Cochlear Implant Workbook

Table of Contents
What is a cochlear implant? 3

Cochlear implant devices 4

Cochlear implant surgery 5

Cochlear implants and meningitis 7

Audiology follow up visits 8

Listening practice 10

Connect with Other CI Recipients 11

What to do if your equipment breaks 12

Warnings with a cochlear implant 13

Tips for traveling 14

Cochlear implant data sheet 15

Cochlear implant team 16

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What is a Cochlear Implant?
A cochlear implant system is a surgical option which restores partial hearing to
individuals with severe to profound sensorineural hearing loss who do not benefit
from conventional hearing aids. It is comprised of 2 main components:

1. Internal (implant): This is a small electronic device surgically implanted under

the skin behind the ear and is connected to an electrode that is inserted inside
the inner ear.

2. External (sound processor): This is externally worn behind the ear or on the
head. It consists of a speech processor, microphone, and battery pack.

By means of magnetic coupling between the implanted and external components,

sound information is picked up by the microphone and relayed to the speech
processor. Sound is then converted into electrical impulses which stimulate the
hearing nerve and result in perception of sounds.

How a Cochlear Implant works

Cochlear implant systems convert everyday sounds into coded electrical signals.
These stimulate the hearing nerve which then relays the information to the
hearing center of the brain. A cochlear implant will not restore hearing to normal
levels. However, the implant can provide the necessary stimulation to restore
sound awareness and improve speech understanding.

Candidacy

The cochlear implant is available for individuals with severe to profound

sensorineural hearing loss in both ears who have little to no speech
understanding, even with hearing aids. This must be confirmed on
comprehensive hearing tests performed without and with hearing aids in both
ears to determine if adequate benefit can be provided either by the patient's own
hearing aids or with new, appropriately fitted hearing aids.

In addition to this, a full clinical evaluation and CT scan (sometimes a MRI scan)
of the ears is necessary to evaluate the condition of the inner ear and
surrounding bone.

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Cochlear Implant Systems (Devices)
There are currently 3 FDA approved multichannel cochlear implant systems
available in the United States. Although there are unique differences among the
cochlear implant systems, they all function in a similar manner.

Cochlear Americas
http://www.cochlear.com/wps/wcm/connect/us/home

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Cochlear Implant Surgery
Cochlear implant surgery is performed at Lahey Hospital & Medical Center in
Burlington, MA. You will undergo general anesthesia for the surgery. An incision
will be made behind your ear. The bone behind your ear will be removed to
access the inner ear where the cochlear implant electrode will be placed. The
internal receiver will be implanted above and behind the ear, under the skin. The
average duration of surgery is 1.5-2 hours. The average recovery time in the
hospital after surgery is 2 hours. You will leave the hospital and return home on
the day of surgery unless you have serious health conditions or side effects from
the anesthesia which require overnight hospitalization for observation.

What to expect after cochlear implant surgery

• After surgery, you will have a special gauze dressing wrapped

around the “operated ear” and your head. This dressing protects the
ear as well as provides gentle pressure to the surgical area. You may
remove the dressing the day after surgery by releasing the velcro
strap.

• The incision behind your ear will be covered by strips of tape which
will be removed at your post-operative visit. The stitches are buried
under your skin and do not require removal.

• It is important to keep the ear incision dry after surgery until the
first follow-up visit. You can use a crumpled wash cloth to protect the
ear and incision line from water exposure. Some patients wash their
hair in a sink for several days after surgery.

• For the first week following surgery, please avoid vigorous

activities that involve straining or lifting objects greater than ten
pounds. Refrain from activities such as aerobics, weightlifting, running,
bike riding, and horseback riding.

• Call Dr. Toh’s office (781-744-8451) when you get home to

schedule your first follow-up appointment 7-10 days after surgery if
you do not already have the appointment scheduled before surgery.

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You may experience any of the symptoms below. These are
normal and expected to resolve over time.

1) Sore throat for a few days.

2) Dry mouth or metallic taste on your tongue for days to weeks.
3) Numbness around your ear for 6-8 weeks.
4) Your ear may stick out for 6-8 weeks.
5) Dizziness or balance problems for days.

