Cochlear implants – what to expect

 

Our team have developed a series of short videos showing a range of patients’ experiences with their cochlear implant.

Cochlear implant surgery

Before surgery

  • Before cochlear implant surgery – video transcript

    Hello, my name is Harry Powell. I'm one of the cochlear implant surgeons here at Guy's and Thomas' NHS Foundation Trust. I am one of a team of five surgeons who may be looking after you or your child.

    In these short videos, I'm going to explain the cochlear implantation procedure and the risks. This is part of the consent process so that you will understand what the procedure involves prior to agreeing to it.

    By now you may have been through the full assessment. This will have involved a number of appointments and also, we will have discussed you in our multidisciplinary team meeting.

    If, as a a team, we think that cochlear implantation will be better for you than your conventional hearing aids, then we may be able to offer cochlear implantation as the next stage in your care.

    Before surgery it is important that you or your child have a vaccination against meningitis. Because the cochlea is close to the brain, there's a very slightly increased risk of meningitis after the operation.

    To minimise this risk, we therefore ask that you have the vaccination prior to the surgery. We're going to give you two envelopes one for the GP and one for yourselves so that you have all the information. We ask that you make an appointment with your GP as soon as possible so that you can have the vaccination at least a week before the surgery.

    Before the operation, a pre-assessment will take place. This is an appointment for us to check your general health prior to the surgery. We may ask you to go for an appointment in the pre-assessment clinic here at St Thomas' after your consultation, or you'll have a separate appointment before the surgery.

    All our adult surgery takes place at Guy's and almost all of our children's surgery takes place at the Evelina London Children's Hospital on the St Thomas' site.

    You will have a general anaesthetic for your operation. The anaesthetic doctors will look after you and put you off to sleep so that you're completely unaware and you don't feel any pain. It is important that you fast before the surgery and we give you a letter with instructions as to when to stop eating and drinking. The operation can take anything from one and a half to three hours for each side every patient is slightly different and the anatomy varies from case to case. This means that sometimes it is more complex than others. The crucial thing to remember is that we will take the time it needs and carry out the operation in the safest possible way.

    You are looked after during the surgery by the anaesthetic team. This involves having a small tube placed through your mouth and into your windpipe so we can breathe for you while you're asleep.

    Sometimes after the operation people get a sore throat for a few days. That's because of the breathing tube and it will settle and there's nothing to worry about.

    There's a nerve that runs through your ear called the facial nerve. It supplies all of the muscles of the face on that side, the ones that enable you to close your eye, to smile and to raise your eyebrow. We monitor this nerve during the operation. To do this we have to put some tiny needles into the face, one at the corner of the mouth and one just above the eye. Afterwards when we take these out, this can lead to some bruising and that usually settles over a week or so.

    We then prepare the area behind your ear by shaving some of the hair. This is so that we can keep the area as sterile as possible. If you or your child are having two implants, then we try to make sure that they're as symmetrical as possible under the skin. We can't, however, guarantee that they'll be exactly the same on either side. In small children and babies the skin and soft tissues are very thin so the implant can look quite prominent behind the ear after the surgery. This is nothing to worry about and it will just entirely settle as your child grows.

    That is the end of the first video. Now you can watch the next video which explains more about the operation itself and what the procedure involves.

 

During surgery

  • During cochlear implant surgery video transcript

    This is a consent form. We write on the inside about the risks and the benefits of the surgery and we ask that you sign on the opposite page, so that we can the have a formal agreement to proceed with the operation.

    We will go through this in your consultation and you'll have an opportunity to ask any questions that you've thought of, and we'll go through everything again on the day of your surgery.

    When everything is ready in theatre, we sterilise the area behind the ear. We make a cut through the skin and the soft tissues. You will have a scar behind the ear but this heals very well and usually after about a year it is barely visible. Once the bone behind the ear is exposed we go through that bone to access the middle ear in the cochlea, without disturbing the ear canal.

    To get to the middle ear space we have to go between the facial and the taste nerves. There is a small risk of damage to both of these nerves during the operation.

