Questions that people often ask when they are considering an implant!!

  • Are there side effects from the implant surgery?

    There is a chance that your balance may be affected immediately after surgery and for some people this can be an ongoing issue for perhaps a few days or even a month. Long term balance problems directly related to the surgery are not common.

    Sometimes your taste can be affected and you might perceive that sweet things taste a bit salty sometimes, or some other disturbance. This can in some cases last a year, but usually settles down much quicker than this.

    Sometimes there is temporary damage to the facial nerve which causes a palsy similar to Bell’s palsy. This is extremely uncommon now.
     
  • Will I hear straight away?

    After the implant surgery there will be a period of 2-3 weeks recovery to allow the wound to heal and the swelling to settle. You will not hear until you attend your “switch-on” appointment when the audiologist issues the external sound processor and programs it specifically for you
     
  • Will I hear normal sound?

    At first when you are switched on, be prepared for the unexpected as it often doesn’t sound very good, especially if you have been deaf for some time. It may sound like people are speaking underwater or they sound very much like robots...However, this can change very quickly so don’t let first impressions fool you. If you wear your processor every day, all day, you will find that things start to sound clearer and you will slowly recognise more words without trying too hard.

    Auditory rehabilitation helps, like listening to audio books, music or the radio
     
  • Will I hear music?

    You will hear music though again it may not sound very good at first. it takes time to learn to hear music and some music is not reproduced very well through a sound processor. Simple music sounds better, such as folk music or solo instruments, but you can develop a better sense and appreciation of music with practice. There is much research currently being undertaken on music and cochlear implants. Programming of sound processors is also constantly developing to try and improve the quality of music as well as better speech recognition
     
  • Will I be able to use the phone?

    This comes with practice. Once you start to get used to listening and hearing more clearly with your implant, it is good to try using the phone with someone you know. You may have to fill in the gaps using the context of what you DO hear. You will need to be patient and just keep on trying. You can try different ways of using the phone, such as using speaker phone or trying the T-switch, which will give you a clearer signal and cut out some background noise so that you have a better chance of hearing the conversation
     
  • Can I swim with a cochlear implant?

    The internal part of the implant is completely sealed under the skin. However the external sound processor which sends the signal through from the outside is not waterproof, though it may be water-resistant with regard to a shower of rain or such like. There is a new accessory which is something like a snap-lock bag which you can wear on your sound processor if you want to swim with it on. You will need to secure it with a cap or something over the top so it does not float away!!
     
  • Should I wait for newer technology before I have my implant??

    There are new developments all the time, but the main thing is that the longer your brain is missing out on sound, the longer it will take you to adapt to the sound of an implant. Implants are designed with future developments in mind and implant companies would expect that most people would not want to have surgery every time there is a new model on the market. So the implant that you have today will be powered by a sound processor that is current model. A better model sound processor may be developed within about 5 years, possibly it will be smaller, will give you more speech information and perhaps better battery life. You will need to consider putting money aside to pay for an upgrade sound processor if you don’t have private health insurance which will cover the cost of upgrading
     
  • Will my activities be restricted with an implant??

    There is not much you cannot do with an implant. Though MRI scans are restricted to some degree.

    Implant recipients can participate in all normal activities and I believe even skydiving and scuba-diving are fine as long as the right precautions are taken. You will need to check any extreme sports with the company that manufactures your implant.
     
  • Can I sleep with my processor on?

    There are some recipients that wear the sound processor in bed and this is really a personal choice. However it is beneficial for your processor to put it in a drying kit at night with fresh desiccant crystals which absorb moisture. This will help to keep it working better. It may also be good to give your head a rest from the pressure of the magnetic coil. Your processor may come off from rolling around in bed.
     
  • Should I get insurance for my processor??

    Sound processors can be easily lost so it is certainly wise to insure it, either under your home contents policy or a stand-alone sound processor policy. You will need to cover it for loss or damage, and please check the wording of the policy carefully. Some health funds will cover repairs and maintenance and upgrades, so check with your fund first to see what is included.
     
  • Is it expensive to maintain my device?

    Most processors are fairly robust if treated correctly and outside of batteries, require a few replacement parts occasionally. Your start-up kit should contain some spare parts and you should read the warranty terms carefully to see what the warranty is on each item. If a fault occurs within a warranty period, you should contact the implant company or your clinic as soon as possible to have the part replaced. You should also make sure you have a price list for replacement parts so you can be prepared for costs that might arise. You can discuss these issues with your audiologist.
  • Maintenance, Medical and Miscellaneous FAQs

There are a range of articles for each section that have come fromm issues of BUZZ magazine that they go back several years and   technology developments mean some bits and pieces may be out of date.  Bearing this in mind, they remain a useful guide for readers to do their own research or talk to their GP, ENT specialist or audiologist.
 

