Children’s Hospital New Orleans Cochlear Implant Program and Other
Implantable Hearing Devices (Bone Vibrating Hearing Aids)
Approximately 4,000 to 12,000 children are born in the United States each
year with severe hearing impairment. While there can be inherited (genetic)
causes of hearing loss, many children are often born to normal hearing
parents. We serve to assist patients, parents, and pediatricians in understanding
the nature of the hearing impairment, the options for supporting best
hearing and speech performance for the individual child, and the benefits
versus risks of each option.
At Children’s Hospital New Orleans, our collaborative team of otolaryngologists,
audiologists, speech pathologists, nurse coordinators, and social service
specialists follow children with hearing loss in an effort to help them
achieve their best results for their learning and language development.
For some children, the path leads to traditional hearing aids, while for
other children with severe to profound hearing loss, that path may lead
to cochlear implantation. Additionally, some children who cannot be fitted
with a traditional hearing aid may benefit from one that vibrates the
bone of the skull to transmit sound.
Cochlear implantation
Developed in the 1960s, the cochlear implant was not only the first technology
to restore hearing in deaf patients, it was the first invention ever to
restore one of the human senses. After success in the adult population,
cochlear implantation was performed in children with newborn hearing loss
in the 1980s, giving many the ability to hear and develop speech and spoken language.
A cochlear implant is a surgically implanted device that can provide a
sense of hearing to a patient who is profoundly hearing impaired by stimulating
the nerve of hearing directly using an electrode (a wire) placed within
the inner ear, which is also known as the cochlea. An external sound processor,
which looks similar to a hearing aid, contains a microphone that transmits
the sound signal to the implant that is beneath the skin.
Figure 1. The external processor attaches to a magnet underneath the skin
on the internal implant. This processor captures sound using a microphone
and converts it to a digital signal that is transmitted to the implant.
Image courtesy of Cochlear Americas.
Figure 2. This image shows a typical implanted device, which contains a
magnet and a sound transmitter with an electrode array that is inserted
into the cochlea. Image courtesy of Cochlear Americas.
Cochlear implantation can give patients the ability to hear at normal levels
with potential for understanding speech and environmental sounds. Newer
devices and upgraded software allow recipients to hear better in noise,
enjoy music, and even use their implant processors while swimming. It
is important to understand that surgery is just one step in successful
cochlear implantation. In order for a child to develop the ability to
hear and verbally communicate, the cochlear implant device must be worn
consistently for all waking hours. A user must attend recommended appointments
to “tune” its performance and go through language therapy
sessions to allow a child to catch up to their appropriate level of hearing
comprehension and language development.
Bone Conducting Hearing Aids and Osseo-integrated (Bone Anchored) Auditory
Device Implantation
About 1 in 6,000 children are born annually with a defect of the outer
ear or ear canal. Children with incompletely formed outer ears or ear
canals often have difficulty with wearing a traditional hearing aid. In
these instances, a specialized hearing aid, called a bone anchored hearing
aid, can be placed onto the bone of the skull to capture the sound vibrations
and allow for hearing. Many children with single-sided hearing loss (hearing
loss affecting only one ear) may also need to use a bone-vibrating hearing
aid to transmit sound to the opposite ear for sound localization.
Under the age of 5 years, children can use use a vibrating hearing device
on a head band. Once the skull bone has achieved enough growth in thickness
to support implantation, a small titanium mounting post above the skin
(FDA-approved for 5 years and older) or a fully implantable device underneath
the skin (FDA-approved for 12 years and older) can be placed surgically.
A user can then place a bone conducting devices either on the post sitting
just above the skin or on top of the implanted magnet.
Our process
Our team members meet monthly to discuss patients with new diagnoses of
hearing loss and to review their progress with hearing and speech milestones.
The team members determine if the current strategy is the best one or
if another option should be recommended.
If a child will need to change strategies, the team members will discuss
the options with the patient/family and collectively we will move forward
with the next steps. For an implantable device, this may mean comprehensive
evaluations for achievement, updated imaging studies, or scheduling surgery
and appointments with team members.
Periodic assessments of progress with hearing, speech/language and developmental
milestones are recommended every 3 months after the activation of a new
device for the first year: hearing device programming may require more
frequent evaluations and speech progress may require less frequent evaluations.
After the first year, on-target patients may move to 6-month progress
evaluations or 1-year progress evaluations depending upon their new achievements
after implantation.
Figure 3. Initial activation of the implant is typically done two weeks
after surgery at the first postoperative visit.
Figure 4. Newer technology has been developed where the external processor
is only a single disc and eliminates the behind the ear component.
Children who are candidates for bilateral devices (for both ears) have
the option to proceed to surgery on both sides in a single setting under
most conditions. This helps children begin the progress of “habilitation”
with balanced left and right hearing whenever possible. The benefits of
bilateral implantation include improved sound localization and hearing
sensitivity.
Please contact our office at
504.896.9551 to schedule an appointment with one of our pediatric hearing loss specialists.
For further reading, a list of helpful websites discussing hearing loss,
hearing aids, and cochlear implantation are listed below.
