FAQ

We start to develop language from the moment we are born. At first, babies only make crying, sneezing, yawning and coughing sounds. Even though they haven’t yet learned to talk, they are constantly listening. A newborn baby can soon recognize its mother’s voice.

If a child has a hearing loss the basic development of language will often by delayed.

Many children with a profound hearing loss also can learn to speak if they are diagnosed relatively early.

So the earlier the hearing loss is detected, and the earlier it is treated the better. With today’s technology, children can be fitted with hearing aids within the first few weeks or months after birth.

Firstly, they need to be fitted with the right kind of hearing aid. Then, when the time is right, the can get special speech and language therapy.

If the hearing loss is so extreme that even very powerful hearing aids don’t help, your child can still learn to communicate using cochlear implants.

Once your child is diagnosed with a severe hearing loss, it is important to act immediately. In the 24th week of pregnancy, the inner ear is fully developed and the foetus is able to hear sounds coming from both inside and outside the mother’s body.

Newborns are already able to recognize their mother’s voice. During the first few months, infants learn to understand a variety of sounds around them. They can very quickly distinguish between human speech and other environmental sounds. The first two years are especially important for language acquisition. Children with hearing loss cannot develop these abilities later on.

The younger a child’s age when receiving a hearing device, the easier it will be for him/ her to learn to hear and speak. If the brain has never processed auditory information, it loses the ability to do so after only a few years.A baby’s brain is better able to process new information than that of older children, and when children are provided with a hearing device at a very young age, they often develop spoken language quickly and can “catch up” with other children born with normal hearing.

Early diagnosis and treatment of severe hearing loss is the first step toward successful hearing rehabilitation.

You should always be aware when your child does not respond appropriately to sounds. Sometimes a lack of response if attributed to inattention, but it is important to determine if inconsistent or no responses actually stem from an inability to hear.

• Not aware someone who is out of view is talking, especially when distractions are minimal.
• Startled or surprised look when they realize their name has been called (at a normal or even fairly loud level)
• Using “what?” or “Huh?” frequently.
• Intently watching the faces of speaker.
• Sitting close to the television set when the volume is sufficient for other family members.
• Increasing the volume of the TV or stereo to unreasonably loud levels.
• Not responding to voices over the telephone and / or switching ears continually.
• Not reacting to intense, loud sounds.

The single most important signs of possible hearing loss, however, is a lack or delayed development of speech and language.

While the majority of people who suffer from hearing loss may be helped with hearing aids, for some, hearing aids do not provide the benefits they need. Why is this?

Simply stated, hearing aids only amplify sounds. For people with a moderate – to – profound hearing loss, even the most advanced hearing aids may not work because making sounds louder does not make them clearer.

You may be able to hear sound with hearing aids, but understanding speech and other sounds may still be very difficult. Using a hearing aid with a moderate – to – profound hearing loss can be likened to listening to a loud, badly tuned radio program. Your experience only fragments of the program, but at full volume. And in some cases hearing aids may not provide audibility. In such cases, a cochlear implant may be the best option.

Cochlear implants differ from hearing aids in two important ways:

• Hearing aids simply amplify sounds. A cochlear implant, on the other hand, transforms speech and other sounds into electrical energy that is used to stimulate the hearing nerve in the inner ear.
• Unlike most hearing aids, cochlear implants have both internal and external components. The implant system consists of an external speech processor and headset (worn behind the ear) and an internal, surgically implanted receiver/stimulator package with an electrode array.

For people who are cochlear implant candidates, the outer ear and the middle ear function normally. However, in the inner ear (cochlea), the tiny hair cells are damaged or missing and do not generate electrical pulses to be sent to the hearing centres of the brain. Therefore, the brain does not perceive the sound.

The cochlear implant attempts to replace the function of the hair cells with electrical stimulation. Sounds are picked up by the microphone of the speech processor. The speech processor analyses and codes sounds into electrical pulses. These pulses are sent to the surgically implanted receiver/stimulator package and through to the electrode array, which stimulates the residual nerve fibres in the cochlea. The hearing nerve then sends these electrical pulses to the brain and which are finally interpreted as sound. Unlike a hearing aid, a cochlear implant doesn’t make sounds louder. Rather, it bypasses the damaged part of the ear and stimulates the auditory (hearing) nerve directly.

Any adult or child with bilateral (both ears) severe to profound sensorineural (nerve) hearing loss who obtains little or no benefit from hearing aids would be considered a candidate for a cochlear implant. Such deafness may be acquired following infection (such as meningitis), toxic effect of ototoxic drugs, trauma or age associated hearing loss.

Some children may be born with deafness. Such congenital hearing impairment is not uncommon with 2 to 3 out of every 1000 live births are born with significant hearing loss. Such children need to be identified at the earliest. This ensures that appropriate measures are undertaken to rehabilitate their hearing loss at a time when language skills can most easily be acquired. Many of these children may eventually require a cochlear implant.

Studies have shown that children who receive a cochlear implant before the age of two, possess spoken language skills equal to or closely ranked with their hearing peers. A delay in language development could have a severe impact on a child’s ability to read and write.

Is your child a candidate?

• Was your child born with a moderate – to – profound hearing loss in both ears?
• Does your child fail to respond to your voice even while wearing hearing aids?
• Has your child experienced a hearing loss after learning how to speak?
• Is your child no longer progressing with speech and communication skills?
• Does your child depend heavily on lip – reading?
• Is your child exhausted at the end of the school day because communication requires such a high degree of concentration?
• As parents, are you highly motivated to work with your child to help them develop age appropriate language and communication skills?