If you experience any of the following symptoms after surgery,

you should call Dr. Toh’s office (781-744-8451).

1) Excessive bloody drainage from the incision or progressive

swelling behind/above your ear.
2) Severe dizziness or vertigo after surgery.
3) Any sign of infection in the operated ear, such as increasing pain,
yellow discharge or swelling behind the ear.
4) Fevers in excess of 102 degrees.
5) Clear drainage from your nose, especially when bending over.

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Cochlear Implants and Meningitis
Patient who receive a cochlear implant are considered to be at a slightly higher
risk for contracting a certain type of bacterial meningitis caused by Streptococcus
pneumoniae (Pneumococcus). The Center for Disease Control and Prevention
(CDC) in conjunction with the Advisory Committee on Immunization Practices
(ACIP) recommend that all cochlear implant recipients be vaccinated to reduce
the risk of meningitis.

They recommend that adults 19 years of age or older who are to receive a
cochlear implant should receive an initial dose of Prevnar 13 (pneumococcal
conjugate vaccine - PCV13), followed by a dose of Pneumovax 23
(pneumococcal polysaccharide vaccine - PPSV23) at least 8 weeks later.

These recommendations can be found on this CDC website:

http://www.cdc.gov/vaccines/vpd-vac/pneumo/vac-PCV13-adults.htm

A second (booster) shot of the Pneumovax 23 vaccine is also recommended for

some individuals. If you receive your first Pneumovax 23 vaccine at age 60 or
younger, you should receive a booster shot at age 65. If you are 61 to 64 years
old when you receive the Pneumovax 23 vaccine, you should plan to get a
booster shot 5 years later. If you first receive the Pneumovax 23 vaccine at age
65 and above, you do not need to obtain a booster shot.

Both of these vaccinations are offered in our clinic upon request. Alternatively,
you may wish to have these vaccinations administered by your primary care
physician (bring a copy of this advisory with you).

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Using the Cochlear Implant Device
Your ear will be allowed to heal for approximately 3 weeks before your implant is
activated (turned on). If you wore a hearing aid in the implanted ear before
surgery, you will not likely notice any hearing with the hearing aid in this ear
during these 3 weeks.

Once your wound has healed and surgical swelling over the implant has
subsided, your implant will be activated by one of our implant audiologists. You
will learn and adjust with the cochlear implant more quickly in the beginning. For
this reason, numerous programming changes are needed in the first year after
surgery.

We will see you for multiple follow-up testing and programming sessions in the
first year.
- Initial activation
- 1 week after initial activation
- 4 weeks after initial activation
- 3 months after initial activation
- 6 months after initial activation
- 12 months after initial activation

After the first year, patients are normally seen once a year. These yearly
appointments are very important. We want to make sure you continue to do well
with the cochlear implant.

What to expect at initial activation

About 3 weeks after surgery, you will be fit with the outside part of the cochlear
implant. This time allows your ear to heal. The main outside piece is called the
sound processor. It has to be programmed for you to hear sound through the
implant. Reprogramming is done multiple times thereafter. As your understanding
with the cochlear implant gets better, less reprogramming visits are needed.

To begin, the speech processor is put behind your ear. The outside magnet (coil)
is put on your head. The outside magnet and inside magnet connect to one
another. The coil is connected to the speech processor through a transmitting
cable.

Next, the programming of the speech processor begins. The speech processor is
connected to the audiologist’s computer. Individual electrodes of the implant are
stimulated. You will hear a series of beeps, sounds or tones. The audiologist will
measure your response to these sounds. We are determining the levels that are
loud but comfortable. We may also measure sounds that are very soft.

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After measuring these sounds, the speech processor is turned on. This enables
you to hear the sounds that are around you, including speech. The volume will be
increased slowly. Hearing speech through your cochlear implant may sound
unnatural initially. The sound you hear on the first day of listening is different for
every patient. For some, speech may sound like “beeps”, while others it may
sound like bells, buzzing, etc. Typically if it sounds like a voice, it is not a natural
voice. Patients describe speech as sounding “mechanical”, “cartoonish” like
“Mickey Mouse” or “Donald Duck”. The quality of the sound will get better with
time and patience.

