A blog about finding out more about cochlear implant technology, choosing between different implants, and wondering what it will be like to have surgery.
My husband and I have become very boring, each of us with one topic dominating our thoughts and threatening to impinge on every conversation. His t-shirt says ‘Ask me about my retirement’ (an eagerly anticipated milestone in 2021) and mine ‘Ask me about my cochlear implant’. Spare a thought for our children here. But now that this is really happening, I find it has become uppermost in my mind and is currently keeping me awake at night. I am very, very, aware that I am fortunate to be preoccupied with elective, potentially life-enhancing surgery, with none of the mental and physical anguish that I imagine accompanies the run-up to surgery for people who are ill or in pain.
A digression – imagining surgery
So, in my luxurious position, what is it that I am thinking about in the wee small hours? Partly it’s mulling over what I’ve read about the different implants, essential homework as I need to make a choice between them. More of that in a bit. But I also start imagining myself undergoing this surgery.
Now, I have experience from my years as a nurse of accompanying patients to theatre and caring for them afterwards, plus a few weeks as a student working in theatres. But this will be my first time on the receiving end. I find myself thinking about trivial things. Like will I have to wear a split-up-the-back gown and will my bottom hang out of it? I wonder what music the surgeon likes to play, having heard from a friend recently about one who started every operation with Club Tropicana by Wham! I wonder if the recovery nurse will think to give me my hearing aid for my non-implanted side, or if both ears will be swathed in a bandage. A bandage which I imagine to be of cartoon proportions but swapped for a small plaster as I leave hospital (with luck) later that day. I wonder how soon I will be able to have a cup of tea, and whether it will be hot. I wonder about pain. I went through childbirth without drugs, instead sniffing lavender on a hankie. Fool. This time, I imagine saying “GIVE ME THE DRUGS!” but actually being sent off with instructions to take a couple of paracetamol. I imagine being at home afterwards and not having the cat on my bed while I’m lying down, as he once bit my head. Well, gummed it, as he hardly has any teeth, but probably not great on the infection prevention front.
Cochlear implants – the basics
I need to stop thinking about all that and get to grips with CI technology. If I am going to be entrusted with this amazing bit of kit, I am determined to learn all I can to get the best out of it. But first, before surgery, I need to choose between two brands of implant.
Let’s take a step back. What are these things?
The external parts of a cochlear implant are a microphone, a sound processor and a transmitter coil. The first two are usually on a behind-the-ear device which looks very similar to a hearing aid, but without the mould. The microphone (you’re ahead, I know) picks up sound, which the processor converts into digital signals and sends to the transmitter coil. The coil is the bit sitting a little way off from the ear. One of the brands also has an option to have all three in one device, away from the ear. Imagine that as a plastic bottle cap stuck on your head, but a really, really expensive one.
The internal parts are the receiver or stimulator with a magnet, which sits under the skin and holds the coil over the receiver. The receiver picks up those digital signals from the coil and sends them to a set of electrodes in the cochlea. These electrodes do what the hair cells should do, hair cells that are now damaged or have gone AWOL, sending signals to the brain via the auditory nerve. Signals that the brain learns, over time (and CI users have to put in the work to help it), to recognise as sounds. Amazing! Though how good a result anyone will get is hard to predict and depends on multiple factors.
Image: ‘A humorous image of two men wearing a revolving hat’, with attachments for eye glass, cigar, scent box, spectacles and hearing trumpet (1830s). Credit: Wellcome Images (details below).
How do different cochlear implants compare?
The good news is that the rival brands of CI are, as far as the professionals are concerned, comparable, and I’m told I’m suitable for either. I’m given brochures for each company and left to make the choice. Once I’ve chosen, I stay with that company for life, so it feels important to consider this carefully.
I read through the brochures and note my reaction to the accompanying pictures. I have more than a passing interest in this, as in my job I have been involved in creating some guidance on choosing images for sharing evidence and choose pictures to go with the health information we share from Cochrane UK. Most of the photos are of smiling people living their best lives, with a clear message that cochlear implants make many things possible. I note I don’t like seeing the photo of the surgeon, scrubbed and peering into his surgical microscope, although it’s the kind of image we might choose at Cochrane UK. Nothing gory, so why not? But I might think twice about this now, having discovered that even a pretty innocuous photo of an operation in progress might be off-putting to someone who then pictures themselves on the table!
