Cochlear implants

"We are a reference center in the realization of cochlear implants, both in children and adults".

DR. MANUEL MANRIQUE RODRÍGUEZ
DIRECTOR. OTORHINOLARYNGOLOGY DEPARTMENT

In many cases, cochlear implants can solve the patient's hearing problem and significantly improve their quality of life.

The Clinica Universidad de Navarra is a center of national and international reference in hearing implants. We have the exclusive dedication of a multidisciplinary team, composed of medical specialists, nurses, audioprotection technicians and speech therapists.

In addition, we collaborate with other departments, such as the Neurosurgery Department, for the performance of some implants. We have advanced technical means for performing surgery and specific lines of research, both clinical and experimental.

The Cochlear Implant Program of the Clinica Universidad de Navarra began in 1989 and has the experience of more than 1,200 implants, approximately half of which are for children.

We also have extensive experience in auditory brainstem and bone conduction implants for the treatment of deafness where cochlear implantation is not feasible.

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When are cochlear implants indicated?

A cochlear implant is an electronic device that replaces the outer, middle and inner ear, capable of collecting sounds, transforming them into electrical stimuli to transmit them to the auditory nerve and restore the flow of auditory information to the brain.

The cochlear implant is indicated for severe or deep deafness and significantly improves the patient's quality of life.

It is indicated in patients who have lost their hearing before (prelocution) or after (postlocution) the development of language.

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Learn about hearing loss and its different treatments (available in spanish)

Most frequent indications:

  • Profound deafness in both ears.
  • Unilateral deafness.
  • Severe hearing loss with auditory remains.

Do you have any of these problems?

You may need a cochlear implant

How are cochlear implants placed?

The surgery lasts approximately one and a half hours and must be performed under general anesthesia.

This operation carries with it the risks inherent in any other surgical act directed at the middle ear. During the operation, it is checked that the implant is correctly placed. For this purpose, radiology is used and neurophysiological studies (telemetry) are performed, which analyze the functioning of the electrodes of the implant and provide useful information for the subsequent programming of the implant.

After the operation, the patient remains hospitalized for approximately 48 hours. Generally, the postoperative period passes without significant discomfort. The following day, patients can eat, get out of bed and walk normally. When the patient is discharged from the hospital, he or she may travel by any means of transportation. You do not start to hear immediately after the operation.

It is necessary to wait about four weeks for the wound to heal completely so that the external components of the cochlear implant can be placed. This will be done in the first programming session.

Minimally invasive or atraumatic techniques
The insertion of a cochlear implant does not necessarily imply the loss of existing hearing in the target ear. These techniques are important in order to keep the cochlea in optimal conditions for new implants or for the prescription of future treatments.

Interventions in one or two stages
In the case of bilateral cochlear implants, it is preferable to place them in a single surgical intervention. However, in those cases where the patient is already a carrier of a cochlear implant, the second one can be implanted in another surgery.

Implanted people hear very much like a hearing person, as shown by the results of some tests and the manifestations of our already implanted patients.

It is not a question of new codes, but rather of sound information that keeps a structure similar to that which we listen to.

Therefore, when a post-lingual deaf person is implanted, who has heard before becoming deaf and who has a good auditory memory, a few days after using the implant he or she is able to recognize the words of a conversation.

The placement of a second cochlear implant has important advantages:

  • Improved auditory hearing capture
    When an implantation is to be carried out in only one ear, the choice is made based on anatomical-surgical criteria, audiological criteria and the duration of the hearing loss in each of the two ears. Therefore, to restore this function, it is necessary to have two sources of auditory information, in this case with two cochlear implants.
  • Location of sound
    The two mechanisms involved in the localization of sounds located in the horizontal plane are: the analysis that the central auditory system makes of the differences in the time that a sound takes to reach the two ears and the differences in intensity that a sound produces in each of the two ears. Therefore, to restore this function, it is necessary to have two sources of auditory information, in this case two cochlear implants.
  • Avoiding the "shadowing" effect of the head
    When voice (signal) and noise come from different locations, the signal-to-noise ratio is different in both ears because of the "shadowing" effect produced by the head. People with normal hearing usually use the ear with the best signal-to-noise ratio. People with bilateral implants reportedly get this benefit from bilaterality as well.
  • Improving speech perception in noise
    The brain could achieve an optimal representation of noise and voice, being able to differentiate them better.
  • Neural auditory plasticity
    Unilateral stimulation exerts irreversible modifications on the development of the higher sectors of the auditory pathway. Just as there is a critical auditory period in children with bilateral deafness of congenital origin, there is also a critical auditory period in the congenital absence of stimulation by one of the two ears.

Programming
A correct programming of the cochlear implant is essential to obtain good results.

For the implanted patient to start hearing, the cochlear implant must be activated and the speech processor programmed. This is done with the help of a computer, with a special program that adjusts each of the electrodes to each person's hearing needs. This is essential for clear sound recognition.

Follow up

A correct follow-up is very important to detect possible complications.

It will also serve to evaluate the results and optimize them with a new programming or with the updating of the stimulation strategies.

The Clinica Universidad de Navarra has specialized personnel to carry out this follow-up of the implanted patient. In addition, we make available to the patient a telephone number and an e-mail address to resolve, in collaboration with the technical service of the manufacturer of the implant, those problems which affect the implanted device.

Phases of auditory rehabilitation

  • Detection. Exercises in which the patient has to signal the presence or absence of sound.
  • Discrimination. To acquire the ability to distinguish if two or more sounds are the same or different.
  • Identification. The patient has to point out, among several options, that word, phrase or environmental sound that he/she has heard.
  • Recognition and understanding. In these, the patient must gradually acquire fluent language recognition by repeating words and phrases and having an interactive conversation, along with the use of media such as television, telephone and radio.

Where do we perform them?

IN NAVARRE AND MADRID

The Department of Otolaryngology
of the Clínica Universidad de Navarra

The Department of Otorhinolaryngology of the University of Navarra Clinic is a national and world reference in numerous highly specialized surgical procedures.

We have the latest technology and we perform all diagnostic tests in less than 48 hours in order to offer our patients the best solution in the shortest time possible.

We were one of the first centers in Spain to use robotic surgery in the surgical treatment with the Da Vinci® System. 

Organized in specialized units:

  • Otology - Hearing.
  • Rhinology - Nose.
  • Pharyngology - Throat.
  • Laryngology - Voice.
  • Balance disorders.
  • Head and neck problems.
Imagen de la fachada de consultas de la sede en Pamplona de la Clínica Universidad de Navarra

Why at the Clinica?

  • Experts in the treatment of hearing problems.
  • Pioneers in axillary surgery to avoid scarring.
  • National reference center in tissue sealing for tonsil removal.

Safer than ever to continue taking care of you

We update safety protocols weekly with the latest scientific evidence and the knowledge of the best international centers with which we collaborate.