Cochlear Implant (Bionic Ear)

Surgically Implanted Neuroprosthetic Bionic Ear Device

Artificial or bionic ear - cochlear implants developed for patients with severe hearing loss or total hearing loss are used.

"Cochlear implant" is the name given to the bionic ear developed for patients with severe hearing loss or who are completely deaf. These implants have been developed to enable patients with damaged sensory hair cells in the inner ear to hear again. The sound quality offered by these devices is different from that of natural hearing. However, over time, patients using this device can learn the sounds of the outside environment and become able to use these devices while listening to music or even while swimming. The cost of cochlear implant devices and the need for long post-procedure therapy periods limit the application. The youngest known patient with double cochlear implant is a 5-month-old baby living in Germany.

Cochlear implants are the treatment method for selected adult and child deaf cases. However, the performance achieved with current implant systems is variable. This difference in performance levels is thought to be due to biological and cognitive factors. Despite a well-designed and placed cochlear prosthesis, it can be predicted that performance will be lower in the presence of auditory nerve damage or atrophy in the central auditory pathways, and that the performance will be better in patients with better acoustic nervous system.

A cochlear implant, often referred to as a "bionic ear," is a medical device designed to provide a sense of sound to individuals who are profoundly deaf or severely hard of hearing. It works by directly stimulating the auditory nerve using electrical signals. Here's how a cochlear implant works and some key information about it:

1. **Components**: A cochlear implant system consists of two main components:

   a. **External Component**: This component consists of a microphone, speech processor, and transmitter. The microphone picks up sounds from the environment, and the speech processor converts these sounds into digital signals. These signals are then sent to the transmitter, which is typically worn externally.

   b. **Internal Component**: The internal part of the cochlear implant is surgically implanted. It includes a receiver-stimulator placed under the skin behind the ear and an electrode array that is threaded into the cochlea, the spiral-shaped, fluid-filled structure in the inner ear.

2. **Sound Processing**: The external microphone captures sounds, which are then processed by the speech processor. The processed signals are sent as electrical impulses to the internal receiver-stimulator.

3. **Electrode Array**: The electrode array contains electrodes that are positioned inside the cochlea. When the electrical impulses are received by the electrodes, they stimulate the auditory nerve directly.

4. **Perception of Sound**: The electrical stimulation of the auditory nerve is interpreted by the brain as sound. Cochlear implant recipients may not experience sound in the same way as those with natural hearing, but they can often understand and perceive speech and other environmental sounds.

Cochlear implants have been a significant advancement in the field of hearing restoration and have helped many individuals who were previously unable to hear to understand and interact with the world through sound. However, not everyone is a candidate for cochlear implants. The decision to receive a cochlear implant is typically made after thorough evaluation by an audiologist and a team of medical professionals.

It's important to note that the success of cochlear implants can vary among individuals, and the outcomes may depend on factors such as the age of the recipient, the duration of deafness, and the individual's ability to adapt to the new auditory input. Cochlear implants can be a life-changing technology for many, allowing them to communicate and engage more fully in their daily lives.

Who Should Have a Cochlear Implant?

There are a number of factors that determine the degree of success of the process and the device itself. Cochlear implant centers also consider factors such as residual hearing amount, speech and recognition ability, health status and family commitment to auditory rehabilitation in order to identify implant candidates on an individual basis.

Features that should be found in cochlear implant candidates:

Deep sensorineural hearing loss in both ears
Having a working auditory nerve
- lived for a short time without hearing (approximately 70 decibels and above hearing loss)
- A family willing to work on treatment, speech and language skills exercises
- No hearing benefit even in using the latest high power hearing aid models
- There is no medical reason to prevent surgery
- The patient's willingness to "live in a world of hearing"
- The patient and family have realistic expectations about the results
- The patient has family and friend support

The 0-12-month period, which is the period before speech and language learning, is called the prelingual period, the period between the ages of 1-4 in which speech and language skills develop, the perilingual period, and the postlingual period (after speech and language learning) at the age of 5 years. Patients who need cochlear implants in the prelingual period should be implanted as early as possible. In the prelingual period, if the hearing loss is due to meningitis, cochlear implant application should be performed at the earliest period to avoid problems in the development of speech and language skills.

There is no upper age limit for cochlear implant application. Early implant application after hearing loss occurs in the postlingual period positively affects the success of the application.

After the procedure, auditory rehabilitation training is initiated for the patient and the family through a language and speech pathologist or an auditory verbal therapist.

Two Different Bone Implantable Devices: "Med-El VIBRANT SOUNDBRIDGE" and "Med-El BONEBRIDGE"

Med-El Company manufactures these new technology devices. I wanted to share with you here because I like the design and operation of the devices.

How Does “Med-El SOUNDBRIDGE” Work? 

This device is an innovative alternative to conventional hearing aids. It is designed for patients diagnosed with mild to severe neural, conductive, or mixed hearing loss.

This device works as follows:

- Sounds are picked up by the microphone of the sound processor.
- The sound processor converts environmental sounds into electrical signals.
- Electrical signals are transmitted on the skin to the implanted part.
- Signals are transmitted to FMT (Floating Mass Transducer).

FMT converts the signals into mechanical vibrations that stimulate the structure of the middle ear (for example, the ossicular chain).
These vibrations cause sound transmission to the inner ear, then sound waves are transferred to the brain and perceived as sound.

How Does “Med-El BONEBRIDGE” Work?

The Bonebridge bone conduction implant system is the new pioneering hearing system designed for patients with conductive hearing loss, mixed hearing loss or unilateral deafness. With Bonebridge, sound is transmitted to the inner ear through bone conduction, since the outer or middle ear is disabled in sound conduction, patients with diseases of this region can also be used.

This device works as follows:

- Bonebridge is a partially implanted hearing system.
- The system consists of an external sound processor and an implant.
The sound processor, in which it is held in place directly on the implant by magnetic attraction, records the sounds transmitted through the skin and then converts them into signals for the implant.
- The implant, embedded in the temporal bone, converts the implants received signals into mechanical vibrations and then mechanical vibrations are transmitted to the surrounding bone.
- The bone structure then transmits these vibrations to the inner ear. In the inner ear, these vibrational stimuli are transformed into neural stimuli and transmitted to the auditory nerve.

Cochlear Implant Operation in Istanbul - Turkey

Regarding this issue, cochlear implant placement, follow-up and rehabilitation of patients is a team work. It would be ideal for you to apply to clinics such as university hospitals that usually perform this procedure and work as a team. In other words, I do not do cochlear implant surgery for now and I wish all our patients healing in this regard.

Resources I can recommend to you on the subject:

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
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