COCHLEAR & HEARING IMPLANT SERVICE

WELCOME TO OUR COCHLEAR & HEARING
IMPLANT SERVICE

Your ability to communicate is a priceless gift. Hearing loss isolates you from contact with other people and is generally most noticed by others around you. Detecting and treating hearing loss early is a significant step towards improving the quality of life.

We are committed to helping you understand your hearing loss and to prescribing and maintaining the best solution for your needs and lifestyle.

Our aim is to restore your quality of life through better hearing, and mission is to provide excellence in client care.

Our cochlear and hearing implant programme offers implantation for all types of cochlear and other ear/hearing implants (such as Auditory Brainstem implant, BAHA implant and Vibrant Soundbridge middle ear implant).

Our team prides itself on:

  • Following very stringent protocols and procedures in each and every step of the journey that our recipients go through in the process of the treatment for their hearing impairment.
  • One of the largest series of successful cochlear implantees in the country (over 700 in 10 years).
  • One of the two teams in India to be recognized for Auditory Brainstem Implantation, and carrying out the first Nucleus Paediatric ABI in India.
  • Having carried out the first Middle Ear Implant for ear atresia and the first Hybrid Cochlear Implant in the country
  • Active academic reputation with numerous presentations at National and International Conferences.

Know the Team Leaders

Dr. (Prof) Ameet Kishore FRCS is the lead cochlear implant surgeon. Dr Kishore has 25 years of experience in the field of ENT and Cochlear Implantation. He has had an extensive training and experience in the UK and Europe for 15 years and is fellowship trained in Paediatric ENT and Otology–Neurotology. He is a Sr. Consultant in ENT, Neuro-Otology & Lead Cochlear Implant Surgeon at Apollo Hospitals, Delhi and the Director of Adventis (Advanced ENT Service). He also holds the post of the Secretary of the Cochlear Implant Group of India.

Cochlear Implantation

What is a cochlear implant?

A cochlear implant is an electronic device that can restore useful hearing and provide improved communication abilities for people who have severe to profound sensorineural hearing loss (nerve deafness) and who cannot benefit from hearing aids.

How is an implant different from a hearing aid?

Cochlear implants differ from hearing aids in two important ways:

  1. 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.
  1. 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. 

How does the cochlear implant work?

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 the 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, which are finally interpreted as sounds. 

Who can benefit from Cochlear Implants?

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 the cochlear implant. Such deafness may be acquired following an infection (such as meningitis), the toxic effect of ototoxic drugs, trauma or age-associated hearing loss.

Children and cochlear implants

Some children may be born with deafness. Such congenital hearing impairment is not uncommon. Every 2 to 3 out of 1000 live births are born with significant hearing loss. Such children must 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 children to help them develop age--appropriate language and communication skills?

If you answered “yes” to several of these questions, your 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 at our cochlear implant clinic.

Adults and cochlear implant

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. 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 at our cochlear implant clinic.

What are the benefits of a Cochlear Implant ?

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 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 social life.

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

Adults

For many adults, suffering a hearing loss is just a 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.

One Cochlear Implant or Two?

Our brain uses information received from both ears to help us hear properly. Binaural hearing is a term used to describe this. Bilateral implantation is becoming a 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 the ears. The greater range provides a better sense of sound balance and quality.
  • An increased ability to distinguish between sounds.
  • Keeping both the 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.

Before the Cochlear Implant Surgery

There are various factors that need to be taken into consideration prior to performing cochlear implantation. Patients will have to meet the audiologist and ENT (Hearing implant) Surgeon of the team. After a thorough check-up, they will decide the best option for the candidate.

  1. A complete audiological, speech assessment along with trial with hearing aids will be performed to know about the severity of the hearing loss, level of speech and language, and the degree of benefit that one may receive with any hearing aid. We may often ask for inputs from other professionals such as developmental paediatrics, neurologists, psychologists, etc.
  1. Imaging - CT and MRI scanning of the ears and brain. We need to see the structure of the ears and the condition of the inner ear and hearing nerves.
  1. Routine preoperative blood tests for anaesthesia. Patients would also be seen by a physician or paediatrician (in the cases of children) to ensure they are fit for general anaesthesia. All candidates need to be vaccinated (against H.Influenza, Pneumococcus and Meningococcus) to reduce the risk of infections.
  1. Deciding the choice of an implant - We have expertise in implanting all makes and models of implants. There are four companies that manufacture cochlear implants. Some offer different models depending on the level of the technology used in the type of internal implant or the external processor. The various brands and models are detailed below (as of July 2016):

Cochlear Implant Surgery

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.

Cochlear implant surgery lasts for about two hours and is performed while the patient is under general anaesthesia. 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, which is usually within a week of the surgery. 

Switching on the implant

Activation of the implant takes place approximately three weeks after the implantation, allowing enough time for the incision to heal properly. Following this, the implant is ‘programmed’ or ‘mapped’. Mapping is done on a regular basis during the postoperative rehabilitation to fine-tune the processor and get the best performance, as the patient gets used to hearing with the implant.

Postoperative Mapping & (Re)Habilitation

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 the patient’s home, and we would help by liaising with the local centre to make sure that they have the appropriate facilities for this. Some of our outstation patients stay in Delhi after the operation, so that the initial mapping and therapy is done here, and later they continue the same at their homes.

(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.

Please also see this video on patients with Cochlear implant 

https://www.youtube.com/watch?v=8svV46gCJ6k

CONTACT US

You may contact the lead members of the team on the following:

Dr (Prof) Ameet Kishore  MBBS, FRCS

Sr Consultant Surgeon, ENT & Hearing Implants

Director, Adventis (Advanced ENT Service), Delhi NCR

Sr ENT Consultant & Coordinator, Indraprastha Apollo Hospital, New Delhi

Secretary, Cochlear Implant Group of India

akishore@adventis.in             Tel: +91 9871729898

Ms Neevita Narayan   BSc , MBA

Consultant Audiologist & Cochlear Implant Specialist

Director, SpHear Speech and Hearing Clinic, Delhi NCR

neevita@sphear.in                  Tel: +91 9810511246