    The facial nerve supplies all the muscles of the face on that side and hence if there was damage this would cause weakness of those muscles. This risk is very small but it's important that we warn you about it and this is also why we monitor the nerve during the operation.

    If the narrow gap between the facial nerves and the taste nerves is so small that we can't get through, then sometimes the taste nerve is damaged. That damage would result in an abnormal taste sensation on the tongue on the side of the operation towards the front of the tongue.

    It causes a sort of metallic taste. That will resolve and settle down but it can take three to six months to do so. Sometimes the nerve is actually bruised and you still get those symptoms but they would settle more quickly.

    Accessing the cochlea can be difficult, particularly if there has been recent infection or there's inflammation in the middle ear or scarring. We always try to insert the implant through one of the cochlear's natural openings called the round window, and we will aim to try and preserve any hearing that you still get benefit from. Despite our best efforts we can't guarantee to preserve the hearing, but we will always try.

    Cochlear implants are currently guaranteed by their manufacturers for ten years. However just like any electrical device, your television, or your washing machine, there could be a fault or a problem with it before then. That said we've got plenty of patients who had their first implant more than 20 years ago and they're still getting benefit from it.

    As you recover from the surgery, you may find that you feel your balance is affected for a short while. Immediately after the operation you might feel very dizzy and sometimes you can feel a little bit sick. This can either be because of disturbance of the inner ear from inserting the implant, which can affect the balance function, or sometimes it's also related to some of the anaesthetic drugs that we give you while you're asleep. Either way we can give you medicines that help reduce the nausea and the sickness feeling, and they'll generally make you feel a lot better. We can also give you medicines that you can take home if you need them, and usually over a few days this will all settle down and you'll feel back to normal.

    Tinnitus is a noise in the ears that some people experience. It's a noise inside the head rather than a sound that comes from an external source. Some patients already have tinnitus and it may get worse after the surgery. If you've never had tinnitus before, you may experience it after the operation.

    Usually it settles over a few days. Sometimes when the implant is switched on, it goes away completely. We can't predict or guarantee what will happen with the tinnitus, but generally it will subside, and we will be here to help you or advise you if it's bothersome.

    Every operation carries a small risk of bleeding. When you wake up from the surgery you will have a head bandage on and this is there to protect that ear and to reduce the chance of bleeding.

    You may get some bruising that runs down the neck from behind the ear. This is more common in older patients and it usually settles over about two weeks.

    There is a small risk of infection due to this we give you antibiotics during the operation whilst you're asleep, through your drip. Sometimes we also give you a couple more doses after the surgery whilst you're still in hospital.

    Occasionally we'll give you oral antibiotics to go home with but we'll explain this after the operation and the nurses would also go through it with you before you go home.

    That is the end of the second video, now you can watch the third video which is about what to expect after your operation.

 

After surgery

  • After cochlear implant surgery – video transcript

    When you wake up from the operation you'll be in a room called the recovery. If your child is having the surgery, then you'll be invited down, once they're awake enough, so that you can see them and look after them yourself. They may be a little bit drowsy or a little bit woozy from the anaesthetic drugs.

    You may not remember much about being in the recovery area. Once you're awake enough, we'll transfer you back up to the ward where the nursing team will be ready to look after you.

    You'll have the bandage on protecting your ear. It usually comes off the following morning, either at home or in hospital before you're discharged home.

    After your operation, you might go home the same day or stay one night in hospital. Depending on what time of day your operation finishes will usually determine whether you need to stay overnight afterwards.

    The operation site will usually be sore for seven to 10 days afterwards and we encourage you to take simple painkillers for that time. Before you're discharged home all of this will be explained to you by the nurses looking after you.

    To reduce the chance of infection, one important thing we ask, is that you keep your ear and the wound dry afterwards for a little while. You cannot wash your hair but you can use dry shampoo. Your surgeon will explain how many days they want you to keep the ear dry for.

    Depending on your surgeon, you may have some white sticky dressings over the wound to protect it while it heals up. These can stay on until you come back to clinic to see us.

    Once you're well enough you'll be allowed to go home. We will make a follow-up appointment for you seven to 14 days after your surgery.