Finally your listening programs are saved to the speech processor. We will then
go over how to use, troubleshoot, care for and maintain your equipment.

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Listening Practice
With each day, with each week, you will hear and distinguish more sounds.
Learning to listen again and understand what you are hearing takes time and
effort. Be patient. Your family and friends should speak to your normally, and
should not raise your voices. Having others read books, magazines, and
newspapers while following along is a good way to practice listening. Listening to
audio books while reading along is a good way to practice on your own. Please
ask your audiologist other ways or ideas that you can learn and practice at home.

There are also some free resources available online which you can listen and
practice with at home. Some of these programs include:

Angel SoundTM is a free, upgraded version of “Sound and WAY Beyond”, an

auditory rehabilitation program based on CAST technology and distributed by
Cochlear Americas. Available at: http://angelsound.tigerspeech.com

The Listening Room sponsored by Advanced Bionics has free activities and
resources to support the development of speech, language and listening.
Available at: http://hearingjourney.com/Listening_Room/preview.cfm?langid=1

SoundScape sponsored by MED-EL has interactive listening activities for

various age groups. Available at:
http://www.medel.com/us/show4/index/id/255/titel/SoundScape

Telephone with Confidence helps you get started with telephone

communications. For ongoing practice, Cochlear Americas has developed a
simple training tool to help cochlear implant recipients gain confidence in their
abilities to communicate on the phone. Available At:
http://hope.cochlearamericas.com/listening-tools/telephone-training

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Connect with Other CI Recipients
It is often helpful to connect with other cochlear implant recipients to share
information and support. The listings below are for local groups of adults with
hearing loss who use cochlear implants and other hearing technologies.

Minuteman Implant Club: meetings in Waltham, MA every-other month. This

group also hosts the biennial Northeast Cochlear Implant Convention

http://necisupport.org/index.html

Hearing Loss Association of America (HLAA): national organization with

chapters local to Boston, North of Boston, Central MA and the Cape. Supports a
large annual national convention.

http://hearingloss.org

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What to Do if Your Equipment Breaks
At some point your outside equipment may stop working. When this happens,
your equipment may need to be repaired or replaced. Please keep in mind that
you should have back up equipment that you can use. You received back up
equipment at your initial activation. It should be in your kit.

Please take the following steps:

1) Pull out your user manual. Look over the troubleshooting section.
2) If you cannot fix the problem yourself, call or email your cochlear implant
company. They can help you troubleshoot the problem and workout what
parts need to be replaced. All companies have audiologists who can
respond quickly.

COCHLEAR AMERICAS 1-877-883-3101

Call the clinic if you are still having a problem (781-337-6860). Ask for a cochlear
implant audiologist. If we are not available, please leave a message. We will
contact you as soon as possible.

Device Warranty Information

“In Warranty” means there is no cost to repair or replace broken parts.

Cochlear Corporation offers a 5-year warranty for the sound processor,

transmitting cable, coil, and Remote Assistant. The battery holder (for
disposable batteries) and rechargeable batteries are covered for 1 year.
Parts are replaced due to normal wear and tear. A one-time replacement for loss
is offered during the warranty period.

If you are in warranty

The company can send replacement parts to your home. If you are within your
warranty period, there are no costs to repair/replace external parts (does not
apply for accessories). These parts are normally shipped via Fed-Ex. DO NOT
throw away the bad parts. The company will want the bad parts back. Your
replacement equipment will come with a pre-paid, pre-addressed Fed-Ex label.
Use this label to ship the broken parts back to the company.

If you are out of warranty

If you are out of your warranty period, there will most likely be a cost to you to
replace or repair parts. In some cases, insurance plans may cover some of this
cost. Requests typically, have to be approved through insurance first. This
means the process or repairing or replacing equipment may take longer.

If you have Medicare:

- Contact the company to determine what parts may need to be replaced.
You can order these parts from the company.

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Warnings with a Cochlear Implant
- Be careful when playing sports and in certain activities (contact sports,
bicycling, rollerblading) without a helmet.

