Cochlear Implants

Once it’s determined that a child is a candidate for cochlear implant evaluation, here’s what typically happens. 

Preliminary Coordination

1. The child’s doctor at Children’s Health or UT Southwestern requests an implant packet from the Callier Center for Communication Disorders at UT Dallas.
2. The intake packet is completed and returned to the Cochlear Implant Coordinator at the Callier Center in the envelope provided.
3. Once the packet is returned to Callier, insurance benefits are verified and outside records are requested (from school, the family doctor, etc.).
4. After insurance benefits are verified and approved and outside records are received, the child will be scheduled for cochlear implant evaluations at our multidisciplinary cochlear implant clinic in either Dallas or Plano.

Testing, Evaluation, and Discussion

1. The child undergoes testing at our multidisciplinary clinic, including speech and language evaluation and hearing and ear function testing.
2. Test results are discussed with the patient’s family and shared with a cochlear implant surgeon. The surgeon will also meet with the patient, obtain a medical history, and perform a complete physical examination to help determine candidacy for cochlear implantation.
3. If the patient and family decide to proceed, it’s time to select the child’s device and the accessories that come with it. A team member will be able to assist, but the final decision is up to the patient’s family.
4. The child should also receive a magnetic resonance imaging (MRI) study at this time. The MRI gives the doctor a picture of the cochlea (the inner ear) and the hearing nerve to further determine if the child is a good candidate for implantation and, if so, which ear to implant.

Surgery and Beyond

1. Surgery is scheduled. Once the patient has a surgery date, his or her caregiver is responsible for making an appointment with Callier for the initial implant hook-up and mapping.
2. Approximately one month after the surgery, which allows time for the patient to heal, the surgeon will examine the child and authorize activation of the device. The audiologist at Callier will then hook up the outside part of the implant and create a map for the child.
3. These mapping visits will continue as needed.
4. We strongly recommend speech/language therapy for the enhanced development of listening, speech, and language. This should have an emphasis on learning how to listen with a cochlear implant 

Meningitis is an infection in the fluid that surrounds the brain and spinal cord. There are two main types of meningitis: viral and bacterial. Bacterial meningitis is the most serious type. Though rare, it’s the type that can occur in people with cochlear implants. Worldwide, there are more than 90 known reports of people getting meningitis after getting a cochlear implant.

Recommendations

• Parents of children younger than 2 years old who have cochlear implants, or who are planning to receive an implant, should consult with their child’s physician regarding meningitis vaccinations.
• Children age 2 years and older who have cochlear implants and have completed the pneumococcal conjugate vaccine (Prevnar) series should receive one dose of the pneumococcal polysaccharide vaccine (Pneumovax 23). If they have just received the Prevnar series, they should wait at least two months before receiving the pneumococcal polysaccharide vaccine.
• Children who have cochlear implants, are between 2 and 5 years old, and have never received either vaccine should receive two doses of Prevnar two or more months apart and then receive one dose of pneumococcal polysaccharide vaccine at least two months later.
• Children age 5 years and older who have cochlear implants should receive one dose of pneumococcal polysaccharide vaccine. 

Source: American Academy of Otolaryngology – Head and Neck Surgery

On the first visit, patients meet with a cochlear implant surgeon and an audiologist who will conduct an otological (ear) exam and a comprehensive hearing evaluation to determine whether they meet the program's admission criteria.

If a patient meets the criteria for admission, here's what to expect:

1. Typically, the surgeon will order an MRI to make sure the patient’s anatomy will allow placement of a cochlear implant and to make sure there is not another cause to explain the hearing loss.
2. If a patient qualifies for cochlear implantation, our team will discuss the three brands of cochlear implants to choose from. After this discussion, the patient again meets with the cochlear implant surgeon, who will go over the details of the surgery and postoperative expectations, as well as the role of preoperative imaging and the need for any vaccinations or preoperative medical evaluations.
3. Depending on the surgeon, a patient might be able to have the surgery date scheduled before leaving.
4. In most cases, cochlear implant surgery is an outpatient procedure that takes about two hours. The procedure is performed under general anesthesia. A small incision is made behind the ear. The receiver-stimulator (implanted part of the cochlear implant) is placed under the scalp behind the ear. The bone under the ear is removed, and the cochlear implant electrode is placed inside the cochlea. The incision is then closed with deep stitches and skin glue. Patients can shower the next day and return to work within a week, in most cases.
5. The first postoperative visit is approximately two to three weeks after surgery, at which time the outside portion of the cochlear implant is provided to the patient and the implant is “turned on” by the implant audiologist.
6. Mapping sessions occur at roughly one, three, six, and 12 months after surgery.

The Centers for Disease Control (CDC) recommends that patients receive two additional vaccines (Prevnar 13 and Pneumovax) because a cochlear implant carries a small chance of meningitis.