If you answered “yes” to several of these questions, you child may be a candidate for a cochlear implant. If you’d like to know more about the viability of a cochlear implant, you should discuss your child’s options with our cochlear implant clinic.

An increasing number of adults are choosing to have cochlear implants as they realize that they no longer need to live in isolation caused by hearing loss. With a cochlear implant talking on the phone, participating in meetings, enjoying concerts and the cinema, and interacting with family and friends may once again become a reality.

Am I a candidate?

• Do you have to ask people to repeat themselves in one – on – one conversations, even in a quiet room?
• Do you only understand relatives and close friends on the telephone?
• Do you depend on lip – reading to understand a conversation?
• While dining with friends in a restaurant, do you have difficulty following the conversation?
• Do you avoid social activities because you can’t hear what is being discussed and are afraid you will not respond correctly?
• Do you watch only captioned television programs?
• Can you no longer hear birds singing?

If you answered “yes” to several of these questions, you may be a candidate for a cochlear implant. To find out more about the viability of a cochlear implant you should discuss your options with our cochlear implant clinic.

Cochlear implant systems can offer a wide range of benefits including hearing speech, environmental sounds and music.

Nearly all cochlear implant users hear environmental sounds, keeping them in touch with their surroundings – including traffic, sirens, alarms etc.

Virtually all recipients hear speech sounds through their cochlear implant. It usually takes some time to begin to understand these sounds especially for children.

Hearing the speech of others as well as their own voice helps CI recipients to tune their speaking abilities.

Many people are able to use the CI system so effectively that they can understand speech without lip – reading and can have interactive conversations over standard and mobile phones.

Infants and children

Children born with a profound hearing loss who received a cochlear implant at a young age may learn to listen and speak, going on to obtain age appropriate language skills. Your child may be able to attend a mainstream school and enjoy success in further education, employment and community life.

Studies have shown that children implanted before the age of two achieved spoken language skills equal to, or closely ranked with their hearing peers.

Adults

For many adults, suffering a hearing loss is just part of getting older. While hearing aids can be effective, there may come a time when a hearing aid just isn’t enough.

A study of people using cochlear implants showed an average sentence understanding of 80% after three months of using a cochlear implant and 90% after six months. This compares to only a 10% understanding when using hearing aids.

Talking on the phone, reading to your grandchildren and taking part in community activities or social events may once again be possible with a cochlear implant.

Our brain uses information received from both ear to help us hear well. Binaural hearing is term used to describe this. Bilateral implantation is becoming a more common practice as hearing professionals worldwide recognize the benefits of binaural hearing.

The benefits of binaural hearing include:

• The ability to localize from where a sound is coming. This is very important from a safety perspective.
• A better understanding in noisy environments as selective listening is achieved more easily.
• Better sound quality as you are hearing in both ears. This greater range provides a better sense of sound balance and quality.
• An increased ability to distinguish between sounds.
• Keeping both ears active. When the hearing nerve in one ear is not used for an extended period of time it tends to lose its ability to understand.
• A less tiring and more enjoyable listening experience.
• A sense of balance. When people hear from just one side they can feel that they have a ‘dead side’, which can be a strange sensation.

Habilitation or rehabilitation is the learning phase of your cochlear implant process and is essential to good hearing and communication outcomes. Babies have to learn to understand the sounds they now hear and to communicate with the people around them. Adults must learn to listen and understand again.

Habilitation for children

If your child has never heard, it may take a while for their brain to make sense of environmental and spoken sounds. Just like a newborn, your child needs time and experience to learn to listen, to learn language and in turn to learn to speak.

A comprehensive educational and habilitation program will increase your child’s ability to benefit from a cochlear implant.

Rehabilitation for adults

If you’ve been without hearing for some time, it may take a while for your brain to adjust to the stimulation of the implant.

Learning to hear and speak again can be a long process for some. A rehabilitation program will help you develop new listening skills through daily activities. Your clinician will help you with techniques to improve your hearing.

Cochlear implant surgery lasts about two hours and is performed while the patient is under general anaesthesia. Hospital stay is likely to be a maximum of two days. We would normally admit on the day of the operation provided all the preoperative tests are satisfactory.

The electrode array is inserted into the cochlea. The receiver/stimulator is secured to the skull. Typically, patients remain in the hospital for two nights. They have a bandage on their head which is removed after four days. Patients return to school or work as soon as they feel well enough to do so, usually within a week of surgery.

Following activation of the implant, the candidate would need regular mapping or programming of the implant and speech (auditory-verbal) therapy – these can be carried out at a place close to home and we would help by liaising with the local centre to make sure they have the appropriate facilities for this. Some of our outstation patients stay in Delhi for a period after the operation so that the initial mapping and therapy is done here and then they continue the same at home.

(Re)Habilitation is an essential part for those who have undergone Cochlear Implantation. All patients need Auditory Verbal Therapy (AVT). In Auditory Verbal Therapy, the emphasis is laid on making the child listen and speak normally, rather than on lip reading and visual cues. Learning to listen takes time and requires concerted efforts from the patient, the family and the person providing habilitation services. Thus the implant can offer a wide range of benefits, including hearing speech, environmental sounds and music.