    While you are recovering, if you get any concerns or you have any unexpected symptoms such as worsening pain, fever, or severe dizziness, then please contact the implant administration team and we'll be able to advise you.

    Thank you for your attention. We hope that watching these films has helped improve your understanding of the cochlear implant operation.

 

Living with a cochlear implant

Dale's journey with a cochlear implant

  • Dale's journey with a cochlear implant – video transcript

    I'm Dale, I'm 29 years old and I've been deaf pretty much all my life.

    And it got worse over time, bit by bit, until I woke up one morning in 2014 and just couldn't hear at all, even with a hearing aid.

    One of my biggest passions in life is music and I play guitar and piano and when my hearing suddenly dropped like that I wasn't able to really play anymore.

    I tried once to have a jamming session with an old guitarist friend of mine, it didn't go well, I couldn't really hear, so I kind of had to give up some of my musical endeavours. I wrote lyrics but that's pretty much all I could do at that stage.

    My expectations about the implant were more nervousness than excitement. I knew that it will be different, there'll be a lot of adjusting to do to the new way of hearing and I'd never be able to hear as well as a normal person might.

    But more than that, I heard there was a chance that I still wouldn't be able to hear music very well and that didn't fill me with a lot of hope.

    But I looked on the internet and there are people out there who can hear music.

    One lady has perfect pitch even with her implant.

    That gave me a bit more hope but I was still nervous.

    When I first had to switch on I was surprised at how sudden the hearing change was.

    I was able to hear a voice, that sounded a little bit like Daleks a little bit electronic maybe even a little bit slightly garbled but I could actually hold a conversation with the audiologist straight away.

    But it was very different and I did need to adjust and I couldn't hear perfectly, but I could just about manage.

    I was advised not to try to listen to music for a short while, while we made some progress on just hearing.

    After a week or two things carried on progressing with my implant I found different voices to be easier or harder to hear than other voices, for instance, my dad's voice which is slightly lower-pitched, was more difficult to hear than my girlfriend's voice, which is quite interesting because before the sudden deterioration in my hearing and the implant I found my dad's voice to be easier to hear than higher pitched voices.

    I continue listening to music and I found some ways better than others. I found the best way of listening to music was using a direct connecting cable into the implant or more powerful speakers were the best way of getting the sound.

    I found it difficult at first with mixed results but I carried on, I persevered. Music such an important part of my life that I didn't want to just give up when things got difficult so I persevered and now I can listen to most genres I've listened to before with good results.

    What also came in handy with practising listening to music was to have lyrics maybe in a separate web browser to a YouTube video or a YouTube video with the lyrics already on and I found that a really good way of practising listening to both music that I'd heard before and it sounded different and also, new music that I'd never heard before.

    Now things have progressed to the point where I come full circle and back to playing music, guitar, piano, exploring myself as a punk artist and as a blues artist. I've even started a new project something that I didn't think I might be able to do before.

    I'm not playing live just yet, but I'm really hopeful that I will be able to play live again. I can't see any reason why not.

 

Dale received his cochlear implant at 29 years of age. He had been deaf since childhood and wore hearing aids, but his hearing got worse over time. He talks about his own unique journey of listening with a cochlear implant. He shares with us the impact of his profound deafness, his decision to have a cochlear implant, his early experiences of listening through a cochlear implant, rehabilitating his listening and the benefits and limitations of his cochlear implant.

 

Kay's journey with a cochlear implant

  • Kay's journey with a cochlear implant – video transcript

    My name is Kay, I'm 54. I have a profound hearing loss. I first noticed this in my early thirties.

    I used to be quite a social animal, I'm quite extrovert, quite lively. I had quite a busy social life, I was very keen on amateur dramatics and I gradually found that as I was in plays I wasn't hearing the cast members.

    I started to veer to – what I would say were quieter activities I began to take up yoga which didn't really involve much listening it was in a quiet environment. I didn't need to rely on my ears I just needed to rely on my eyes and my memory.

