with small grommet in the ear so that the fluid dries up and the hearing comes back to normal. It is temporary and it is quite common in children especially with those who have adonoid issue or common cold or a lot of cold.

Then if he gets a sensorineural hearing loss that means a loss related to the inner ear or the cochlear, then we have to look at how much of hearing loss is there if it is mild to moderate hearing loss, that means hearing loss or even up to severe that means hearing loss in the range of up to 70 decibels of sound, then we have to think of giving a hearing aid to the child immediately so that the child can start hearing sound as commonly we do and start to develop language and speech and hearing. The important thing to understand is that children, when they are born brain, is very plastic it is very easily able to understand, to make use of sound to accumulate to learn to hear, to learn to speak. Once the child grows older and if they have not heard the sound for long-duration say the 10-year-old child and then we give them a hearing aid then usually the responses are not really good. There will be some improvement but not much. So as young as the child, as young as we can find them and investigate them and diagnose them and then put them on the hearing aid that’s the best thing for the children, children as young as three months to six months can be fitted with hearing aids. If the hearing loss, however, is more than 70 decibels then that means that we are looking at severe to perform hearing loss and in which case then special surgery called cochlear implant surgery is there wherein a cochlear implant is put under the skin behind the ear of the patient and once after 10 days period approximately the child wear something which looks like a hearing aid again here outside and the child starts hearing and in this way we are able to treat children with profound deafness or totally deaf children also with implants. All these children the whole idea is once they either wear a hearing aid or implant depending on the hearing loss they should go to normal school, go into normal stream schooling go into a normal college after that and hopefully become good representative of society, socially useful and productive members of our society just like the normal hearing people around them.

Thank You!