Cochlear Implants

Welcome to the South Wales Adult Cochlear Implant Programme!

Here you will find a wealth of information about cochlear implants and the services we provide.

Please use the tabs on the below for further information

Contact Details

If you wish to contact the adult cochlear implant team, please use the following email address.

implantable.devices.cav@wales.nhs.uk

Medical Emergency

If you have a medical emergency please contact your local A&E Department. If you have a medical concern during working hours please contact the Cochlear Implant Team on the contact details above, outside of normal working hours contact NHS Wales 111 Service for advice.

What to do if a battery is accidentally swallowed:

In the event of battery ingestion, seek immediate medical attention at your local Accident & Emergency Department.
Do not eat or drink until an X-ray can determine if a battery is present.
If you still have the battery packaging or the device containing the battery take this with you to help the doctor identify the battery type and chemistry.

Batteries

Disposable batteries are available from us and can be requested using our email address or telephone numbers as listed above. However, we recommend the use of your rechargeable batteries when these are provided.

How We Hear

In a normally-hearing ear, the outer part (the pinna) catches sound waves and directs them into the ear canal and towards the eardrum, causing it to vibrate. The eardrum is attached to three bones in the middle ear known as the ossicles. These bones strengthen the vibrations from the eardrum and pass then to the inner part of the ear, known as the cochlea.

The cochlea looks like a snail shell and is filled with fluid. It also contains thousands of sound-sensitive cells, called hair cells. The vibrations entering the cochlea from the middle ear cause the fluid inside the cochlea to move, and the hair cells to bend (like the movement of seaweed on the seabed when waves pass over them).

This hair cell movement causes electrical nerve signals to be sent from the cochlea, along the auditory nerve, to the brain where they are recognised as sound.

Hearing Loss

Hearing loss (or deafness) occurs when one or more parts of the ear are not working properly. There are two main types of hearing loss:

1. Conductive hearing loss

This happens when the sound waves cannot pass efficiently from the outer ear and middle ear to the inner ear. For example:

Wax blocking the ear canal
Fluid in the middle ear (glue ear)
Perforated eardrum

A conductive hearing loss can be either temporary or permanent, depending on the cause.

2. Sensorineural Hearing Loss

This happens when the inner part of the ear (the cochlea) isn’t working effectively, usually because of damage to the hair cells. Sensorineural hearing losses are usually permanent.

It is also possible to have a combination of a conductive and sensorineural hearing loss, known as a mixed hearing loss.

Hearing loss is classified as mild, moderate, severe or profound, depending on what sounds a person can hear. The diagram below shows the categories of hearing loss on a hearing chart, called an audiogram.

Conductive hearing losses usually cause a mild or moderate hearing loss. Sensorineural hearing losses usually cause permanent deafness which can be of any severity.

A cochlear implant may be suitable for adults:

with a bilateral (in both ears), severe to profound sensorineural hearing loss, where the hearing loss is worse than 80 dB at 2 adjacent frequencies, bilaterally
who find that conventional hearing aids no longer give them benefit

What is a cochlear implant?

A cochlear implant is a small electronic device that can provide a sense of sound to a person with a severe or profound hearing impairment. They may be suitable for children or adults who receive little benefit from conventional hearing aids.

All cochlear implants have external and internal parts.

The external part consists of a sound processor and transmitter coil. The sound processor is worn behind the ear and has a microphone to pick up the sounds. The transmitter coil passes sound information from the processor to the internal part.

The internal part is implanted into the inner ear (cochlea) during surgery. It consists of a receiver placed under the skin just above and behind the ear, and an electrode array which goes inside the cochlea.

Both the external transmitter coil and internal receiver contain magnets to allow the transmitter coil to stay in the correct position on the head.

Sounds are picked up by a microphone on the sound processor and are sent to the transmitter coil on the outside of the head. This sends it to the receiver coil underneath the skin.

The receiver coil then sends electrical pulses into to the cochlea where they are received by different points of the implant called electrodes.

The electrodes stimulate nerve fibres in the cochlea, sending information along the auditory nerve to the brain, which recognises the signals as sound.

A cochlear implant can only help a person to hear sounds when it is worn. It does not give normal hearing, and the person will not be able to hear anything when the processor is not worn.

How does a cochlear implant help?

