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Ear, Nose, and Throat - Otolaryngology

The MUSC Health Cochlear Implant Program is the largest cochlear implant program in the state of South Carolina. We serve both children and adults, and since 1991 we have implanted over 1,000 ears. The number of new patients continues to rise each year. (Figure 1)

Commercial development of a multi-channel cochlear implant device began in the early 1980’s. In 1985, the United States Food and Drug Administration (FDA) granted the first cochlear implant approval for clinical use. Currently, MUSC Health offers three FDA approved multi-channel cochlear implant systems: Advanced Bionics Corporation, Cochlear Americas Corporation, and Med El Corporation. The devices are safe and effective in providing hearing for appropriate candidates. The cochlear implant is not a cure for deafness, it is an implanted device that simulates the hearing process.

MUSC Health began providing cochlear implant services in April of 1991. In August of 2000, the MUSC Health Cochlear Implant Program was established to provide rehabilitation therapy and support services to families and professionals. The program provides people with severe-to-profound hearing loss with medical, technological, and rehabilitative resources necessary for successful usage. Our program involves an interdisciplinary team approach to the evaluation and management of potential candidates for and users of cochlear implants. 

Figure 1: Number of cochlear implant surgeries per year



Cochlear implant services are offered at our Downtown location (Rutledge Tower, 135 Rutledge Avenue) and in our satellite locations (East Cooper Medical Pavilion located at 1600 Midtown Avenue, Mount Pleasant, SC and the North Charleston Medical Pavilion located at 8992 University Boulevard, North Charleston, SC)

 

How cochlear implants work
A sensorineural hearing loss is the result of highly specialized cells (hair cells) in the hearing organ failing to trigger electrical signals in response to sounds. Even though there is damage in the hearing organ, there are many usable nerve fibers that can be directly stimulated by the cochlear implant to transmit sounds to the brain.

 

The cochlear implant is a device that uses advanced technologies to enable a person with a severe-to-profound sensorineural hearing loss to detect speech and environmental sounds. The internal portion of the device is surgically placed under the skin behind the ear with an electrode array inserted into the hearing organ (the cochlea). The external portion, which includes a sound processor, cord, transmitter, and microphone, is worn like a behind-the-ear or body style hearing aid.

The cochlear implant does not work like a hearing aid. Instead, it is a medical device that bypasses the damaged hearing organ and stimulates the usable nerve fibers that go to the brain to respond to environmental sounds and speech (Figure 2). Through this stimulation, people can often learn to listen and understand speech and environmental sounds.

Figure 2:  Cochlear implant


Photo Courtesy of Med El Corporation

 

Benefits of the cochlear implant
People who receive the cochlear implant report they feel more connected to the world around them. They can hear environmental sounds like birds singing, telephone ringing, cars approaching, and the turn signal clicking to name a few. People with the cochlear implant can learn to detect and understand speech. This connection to their environment often results in feeling less isolated and more independent and self-confident. 

Children who generally benefit the most from their cochlear implants are those who are deaf for a short period of time, in good auditory training programs, and have families who are strongly committed to the training process. An additional factor is the length of time a child has used the implant. Children who have used their device for more than three years are still demonstrating improvement. 

As for adults who have already developed spoken language, the cochlear implant provides an opportunity to regain personal communication. It also allows individuals the ability to have a sense of security, more freedom, and an opportunity to be more socially engaged. Currently, there are no definitive tests, which can be administered prior to cochlear implantation to determine the precise degree of benefit an individual may receive, but nearly all show significant benefit.

 

Cost of the cochlear implant
Virtually all insurance carriers provide full or partial coverage for the cochlear implant and the associated costs. The financial counselor on the MUSC Health Cochlear Implant team will submit the proper documentation to your insurance carrier for approval. The amount of coverage, however, depends on your specific insurance carrier. The financial counselor will work with you and your insurance company to help secure the maximum insurance coverage available.

 

FDA candidacy criteria
For adult patients:

  • 18 years of age and older (there is no upper limit)
  • Bilateral severe to profound sensorineural hearing loss
  • Limited or no benefit from amplification (hearing aids)
  • Good general health
  • Motivated to communicate better

For children:

  • 12 months of age and older
  • Bilateral profound sensorineural hearing loss
  • Limited or no progress in auditory development
  • Good general health
  • Willing and motivated to be actively involved in therapy

Candidacy determination can be a complex process. The above guidelines should only serve as a broad indication for cochlear implantation and not as the only cases for which a cochlear implant would be appropriate. 

If you or someone you know are interested in more information about the cochlear implant process, please contact our program for more information. We will send you a cochlear implant packet to fill out and submit back to the clinic. Following review of your information, appropriate appointments will be scheduled. Please contact Meredith Holcomb, AuD, Clinical Director of the MUSC Cochlear Implant Program, at holcombm@musc.edu for more information.

 

Evaluation process
The procedures involved in evaluating an individual for a cochlear implant will include:

  • Audiological evaluation: A comprehensive hearing assessment will be completed with and without the individual’s hearing aids. 
  • Computerized tomography scan (CT) or magnetic resonance imaging (MRI): A CT Scan is a specialized x-ray to evaluate the anatomy of the hearing organ.  An MRI scan is sometimes obtained instead of or in addition to a CT scan to better assess the inner ear structures.
  • Medical evaluation: The otologist (surgeon) will perform a comprehensive exam, review the CT scan or MRI, and determine the patient has any medical contraindications that would prohibit the surgery. 

