Cochlear implants (CI)
The CI is arguably one of the greatest advances in modern medicine, a neural prosthesis that can substitute for the ear sensory organ. For the totally deaf child or adult, it is a chance to hear and speak again. There have been notable achievements in implantable electrodes in the cochlear, safe surgeries and sound processing strategies. Indications for CI have expanded to bilateral CI, CI in infants and the elderly, CI for unilateral hearing loss and CI for residual hearing.
Currently, there is intensive research into oto-protective drugs, electrode designs and placements, stem cell regeneration, gene therapy, atraumatic electrode insertions, optical stimulation of the hearing nerve and even fully implantable CI. Each offers promise, but requires further research.
Our Centre in Singapore currently implants Advanced Bionics, Cochlear and MedEl brands of CI, for patients from 6 months to 80 years of age. It believes in binaural/ bimodal hearing and bilateral CI simultaneously and sequentially where needed. Besides a careful and safe surgery, post-operative readily available support by the companies/ clinics for the patients and families is critical. There must be commitment by families to speech/ auditory verbal/ total communication rehabilitation and fine-tuning and mapping for the CI.
There has been impressive performance for many patients born with total hearing loss bilaterally – if implanted early, with most attending standard schools.
- For children with other neurological and cognitive deficits, the outcomes are more variable, but improvement in hearing is always helpful in the holistic rehabilitation and care of these patients.
- For adults who already have speech and language, the duration without hearing aids/ implants, cognitive, central auditory processing abilities and other systemic disorders are factors that impact on their performance with CI.
- For adults who have not developed speech at all, hearing improvement helps increase safety and interaction with their loved ones; even if their speech may not match those who opt for implants much earlier on in life.
- The individual’s as well as the wishes of the Deaf Community are always respected.
- Correct pre-surgery indications, patient/ family expectations and detailed pre-surgery discussion are important.