Now that you have a cochlear implant should you wear some sort of medical alert identification in case of an emergency?
The most important precaution when you have a cochlear implant is to avoid MRIs unless the proper steps have been taken. For some implants that means removing the internal magnet with a local anesthetic (leaving the implant in place), doing the MRI with a compression bandage, and then replacing the magnet with a new, sterile magnet.
Some implants don’t require magnet removal, but a compression bandage is still required. Low-strength MRI machines may make the logistics easier. But low-strength machines aren’t very common, and the image quality is not as good. (see cochlear MRI guidles)
These coloured bands are available for purchase from CICADA
A main concern is that you may be given an MRI in an emergency situation, and that the high magnetic field strength may damage the magnet or even cause the implant to shift. Based on information received from paramedics, emergency room physicians, and radiologists, the chance of receiving an MRI while unconscious is remote. While cochlear implants are still somewhat uncommon it could save you from extra injury.
What they mean
- Activation:the post-operative process by which the external sound processor is linked with the internal implant.
- Bilateral:Both ears implanted.
- Bimodal:One implanted ear with a hearing aid other ear.
- Binaural:Hearing with both ears.
- Bluetooth:wireless technology.
- BTE:Behind the ear sound processor.
- BWP:Body worn sound processor.
- CI:Cochlear implant; often used to describe the complete implant package, the internal implant and external sound processor.
- CT/CAT: Computed tomography or computed axial tomography
- dB: Decibels.
- Electrode Array:the part of the implant inserted into the cochlea to stimulate the auditory nerve.
- ENT:an Ear, Nose and Throat doctor (Otolaryngologist)
- HA:Hearing aid
- Magnet:Located in the center of the RF coil providing adhesion to the head. Often used when referring to the RF coil or headpiece. See “RF Coil”
- MAP/Mapping:A program adjustment made by an implant audiologist.
- MRI:Magnetic Resonance Imaging
- RF:Radio Frequency.
- RF Coil:The external transmitting RF coil used to power and send signal to the implant.
- Sound Processor:The external device that converts sound into electrical signal transmitted to the internal device (implant).
- Switch on:See “Activation.”
- T-Coil:Telecoil; A very small wire coil that serves as an antenna built into BTE processors and used to receive input signal from telephones, FM systems, etc.
- Unilateral: One implanted ear
CICADA AGM Live stream – Streaming Help – It’s easy!!
- How can I watch the CICADA AGM 2022 through the Internet?
On the day just click on this link: https://vimeo.com/event/1844910/4f333c7435
Try it now to make sure it works, you should see the video screen. But remember it won’t be live until the day. - Will the live stream have captions?
Yes. We have captions produced by the streaming platform so accuracy may vary. - Can I ask a question using chat? (AGM Chair will let you know when questions are being taken from the floor.
Alongside the viewing window to the right, you will see a chat/Q&A window. There are three simple steps (see the screenshots below).
First Step: Sign up to chat by choosing a name. And don’t worry, your email is not required
Second Step: You will see Have a Question’ – Click ASK
Third Step: Type in your question and click send ( Remember AGM Chair will enable the Question and Answers (Q&A) during the meeting. Any questions please email
Please remember that support will not be available on the day because we will be working hard to keep the Video going.
How to sign up for CICADA Live stream events
First Step: Sign up to chat (email not required) just choose a name
Second Step: ‘You will see Have a Question’ – Click ASK
Third Step: Type in your question and click send
( Remember AGM Chair will enable the Question and Answers (Q&A) during the meeting.
Any questions please email
Question: Is it possible that my cochlear implant is still affecting my inner ear balance after 20 months? I have to be very careful moving as I easily lose my balance.
Dr Melville da Cruz
Answer: Melville da Cruz – Ear, Nose & Throat Surgeon
Our inner ear balance system and hearing mechanisms are very closely linked. This is because they share common inner ear fluids called perilymph and endolymph.
When a cochlear implant electrode is inserted into the cochlea, it usually disturbs the balance system. Usually, this disturbance is short-lived before returning to normal. A few days at most.
The balance system in the opposite ear, as well as your sense of vision, both have a strong role in taking over to return your overall balance to a new equilibrium.