For pediatric patients:

  • Sedated auditory brainstem response and otoacoustic emissions tests: These tests are objective measures of hearing sensitivity. Some children require sedation to undergo testing. All children under the age of 3 years will be required to complete the ABR test.
  • Speech-Language evaluation: A speech pathologist will conduct a formal assessment of the child’s communication abilities with his/her hearing aids. Communication goals will be discussed at this appointment.

The evaluation may also include:

  • Cognitive and psychological evaluation: Evaluations are obtained for some patients to help with understanding expectations and coping strategies of the individual and their family members. Family expectations will also be discussed. 
  • Developmental evaluation: This is a formal assessment of the child’s developmental milestones and capacity to learn. Family expectations will also be discussed. 
  • Educational assessment: The child’s school will be contacted regarding educational placement, support, and the need, if any, for training on cochlear implants.

Additional evaluations will be recommended based on the information obtained during the candidacy assessment. 

After all assessments are complete, the members of the MUSC Health Cochlear Implant team will meet and determine if the individual is a candidate for the cochlear implant. If the individual is not a candidate, the individual will be contacted and alternative options will be discussed. If the individual is determined to be a candidate, a surgery date will be scheduled. Approximately two to four weeks after the surgery, the candidate will return to MUSC Health for activation of the cochlear implant processor. 

 

Activating the cochlear implant
Approximately two to four weeks following the surgery, the patient will return to MUSC Health for fitting and programming of the external portion of the cochlear implant. This is the first time the person will be able to hear with the cochlear implant. The cochlear implant audiologist will use a computer to set the soft and loud levels of the CI to produce audible sounds once the device is turned on. Each program is unique since each person’s auditory system is different. The person returns frequently during their first six months with the cochlear implant for reprogramming of the sound processor. These frequent visits are necessary for the ear to adjust to the new form of stimulation. Usually after the first six months, the patient will return every six months for the first three years for fine tuning the program and updating the sound processor’s software. After the three year mark, patients will return on an annual basis.

 

The importance of therapy
For both children and adults who have been without sound stimulation, therapy is absolutely critical for successful use and understanding of speech. For adults, they have a lifetime of auditory memories to draw upon and usually learn to recognize the new speech sounds provided by the cochlear implant in a relatively short period of time. Therapy consists of listening to individual speech sounds, words, phrases, sentences, and conversations, practicing using different strategies to improve communication situations, telephone use, and counseling focusing on the issues concerning hearing impairment and the cochlear implant. Each cochlear implant company website contains listening activities for the CI user.

As for children with little or no listening experiences, there are no auditory memories on which to draw. Without intensive therapy and education, these children will not benefit from the cochlear implant. In May, 1995, the National Institute of Health (NIH) held a conference on cochlear implants. A statement issued by the panel at the end of this conference was “Access to optimal educational and (re)habilitation services is important to adults and is critical to children to maximize the benefits available from cochlear implantation.” If parents choose to pursue spoken language communication mode for their newly implanted child, they must attend regular speech therapy sessions with a speech therapist trained to work with hearing impaired children (preferably an Auditory Verbal Therapist), and the family must provide intensive follow through of therapy in the child’s natural environment.

 

Realistic expectations
It is difficult to predict how well an individual will perform with a cochlear implant. Even though the cochlear implant significantly improves access to auditory information, the cochlear implant does not return the person’s hearing to normal. 

While each person’s experience with the cochlear implant is different, adults can expect better detection of everyday sounds in his/her environment, improved face-to-face communication, an increased ability to understand speech through hearing alone, and greater confidence to interact and socialize. Children can often achieve the same benefits as adults with intensive aural habilitation therapy. Some children are able to understand speech by listening alone with no visual cues. However, there are other children who will require the use of lip reading and/or sign language to help them to understand spoken language. Generally speaking, people who have not developed listening skills that assist their communication by their teenage years are unlikely to do so by receiving a cochlear implant. Research shows shorter the duration of hearing loss, the more the person will gain meaningful information from the cochlear implant. 

 

Resources & troubleshooting for cochlear implant users
The most efficient resource for device information and troubleshooting is the device manufacturer. They provide step-by-step instructions to troubleshoot an issue, provide replacement equipment, and assist with new orders.

Advanced Bionics Corporation
877-829-0026
800-678-3575
CustomerService@AdvancedBionics.com

Cochlear Americas Corporation:
800-483-3123
Customer@Cochlear.com

Med-EL Corporation
888-633-3524
Implants-usa@medel.com
 

 

More care team members

Nevitte Morris, MS, CCC-SLP, Cert. AVT | Speech-Language Pathologist
Jaclyn Parsons | Financial Counselor
Anita Cheslek | Administrative Assistant
Debra Poinsette, MBA | Administrative Assistant
 

 

Contact us:

MUSC Health Cochlear Implant Program
Medical University of South Carolina
135 Rutledge Avenue, Room 216
MSC 550
Charleston, SC 29425-5500

843-792-7162
843-792-5271(fax)

holcombm@musc.edu

 

Contact Us

Schedule an Appointment

843-792-3531
 

Mailing Address

Otolaryngology - Head & Neck Surgery
MUSC
135 Rutledge Avenue
MSC 550
Charleston, SC 29425
 

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843-792-2200 or 800-922-5250