Deciding whether your child should have cochlear implants is a decision that will affect many areas of their life. Before surgery can be considered, your child will undergo thorough testing to assess their suitability for the procedure. If suitable, surgery will be arranged, followed by post-operative follow-up and speech therapy to ensure that they get the best results with their cochlear implants.
Pre-operative assessment
The implantation centre’s team will conduct a pre-operative assessment to test your child's hearing and understand the family’s motivations. It consists of a number of evaluations.
Medical evaluation: this is to determine your child’s overall health. In addition to an MRI, a CT scan is usually required to determine the feasibility of the surgery and in which ear to implant. Imaging enables the medical team to check whether it is possible to insert an electrode array into the cochlea. In some cases, this can enable the surgeon to avoid foreseeable surgical difficulties.
Audiometric evaluation: the audiologist performs various audiometric evaluations and tests with a hearing aid (tonal and vocal audiometry). This tests your child’s hearing and assesses the level of hearing loss, as well as the level of amplification supplied by the hearing aid. Sometimes, the audiologist may recommend a trial period with a more powerful hearing aid in order to evaluate the potential benefit in relation to a cochlear implant.
Your otolaryngologist, hearing aid specialist or other hearing healthcare professional will help you identify the type of hearing loss your child suffers from. You may also be sent to the nearest implantation centre to determine whether your child is a candidate for cochlear implantation. Cochlear implantation is a long and challenging process that requires the family to be involved in supporting and assisting their child. If this is not possible, another solution should be considered.
Surgery
Surgery is required to insert the internal part of the implant system. The surgeon makes a small incision behind the ear to be able to place the receiver containing the electronic circuits. Next, the electrode array is carefully inserted into the cochlea.
Implant surgery is performed under general anaesthesia and generally takes under two hours, although it usually requires hospitalisation for a few days. Insertion of a cochlear implant presents the same risks as any other ear surgery.
Until the sound processor is attached and activated, the child will not be able to hear. This usually happens around one month after leaving hospital. This period of time is required to recover from the anaesthesia and to allow the scar covering the incision to form, which can take several weeks.
Post-operative follow-up
For the implantation to be successful, it is also necessary to adjust the settings and sound quality of the external processor, and the child must also undergo speech therapy in order to be able to encode and interpret perceived sound information.
Fittings
During the first setting session, the audiologist provides the sound processor and explains how it works to the child and his or her parents. This consultation involves defining the stimulation levels produced by each electrode inserted into the cochlea. Other parameters are also adjusted to optimise the perception of sound information.
In the months following surgery, several adjustment sessions will be required to gradually improve the quality of sound information. Visits will be spaced out over time, until the settings are considered stable and optimal.
Speech therapy
Following surgical implantation, children have to get used to the signal generated by the implant. Even for children who have experienced a sudden loss of hearing, the message supplied by the implant is perceived differently from how they remember hearing. The brain has to adapt to this new stimulation and learn to interpret it.
It is therefore essential to enrol in speech therapy to facilitate this adjustment. The duration and difficulty of speech therapy varies depending on the cause of the hearing loss and the length of time the child has suffered from a hearing loss. It will take longer and be more difficult for children who have been deaf since birth or who became deaf before learning language.
Like the sound processor fitting sessions, speech therapy sessions are usually held regularly and frequently at first, before gradually becoming more spaced out after the first year. The speech therapist’s work will vary depending on the type of hearing loss suffered by your child. However, it is based on some basic principles: developing perception skills by identifying various sound sources, listening and learning to speak.
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