Occasionally, the balance system doesn’t fully recover following inner ear surgery. This is because the remaining balance in the other ear and sense of vision doesn’t have enough reserve function to take over fully.
You’re more likely to experience this if you’re older or have a cochlear implant in your better balancing ear.
What to do when your balance is still not better?
There is no easy solution to this problem. The best advice is to maintain a vigorous (daily) exercise program. Also, avoid medications
that may further suppress the balance functions (eg Stemetil). Take extra care in the dark (reduced vision) or in unfamiliar or dangerous situations (heights or near moving machinery).
This FAQ originally appeared in Hearing HQ Magazine.
Question: Would I be eligible for a middle ear implant? I have total hearing loss in the left ear due to an immune response after I had a stapedectomy and have partial hearing loss (mixed, I think) in the right ear.
Dr Melville da Cruz
Answer: Melville da Cruz – Ear, Nose & Throat Surgeon
Stapedectomy Surgery
Stapedectomy surgery, for conductive or mixed hearing loss due to otosclerosis, usually has wonderful results. The
hearing threshold improves and the quality of sound is very natural. However, there is a risk of a dead ear in 0.5-1.0% of surgeries despite the surgery being carried out competently.
In this situation, it would leave only one hearing ear on the opposite side. So it is strongly advised not to undergo surgery on the opposite side because of the small risk of a second dead ear.
Bone anchored hearing implant
Fortunately, there are several options for rehabilitating hearing in this situation with hearing aids of various kinds. A bone-anchored hearing (BAHA) implant is one such device that can help. Inserted under the skin in the mastoid bone behind the ear, it works by bypassing the middle ear and stimulating the cochlea directly through the bone of the skull. Bone anchored hearing implants have predictable hearing outcomes in conductive hearing losses.
You can trial the hearing experience of a bone-anchored hearing implant before surgery. The surgery to implant a bone-anchored hearing implant is simple and carries no risk to the underlying hearing. An external speech processor held on by a magnet or small clip generates sound vibration to be transmitted to the implant under the skin.
Middle ear implant devices
There are several other kinds of middle ear implant devices that can also work in this situation. The Bonebridge, for example, is an active middle ear implant that has the source producing the sound vibrations implanted within the mastoid bone behind the ear. Rather than externally in the speech processor as with the bone-anchored hearing implants.
Many other implantable devices are in development. Some are active devices that attach to the middle ear bones such as the Vibrant Soundbridge. However, these devices require more complex surgery than the Bonebridge or bone-anchored hearing implant for placement. They also require manipulation of the middle ear bones and hence carry a risk to the underlying hearing. These devices would not be suitable for surgery on the side of an only hearing ear.
This FAQ originally appeared in Hearing HQ Magazine
Question: I have severe to profound hearing loss and need a cochlear implant. Will I be able to have MRI scans after I receive an implant?
Roberta Marino
Answer: Roberta Marino, Audiologist
Your ability to undergo MRI (Magnetic Resonance Imaging), depends on the type of implant you receive. It also depends on the strength of the machine.
It is good to discuss your MRI options with your Ear, Nose and Throat surgeon so you understand what scanning limitations may be present after cochlear implantation.
MRI is an important medical test that most of us will need at some time in our life. It is popular as it allows good visualisation of internal body structures with no adverse effects.
If a cochlear implant is not MRI-compatible or only compatible at a certain strength of machine, undergoing this scan of any body part (not just the head) can cause:
- de-magnetisation of the internal implant magnet,
- displacement or turning off the magnet,
- heating and/or vibration of the implant.
If you have a middle ear or bone conduction implant you may hear loud noises during the MRI imaging.
MRI Machine CC BY 2.0 by Liz West
Magnetic Resonance Imaging Strength
The strength of MRI is measured in Tesla (T). The higher the T-rating, the higher the image quality and the faster the scanning times. However, a higher rating results in a greater risk of interaction with an implant. This includes cochlear implants, middle ear and bone conduction implants. Typically MRI scans are measured at 1.5T however there are MRI machines that can measure at the higher strength of 3T and even 7T.
Most implantable devices are now able to undergo MRI imaging of 1.5T without removal of the internal implant magnet. Newer implants can undergo imaging of up to 3.0T.
