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Cochlear Implants 

Welcome to the Pediatric Audiology Department at SSM Cardinal Glennon Children's Medical Center.

 Cochlear Implant Program Overview
 Making the Decision

 Commonly Asked Questions

  Cochlear Implant Program Overview

     The Cardinal Glennon Children’s Medical Center motto is "At Cardinal Glennon, our love for kids just keeps on growing." Children at Cardinal Glennon are given care in a warm and friendly environment. Our cochlear implant team upholds the standards of Cardinal Glennon, and is dedicated to providing compassionate and excellent care to children and their families.

     Our cochlear implant program is a joint program offered by Saint Louis University and Cardinal Glennon via the Department of Otolaryngology. Our team has been involved with cochlear implantation for several years, and has provided services for many patients including those needing bilateral cochlear implants. The experience of the cochlear implant team has ensured that patients have access to the latest information, surgical and programming technology.

     In addition to the surgeons, the cochlear implant team consists of many individuals with varied but important experiences. Our team members have experience in pediatric audiology, educational audiology, speech pathology, education of the hard of hearing, cochlear implant research and pediatric ear nose and throat problems. The team members have been selected to enable care of the child as a whole person. We believe that a child with hearing loss can get the best care with a team approach. As a pediatric children’s hospital, our children have access to medical and audiologic professionals who specialize in working with children with hearing aids and cochlear implants.

     Our cochlear implant team works with the families and children to determine whether cochlear implantation is the right option for the child. If the child is felt to benefit from the cochlear implant, our team will provide information and guidance about the process, and help support the family in their decision. Once a decision is made, our team will provide the initial services including monitoring unaided hearing, initial programming of the cochlear implant, adjusting the cochlear implant programs as needed over time, initial auditory training, monitoring the child’s progress, medical follow-up, and providing information about advances in technology.

     Our goal is to enable our children to succeed to the best of their ability, and provide a nurturing and supportive environment.

     Please call (314) 268-6458 for appointments or more information.

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Making the Decision

     When a child is diagnosed with profound hearing loss, the family must decide how to address the child’s fundamental communication needs. Options include strictly oral/aural communication which is speaking and listening, American Sign Language (ASL), manually coded English (MCE) which is English-based sign language, or Total Communication which is a combination of sign and spoken/auditory communication. Auditory options include using hearing aids, a cochlear implant, or simply foregoing any type of amplification and raising the child with Sign language communication.

     For many children with severe-to-profound hearing loss, hearing aids may not provide adequate benefit even after extensive experience and auditory training. Families arrive at the point of considering a cochlear implant at various stages in a child’s development. Each child presents with a unique background and circumstances that can impact the child’s potential to benefit from the device.

     Factors that can affect benefit with an implant include: duration of deafness, length of hearing aid use or other amplification, family and educational support, and whether the child already has some system of communication in place. For an infant with profound hearing loss, time is critical to enable aural rehabilitation.

     Families often have varied degrees of information regarding cochlear implantation and the expected outcomes. Families are encouraged to speak with audiologists, speech language pathologists, educators, physicians, and/or counselors who are familiar with the cochlear implant process. Families also are encouraged to talk with parents of children who have received cochlear implants, as well as members of the deaf community. Active participation in this process is critical to making an informed decision for your child in regard to a cochlear implant.

     There are experienced professionals and other resources available at Cardinal Glennon Children’s Medical Center that can provide useful information for potential candidates and their families. Our cochlear implant center can assist in addressing issues that are unique to each child and his/her needs. The Hospital offers a wide range of expertise in the diagnosis and treatment of pediatric hearing loss. The Cochlear Implant Center is comprised of a team of professionals whose aim is to serve the whole child. The team comprises of surgeons, audiologists, a speech and language pathologist, a nurse, a social worker, an implant coordinator, and our patients with their families.

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Commonly Asked Questions

 How do I hear sound?

     The ear is a complex part of the body made up of five sections: the outer ear, the middle ear, the inner ear, the auditory (hearing) nerve, and the brain’s auditory processing center.

     The outer ear is the part of the ear that is visible on our heads, which is called the pinna. The pinna is responsible for collecting the sound vibrations. The sound travels through the ear canal, which is covered with tiny hairs and wax to reach the ear drum. The hair and wax in the ear canal help to keep out foreign debris such as dirt and bugs.

     The eardrum is the beginning of the middle ear. The eardrum is made up of a translucent fiber. Connected to the eardrum are three tiny bones called the ossicles. When sound waves reach the eardrum the ossicles vibrate which produce mechanical sound waves. These waves are transmitted to the inner ear.