A cochlear implant by-passes the damaged hair cells in the cochlea and activates the hearing nerve directly. People with profound hearing loss can therefore experience hearing sensations that they cannot get from a hearing aid. The sounds are not exactly the same as natural hearing, but loud and clear enough to detect and identify environmental sounds and begin to understand speech with the help of lip reading. Intensive rehabilitation is then needed to help the person to start making sense of the sounds.

Rehabilitation

This is the process used to maximise the new hearing that you receive from your cochlear implant. It helps to develop your understanding of sounds and assist with discrimination and identification of sounds, including speech.

Learning to listen and make sense of sounds you have not heard in a long time is not easy, therefore you need to be consistently exposed to sound during all waking hours. You will gradually begin to recognise sounds, such as the doorbell, telephone, washing machine etc., and in time you may recognise your name but it will take a lot of patience and work.

We will also focus on listening skills such as discriminating (hearing the difference between) specific speech sounds, discriminating between words with different syllable numbers and recognising routine phrases.

The success of an implant has many variables, for example why a person loses their hearing, how long they have been deaf, their use of hearing aids, general health and well-being, use of processor and commitment to rehabilitation programme. It is important to remember that not all implant users can use the telephone, enjoy music or watch the television without subtitles.

You will always be profoundly deaf. We will only recommend a cochlear implant if we feel that there is more benefit to be gained from an implant than from continuing to be a hearing aid wearer. If you are suitable for an implant we will be fully committed to your future progress and working closely with you and your family/significant others to achieve the optimal outcome for you.

Assessment process

The cochlear implant assessment procedure can take between 3 and 9 months. This time is necessary to determine if your child would benefit from cochlear implants (CI). During this time everyone involved in making a decision about cochlear implants (family & professionals) can gather all of the information needed.

Step 1: Referral to adult’s cochlear implant co-ordinator

Step 2: Initial appointment for information giving and audiological assessment

Step 3: Appointment with audiovestibular consultant to discuss medical suitability

Step 4: CT/MRI scans

Step 5: Joint decision made between patient and professionals on whether to proceed with cochlear implants

Step 6: Meet with another implantee

Step7: Cochlear implant operation

Step 1 - Referral

The initial referral is usually made by your local audiologist or ENT consultant. An initial appointment will then be arranged for you.

Step 2 - Initial Appointment

This is an opportunity for you to find out all about cochlear implants, and can ask as many questions as you like! It is also an opportunity for us to gather as much information as possible from you, including medical history and cause of deafness, and discuss these issues with you. We will also explain what the operation involves, and the risks involved.

We also need to ensure that you and your family/significant others are aware of the limitations of a cochlear implant and have the appropriate expectations for the future. Not all implantees gain the benefit that they might hope for and therefore reassurance and support from family and significant others is very important. Sometimes we issue homework and the support and encouragement of your friends and family will be very helpful in assisting you with this.

Hearing assessments

We will also do some hearing tests. These will be similar to the tests usually done at your own local audiology clinics, but will also include additional tests to determine what benefit your current hearing aids are providing. This will indicate whether cochlear implants or hearing aids will provide the best sound for you. Sometimes it is necessary for new hearing aids to be fitted and tried for a set period of time.

Step 3 & 4 - Appointment with audiovestibular consultant

An appointment will then be made for you with an Audiovestibular consultant to discuss medical suitability for CI surgery. CT and MRI scans will be arranged to assess the condition of your cochleas.

Step 5 - Joint decision made between patient and professionals on whether to proceed with cochlear implants

When we have all of the information that we need to make a decision on whether you are suitable for cochlear implants, we will invite you to attend an appointment with the ENT surgeons, Audiovestibular consultant and CI co-ordinator or audiologist. During this appointment we will discuss with you all of the results and whether you and the cochlear implant team are happy to proceed with an operation to give you a Cochlear Implant.

Usually only ONE implant is offered but in special cases (where a person is registered blind) TWO implants may be offered.

Step 6 - Meeting another implantee

Professionals can give you a lot of information, but talking to another person who has been through the whole cochlear implant process can be invaluable. We always offer this opportunity during the assessment process.

Cochlear Implant Surgery

The operation is carried out at either the University Hospital of Wales in Cardiff or Llandough, and is performed by a team lead by one of our experienced Consultant ENT Surgeons: Mr Roblin, Mr Williams or Mr Hall.