Hearing implants can create a blurring effect on the image making it difficult for doctors to pick up fine details, particularly on the implanted side. And in some cases, the magnet may need to be removed prior to the scan and replaced afterwards with minor surgery.
What you need to do
Always advise your doctor and radiologist that you wear an implanted device. It is also advisable to carry a patient identification card with your important contact information and your implant make and model. This way, if necessary, the implant manufacturer can be contacted. A Medic Alert necklace or bracelet telling people you wear an implant is also useful.
People wearing bone conduction implants and middle ear implants also need to be aware of MRI compatibility before undergoing any scans. Some older middle ear implants such as the Vibrant Soundbridge are not MRI-compatible. The newer model implants are safe to use in MRIs up to 1.5T.
This FAQ originally appeared in Hearing HQ Magazine
Question: I have had outer ear infections with blocked hearing after swimming. My doctor has told me they are due to swimmer’s ear and exostosis. Do I need surgery?
Dr Melville da Cruz
Answer: Melville da Cruz – Ear, Nose & Throat Surgeon
Swimmer’s ear and exostosis are common in people who swim a lot. The repeated exposure to cold water over many years produces a mild inflammation of the lining of the bony external ear canal on both sides, stimulating bone growth – a little like growth rings on a tree trunk.
Exostosis progression
As the bone growth slowly progresses it produces three visible swellings in the ear canal (exostosis) which eventually constrict the canal leading to blockage. While the swellings are small, there may be minimal symptoms. As they grow however you may find water gets trapped after swimming. This can cause your hearing levels to fluctuate but can improve spontaneously after a day or two. In time, trapped water, wax and debris lead to recurrent infections which are difficult to clear.
Eventually, with large exostosis, there is near complete blockage of the ear canal and long periods of reduced hearing
Exostosis – CC BY-SA 3.0 by Welleschik
which can be disabling if they involve both sides. At this stage, using ear drops and clinical ear cleaning is not enough.
There are few symptoms when exostoses are small. They are often found during an ear examination for unrelated symptoms. As they enlarge, symptoms of blockage and hearing loss become more troublesome, especially for those who swim daily. While being diligent with your water precautions, such as wearing earplugs and drying well after swimming can be, at this stage, you should consider whether surgery is an option. Patients with larger occluding exostoses, who wish to continue swimming, will need to consider surgery as the painful infections are almost impossible to treat without a general anaesthetic for ear canal cleaning.
Surgery for exostosis
Surgery involves “drilling out” the exostosis to widen the bony ear canal back to its usual dimensions, under a general anaesthetic. It takes up to two hours depending on the size of the bony swellings and requires an overnight stay in hospital.
It can take several weeks for the skin to grow over the widened canal. While healing you will need to follow strict water precautions and have repeated dressings. In time, the second side will require surgery. It is rare, once the exostoses have been surgically corrected and the area has healed, that any further treatment is needed.
This FAQ originally appeared in Hearing HQ Magazine
Question: I had a sudden unilateral deafness (hearing loss in my right ear) a few months ago (unilateral deafness). Although the other ear still functions well. What could have caused this and what can I do to hear with ‘two ears’ again?
Roberta Marino
Answer: Roberta Marino, Senior Audiologist
To help answer this question, I’ve enlisted the help of Dr Dayse Tavora-Vieira and Prof. Gunesh Rajan. They are from Perth’s Hearing Implant Research Unit, experts in implantable hearing devices and cochlear implants for deafness on one side (unilateral deafness).
About unilateral deafness
Around 0.8-2.7 per 1,000 people experience unilateral deafness (UD). And it increases substantially in school-aged children ranging from one to 56 per 1,000.
In the United States, 60,000 (est) people acquire UD each year. And in the United Kingdom, 9,000 (est) people develop profound UD each year.
Unilateral deafness can be present from birth or caused by conditions including;
- mumps,
- acoustic neuroma (a benign growth on the hearing/auditory nerve),
- viral infections,
- head trauma,
- Meniere’s disease, and
- genetic disorders.
But, sometimes there is no known reason for the loss of hearing which can occur suddenly.
Suffering from sudden unilateral deafness can be traumatic. Especially when accompanied by the onset of severe tinnitus (noises in the head/ears in the absence of external noise).
