Key words: Cochlear implant- congenital deafness- genetic causes of deafness- otoacoustic emissions- brainstem evoked response audiometry (BERA)-audioverbal therapy ((AVT)- HR CT scan temporal bones- switch on - mapping

Hearing Screening of newborn infants

Confirmation that the child is indeed deaf.

Tests needed are (1) Impedance audiometry, (2) Otoacoustic Emissions (OAE), (3) Brainstem Evoked Response Audiometry (BERA).

All newborns are subjected to impedance audiometry and OAE. These are objective tests and can be replicated/ repeated in any other hospital / institute to confirm the same findings.. If the reports are found to be normal no further tests are carried out. If there are abnormal reports, then those tests are repeated a month later.

If the child is confirmed as having suffered profound, irreversible hearing loss then the child is investigated fully and completely with the purpose of diagnosing

1. Is the child deaf?
2. Are both ears deaf?
3. The type and degree of deafness.

If the child is profoundly and irreversibly deaf in both ears then all 3 tests are repeated { Impedance audiometry, Otoacoustic emissions, Brainstem Evoked Response Audiometry BERA)}, a High-resolution CT scan of the Temporal Bones (the ear) and an MRI of the brain is performed.

If the child is confirmed to suffer from profound, irreversible, sensorineural hearing loss then the parents are counselled about the merits of cochlear implants for hearing restoration. The child is termed as a likely cochlear implant candidate.

Cochlear implant candidates who suffer from congenital hearing loss should be:-

1. Proven to suffer from profound, irreversible sensorineural hearing loss.
2. Should have a normal cochlear on HR CT scan and normal MRI.
3. Should be in otherwise good health.

The earliest age of cochlear implantation is 9 months.

Optimal (best) age is 2 years.

The uppermost limit is 4 years. Beyond 5 years, the benefits of cochlear implants decline significantly.

Tests are conducted for the child’s IQ, checked for other abnormalities, vision, spine etc. The child is also vaccinated against meningococcal/ H. influenza, Hepatitis B and Pneumococcal diseases.

The child’s socioeconomic status is determined. This is needed so that following cochlear implant surgery the parents need to give the child Audioverbal Therapy (AVT) sessions that are twice a week for a minimum period of 3 years.

(1) We now implant both ears simultaneously as according to all the medical literature available simultaneous cochlear implants in both ears bestow massive scholastic and behavioral benefits versus a single sided cochlear implant.

(2) The cost of each implant is 6.5 lakhs. The cost of surgery is 1.50 lakhs.

(3) There are 3 companies that manufacture cochlear implants. (a) Cochlear from Australia, (b) Med El from Austria, Europe and ( c ) Advanced Bionics.

(4) Each company has a base model costing up to 6.5 lakhs to the advanced model costing 12 lakh.

(5) The device is NOT manufactured in India.

(6) The device is expected to last a patient’s lifetime.

(7) The cochlear implant consists of 2 parts (a) The actual cochlea implant which is inserted through surgery into the cochlear. (b) The microphone which captures the sound and transmits across the skin to the cochlear implant. This device is known as the "speech processor".

(8) Following successful surgery the device. This is termed “mapping”. is turned on. This is usually done 2 to 3 weeks following surgery. This is termed “switch on”. The device is then tuned across various frequencies to the patient’s comfort.

(9) Since the child is hearing for the first time the volume of the sound is gradually increased to the patient’s comfor

(10) The child is then sent for therapy to a special center which gives therapy in the form of Audioverbal Therapy. (AVT). At the center the child acquires speech and language. Therapy is given twice a week for a minimum period of 3 years. The child undergoes “mapping” as well which is performed 4 times a year.

(11) We have a support modality which focuses on troubleshooting and problem solving. This is done in conjunction with the cochlear implant company personnel.

(12) The Cochlear Implantee that we had performed 17 years ago is still doing well, has got an excellent job in TCS, has married a man who has normal hearing and is coping very well. She is leading an absolutely normallife.

(13) We have performed over 500 cochlear implants successfully.

(14) I have authored the world’s most comprehensive textbook on the subject.

(15) Adults who have lost their hearing have also benefited from cochlear implants. Many whom we have implanted have got their jobs and their lives back.