Meningitis is a serious infection of the fluids and linings surrounding the brain and spinal cord. It can be caused by a range of viruses or bacteria. Although the incidence of meningitis following cochlear implantation has been very low, there was an increased concern of the risk of meningitis by implantees, their families and doctors following a report in the US (Sept 2003) of a cluster of bacterial meningitis cases in cochlear implant recipients. The report investigated 118 meningitis cases in implant recipients. Both adults and children recipients were affected with the age range of 13 months to 81 years. The onset of the infection ranged from less than 24 hours following implant surgery to more than 6 years after. The most common infection was due to a particular organism called Streptococcus pneumonia. Although these cases suggested that meningitis was more prevalent in implantees these cases had occurred over a period of 20 years during which around 60,000 implant surgeries had been performed.

In the paediatric population the incidence of implant-associated meningitis was higher than non-implanted children indicating that cochlear implant surgery was an added risk factor for meningitis. Subsequent investigations, both clinical and laboratory based, suggested that there were multiple factors involved in the meningitis cases leading to an ‘at risk’ profile of implant cases where particular actions are taken around the time of surgery to prevent meningitis. These risk factors included the presence of inner ear malformations, CSF leak2 during or after implantation, history of VP shunt2 (used for treating hydrocephalus) and recurrent otitis media (middle ear infection). There was also a particularly high incidence of post-implant meningitis with an electrode designed with a positioner (a small wedge designed to place the electrode closer to the auditory nerve endings), which has since been withdrawn from the market and subsequent electrode designs modified to minimise this risk. Several strategies have been developed to minimise the risk of post-implantation meningitis. Not all strategies have been universally accepted, with the adoption of a range of strategies being left up to the protocols in various implant clinics, individual surgeons, implant recipients and their families.

Antibiotics are universally administered during implant surgery and continued for several days after. Similarly, measures to reduce the incidence of recurrent acute otitis media in infection-prone children by insertion of a grommet in both the implanted and non-implanted ears, is also commonly practiced. Emphasis has been placed on immunisation against a range of bacteria for implant recipients, particularly children, but also adults, those with inner ear malformations, CSF leak at the time of implantation or with VP shunts to optimise their immunisation status. In Australia the national immunisation program ensures that children and adults have access to a range of bacterial vaccines to minimise the chances of infection, particularly Streptococcus pneumonia, Haemophilus influenzae type B (HIB) and menigococcus, from a young age. Immunisation against Streptococcus pneumonia, the most common bacterium involved in post-implant meningitis is strongly recommend for implantees of all ages by most surgeons. The immunisation schedule is widely practiced, and changes made as new knowledge concerning the prevalence of infections in the community and more effective vaccines become available. Hopefully these measures will see a further reduction in the already low incidence of bacterial meningitis in cochlear implant recipients over time. 

If a cochlear implant recipient is using Autotelecoil they may find that the telecoil activates when they enter a looped area. This can sometimes be surprising if the looped area is not obvious e.g. a train station, tram, exhibition at a museum etc. Also if the telecoil is enabled the wearer may be more susceptible to interference from the environment. 

When the telecoil is enabled you may hear a buzzing sound. This is to let you know the processor is now ready and waiting for a telecoil connection to happen (telephone or looped room). Sometimes you may also find that speech does not sound right, which means that the telecoil and microphone are mixed to enable you to hear people next to you while you also hearing what is being transmitted through the loop. Apart from the straight telecoil setting there is also a new setting called Auto-Telecoil. It enables someone who works in an office to pick up the phone and the telecoil will activate automatically. However, because the telecoil is constantly looking for a connection, it may mistake emissions from a microwave oven, fluorescent lights, computer or other electronic devices for a telecoil, resulting in buzzing that is stronger near certain devices and speech that does not sound quite right. Use the remote assistant to look at the se ttings when you experience something unusual. If you see the Telecoil or the Auto-telecoil symbol in the display window, deactivate them with a short button press for each setting. To help you notice that you are on the telecoil setting accidentally you can adjust the telecoil to eliminate the microphone input on the remote assistant. 

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. 

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. 

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