Adults with unilateral deafness find it difficult to detect the direction of incoming sounds, hear speech in background noise and hear when speech is presented to the ‘deaf’ ear. Indeed, twenty-six per cent of people with UD struggle with conversations in quiet and 73 per cent report some level of handicap.
What can you do about unilateral deafness?
Unfortunately, there is no cure for UD when the cochlea or hearing nerve is affected. However different hearing technologies can assist. These include
- the CROS (Contralateral Routing of Signal) hearing aid,
- bone conduction hearing aids,
- bone conduction hearing implants, and
- cochlear implants.
You can get a good idea of the potential benefits of a bone conduction implant by doing a trial of a bone conduction aid.
Alternatively, if your hearing nerve is viable, you could consider a cochlear implant for the ‘deaf’ ear.
You will need a full diagnostic evaluation to establish whether your hearing nerve is viable. So, you will need an audiologist specialising in this area who will consult with an ear, nose and throat specialist. However, it will be difficult to ascertain the potential listening benefits if there hasn’t ever been any auditory stimulation to the deaf ear throughout your life.
A cochlear implant is the only option if the deaf ear is directly stimulated. Research has shown this can also ease tinnitus.
Finally, all the other hearing solutions described work on delivering sound to the better hearing ear. If there is a viable auditory nerve and the system works well, the patient would need to participate in an intensive rehabilitation program.
This FAQ originally appeared in Hearing HQ Magazine
Question: After a stapedectomy two years ago my hearing is deteriorating slightly. I already have a powerful aid in that ear. And I had a sudden total hearing loss in it a couple of years ago. Hearing was partially restored with the help of steroids. Will the stapedectomy plus hearing aid see me out?
Dr Melville da Cruz
Answer: Melville da Cruz – Ear, Nose & Throat Surgeon
Otosclerosis is a hereditary disease affecting the hearing elements derived from the otic capsule (bony labyrinth). The otic capsule forms the complex inner ear (cochlear and balance organ) as well the stapes bone (the third of the three middle ear bones).
In individuals affected by otosclerosis both the cochlear and the stapes involvement contribute to the overall
Lateral view of the otic capsule also called the bony labyrinth by Henry Vandyke Carter et al Gray’s Anatomy, Plate 920
hearing loss. In cases where the conductive hearing loss is the greater component, due to involvement of the stapes bone, surgery in the form of stapedectomy (or stapedotomy) is a suitable treatment option. If the sensory-neural or cochlear component is the greater component, then stapedectomy will not be effective in reversing the hearing loss. A hearing aid is the best option.
In many cases of otosclerosis hearing loss is a mix of both cochlear and middle ear components. So, careful hearing testing will establish
- how much hearing surgery can restore, and
- how much will require sound amplification with a hearing aid.
However, over time the history of hearing loss due to otosclerosis (and other conditions such as aging and noise exposure) is for the hearing levels to slowly decline (over years to decades).
Monitoring changes
Monitoring hearing levels in both ears at regular intervals will help ensure optimum hearing outcomes. Decline in hearing following initially successful stapedectomy surgery also needs particularly careful testing to understand why the hearing is dropping. Generally, it is the sensory-neural or cochlear component of the hearing changes that declines with time. Which surgery cannot reverse. So, an adjustment of the current hearing aid or fitting a more powerful aid will be required.
If the hearing decline is due to a recurrence in the conductive component of the hearing loss then revision stapedectomy surgery may improve the hearing levels. Sometimes dramatically. Rarely, the hearing levels decline to a severe degree which responds poorly to even the most powerful hearing aids. In this situation a cochlear implant will be indicated, often improving the hearing to that experienced several decades before. Careful testing of hearing and consideration of the type of hearing loss will allow your ENT surgeon to advise which pathway is the best for you.
This FAQ originally appeared in Hearing HQ Magazine
Question: Why does the area under my transmitting coil feel hot and sore sometimes?
Answer: Sue Walters, Clinical Support Officer NextSense
At the time of your switch-on, the magnet holding the transmitting coil to your head will be fitted for comfort.
The magnet needs to hold firmly enough so the transmitting coil does not fall off easily but if it is too strong, it can cause a pressure sore over time. So, it is very important to have the correct strength magnet.
