Cochlear Implant Devices
The History of Cochlear Implants
Age of Research
In the early years of development cochlear implants were very experimental. No one knew what the effects of electrical stimulation of the inner ear would be. It was apparent that a "sense" of hearing occurred with this stimulus. However, a great deal of experimentation would be needed to determine whether this could be used to restore useful hearing.
Age of Acceptance and Expansion
With the advent of multichannel implants, particularly the Nucleus 22, it soon became apparent that very useful hearing could be provided through electrical inner ear stimulation and could be done safely, even in children. The more advanced processing strategies produced better and better performance. For the first time in history the prosthetic restoration of a human special sense was taking place. More and more patients of all ages could now benefit from this technology. The question of whether or not cochlear implants work was clearly answered with a yes. Now the only question remaining was how well can they be made to work?
Age of Refinement
In the late 1990's, new processing strategies, miniaturization of the processors, and advancement of postoperative aural rehabilitative therapy improved rapidly. The Nucleus 24 was approved for implantation in children 12 months of age or older, as it became apparent the younger a deaf child is implanted, the sooner the child will assimilate language. Implant performance has improved dramatically in the 1990's that adults who had some residual hearing but were performing sub optimally with hearing aids became potential candidates. Some adults were achieving word recognition over 90% with the implant.
Outcomes studies began to show the remarkable cost benefit of cochlear implants. Cochlear implants were found to be one of the most cost effective medical interventions in terms of the long-term impact on a recipients quality of life relative to their cost. Children who received a cochlear implant in early childhood were found to be twice as likely to be in mainstream education classrooms as children without implants. Cochlear implants in children were found to save society up to 1 million dollars in educational and assistive benefits over the life of that individual.
|Cochlear - Makers of the Nucleus Cochlear Implant|
|MED-EL Sonata Implant and Opus Processor|
|Advanced Bionics Cochlear Implant - Makers of the Clarion Cochlear Implant|
A note from Dallas Ear Institute regarding choosing a Cochlear Implant device
The technical performance information on cochlear implant devices can be confusing and potentially misleading for patients and parents. Such information can be obtained from each device manufacturer's web site if desired. However, I am in disagreement with the marketing tendency on the part of some manufacturers to use technical data to try to "convince" patients or parents of the superiority of their device. The long term patient performance data do not support such presumption. When the devices are compared to one another the pros and cons of each are minor, offsetting issues. Our center implants all 3 manufacturers’ devices and we solicit the patient’s and parent’s involvement in choosing which cochlear implant to use. On rare occasions a patient may have a medical reason requiring the choice of one implant over another. The majority of patients are encouraged to make their decision based on their subjective preference for the appearance of the external processor or confidence in one device over the other as they have networked with other implant recipients. If the patient or parent has no preference concerning which implant to use, as is often the case, we alternate between the devices.
We are often asked by patients and parents, "Which device should I choose?" Our answer is always the same: "Any of them." Each of the devices listed in this section are excellent devices with comparable electronic capabilities made by stable, well established companies. The specific technical information on each device has very little to do with how well a patient will ultimately "hear." Rather, patient performance with a cochlear implant is determined more by "patient specific" factors (age, duration of deafness, amount of speech acquired before the onset of deafness, educational setting, amount of time with the implant, how hard patients and parents work in therapy after the implant, etc.). It is crucial that patients and parents place their focus on these issues and not expect the device to guarantee a good outcome.
We are also frequently asked, "Should I wait for future technology before proceeding with cochlear implant surgery." The answer is, "Absolutely not." The current generation of cochlear implants provide excellent auditory detail and can be upgraded to better technology in the future if warranted. The duration of deafness before implantation and conversely the amount of time an individual has been using an implant are two major determining factors in hearing performance. Each day, each month, and each year without an implant is time lost towards auditory integration and speech acquisition, especially in children who have a limited "window" of opportunity to obtain maximum benefit from an implant. Cochlear implants are amazing, but they are not magic. They are only the beginning of a long, strenuous journey toward the hearing world.