Thursday, March 20, 2008

Frequently Asked Questions

Can cochlear implant users drive a hybrid car/SUV? Yes.

Ride roller coasters? Yes

Scuba dive? There is a depth limit. If a person with a cochlear implant goes beyond the specified depth the internal implant (plastic casing) holding the magnet will break.  The individual will not be affected. The internal implant is validated to withstand pressure at a depth of 82 feet underwater.

Go into MRI machines? The problem is that the internal part of the cochlear implant has a magnet in it and an MRI means Magnetic Resonance Imaging. Having two technologies that contain magnets are not compatible. The test will not be effective. The person will not be harmed. Some of the newer cochlear implants are compatible with MRI equipment that does not have a strong magnetic strength. But… sometimes a weak MRI is not enough. So… with a cochlear implant, some people do have to have the magnet removed surgically—the implant is designed to have that done, then have the MRI and have the magnet put back in again. (that can happen all at the same time). Note that the plastic casing holding the magnet and the coil inside the cochlea stays. Only the magnet is removed.

Play football/physical sports? Yes, of course the processor may fall off (just like eyeglasses) and may need to be left aside to continue playing. As with anyone who wants to protect themself during a rough sport—wear a helmet—if a person is hit in the head it can possibly dislodge the internal part of the CI, but this will not harm the person.

Airport metal detectors? Walking through will not harm the internal part of the cochlear implant or hurt the individual. Just to be on the safe side, remove the external speech processor and ask the airport personnel to not place it through the x-ray screener.

Water sports? Most CI’s are now water resistant. It does not mean that they are water proof . So getting them wet with a small amount of water is ok. It is not recommended to shower with the external part of the cochlear implant or swim, but if they get wet in the rain or have excessive sweating it should not be a problem. CI’s still can’t be submerged, so when swimming, surfing, bathing the CI user is Deaf.

Will static electricity affect the cochlear implant? Electrostatic discharge can cause damage to any electronic device, however, implant manufacturers are improving the design of implants to provide greater resistance to this problem. Clarion indicates that their CII Bionic ear implant system is designed with special safeguards for greater resistance to electrostatic discharge.

What is the risk of internal device failure? While the risk of device failure is small, it is possible. In these situations, additional surgery may be required to replace the device or in some situations to reposition a device that has migrated from its intended placement.

Can implanted children participate in sports? Cochlear implantation should not interfere with most recreational activities. Judgment should be utilized in determining if the external portion of the implant should be used during sports. Of course, the external processor should be removed for participation in water sports. In addition, be aware that sweating and moisture can affect the device. The surgically implanted portions of the implant will not be damaged by water sports or diving into a swimming pool. The only restriction that seems to be made by implant companies is related to deep-sea scuba diving. This is based on severe pressure changes. For sports that involve particular risk of head injury, common sense indicates that head protection be utilized. Clinics usually advise avoidance of activities like boxing, where a severe blow to the head is likely.

What about waiting for the technology to improve before choosing to implant? Research and observation suggest that early implantation in children is closely related to increased outcomes in spoken language development. Studies also suggest that shortened duration of deafness also positively impacts spoken language growth with an implant. Given these findings, waiting for new technology may negate the benefits of cochlear implantation. If early implantation and shortened duration of deafness are seen as primary impacting factors on cochlear implant success, then waiting for new technology would not be recommended.

In addition, as of early 2003, the three major implant manufacturers have introduced new technologies into the marketplace. It does not appear that there will be changes to the surgically implanted portion of the device in the near future. Changes to the devices, should they occur, will probably be related to external hardware and software of the systems. Persons obtaining cochlear implants at this time should therefore be able to take advantage of these advances without further surgery.

What are the surgical risks? In general, the surgical procedure is not considered risky. The risks reported are those associated with any surgery requiring anesthesia. The areas involved in surgery include the mastoid bone behind the ear (where the magnet portion of the implant is housed) and the cochlea housed in the inner ear (where the electrodes are implanted) . This is not "brain" surgery.

As the hearing system is close to the balance system, some patients report periods of dizziness following implantation. There are other possible, though uncommon, risks associated with surgery related to the facial nerve, sense of taste, and possible infection that should be discussed with the physician. (Also see the module, Surgical Considerations.)

What about the possible relationship between cochlear implants and the risk of meningitis? On July 24, 2002, the FDA issued a Public Health notification highlighting the possible association between cochlear implants and subsequent bacterial meningitis. While the FDA announcement discusses the possible association between implants and meningitis, it also explains that the implant has not been proven to be the cause of the meningitis in the cases noted. The full report, Cochlear Implant Recipients May Be At Greater Risk For Meningitis, can be found at: http://www.fda.gov/cdrh/safety/020606-cochlear.html.  Now it is a requirement for any child or adult considering a cochlear implant to be vaccinated for meningitis.