     The inner ear is comprised of many different parts.  However, the main vessel in the inner ear is the cochlea. The cochlea is the size of a pea and resembles the shape of a snail. The cochlea holds the Organ of Corti, which is the sensory receptor of the ear. Inside the organ of corti are tiny hairs, which act as the nerve receptors of hearing. The nerve receptors send messages to the brain about the sound such as the loudness and pitch. In children with severe to profound hearing loss, the hair cells and parts of the auditory nerve are affected, causing a sensorineural hearing loss, which prevents the sound signals from being transmitted to the brain.

 What is a cochlear implant?

     A cochlear implant is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing. Unlike hearing aids, the cochlear implant does not amplify sound, but works by directly stimulating any functioning auditory nerves inside the cochlea with an electric field.

     External components of the cochlear implant include a microphone, speech processor and a transducer or primary headpiece coil. A secondary coil is implanted beneath the skull's skin. The headpiece coil has a magnet by which it attaches to another magnet placed on the secondary coil often beside the cochlear implant. The implant relays the incoming signal to the implanted electrodes in the cochlea. The electrodes stimulate the auditory nerve, which sends nerve impulses to the brain and are interpreted as sound. The speech processor allows an individual to adjust the sensitivity of the device. The implant gives recipients additional auditory information, which may include sound discrimination fine enough to understand speech in quiet environments. Post-implantation rehabilitative therapy is often critical to ensuring successful outcomes.

    As of 2009, approximately 150,000 people worldwide had received cochlear implants; in the United States, about 30,000 adults and over 30,000 children have been recipients. Cochlear implants are recognized by the American Medical Association and American Academy of Otolaryngology Head and Neck Surgery as an approved medical procedure for children. They were approved by the Food and Drug Administration (FDA) in 1984 and are covered by insurance policies.

 How do I know if my child is a cochlear implant candidate?

     Each child is carefully evaluated by the Cochlear Implant team to determine if the implant is right for them. A child with bilateral severe to profound hearing loss, who gets limited benefit from hearing aids, is often a candidate for a cochlear implant. Each child is evaluated individually. The criterion for a child to receive a device has expanded since cochlear implants were first approved for children, due to the improved performance of children with cochlear implants.

 How does the evaluation work?

     In order to have your child evaluated, please contact our program at (314) 268-6458 to set up an initial appointment. At the initial evaluation, you and your child will meet with an implant surgeon and cochlear implant audiologist. The implant audiologist will perform several tests and go over the process at Cardinal Glennon. Other appointments will then be scheduled as needed.

If your child appears to be an implant candidate:

     - A letter of medical necessity will be drafted. The letter will be sent, along with the audiology report and surgeons notes, to the child’s insurance company to determine coverage.

     - A CT scan and possibly an MRI of the head (temporal bones) will be scheduled to determine the inner ear structure.

     - The surgeon will evaluate the child’s overall health, the CT scan or MRI, do an examination of the ears, and check immunizations. The surgeon will discuss the risks of surgery.

     - A family counselling session will occur with the audiologist prior to surgery to cover expectations, follow-up care and choose device specifications.

     - Once the insurance company has sent approval, a surgery date will be scheduled.

 What kind of follow-up occurs after surgery?

     One of our surgeons will see your child about 1-2 weeks after surgery to inspect the incision site and check the ear. Approximately 3 weeks after the surgery, the external portion of the cochlear implant (the speech processor and coil) will be placed. This appointment is called the “Initial Stimulation,” and your child will hear through the implant for the first time. The external equipment will be programmed by the audiologist through the computer. Each child will have a unique program that is saved on the speech processor, enabling him or her to achieve the maximum benefit.

 What should I expect at the Initial Stimulation?

     Every child reacts to the Initial Stimulation differently. Some children are nervous, and some are excited. Babies who are born with profound loss may even cry because the sound is new to them. However, most children will wear their device and respond to sound.

 How often does my child need the speech processor programmed?

    During the first few months after surgery, your child will need to see our audiologists often. Typically children are seen for 2 initial stimulation sessions in the first week, then 2 weeks after the initial stimulation, and then 1 month after initial stimulation. After this, your child may be seen monthly or every 3 months. After a few years or wearing the implant, your child will need to be seen at least once a year. The yearly appointments are important to monitor his or her progress, as well as ensure that the program on the speech processor is optimized for your child’s potential.

 Does the implant team communicate with the child’s teachers and other educational professionals?

    Our team of audiologists works very closely with each child’s school both during the evaluation process and after implantation. Our audiologists and schools communicate regularly and work together to help your child succeed with the implant, and monitor his or her progress.

 After my child receives a cochlear implant, will they be able to hear and talk like normally hearing children?

Once your child gets a cochlear implant, he/she will be able to hear sounds that they did not hear with hearing aids. Although your child will be able to hear more sounds, he or she will need to be trained to use and understand these sounds. Receiving the cochlear implant is just the first step in a long process. Your child will learn the meaning of sounds and words through intensive rehabilitation. The degree of success in each child cannot be predicted, but with intense training after cochlear implantation, your child will have the best chance of using auditory input for communication and sound awareness.

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