One of the companies offers implants in lovely colours and I would really like to be able to choose Caribbean Pirate (teal) or perhaps Princess Pink (though I dislike the gendered name) rather than Inevitable Beige, Can’t Find It Black or Best of A Bad Lot Silver. Shallow, I know, but I love to wear bold colours and this thing is going to be a permanent accessory! However, this isn’t an option on the NHS, so I move on to other details.
It’s funny to note the things that influence us, things we can recognise as really NOT the things that should be informing our decisions. I like the sound of Advanced Bionics rather better than its rival company, Cochlear. I feel like the people working for the latter must have expended all their energies on developing this incredible technology and then just looked at each and said “shall we just call it ‘Cochlear’?” “Yeah why not?”
A glimpse of amazing possibilities
I read a review of one of the latest implant from Advanced Bionics and it gives me a glimpse of possibilities I hadn’t imagined – of things I might (might…) hear again and never expected to. The reviewer mentions it enables him to hear “subtle environmental sounds, such as the collar of my shirt rubbing against my neck”. Whaaaat! It’s fair to say that this is not something I’ve missed and, ridiculously, I have this sudden thought that perhaps I’ll be able to hear spiders moving… I’m frightened of spiders and have found it both surprising and appalling to learn that anyone can hear this! Still, got to take the rough with the smooth, right?
There are more surprises, and frankly I expect to be constantly astonished for a while, until I’m reading things about implants that I’ve already come across. “While conversing in a car, music would play quietly underneath speech, but would become louder and clearer when speech stopped.” What kind of magical devices are these implants?!
I find myself wishing I had a comparison chart, the kind of thing you can get to compare washing machines and the like. I later find a comparison chart, and there’s lots of useful information on this Cochlear Implant HELP site. Also, the University of Southampton Auditory Implant Service has a device choice resource, with some really useful information. It’s just a shame for me that they don’t offer Advanced Bionics so most of their information doesn’t include that company.)
Waterproof covers – check!
Rechargeable batteries – check!
Astounding technology enabling the wearer to hear a small bird cough in a distant tree – check!
They both do all sorts of wonderful things, such as making adjustments depending on the sound environment using artificial intelligence and connecting with smartphones and Bluetooth-enabled devices. Calls and audio can be directly streamed to the implant. They’re also both compatible with MRI scanners. It’s all a bit mind-boggling.
Then there’s the possibility of a hearing aid on the other side that ‘talks’ to the implant (this is known as a ‘bimodal solution’). I’m impressed that when I ask the surgeon about this he admits that it’s unclear whether this results in tangible benefit for wearers. I like his focus on things that matter to the people on the receiving end.
Peer support from a cochlear implant group
Hearing from people living with cochlear implants is surely where I might get some useful information to supplement the technical spec in the brochures. I’ve joined a group (online only at the moment) of people waiting for a cochlear implant and others who already have one. I ask them why they chose the implant they’ve got and what they like about it. I get lots of useful replies. Some people received their implants many years ago and of course the technology has changed; others are more recent recipients. Incidentally, everyone gets an upgrade every five years – brilliant!
They are a helpful, friendly bunch, and aside from the usefulness of hearing about their particular implants, it is so lovely to read how much they’re benefiting from them. I’m also encouraged by one person’s summary – “you can’t choose a bad make!” and this is what I’ve been told by hearing professionals too.
So what’s the bottom line? Cochlear implants offer amazing possibilities. The offerings from the different companies are very comparable and all choices are good choices. But forget the fancy colours!
Page updated on 28 April 2021.
Wellcome Image credit: A humorous image of two men wearing a revolving hat’. This file comes from Wellcome Images, a website operated by Wellcome Trust, a global charitable foundation based in the United Kingdom. See Wellcome blog post (archive). https://commons.wikimedia.org/wiki/File:A_humorous_image_of_two_men_wearing_revolving_top_hats_Wellcome_V0015848.jpg See page for author, CC BY 4.0 https://creativecommons.org/licenses/by/4.0, via Wikimedia Commons
I think an important consideration in being bimodal is that even if it does not improve comprehension it keeps the other ear listening should the cochlear implant in the other ear have to be removed for some reason. The auditory nerve on the hearing aid side will have some continuous function and may adjust to a replacement cochlear implant more easily.