Surgery is usually done under general anaesthetic and usually takes around 2 hours. You may need to stay in hospital for one night.

During the operation, the implant is placed under the skin and the electrode inserted into the cochlea. The skin is closed with stitches that fall out naturally and a bandage is wrapped around the head to protect the ears and the scars. The bandage needs to stay in place for 48 hours.

A post-op x-ray will be carried out to check the position of the implant within the inner ears, and an appointment will be made for you to return to the hospital in one week to check the ears again.

It is normal for the scar to look a little red in the first few weeks but this will improve in time.

Switching-on the processors

This is done approximately 4 weeks after surgery.

During the appointment, the audiologist will check the ears and scars and ensure that the processor is fitting well. Some checks will be carried out to find out what level the implants need to be for you to start hearing with them. The processors will then be switched on at very quiet levels.

It is impossible to predict how someone will react when the processor is switched on for the first time. The initial sound level is very low and you will be given as much sound as is comfortable for you, but the aim of the switch-on appointment is to provide you with a low level of sound that you can gradually get used to at home until the next tuning appointment. It is important that you wear the processor as much as possible from now on.

During the initial tuning appointments, the maps (sound levels) will adjusted to make sure the sounds are comfortable and are at optimal levels for you. It will take weeks or months to learn to listen to and make sense of the sounds with the cochlear implants.

After the switch-on appointment, further tuning appointments will be arranged for:

1 week

1 month

3 months

6 months

12 months

After this, tuning appointments will usually be every two years years. However, additional appointments can be arranged if required.

About us

The University Hospital of Wales Adult Cochlear Implant Programme began in 1995. It has gradually expanded and is now a well established, highly professional centre based in clinic 7 of the adult out-patient department. The team have developed a wealth of experience implanting adults with a range different audiological backgrounds.

Aim of the Programme

To provide a high quality cochlear implant programme at Cardiff and Vale University Health Board.
To provide a programme with lifelong commitment to patients.
To meet all of the British Cochlear Implant Group recommendations/Quality Standards

The Adult Cochlear Implant Team

Our team consists of a range of professionals who work closely together and with other local professionals.

Mr Rhodri Jones Consultant ENT Surgeon

Mr Graham Roblin Consultant ENT Surgeon

Mr Andy Hall Consultant ENT Surgeon

Dr Deepak Rajenderkumar Consultant Audiovestibular Physician

Heidi Williams Implant Lead and Advanced Audiology Practitioner

Rhian Hughes Chief Audiologist

Eirwen Jones Chief Audiologist

Steve Jaques Chief Audiologist

Hannah Winters Rehabilitationist

Gemma Saxelby Rehabilitationist

Vanessa Sadler Specialist Speech and Language Therapist

Tracy Hughes Cochlear Implant Administrator

Faulty processor and replacement parts

Please make sure that any broken cables or coils are replaced from your child’s kit as/when required so that he/she is always able to use the device. If spare and/or replacement parts are needed, please contact the manufacturer of your child’s implant, as listed below

Advanced Bionics

Please contact “AB4U” for spares and repairs, who will send them directly to you.

Phone: 01223 847 888

Mobile: 07827 324211 (SMS only)

Email: customerservice.gb@advancedbionics.com

Cochlear

Please contact “Cochlear Care” for spares and repairs, who will send them directly to you.

Freephone: 0800 035 6318

Direct Line: 01932 263 630

Mobile: 07767 167 824 (SMS only)

Email: ukcare@cochlear.com

Address:

Cochlear Europe Ltd
6 Dashwood Lang Road
Bourne Business Park
Addlestone
Surrey
KT15 2HJ

MED-EL

Please contact “MED-EL Direct” for spares and repairs, who will send them directly to you.

Freephone : 0330 123 5601*

Mobile: 07930 363351 (SMS only)

Email : direct@medel.co.uk

*Please check with your network provider as fees may apply

Useful links

The British Cochlear Implant Group (BCIG) is a professional body run by healthcare professionals and other interested parties, representing all the cochlear implant centres and other specialists involved in cochlear implantation in the UK.

The Royal National Institute for the Deaf (RNID) information on all aspects of hearing loss, including a wide range of leaflets and fact sheets.

Battery safety information

Manufacturer Specific websites and information leaflets

Cochlear

MED-EL

Advanced Bionics