The Utah Cochlear Implant Program has implanted more than 1,000 patients, both adults and children. Our typical volume is 60 to 100 implants per year. We implant devices from the three available manufacturers, and surgeries are performed at University of Utah Hospital, Primary Children's Hospital, and LDS Hospital, depending on insurance and the age of the patient. The latest surgical techniques are used, including soft insertion, minimal or standard access, and bilateral simultaneous implantation. Facial nerve monitoring is standard.
Cochlear Implant Surgery
Cochlear implant surgery is usually performed as an outpatient procedure and takes one to three hours. Patients of any age can be implanted, (we have implanted patients in their nineties!) but it is unusual to implant a child before age six months. Children less than 24 months old are observed in the hospital overnight. Recovery is typically three to five days. Post-operative activation with the speech processor generally occurs two to four weeks after surgery. The pre-operative evaluation process involves audiologic testing, a medical evaluation, and imaging of the inner ears. For patients traveling a distance, this evaluation can be accomplished in a single day.
Utah Cochlear Implant Team
The Utah Cochlear Implant Team is a multidisciplinary group of professionals, who are dedicated to providing the finest care to severely hearing impaired patients. This team includes implant audiologists, surgeons, deaf educators, members of the parent/infant program, and speech pathologists. The team meets monthly to discuss potential cochlear implant candidates and make recommendations for the best possible treatment. Our surgeons are fellowship-trained and board-certified or board-eligible in neurotology.
To make appointment for an evaluation, please contact us:
Email Sherry Hogge
What is a cochlear implant?
A cochlear implant is an electronic device manufactured and designed to assist severely to profoundly hearing-impaired adults and children who have gained little to no benefit from hearing aids.
How does a cochlear implant work?
There are two main components to a cochlear implant:
- The receiver/stimulator (implant), which is surgically implanted
- The speech processor (headpiece) which is worn externally either behind the ear (ear-level speech processor) or on the belt (body-worn processor)
Sound is picked up by the microphone (part of the externally worn speech processor) and is converted into an electrical signal. The signal is then coded or converted to specific patterns or pulses. This coded signal is sent by the transmitting coil of the speech processor to the receiving coil of the internal receiver/stimulator (the implant). The signal is sent across the skin inductively; there is no direct connection with the implant, since it is implanted beneath the skin.
The implant now sends the coded electrical signal to the electrode array, which is implanted into the cochlea (inner ear). Multiple channels and points of stimulation now fire in a pattern that the cochlea can recognize stimulating the acoustic nerve ending in the cochlea. The auditory nerve picks up these signals and transmits them to the brain (auditory cortex) where they are perceived as sound.
Who is a candidate for a cochlear implant?
Essentially any adult or child, who is severely hearing impaired and does not receive benefit from a hearing aid, is a candidate for a cochlear implant. Children as young as six months can be implanted. Adults in their eighties and nineties can and have been implanted, as long as there are no medical reasons which would impact the implant surgery.
Good candidates for the cochlear implant have/had the following:
- Minimal to no benefit from the use of conventional hearing aids
- Severe to profound sensorineural hearing loss (SNHL)
- An environment at home or in school where oral communication is encouraged
- Realistic goals concerning the implant
- Realistic understanding of the surgery, the risks, and inherent benefits to cochlear implantation
- No significant medical issues that would make the risks of implant surgery greater than the benefit
- *For children* Failure to develop good oral language skills despite intensive speech and language rehabilitation and an adequate period of hearing aid use
What are the potential benefits of cochlear implants?
The benefits of cochlear implants can vary from individual to individual depending on a variety of factors, which include length of hearing loss and degree of rehabilitation following surgery. For most good candidates, the benefits are significant. Benefits may range from improved sound awareness to hearing and understanding speech in noise:
- Sound awareness
- Hearing everyday sounds
- Improved lip reading
- Hearing and understanding speech
- Improvement of the user’s own speech
- Listening in background noise
- Use of a telephone
Your surgeon and audiologist can discuss what would be reasonable expectations for performance for you or your child as the level of performance depends on certain variables including length of hearing loss, motivation, and available rehabilitative services among others.
How do I determine if I am a cochlear implant candidate?
Anyone who is hearing impaired and not receiving benefit from conventional hearing aids is a potential candidate for a cochlear implant. It is wrongly assumed by some that total deafness is required prior to being a candidate for a cochlear implant. Currently, patients with residual (remaining) hearing are allowed to undergo implantation with significant improvement.
An evaluation by an audiologist experienced with cochlear implantation is necessary to determine candidacy. This evaluation is termed a candidacy evaluation and involves the following:
- Extensive hearing examination, with and without hearing aids
- Standardized testing that determines to some degree if performance would be greater with hearing aids or with a cochlear implant (CNC words, HINT sentences)
- Speech language evaluation for communication ability and language development
Once candidacy has been established, the cochlear implant surgeon will do the following:
- Perform a complete history and physical examination
- Discuss the surgical procedure in detail
- Discuss the options to surgery
- Discuss all the risks inherent to the surgical procedure
- Discuss the device types and implant options (at our center this is also done by our implant audiology team)
In addition to this evaluation, other evaluation may be required and includes the following:
- Radiology evaluation (CT scan, MRI or both)
- Neuropsychological testing
In general, the cochlear implant team will meet and discuss their evaluations and concerns prior to recommending surgery.