Does your magnet need to be changed?
Anatomy of a cochlear implant showing transmitting coil and battery placement. Image CC BY-SA 4.0
You may need to change the strength of the magnet over time. Some situations requiring a change of magnet strength include if you
- put on weight or your hair grows thicker, you may need to change to a stronger magnet
- lose weight or your hair becomes thinner, you may need to change to a weaker strength magnet
What you can do to alleviate pain
If it does become sore, place a soft padded dressing under the coil to relieve the soreness and contact your clinic to order a weaker magnet. You should also ask someone to check the area under your magnet on a regular basis to make sure there is no inflammation. And, if the skin becomes broken, put a soft dressing under the coil, see your GP as soon as possible. Then contact your clinic or supplier regarding a weaker magnet.
Question: I am considering a cochlear implant and feel I should be asking my surgeon questions but just don’t know what to ask. Can you help?
Sarah McCullough
Answer: Sarah McCullough, Audiologist
The decision to get a cochlear implant can be quite daunting. Knowing what to ask your surgeon can help you to move forward with more confidence.
The first step is to find out if a cochlear implant is the best choice for you. To determine this ask “Am I likely to obtain more benefit from a cochlear implant compared with my hearing aids?”
If you are likely to benefit and you feel it is the right time for you, there are some specific questions about the surgery you might want to ask:
- Will I lose the hearing I currently have?
- Are some implants better for keeping my remaining hearing?
- What does the surgery involve?
- Is there anything I can’t do after surgery?
- Will the surgery affect my balance or tinnitus (sounds in the ear)?
- How long will I be in the hospital?
- How long does it take until I can hear with the cochlear implant?
The answers to these questions will help you prepare for the surgery and understand what to expect.
When you’ve decided to go ahead
You will need to decide which cochlear implant is the right one for you and your lifestyle. You could ask ‘What implants are available and what are their differences?’
If you are receiving only one implant, ask if there is an implant compatible with your other hearing aid so that they can work together post-surgery. It is also important to consider what you enjoy in life and compare your needs to the options that each implant can provide.
If hearing in water is important, you might ask about the options for swimming and bathing. Consider asking about phone use, connecting to your television or music and the ability of the implant to be upgraded for use with future technologies. It can also be important to ask about how the implants themselves work on the inside to replicate hearing. If choosing for your child, ask about wearing options, ease of use and monitoring and availability of accessories for listening in school.
These questions will help you make a decision as to which implant might be best for you and why. It will also give you some information as to where to start if you want to do further research into your options. The choice of implant is a very personal decision. Explore all the options and choose what is right for you and your family. Whatever you decide, you will open up a whole new world of hearing.
This FAQ was originally published in Hearing HQ Magazine
Question: My child is due to have cochlear implant surgery soon. I’ve heard cochlear implant recipients have a higher risk of contracting meningitis. What precautions can we take?
Dr Melville da Cruz
Answer: Melville da Cruz – Ear, Nose & Throat Surgeon
Meningitis is a serious infection of the fluids and linings surrounding the brain and spinal cord, caused by a range of viruses or bacteria. The incidence of meningitis following cochlear implantation has been very low.
The report that caused concern
However, there was a concern about the risk of meningitis following a report in the US (1) in Sept 2003 of a cluster of bacterial meningitis cases in cochlear implant recipients.
The report investigated 118 cases of reported meningitis cases in implant recipients from 13 months to 81 years old. 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 Streptococcus pneumonia. These cases suggested meningitis was more prevalent in implantees, however, these cases were over a 20 year period and approximately 60,000 implant surgeries. In the paediatric population, the incidence of implant-associated meningitis was higher than in non-implanted children indicating that cochlear implant surgery was an added risk factor for meningitis.
The real picture & causes
Follow up clinical and laboratory-based investigations suggested multiple factors lead to the ‘at risk’ profile. These risk factors included the presence of inner ear malformations, CSF leak (2) during or after implantation, history of VP shunt (2) (used for treating hydrocephalus) and recurrent otitis media (middle ear infection).
In addition, an electrode with a positioner was used in a high proportion of the cases of meningitis. The positioner involved a small wedge to place the electrode closer to the auditory nerve endings. Withdrawn from the market, subsequent modified electrode designs minimise this risk.
