University of Virginia Health System

Cochlear Implant Program

Our nationally known Cochlear Implant
Program provides an opportunity to restore hearing for those who are unable to benefit from conventional hearing aids. Since 1984, the University of Virginia Cochlear Implant Program has been active in both clinical care for adults and children and research in this field.  Our multifaceted program combines technical expertise and a uniquely strong interface with educational and theraputic programs throughout Virginia and elsewhere.

• History of the UVA Cochlear Implant Program
• Anatomy of the Ear 
• What is a cochlear implant?
• Surgery for cochlear implantation
• Who is a cochlear implant candidate?
• Cochlear implant manufacturers
• UVa Cochlear Implant Team
• Aural Habilitation Program
• Ongoing research
• Contact a cochlear implant recipient in your area
• Helpful links and resources
• Recent Articles
• Contact us

Our program's first cochlear implant was performed in 1984. The implant was a single electrode device. Since that time, many more cochlear implant surgeries have been performed at the University of Virginia. Dr. Roger Ruth and Dr. Paul Lambert, now in South Carolina, started the program with a team of audiologists and surgeons. As technology advanced, so did the program. The first multi-channel device designed by the Cochlear Corporation was FDA approved and implanted at the University of Virginia in 1985. A second implant device designed by the Advanced Bionics Corporation was approved by the FDA in 1995 for adults and 1997 for children. The first implantation of this new Advance Bionics device was performed soon afterward in 1998.  In 2003 UVa began implanting MedEl cochlear implants. 

Over the past years our program has grown exponentially. We celebrated implantation of the 100th recipient in the summer of 1999 and over 350 procedures have been performed.

 

When the delicate hair cells of the cochlea become injured or deteriorate, we say the patient has a sensorineural hearing loss.  Hair cells do not regenerate, and if enough hair cells are lost, the patient has a severe or even profound hearing loss.

The Cochlear Implant

If a patient loses enough hair cells, he/she may be a candidate for a cochlear implant.  A cochlear implant is a device that converts sound energy into an electrical signal and sends the signal down an electrode directly into the cochlea, bypassing the hair cells and stimulating the usually healthy auditory nerve cells.

A cochlear implant is a device which transforms sound into electrical impulses, and then transmits these impulses to the inner ear. These electrical impulses stimulate the nerve associated with hearing, the cochlear nerve, to provide sound which can be perceived by the auditory centers in the brain. Changes in the pattern of stimulation allow for perception of a multitude of sounds.

The device that allows for this transmission of sound includes an external device to detect the sound (the microphone), a device to convert the sound into electrical impulses (the speech processor), and a device to transmit these electrical impulse patterns across the skin to the internal device. There is also an internal device which accepts these patterned impulses and transmits them down to an electrode array which is housed within the cochlea, or the inner ear. The impulses then leave the electrode array to stimulate the cochlear nerve, with perception of sound soon to follow.  Which sends the signal to the brain, where the electrical information is perceived as sound. 

The operation to place a cochlear implant generally takes 2-3 hours and is often outpatient.  An incision is made behind the ear to be implanted, and bone is removed to access the cochlea.  The electrode is placed into the cochlea, and a well is created in the side of the skull to house the internal receiver (see previous picture - "implantable cochlear stimulator").  The incision is closed, and a dressing is placed.

If you or someone you know is 18 years of age or older and have severe to profound hearing loss in both ears, you could be an implant candidate. During the audiologic evaluation the candidate is given a series of tests to evaluate understanding of speech while wearing hearing aids. If you have difficulty understanding speech while wearing your hearing aids, you may be considered a candidate for the implant.

A child (12 months to 17 years of age) with profound sensorineural hearing loss in both ears could be a candidate for a cochlear implant. Each child is given a series of tests appropriate for their age to assess basic hearing milestones in the development of his/her listening skills. If the child is unable to demonstrate these skills while using their hearing aids, then the child may be considered a candidate for a cochlear implant.

Not everyone is a candidate. Once the above audiologic criteria are assessed, the candidate is interviewed to discuss reasons for wanting a cochlear implant, and to evaluate the level of commitment by the candidate and his or her family and friends. This commitment and support are essential for successful cochlear implantation.
  

