Cochlear Implant Clinic Closed

You must be 18 years or older to be referred to our program. You can be referred to our program by a:

• Family doctor
• Ear nose throat (ENT) specialist
• Registered audiologist
• Registered hearing instrument practitioner

When we receive your referral, we will send you a package that will include:

• Hearing Aid Check: Take the form to your audiologist or hearing aid provider and ask them to fill it out. The audiologist will test your hearing aids and check if they fit properly. They will also do real ear measurements (REM) to make sure the hearing aids are fit well. Please also send us a copy of a recent (within six months) complete hearing test. Copies of previous hearing tests are also helpful.
• Cochlear Implant Dizzy Questionnaire: You or a support person are to complete this questionnaire that outlines your history with dizziness.
• Cochlear Implant Questionnaire: You or a support person will complete this questionnaire which will provide us detailed patient information.

Complete these forms and return them to our clinic. Our team will review them and respond in one of three ways:

• We will contact you to schedule an assessment to see if you are a candidate for a cochlear implant.
• We will send you a letter letting you know that you are not/not yet a candidate for a cochlear implant. This is based on the results of your most current hearing test or other information.
• We will ask you to have your hearing aids adjusted. Before scheduling an assessment, we may also ask you to try more appropriate hearing aids.

If you have a hearing loss that might be helped by hearing aids, you need to wear them daily or be willing to undergo a trial before we can assess you for a cochlear implant. This is the case even if you have tried hearing aids in the past and did not like them or did not feel they were helpful.

It may take a few months to complete the above process due to the number of referrals we receive at this clinic. We thank you for your patience.

Plan to spend a full day (from about 9:00 a.m. to 3:00 p.m.) at the Cochlear Implant Clinic. We encourage you to bring a family member or friend for support.

Please bring your hearing aids to your assessment. We need them to complete the cochlear implant candidacy assessment. Be sure that they are working and have been set appropriately for your hearing loss.

Your audiologist will review the completed Cochlear Implant Questionnaire. To understand your medical and hearing loss history, they may ask more questions. They want to be sure they understand your history, concerns and expectations.

The assessment for cochlear implant candidacy has more than one step (see list below). Not every patient requires every test. Your audiologist will let you know which tests you will undergo.

• Complete hearing test: determines the type (conductive, sensorineural, or mixed) and degree (mild to profound) of hearing loss you have.
  • Pure tone air and bone conduction threshold testing: tests the type and severity of hearing loss.
  • Tympanometry: tests the mobility of the eardrum and middle ear bones.
  • Acoustic reflex testing: tests the function of the middle ear.
  • Otoacoustic emissions: tests the function of the sensory hair cells in the inner ear.
• Speech testing: tests how well you can understand speech. You will listen and repeat back a series of words and sentences with and without your hearing aids.
• Real Ear Measurements: to check that your hearing aids are set properly.
• Auditory Brainstem Response testing: tests the function of the hearing nerve.
• Vestibular testing: tests the function of the vestibular end organs in your inner ears.

Our social worker may also meet with you to discuss how hearing loss affects you and others. They can also provide you with information about resources that may be helpful to you and your family.

Testing is thorough and can take several hours. You will take breaks during the day, including one for lunch.

Your audiologist will review your test results with you. Usually we are able to tell you at the end of your assessment if you are an audiological candidate for the cochlear implant. Sometimes we determine that your hearing aids are fit poorly, or we are not able to complete all the required tests. If this happens, you may need to come back for further testing.

Next, one of our surgeons will assess you to complete the medical/surgical candidacy assessment. If an audiologist or hearing aid provider referred you to the Cochlear Implant Clinic, your primary care provider or doctor from a walk-in clinic will need to refer you to the surgeons.

If you are not yet an audiological candidate for a cochlear implant, a clinic audiologist will recommend ways to help you address some of the difficulties with your hearing loss.

If you meet the audiological and medical/surgical candidacy criteria for a cochlear implant, we will put you on the surgery waitlist.

You and your family will likely have many questions. Your audiologist will be happy to answer any questions or concerns you may have.

If you have any other health issues, you may need to go to the Pre-Admission Clinic at St. Paul’s Hospital before your surgery. This may involve a separate trip to Vancouver.

There is currently a waitlist for cochlear implant surgery. We are usually able to give two months' notice of the surgery date. If you are not able to take the surgery date we offer, we will give you the next available surgery date that works for you.

All adult cochlear implant surgeries are performed at St. Paul’s Hospital in Vancouver.

The surgery takes approximately two hours. It is performed under general anesthetic.

The surgeon will make an incision behind the ear. They may shave a small amount of hair around the incision. The surgeon will drill through the mastoid bone, a honeycomb of air cells behind your ear. This allows access to the area behind your eardrum through which the implant electrode is inserted into the cochlea, the organ of hearing.

The surgeon closes the incision using dissolvable sutures under the skin. This means there are no sutures to remove later. They will place a head dressing over the incision. You can remove the dressing at home the day after surgery.

After the surgery, we will monitor you in the recovery area until you are fully awake. In most cases, you are able to leave the hospital the same day. If you are feeling unwell, you may be required to stay one night in the hospital. If you live outside of the Lower Mainland, you should plan to stay in a hotel in Vancouver the night before and the night of the surgery. You may fly or drive home over mountain passes the day after the surgery. Otherwise, it is best to avoid flying for about six weeks after surgery. You will not be able to use a hearing aid in the operated ear for four weeks after surgery (if the residual hearing is preserved).

The risk of a serious complication occurring during general anesthetic is approximately one in 200,000 patients.

You may experience some numbness at the top of the ear that usually recovers over several months. It is rare for this numbness to be permanent.

The surgeon needs to drill beside a nerve that goes to the muscles of the face. If that nerve is damaged, you will have either a temporary or a permanent weakness (paralysis) of one side of your face. The risk of paralysis of your face is around one in 1000 patients (0.1 per cent).

There is a second nerve that supplies taste to one-half of your tongue. A temporary change in the sense of taste or a metallic taste is seen in 10 per cent of patients. Some complain about a permanent change in their taste, but this is extremely rare.

When the implant is inserted into the cochlea (inner ear), you will probably lose any natural hearing in that ear.

Dizziness is common for two or three days. Occasionally people can have dizziness for several weeks, but this is rare. If this occurs, you should call your surgeon.

There is a risk of an infection after the surgery, but it is less than one per cent. If an infection occurs, the implant may need to be removed.

If an infection occurs, there is also a risk of meningitis, an infection of the brain. The risk of meningitis immediately after surgery is one in 5,000. The risk of meningitis once everything has healed is about the same as for the general population. To lower the risk of meningitis, we'll provide information on vaccinations. We recommend discussing this information with your primary care provider.

During your switch-on appointments, you will work with your audiologist to create a MAP. A MAP consists of a variety of parameters that control how your cochlear implant will electrically stimulate the hearing nerve. This is what allows you to hear. Your MAP is unique to you.

Once we have created your MAP, the audiologist will activate your speech processor. This allows you to hear with your cochlear implant for the first time.

Patients often say that it is confusing hearing with the cochlear implant for the first time. They often report they can hear sounds but can't understand what those sounds are or mean.

It takes time and practice to learn the meaning of sounds from a cochlear implant. Some patients do this faster than others. How much you first understand does not predict how you will do later on. The more training and practice you commit to, the better you will hear.

You will work with the audiologist to prepare for life with your new implant. This includes:

• Learning how to practise listening.
• Reviewing your equipment.
• Completing a series of baseline tests.

We will repeat the baseline tests at your follow-up appointments. These will help us check your performance with your cochlear implant.