Cochlear implants

Cochlear implants. Treatment at the Clínica

The Clínica Universidad de Navarra is a reference centre for cochlear implant surgery, in both children and adults and in over 20 years' experience with the Cochlear Implant Programme, we have carried out over 1.000 implants. The youngest patient operated on was just 5 years old and the oldest, 86.

Cochlear implants are used in serious cases of deafness and notably increase the patient's quality of life.

The procedure is aimed at both patients who have lost their hearing before (prelingually) or after (postlingually) they have developed language.

Surgery lasts approximately an hour and a half and must be carried out under general anaesthetic. The hospitalisation period is around 48 hours.

For the best surgical outcome, rehabilitation and follow-up care for the patient, the implant is done with a multidisciplinary team of professionals: otorhinolaryngologists, neuroradiologists, psychiatrists, psychologists, speech therapists, neurophysiologists, hearing aid specialists and experts in programming and maintaining the cochlear implant. Neuropediatrists, social workers and educators also assist wherever necessary.

El Dr. Manuel  Manrique, especialista del Departamento de Otorrinolaringología y director del Programa de Implantes Cocleares de la Clínica Universidad de Navarra, explica en qué consiste esta intervención.
A cochlear implant is an electronic device which is capable of picking up sounds and transforming them into electrical stimulations. [Video only available in Spanish]

The work of the well qualified team of professionals is essential in order to choose and carry out the most appropriate form of treatment”

A cochlear implant is an electronic device that is situated in the outer, middle, and inner ear, which is capable of picking up sounds and transforming them into electrical stimulations to transmit them to the auditory nerve and re-establish the flow of auditory information delivered to the brain.

These electrical signals are processed through different parts of the cochlear implant: an internal component that is implanted surgically and some external components: the microphone, transmitter and speech processor.

Cochlear implants are used in serious cases of deafness and notably increase the patient's quality of life.

The cochlear implant picks up sound using the two microphones located behind the ear. The signals are transmitted to a speech processor, which is a small computer capable of selecting and coding the useful sounds.

The electronic codes produced by the processor are sent by a cable to the coil that, through the skin, passes them to the antenna and from there to the receptor- stimulator which are both positioned on the skull bone under the skin. These codes are sent to the electrodes located inside the internal ear, in the cochlea, in order to stimulate the hair fibres of the auditory nerve. The brain cortex receives these signals and interprets them.

The processor, which is positioned behind the ear, has either a battery pack, normally used for babies, or the batteries are incorporated into the device behind the ear for young children, teenagers and adults.

The cochlear implant can be activated and regulated from a distance using a remote control.

The procedure lasts approximately an hour and a half and must be carried out under general anaesthetic.

During the operation, the doctors confirm that the implant is positioned correctly. For this, they use radiology and neurophysiological studies (telemetry) that analyse the functioning of the implant's electrodes and supply useful information for the post-operation programming of the implant.

After the operation, the patient is hospitalised for approximately 48 hours. In general, the post operation period passes without any serious issues. The next day, the patient can eat, get out of bed and walk normally. When they are discharged, they can travel by any means of transport. However, they do not start hearing immediately after the operation.

It's necessary to wait around four weeks for the scar from the surgery to heal completely. Then, we are able to position the exterior components of the cochlear implant, before carrying out the first programming session. 

Minimally invasive techniques
Installing a cochlear implant doesn't necessarily mean losing the rest of the ear's pre-existing hearing ability. These techniques help to maintain the optimum condition of the cochlea when facing new implants or for future treatments.

One or Two stage Operations
For bilateral cochlear implants, it's preferable to implant them both in one surgical operation.

Nevertheless, in some cases in which the patient already has a cochlear implant, the second can be implanted in another surgical procedure.

Implanting a second cochlea carries some important advantages

  • Better hearing capabilities
    When an implantation is carried out in only one ear, it is chosen on an anatomy-surgical basis, the type of hearing and the length of hearing loss in each of the ears. Therefore, to re-establish their function it ́s necessary to have two sources of auditory information, in this case with two cochlear implants.
  • Sound Location
    The two mechanisms used for the location of sounds on a horizontal plane are: the central hearing system ́s analysis of the difference in time that a sound requires in order to reach each ear and the difference in intensity that a sound produces in each of the two ears. Therefore, to re-establish this technique, it's necessary to have two sources of auditory information, in this case, with two cochlear implants.
  • Avoiding a 'head shadow effect'
    When voices (signals) and noises come from different places, the signal/noise relation is different in each ear because of the 'head shadow effect'. People with normal hearing use the ear which is closest to the signal/noise, and people with bilateral implants also benefit from this bilateralism.
  • Improved perception of words in noisy environments
    The brain is able to optimise noise and voice recognition as it is capable of improved differentiation between sounds.
  • Neural auditory plasticity
    Unilateral stimulation irreversibly modifies the development of the highest sections of the auditory canal. Just as, in congenital bilaterally deaf children, there is a critical auditory period, there is also a critical auditory period before congenital absence of stimulation for one or both ears.

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