Three corporations make devices which are currently approved by the U.S. Food and Drug Administration (FDA) for cochlear implantation, all three are offered at the University of Virginia. Based in Australia with an American home in Denver, Colorado, Cochlear Corporation makes a device named the Nucleus Freedom.  The Advanced Bionics Corporation, based in California, makes an implant called the Hires 90k.  MedEl Corporation is based in Austria with an American home in Durham, North Carolina.  MedEl manufactures the Pulsar CI100.

  

The Aural Rehabilitation Program is dedicated to maximizing the success of every child who receives a cochlear implant.  The program provides numerous services for patients and for the therapeutic and educational programs who serve children with cochlear implants.

• Offer counseling sessions dedicated to the parents of newly-diagnosed children with hearing loss, including an explanation of communication choices, provision of local and national informational resources, and consultation to address concerns and questions regarding communication development in children with cochlear implants;
• Provide pre-implant evaluation of current speech, language and auditory skills;
• Serve as a resource, by providing consultation, evaluation, and in-service presentations, to educational and therapeutic programs who request assistance in the provision of appropriate rehabilitation services to children in their care;
• Provide post-implant evaluation of speech, language, and auditory skill development;
• Offer post-implant rehabilitation therapy using the Auditory-Verbal Approach.

Our team believes that adequate aural rehabilitation is an essential component to the success of children post-implantation.  Following are the principles by which we guide families through this process:

Early Intervention
The earlier the better.  Research has proven that early intervention is essential for the success of children with hearing loss.  Early identification of the hearing loss and subsequent fitting of hearing aids lessens the length of sensory deprivation to the auditory pathways. If children fail to gain benefit from hearing aids with appropriate rehabilitation, they should receive a quick referral for determination of cochlear implant candidacy.    

Aggressive Post-Implant Rehabilitation
Regardless of the method of communication the child uses, it is essential that he/she receives adequate aural rehabilitation therapy post-implantation. Although the expectations for outcomes and style of therapy can differ between the methods, all therapy should target auditory skills using normal sequences of development and should seek to attain skills at an expected rate.

High Expectations
The achievements of children are guided both by opportunity and ability.  Our team believes that children should be given the opportunity to succeed to the highest level that their abilities will take them.  There are many factors that contribute to the success of auditory skill development.  Through extensive pre-implant counseling, families are made aware of these factors and how they might impact the progress of their child.

Audiological Management
Children need to have complete and consistent access to sound in order to develop skills at an acceptable rate.  Regular appointments with our cochlear implant audiologists to evaluate the child's cochlear implant are essential to the optimal functioning of the device.  In addition, parents must maintain extra parts and batteries and become skilled at trouble-shooting, in case the implant becomes unworkable at home.     

Family Support
Parents and caregivers must be an active participant in the child's rehabilitation.  Children's first and most important teacher is their primary caregiver.  Therefore, parent training is essential for the linguistic success of the child.  Children cannot develop a functional communication system, if the only intervention they receive is in a therapy room.  Specific speech, language and auditory goals should be targeted daily in the child's home environment.

Educational Support
Professionals involved with a child in an aural rehabilitation program should create a system that allows for consistency and coordination of services.  We work hard to develop and maintain a strong working relationship with the therapeutic and educational professionals, who work with our patients.  Our program provides consultation services, as well as in-service trainings, for private and school-based professionals serving children with cochlear implants.

If you have any question regarding the Aural Rehabilitation Program or auditory-verbal therapy, please contact Lori Bobsin at (434) 982-0128.

The University of Virginia Cochlear Implant Program is actively involved in ongoing research both in the laboratory and in the Hospital. Much of this research has led to presentations at National and International Conferences, resulting in the highest possible auditory rehabilitation for our patients. Interests include hearing loss secondary to meningitis, newborn hearing screening, auditory neuropathy, new device technology, and binaural processing.

Adult Cochlear Implant Patients

Pediatric Cochlear Impant Patients

Honor Student Setting Example, Daily Progress, February 28, 2003
It's hard enough to be an honor student. Try doing it if you can't take notes...

12-year-old wants chance to hear again, Source Unknown

Cochlear Christmas (a gift of hearing) Lori Plank, MSP, CCC-SLP

University of Virginia Cochlear Implant Program
P.O. Box 800871
Charlottesville, VA  22908-0713
ATTN: Amber Gardner or Anne De Michele
Phone: (434) 982-0129
FAX: (434) 243-5207

George Hashisaki, M.D.
(434) 924-2040

Bradley Kesser, M.D.
(434) 924-2040