Related to the possible risk of meningitis, the following should be taken into consideration:
any surgery on the inner ear can increase the risk of infectious diseases like meningitis,
some deaf individuals may have congenital abnormalities of the inner ear that make them more prone to meningitis with or without a cochlear implant, and
some individuals who are deaf from meningitis may be at an increased risk for subsequent episodes of meningitis in comparison to the general population.
Is the residual hearing in the implanted ear destroyed as a result of surgery?

The design of improved electrode arrays and implantation procedures seem to be increasing the chance that the cochlea may be preserved following implantation. There continues to be the potential loss of residual hearing following implantation, and implant companies continue to warn patients that implantation will probably result in the loss of residual hearing.

What about Magnetic Resonance Imaging (MRI) for persons with cochlear implants? Implants and MRIs are generally not compatible due the magnetic component of the implant. The Nucleus 24 device designed by the Cochlear Corporation has a surgically removable magnet and a design feature to withstand some MRIs. If MRIs are an issue of concern, this should be discussed with your hospital implant center. The MED-EL Device, COMBI 40+, is under investigation for allowing MRIs under certain conditions.

Some of the questions/answers here came from Gallaudet University's Cochlear Implant Education Center (CIEC) page - click here to go directly to their page.

We will continue to add your new questions and our answers to this post.

7 comments:

lauren said...

My 21 month old granddaughter received the external magnet, etc today for her cochlear implant. The magnet keeps falling off and will not stay on securely. The increased the magnet and it still is falling off as well as her skin becoming red with the extra magnetic power. Is this a concern? Will the magnet stay eventually? Has there been any problems with this issue? Could the implant not be placed properly?

lauren said...

My 21 month old granddaughter received the external magnet, etc today for her cochlear implant. The magnet keeps falling off and will not stay on securely. The increased the magnet and it still is falling off as well as her skin becoming red with the extra magnetic power. Is this a concern? Will the magnet stay eventually? Has there been any problems with this issue? Could the implant not be placed properly?

Li-Li's Mom said...

Hi Lauren!
At 18 months, my daughter's first magnet fell off all the time, too, but increasing to a stronger one worked like a charm. Fortunately we haven't have any problem with the contact site, even thought she's like the Princess and the Pea (her skin is soooooo very delicate).

I recommend you join this group if you haven't already: http://groups.yahoo.com/group/cicircle/
These folks share all kinds of tips and tricks specific to CI children. I'd ask your granddaughter's audi for advice -- ours is a font of knowledge about finding the right mix of accessories and earpieces and earhooks -- he or she should know whether the magnet is working correctly.

One thing I didn't realize at first was that I could adjust the magnet strength simply by rotating it right or left within the coil -- if the skin is red, you may want to lessen the strength of the new stronger magnet by rotating it to the left, which pulls it away from the skin. (*may be specific to Cochlear, not sure if this applies to AB as well). But we are new to all of this, I'm sure you will find others with the right solutions.

At 28 months we 'graduated' from the Babyworn with clip on processor to the behind the ear version: what a great difference -- no more cords to chew on! Now she runs around with something that looks just like a bluetooth and can put it on and off herself.

Anonymous said...

My two year old granddaughter has had her cochlear implant now for about two months. She is attending therapy and her parents have been very active in trying to teach her but sit appears she is not even reacting to sound. My daughter says that, from what she has heard, this may be common and may take a while to teach her to hear. I guess I don't understand if the implant is not defective in any way, why is she not even reacting to sudden loud noises. Does anyone have any words of encouragement? Thanks.

Anonymous said...

hello:
My two year old granddaughter was hooked up to her coclear implant about 2 months ago. Since then she has attended therapy biweekly and her parents have been very active at trying to help her to hear. She does not seem to be doing very well and doesn't even respond to a loud sudden noise. My daughter says she needs to be taught how to hear. I don't quite understand this. How do we know if the implant may be defective. My daughter says it is not defective, however they did say that 2-3 electrodes are not working but it should not affect her ability to hear. Does anyone have any words of encouragement for me. Thanks

Anonymous said...

hello:
My two year old granddaughter was hooked up to her coclear implant about 2 months ago. Since then she has attended therapy biweekly and her parents have been very active at trying to help her to hear. She does not seem to be doing very well and doesn't even respond to a loud sudden noise. My daughter says she needs to be taught how to hear. I don't quite understand this. How do we know if the implant may be defective. My daughter says it is not defective, however they did say that 2-3
electrodes are not working but it should not affect her ability to hear. Does anyone have any words of encouragement for me. Thanks gmcd52@cox.net

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