    We went on a family holiday and my son stopped, he said 'Mum, I really think you should get a cochlear implant, you just can't follow what we're saying' and within a couple of days he'd done a lot of research on Google and sent me a lot of information about implants and I thought, yes, I'll go for the assessment.

    So, I had the operation and as the day of activation came further forward people were saying to me I expect you’re really excited, and actually I wasn't excited, I was quite nervous.

    After a couple of hours I went for a walk downstairs into the hospital canteen to try and get familiar with some of the sounds everything sounded completely different, not one normal sound.

    The whole day had been one of very mixed emotions, I'd been nervous about having the implant activated, I was excited, I was very over stimulated by all the new sounds and then I suppose I was very tired and a bit disappointed.

    After my implant had been activated I was determined to make it work, so once it was on, it was on and it was staying.

    I'd been advised to follow some exercises on the computer and I did these religiously.

    I haven't been able to use the telephone for about five years prior to my implant,so after my implant my speech therapist said to me let's try using the telephone. I recoiled in fear I have psychological issues with the telephone! But she said, 'no, no we'll take it stage by stage'.

    Caroline went into another room and she phoned me and I tentatively picked up the telephone and she said, 'Hello Kay, it's Caroline here can you hear me?' I couldn't believe it, I could hear her as clear as a bell and we went on from there.

    I knew the topic we were going to talk about and I was able to fully understand and hear probably 90 percent of what she said. It's just practice now.

    All three of my children live abroad but now I can really enjoy Skype. Before, I was struggling, but now we can have really good conversations.

    So now, five months down the line, what can I say about my implant? There are limitations to what I am able to do, for example, when all my friends are laughing and joking and there's quick banter going on, no sometimes I just have to sit down and think I can't enjoy this. But I don't keep saying pardon all the time and with familiar voices I don't even have to look at the person.

 

Kay received her cochlear implant when she was 54 years old as she had become progressively deaf from the age of 30. She talks about her own unique journey of listening with a cochlear implant. She shares with us the impact of her profound deafness, her decision to have a cochlear implant, her early experiences of listening through a cochlear implant, rehabilitating her listening and the benefits and limitations of her cochlear implant.

Les' journey with a cochlear implant

  • Les' journey with a cochlear implant – video transcript

    My name is Les, I'm 80 and I've had a cochlear implant for a year.

    During the 1990s, my hearing got steadily worse and it got that the hearing aids couldn't keep up with this, even better hearing aids, and eventually in the early 2000s I gave a series of lectures, by request, to MSc students, and I had to ask students to write questions down so I could easily put the answer on the board. It was often mathematical questions where we have to write something down.

    I felt this wasn't really good enough because it was time consuming and I didn't like imposing. I found that friends and family were very sympathetic and helpful and doing things like speaking slowly and carefully, occasionally writing things down, and then sometimes my wife would interpret for me. My wife and I knew each other so well I didn't have to say much to her and she didn't have to write much down in reply.

    Only in 2014 my wife said something really needed to be done about my hearing. After I had the implant, I came back to St Thomas' for the switch on and, when they finally turned the sound up enough for me to hear it, I jumped. I think everyone was very pleased with it at this stage, it was working.

    When the implant was first switched on, I started hearing all types of sounds around me. I think the most noticeable one was high heels clicking, which I haven't heard for a long time.

    As I was adjusting to the implant I started becoming aware of more sounds like my own breathing, wind howling in the chimney and the children next door playing in the garden, but I still found face-to-face communication difficult. It was difficult to differentiate between male and female voices. Face-to-face, I did get some clues from watching the speaker's face and as time went on things did get better.

    To start with I did listening practice as suggested using the computer, the online resources there and was meticulous about this and I did a session most days. I eventually found this wasn't really the answer.

    I moved on and came back to St Thomas' to see the speech and language therapist. She gave me the various exercises. At first she typed so that I could see things in the laptop as well as speaking and as things gradually got better I could pick up cues by watching her face, see her lips moving and then at one stage she tried putting a mask over her mouth so I couldn't see that, to see how well I got on. I found the therapy helpful because I got immediate feedback. Where necessary things could be repeated and this did help me build up my confidence.