What is involved in the surgery for cochlear implantation?
The cochlear implant surgical procedure is done in the hospital setting under general anesthesia. The majority of the patients are able to go home on the day of surgery. The procedure usually takes from one to three hours.
Surgery - Depending on the make and model of implant chosen, a minimal access approach may be used. Once the incision is made, the bone behind the ear is exposed for insertion and securing of the implant. The aerated bone behind the ear is removed (mastoidectomy). The ear canal and eardrum are not disturbed during the procedure. The cochlear implant is placed in its position under the skin and muscle and secured. A small opening is made in the cochlea (cochleostomy). The electrode is inserted into the cochlea via the cochleostomy.
A soft technique is routinely used in an attempt to preserve any residual hearing and cause the least amount of disturbance to the balance system. The skin is closed and a dressing is applied. The dressing is removed the next day at home.
Follow-up and Rehabilitation - Four to six weeks after surgery the patient is scheduled to return to the clinic. At this time the external device (the speech processor) is fitted. This process is called term-device activation and involves individual programming or mapping of the device by the audiologist. This programming is intensive and may take two to eight visits to accomplish the best map. The intensive programming is required to achieve the maximum hearing with the implant. Experience with this process and knowledge of expected progress is essential to success. Programming time and number of visits vary depending on the patient.
What are some cochlear implant device types?
The University of Utah physicians implant cochlear implant devices from all three device manufacturers. The center has experience with the surgical procedure and the rehabilitative process involved with all of the manufacturers device types. The center enjoys a strong relationship with the individual manufacturers and receives significant clinical support in programming, rehabilitative, and surgical issues with the respective implants.
For more information, we recommend you visit the manufacturer’s sites:
What does Meningitis have to do with cochlear implantation?
Meningitis has been a topic of concern to many individuals interested in cochlear implants particularly because of several news reports on investigations into the relationship of cochlear implants with meningitis. The results of these investigations are summarized below:
- Meningitis is an infection of the spinal fluid that surrounds the brain and the spinal cord. The type of meningitis associated with cochlear implants is called bacterial meningitis.
- 90 known cases of meningitis are known worldwide. Over 60,000 cochlear implants have been implanted worldwide.
- Children with cochlear implants are more likely to get meningitis than children without cochlear implants
- Individuals undergoing cochlear implants should undergo routine vaccination for meningitis as outlined by the CDC. Recently, the CDC and the FDA have completed an investigation that has determined children with cochlear implants have a higher chance of getting bacterial meningitis than children without cochlear implants. Some children with hearing loss who are candidates for cochlear implants have anatomic abnormalities, which put them at an increased risk for meningitis, whether they undergo surgery or not.
The CDC has made recommendations for vaccination for meningitis that the physicians of the Utah Cochlear Implant Team follow for individuals undergoing surgery or who have existing cochlear implants. The recommendations according to the CDC include the following:
- Children who have cochlear implants or are candidates for cochlear implants who have not received any previous doses of PCV7 should receive PCV13 because it is recommended routinely for all infants and children. Older children with cochlear implants (between their second and sixth birthdays) should receive two doses of PCV13 if they have not received any doses of PCV7 or PCV13 previously. If they have already completed the four-dose PCV7 series, they should receive one dose of PCV13 through age 71 months.
- In addition, children six through 18 years of age with cochlear implants may receive a single dose of PCV13, regardless of whether they have previously received PCV7 or the pneumococcal polysaccharide vaccine (PPSV) (Pneumovax®).
- Also additional to receiving PCV13, children with cochlear implants should receive one dose of PPSV at age two years or older and after completing all recommended doses of PCV13.
Lisa Dahlstrom is a native of Salt Lake City and an audiologist with the Divison of Otolaryngology at the University of Utah, where she has worked since 1989. She has a special interest in cochlear implants. Her hobbies include playing the piano and classical guitar, and enjoying time with her family.... Read More
Dr. Richard Gurgel graduated magna cum laude from the University of Utah with an Honors B.A. in Biology. He then continued his training by attending medical school at the University of Utah. There he was elected to the Alpha Omega Alpha honor society as a junior. Dr. Gurgel did his residency in Otolaryngology – Head and Neck Surgery at Universi... Read More
Dr. Shelton has been associated with the University of Utah since 1994. Prior to that time, he was a partner at the House Ear Clinic in Los Angeles. He has lectured throughout the world on Neurotology disorders. He has published over 100 articles and edited books on Neurotology. He is an active member of both national and international professi... Read More
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