The concept of an implantable hearing solution is an exciting one. It is also a complex procedure whose long-term success requires input from a multi-disciplinary team of highly-trained professionals including an audiologist; ear-, nose- and throat specialist (ENT); speech and language therapist; radiologist; and, if necessary, psychologist. It is important to remember that an implantable hearing device is not a solution for everyone. Before we can go ahead with the surgery to implant a hearing device, you will have to undergo a series of tests to ensure that you are a suitable candidate for this procedure. In other words, we have to be sure that at the end of the day, you will derive real benefit from what is essentially an invasive, complex and expensive procedure.
A CHi audiologist will conduct a preliminary assessment to evaluate your (or your child’s) suitability for a hearing solution implant or cochlear implant. This will involve a series of audiological assessments to evaluate the extent and severity of damage to all parts of the ear as well as interviews (see below).
If you have not yet been seen by an ENT, the audiologist will arrange for a consultation with one of our ENT surgeons to take place as soon as possible. A final decision about whether or not to go ahead with an implant will be made by the ENT in consultation with the audiologist and other members of the team.
With some implantable hearing solutions, you could be offered a non-surgical trial device before making a final decision for implantation.
The audiologist will also spend some time ensuring that you have a clear understanding of what the entire procedure entails, as well as realistic expectations regarding the outcome.
The audiological assessments you can expect to undergo include:
- Case history. The audiologist will ask you about the history of your hearing loss; what, if any, auditory rehabilitation you have undergone; what communication challenges you face; and what types of communication methods you use – for example, do you use sign language?
- Unaided Pure tone audiogram. CHi audiologists use both air conduction and bone conduction tests to determine the type and degree of hearing loss. The audiogram also enables the audiologist to compare ears when deciding which ear to implant.
- Aided Pure tone audiogram. This test is used to determine how much benefit you are, or could achieve from appropriately fitted hearing aids.
- Full Speech audiogram (unaided and aided). Using these tests, the CHi audiologist will be able to determine how much speech (single words and sentences) you can understand at different loudness intensity levels.
- Tympanometry testing. This test provides information about the functioning of the eardrum and middle ear.
- Otoacoustic Emissions (OAE). This test is used to determine whether or not there is any damage to the outer hair cells in the cochlea (inner ear).
- ABR (Auditory Brainstem Response), Tone bursts and ASSR (auditory steady state response. Our audiologists cost this series of tests to determine if there is any neurological and retrocochlear involvement (hearing loss that occurs beyond the cochlear) in your hearing loss. These tests also allow the audiologist to obtain objective, frequency-specific estimated hearing thresholds.
- There are several different questionnaires that you ( (if an adult) or the patient’s guardian (if a child) will be asked to complete.
- The CTi audiologist will spent some time finding out about what you (and your family) expect from the implant surgery as well as your understanding of all aspects of the rehabilitation process (e.g., mapping, auditory training, and medical follow ups).
- Past audiological records. The CTi audiologist will require access to your audiological records in order to compare audiograms over time and determine whether the hearing loss is stable, fluctuating, or progressive.
Please bring any audiological records you may have with you to your first assessment consultation with our audiologist.
Regardless of whether you are referred to a CHi ENT surgeon for an implantable hearing solution by your general practitioner (GP) or by an audiologist, one of our ENT surgeons will still have to examine you to determine whether you are a suitable candidate for implantation.
All CHi’s ENTs have received the highly specialised training necessary to perform implantable hearing solution surgery.
At the initial consultation, the ENT will ask about your previous medical history, perform a clinical examination and arrange a radiology assessment.
If the tests and assessments indicate that you are a good candidate, the ENT will then discuss the different types of products and devices that are available, and the different procedures involved in their usage.
If cochlear implantation (CI) is decided on, you will require special immunisation. This will be arranged by the ENT surgeon.
All these processes and procedures can take place at any time during the evaluation process.
However, your relationship with your ENT surgeon will not end with your surgery. CHi ENTs will always be available to look after you after implantation.
Speech and language assessment
Another important component of the process to determine suitability for an implantable device, specifically a cochlear implant, is an assessment by a speech and language therapist. This is to determine your current level of communication skills, and whether or not there is a realistic chance of you developing functional auditory verbal capabilities.
During the assessment, our therapists will discuss your expectations, as well as various aspects related to your (or your child’s) communication skills such as receptive and expressive language, speech production skills and listening skills. The initial assessment for children also considers other areas related to their communication development, like attention and behaviour, the development of play skills, social skills, and so on.
The assessment results provide the therapist with a baseline level of your communication skills and allows for the development of measurable therapy goals that are specific to you. This will assist in determining whether or not you would actually benefit from an implantable device. In some cases, our therapists find that patients are progressing well using alternative means of communication such as sign language; or they may have additional needs that could make it challenging for them to learn and use auditory information to develop spoken language.
The final decision with regards to your suitability for an implantable device will always be made in conjunction with all members of the multi-disciplinary team.
One of the pre-requisites for any implantable hearing device is favourable anatomy that can accommodate an implant. The anatomy of the ear structures is assessed by means of radiological imaging – usually computed tomography (CT) and/or magnetic resonance imaging (MRI). The imaging, in conjunction with some sophisticated computer programs, is used to help the ENT surgeon to determine which specific type of implant should be used and where the most favourable position for the implant is.
Psychological assessment and support
Hearing impairment is often marked by a variety of psychological issues which can create a significant amount of stress and uncertainty for a family. An individual family member’s challenges can often have a negative impact on the whole family, including siblings with normal hearing. When it comes to an implantable hearing solution, the actual surgery can also be traumatic for the entire family. CHi offers psychological services to patients and their families to help them to identify their main stressors and also to assist them in finding more effective ways to cope with these difficulties. The psychologist also assists you and/or your family to manage their expectations regarding the process. In addition, the psychologist supports you and your family to adjust and cope with all the new individual and family dynamics that arise from this type of procedure, and which may persist for years to come.