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A cochlear implant is a device that measures sound using a microphone,
same way a hearing aid does.
But then, instead of just amplifying that sound through a speaker,
the way a hearing aid would, it processes the sound,
breaks it into different frequencies.
And then, electrically stimulates parts of the cochlear nerve,
the hearing nerve,
to bring sound into a person who couldn't otherwise hear.
Because the ear can't understand amplified
sound waves coming in through the eardrum.
So this is a device, it's essentially a bionic ear.
And it's a way for
us to talk directly into the hearing part of the central nervous system,
in people who we couldn't otherwise get sound into.
[MUSIC]
The candidate for a cochlear implant is really someone who can't hear
well enough, despite using traditional hearing aids
that have been tuned the best that they can.
When I say can't hear well enough, I mean not able to hear about more
than about 50% of what someone else is saying and understand it.
So, when these are adults, which means people who have severe or
profound hearing loss that we as surgeons can't fix another way.
And have found it too frustrating to talk with friends, or family, or
coworkers using traditional hearing aids.
The formal measurement is that you have to have worse than about 50%
word understanding and sentence understanding scores,
on special tests that we do.
For kids it's difficult, because we can't use sentence testing,
so we rely on things like auditory brain stem response tests.
And other special tests designed to help determine if a small child can
hear or not.
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Well, to talk about age restrictions,
we could talk about both ends of the age spectrum.
At the young end, we try to implant as early as possible once we
determine that a child needs a cochlear implant to access sound.
The earlier the better, because that helps that child's brain gain
access to the sound that's needed to learn language skills early.
And we've moved as a field from doing five year olds,
to two year olds, to one year olds, and
now we're to children who are under a year.
I think lately we've been implanting children around ten months, but
it really depends on the child's overall health, and
the size of the child at that point.
At the other end of the spectrum, there's really no age limit.
It more depends on whether you're physically healthy enough to undergo
a surgery under anesthesia.
The oldest person I implanted was a charming 88 year old,
a few years ago.
And just a couple of months ago,
I saw him at a Costco talking to an employee and having a fun time, so
there is really no upper age limit.
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With a hearing aid, the idea is to just amplify the sound.
And so,
if your ear can receive the sound from a conventional hearing aid,
you hear something that ought to be close to a normal spectrum of sound.
With a cochlear implant, we have to process the sound and
bring it in through a smaller number of channels.
And so, when it's first turned on people say well it sounds different,
it sounds electronic, sometimes they say it sounds robotic, but
the brain is an amazing learning machine.
And over the months after a cochlear implant is turned on,
your brain is really quite good at learning how to make that sound into
something that sounds natural to you and useful.
So, if I talk to patients who've had cochlear implants for some time,
they say well yeah it's different then I remember my
hearing was before I needed a cochlear implant, but
it's infinitely better than without my cochlear implant.
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Right after surgery, there's a time that we wait for patients to heal,
and so we don't turn on the device until a few weeks after surgery.
But right after that first activation, people usually hear at
least some sounds, and often, they can hear some speech sounds.
That then starts a process of learning,
during which your brain learns to take those sounds, and turn them
into things that understand as speech and other sounds around you.
And so, you do hear right after the device is activated, but
you don't hear as well as you ultimately will.
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Cochlear implant surgery is typically covered by insurance,
there are some cases where an insurance company asks for
more information.
But, we as a team have been very successful at working
with our patients in those situations,
to ensure that they get the coverage for this procedure.
Ultimately, insurance companies cover this, because it's the right
thing to do, and it brings a great amount of benefit to a patient, and
a patient's family.
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The reason to come to Johns Hopkins for your cochlear implant surgery,
is because we have the experience, we have the team, we have
the dedication to make sure that we get you the best possible outcome.
We have surgeons who do a large number of implants per year,
between 150 and 200 per year, currently.
We've had thousands of patients, and
thousands of surgeries accomplished successfully here at Johns Hopkins.
We have audiologists, who are among the most experienced audiologists in
the world, who can do the critically important programming and
candidacy evaluations.
To make sure that you're getting an implant for the right reason, and
you're being programmed properly to get the best possible
outcomes of the device.
We have auditory rehab therapists, who are leaders in their field
at this critically important part of the process, so
that you don't simply get an implant and
then go back home without having an understanding of how to use it.
But instead, you get the most important intervention
after implantation, which is to help your brain
learn how to make use of the information that this brings in.
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