Pain on the head behind the ear is most likely to be due to an external cause, given that the skin has the most pain receptors. It is not unusual for people to screw in the magnet to ensure that the coil does not fall off easily. However, this can gradually produce a pressure point especially if the magnet actually touches the skin beneath. The skin of the elderly is particularly delicate especially if there is also little hair cover. Excessive pressure from the magnet and the coil, which do not change position, constrict the microscopic blood flow in the skin. In chronic cases, a small portion of skin dies off and a pressure sore develops, sometimes in the elderly without even causing pain. At this stage, bacteria entering the wound can cause an infection which can spread to the implant itself. At switch-on your audiologist would have instructed you to ensure that the magnet strength needs to be adjusted so that the coil stays in place without falling off, but without touching the skin. This is achieved by having a magnet that holds well without going past the last thread on the rim underneath. The magnet in the coil comes in various strengths, so that it is tailored to your individual need. Over time, depending on changes to your skin and hair, the strength may need to be adjusted. At your annual implant check-ups your audiologist will inspect the skin under the coil, making sure that the skin is healthy. Please take some time today to ask someone to check your head. If an indentation from the coil or magnet can be felt, it is possibly too strong. Adjusting the magnet by slightly unscrewing it will probably be sufficient, but also placing a protective barrier, such as a layer of moleskin (Scholl footcare product at chemists), may provide added protection for an elderly skin. Although the most likely cause of pain behind the ear is physical pressure, it is still possible that it might be due to a more serious issue. If the pain on the head also includes a fever and spreads into the ear, it may be a middle ear infection, which needs urgent attention from your family doctor and surgeon to ensure it does not spread to the implant and inner ear. 

If you have cochlear implants included in your policy cover, your health fund is required by law to cover 100% of the cost of the implant(s) and sound processor(s). Therefore, understanding your health fund policy is vital. Some private health funds will include cochlear implants in their basic hospital cover, and some won’t. Upgrading your policy to include cochlear implants may incur a waiting period before a claim can be made, but if you already had comprehensive cover you should be able to switch to a lower level of cover and not have to wait. This is something you should check with your health fund. Cochlear implants are covered under implantable prostheses, which is different from the type of cover applied to hearing aids. It’s therefore important to check your health fund policy if you think that a cochlear implant is something you might need in the future. When checking with your health fund you need to ask three basic questions:
1. Will my insurance cover the total cost of one or two cochlear implants?
2. Will my insurance cover the total cost of subsequent upgrading of my external components (sound processors)?
3. If so, how often am I eligible for an upgrade? Down the track, some health funds will only cover partial payment of an upgrade to your sound processor, and some private audiology clinics may ask you to make a payment for your appointments.
Some manufacturers work very closely with the health insurance industry and with various health funds, to ensure that you receive the best entitlements possible when claiming for cochlear implant surgery and device upgrades. Your cochlear implant clinician may call upon the experts within the industry to enlist support and advocate on your behalf. But remember – please check the fine print and the product disclosure statement. You have a cooling off period when you enrol in a health fund or make changes to your existing policy, so please check everything and take the appropriate action if required. If you do have private health insurance cover for cochlear implants and go through a non-profit cochlear implant clinic that doesn’t charge a gap fee, you will not pay a single cent in out-of-pocket expenses. 

Every case of hearing loss responds to cochlear implantation differently. However patients with an auto- immune hearing loss generally do very well with cochlear implants. This is because their hearing loss is post

lingual, the duration of the loss has been short and because the ganglion cell population in the cochlea is well preserved. The patients at my clinics with auto immune hearing loss (AIED, Sweet’s disease, Cogan’s syndrome, lupus and others) have all had good outcomes. 

The tympanic membrane is recognised by examining the ear with an instrument called an otoscope. It has a bright light, attached speculum and magnifying lens that allow the trained eye of your doctor or ENT surgeon to recognise the structures deeper in the ear canal. A normal ear drum gives off a reflection of light called the light reflex. If the drum or middle ear is abnormal, most commonly due to middle ear fluid or infection, the light reflex is lost and the ear drum appears dull. Of course there are other causes of loss of the light reflex (including flat batteries in the otoscope!) that need to be excluded before diagnosing the ear drum appearance as abnormal. Generally a few weeks after the middle ear condition has resolved, the drum resumes its normal shiny appearance and the light reflex returns. 

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