Minimising risk of meningitis
Several strategies minimise the risk of post-implantation meningitis. The adoption of a range of strategies is up to the protocols in various implant clinics, individual surgeons, implant recipients and their families.
Antibiotics
Antibiotics are standard during implant surgery and continued for several days after. Similarly, the insertion of a grommet in both the implanted and non-implanted ears is also common. This helps reduce the incidence of recurrent acute otitis media in infection-prone children.
Immunisation
Immunisation against a range of bacteria for all implant recipients is important. Particularly 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 children and adults have access to a range of bacterial vaccines to minimise the chances of infection. Particularly Streptococcus pneumonia, Haemophilus influenza type B (HIB) and meningococcus, from a young age.
Streptococcus pneumonia is the most common bacterium in post-implant meningitis. So, immunisation is strongly recommended for all ages. The immunisation schedule is widely practised (2) and updated as new knowledge and more effective vaccines are available.
Hopefully, these measures will see a further reduction in the already low incidence of bacterial meningitis in cochlear implant recipients over time.
References:
(1) Cochlear implants. Bethesda, Md.: National Institute on Deafness and Other Communication Disorders, 2003. (Accessed 1 July 1 2003, at www.nidcd.nih.gov/health/hearing/coch.asp.)
(2) www.health.gov.au/internet /immunise/publishing.nsf.
A ventriculoperitoneal (VP) shunt relieves pressure from the brain caused by fluid accumulation. VP shunting is a surgical procedure primarily to treat hydrocephalus. Hydrocephalus occurs when excess cerebrospinal fluid (CSF) collects in the brain’s ventricles. CSF cushions your brain and protects it from injury inside your skull.
The fluid acts as a delivery system for nutrients that your brain needs, and also takes away waste products. Normally, CSF flows through these ventricles to the base of the brain. The fluid bathes the brain and spinal cord then is reabsorbed into the blood. When this normal flow is disrupted, the build-up of fluid can create harmful pressure on the brain’s tissues. This can damage the brain. VP shunts surgically placed inside one of the brain’s ventricles diverts fluid away from the brain. This restores the normal flow and absorption of CSF.
This FAQ originally appeared in Hearing HQ Magazine
Question: I have otosclerosis and I am considering stapedectomy surgery to improve my hearing. My surgeon has recommended stapedectomy surgery, but in my research I have read about stapedotomy surgery being better. What is the difference between the two operations?
Dr Melville da Cruz
Answer: Melville da Cruz – Ear, Nose & Throat Surgeon
Otosclerosis is a hereditary disease resulting in progressive stiffness of the stapes bone; the third of the three middle ear bones.
As the stapes bone becomes progressively stiff it transmits sound energy less efficiently through the middle ear resulting in conductive hearing loss.
What is so exciting about otosclerosis is that the middle ear component of the hearing loss is treatable by surgery. Generally called stapedectomy.
Stapedectomy versus stapedotomy
This operation restores sound transmission to the inner ear bypassing the fixed stapes bone. This can be either by removing the entire stapes bone (stapedectomy) or drilling a very fine hole through it (stapedotomy) and replacing it with an artificial stapes bone.
When stapes operations were first developed in the 1950s, it was necessary to remove the whole stapes bone before introducing an artificial stapes replacement (generally made of fine stainless steel wire and fat taken from the ear lobe).
With micro drills and more recently lasers, it is possible to drill a fine hole (less than 1 mm in diameter) through the stapes footplate. A replacement stapes bone (made of titanium/platinum and Teflon) effectively bypasses the fixed bone, leaving the remaining footplate largely intact.
Both operations in skilled hands produce wonderful hearing results. And both operations still carry similar risks of permanent and severe hearing loss (dead ear, less than 0.5%).
However, the stapedotomy operation produces less trauma to the inner ear, preserving the higher hearing frequencies.
The modern stapedotomy replacement bones are also safer to revise if necessary. The replacement prosthesis is also compatible with MRI scanners if imaging of the region is required.
Because of these advantages, all modern stapes surgery for otosclerotic hearing loss is in the form of stapedotomy.
This FAQ was originally published in Hearing HQ Magazine