- Try not to hit your head during activity (football, soccer, hockey, etc.).

- Wear a helmet for sports like riding a bicycle.

- If the inside implant stops working (rare), then you may need another
surgery. This is called a “revision surgery”.

- The US Food and Drug Administration (FDA) does not allow certain
imaging (MRI= magnetic resonance imaging) with some cochlear implants.
Check with your implant team before getting a MRI scan.

- The use of high-frequency electric current to cut tissue during surgery

(electrosurgery) and electroshock therapy can permanently damage the
device and any residual hearing you may have in the implanted ear.

- Electrically induced heat (diathermy) or spinal cord stimulation

(neurostimulation) cannot be used over the implant. This can hurt the
tissue and the inside implant.

- A treatment for some types of cancer (Ionizing radiation) will hurt the
inside implant.

If you have a medical problem or question, please contact your cochlear implant
doctor.

If you plan on having any of the above procedures please inform your cochlear
implant doctor.

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Tips for Traveling
- Take extra parts (like a back-up speech processor, battery pack, coil and
cables) with you in case of emergency.
- Take plenty of batteries (disposable or rechargeable). If you use
rechargeable, do not forget your battery charger (and adapter if needed).
- Remember to take you drying jar or Dry and Store box with you so you
can put your processor in it overnight. This is important if you will be
somewhere with high humidity.

Will anything happen to my cochlear implant when I walk through airport

security?
Not normally. You should leave your sound processor on so you can hear what is
going on around you. If your processor is set on the telecoil “T” setting, you may
hear some buzzing. This is normal.

If the metal detector alarm goes off, what should I do?

Metal detectors and scanners will not hurt the inside piece or outside sound
processor. If you pass through the security metal detector, your cochlear implant
may set the alarm off. If the alarm goes off, security may use a handheld wand to
screen you. The wand will not harm your cochlear implant, but it will beep when it
passes over your implant. Show your patient ID card and explain that you have a
hearing implant. Tell security staff that the speech processor is a hearing device
that you will wear in order to hear through the implant.

What should I do with my back-up speech processor when I fly?

Turn your spare speech processor OFF and keep it inside your carry-on bag.
Place the bag onto the conveyor belt at airport security. Never place your
processor right onto the conveyor belt. Static electricity may build up and harm
your program. The x-ray machine should not affect your program if the processor
is turned off.

Will my implant send signals that can interfere with the plane’s navigational
instruments?
Your implant cannot get in the way of the plane’s systems. Your implant sends
out radio frequency signals. These are very short range (less than five feet from
the outside coil). Your remote control (if applicable) does send out high frequency
radio waves and should be turned off during take-off and landing. If your remote
does not have an “off” switch, do not use it.

Like other electronic devices, should I turn off my speech processor during
take-off and landing?
No. Cochlear implant patients DO NOT have to turn off their speech processors
when instructions are given to turn off cell phones, music players, or anything
with an on/off switch. The FAA views cochlear implants as within the Hearing Aid
category.

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Cochlear Implant Data Sheet
Imaging Studies Date
CT Scan

MRI Scan
(If applicable)

Prevnar Pneumovax Pneumovax

Immunizations (PCV13) (PPSV23) Booster

Vaccination Date

Date Date
Surgery Surgery

Activation Activation

Warranty
Model Serial Number Expiration

Device Internal

External

Warranty
Model Serial Number Expiration

Device Internal

External

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 Cochlear Implant Teams:

Department of Otolaryngology-Head & Neck Surgery

Balance & Hearing Implant Center
41 Mall Rd
Burlington, MA 01805

Elizabeth Toh, MD
Surgeon
Phone: 781-744-8451
Email: Elizabeth.Toh@lahey.org

Eva M. Bero, AuD

Clinical Director, Audiology
Phone: 781-744-2528
Email: Eva.M.Bero@lahey.org

Hearing Healthcare Professionals, LLC

20 East Street Unit 1
Hanover, MA 02339

Elena M. Schepis, Au.D.

Owner / Audiologist
Phone: 617-571-0157
Fax: 781-658-2538
Email: elena@hearinghealthHHP.com

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