    Overall, one year on, the implant has been well worthwhile. Things aren't perfect, the one outstanding issue is I cannot use a telephone. The feeling is I will get to the stage when I can use a telephone.

 

Les received his cochlear implant at 79 years of age as he became progressively deaf over the last 26 years. He talks about his own unique journey of listening with a cochlear implant. He shares with us the impact of his profound deafness, his decision to have a cochlear implant, his early experiences of listening through a cochlear implant, rehabilitating his listening and the benefits and limitations of his cochlear implant.

Glyn's journey with a cochlear implant

  • Glyn's journey with a cochlear implant – video transcript

    Glyn: My name is Glyn and I've had significant hearing loss since I was about 8 years old. It's quite a steep learning curve for Shona [my wife] I think, in terms of deaf awareness, and she's had the patience of a saint to be perfectly honest, and she still has, in order to get my attention when she speaks to me.

    Shona: When I had a conversation with Glynn, I always had to make sure that he was looking at me and I had his full attention.

    Glyn: So we can't speak to each other, or we couldn't, when we were in different rooms for example.

    Shona: It could be obvious that somebody was at the door, and I'd shout, 'there's somebody at the door', but even if he was in that same room he wouldn't hear.

    Glyn: Or, you know, when I've taken my hearing aids off at night time, those type of things. It took quite some time really for us to learn to live with that. I considered an implant several years ago, but at that time I just wasn't ready, and that's because I didn't think I was deaf enough and it was such drastic action to take. Switch on day was really interesting, it was and it wasn't what I was expecting, all rolled into one. When I was switched on we went through the pure tones and I can hear all of those tones, that was really exciting, but they were just tones and then we went outside and were told to come back and record what I could hear outside.

    Shona: Big Ben was chiming and that's really loud and a lovely noise. So I'm asking, 'Glynn can you hear that, can you hear that?'

    Glyn: And I heard virtually nothing outside.

    Shona: We all tried to tell ourselves that it was going to be a little bit of time to retrain his brain and get used to hearing all these noises but I suppose deep down I thought he's going to get switched on and he's going to start to hear things and I thought it would be better on switch on day than it actually was.

    Glyn: On day one when we got home I put the radio on, and it was awful and I couldn't hear anything apart from a horrible jingling high-pitch noise.

    I did pretty much listen exclusively to talk radio for the first few months. Quite suddenly one sentence jumped out of the radio that I quite clearly caught. I heard it and then it was gone again it was all noise. So that morning I was listening to the radio for about 40 minutes and just one sentence appeared for me that really was a bit of a turning point for me and that was probably week one or week two.

    So it was quite some time, it was at least three, maybe four months before what I could hear I would call normal myself. Before that time for the first few months I had an overlay of sound which was almost like being in a big bird cage where there are loads of birds cheeping and all of that sound was real sound that my brain couldn't actually, it couldn't pigeon-hole, couldn't determine where it was coming from and I had to hear through that sound almost in order to pick things out. That was quite frustrating and I was hoping that might clear up quicker than it did. But it did take three or four months for that to happen.

    I have questioned why the radio has become a focal point and when you think about it, there is nothing wrapped round radio, there's no visual clues, you either hear it or you don't hear it. The other bits of your life, all the other things that you’re used to relying on, the visual clues and the topics of conversation, it's difficult not to do them. Slowly, I'm learning what to do but it's still very difficult not to do those things and they override the trust you have in what you're actually hearing.

    And I think when you get your head round what the brain is doing to rewire itself and what you're doing to help it, to trust what you're hearing, trust the information that's given you, when you get that, really it just makes you much more comfortable and positive about the journey that you're on and about the time that is going to take for that to happen.

 

Glyn gradually became progressively deaf from the age of eight and he received his cochlear implant in 2015. He talks about his own unique journey of listening with a cochlear implant. He shares with us the impact of his profound deafness, his decision to have a cochlear implant, his early experiences of listening through a cochlear implant, rehabilitating his listening and the benefits and limitations of his cochlear implant.