Cochlear implants have been proven to be beneficial for children who are born deaf and have been a boon for those who cannot hear completely.

A 24-year-old man suddenly lost his hearing in both ears while studying at the undergraduate level. He experienced suicidal thoughts as a result. However, he has since regained his hearing with a cochlear implant, and happily shares how he feels after the experience.

We also knew a lady who had to endure a very challenging life with complete hearing loss for 16 years. However, after receiving a cochlear implant at the age of 27, she began to enjoy hearing life once again and experienced a significant change. She is now able to share the reality of these positive changes in her life.

Parents of children born deaf with delayed speech and language development have been stigmatized as "parents of the deaf and dumb" by society, although this is not appropriate terminology nowadays. However, we now have the pleasure of connecting with many of these parents and seeing tears of joy in their eyes as their children begin to call them "mom and dad" after receiving a cochlear implant and proper speech therapy.

As doctors, audiologists, and speech-language pathologists who work with cochlear implant patients, immersing ourselves in various sensations, experiences, emotions, and feelings brings us a unique sense of joy. If you are a Nepali in need of treatment and are wandering, it is important to know that you can receive treatment for such problems in Nepal.

What is a cochlear implant?

A cochlear implant is a modern device that works like the human ear and can be used to make hearing-impaired people able to hear. A cochlear implant has two parts. One part is surgically inserted deep into the skin and muscle behind the ear and connected to a wire electrode into the inner part of the ear, cochlea. The other part is called the sound processor, which remains outside the skin and is attached to the inside by a magnet. The externally connected part contains a microphone through which environmental sounds reach the sound processor. The various sound energies from the processor are split into radiofrequency signals to the implant which leads to the electrode placed in the cochlea. From there, this electrical information reaches the brain via a nerve, called the cochlear nerve and the sound is heard. A cochlear implant thus bypasses the damaged inner ear (cochlea) and transmits sound to the brain.

Who can get a cochlear implant?

1. Cochlear implants have been proven to be beneficial for children who are born deaf and have been a boon for those who cannot hear completely. Without a timely diagnosis, these children may not be able to speak. However, with a cochlear implant and speech therapy, a child's speech can be improved to a normal level. Due to illiteracy and a lack of awareness, when this problem is not recognized on time, it can delay cochlear implantation and impede the development of speech and language. Thus, in the case of a congenitally deaf child, it is very good if a cochlear implant can be done before the age of three years, but after six years, even if the hearing ability can be improved through the cochlear implant, there may not be good progress in the development of speech (spoken language).

2. In case of complete hearing loss for any reason in people who can hear and speak well, the cochlear implant is the only solution that can restore hearing. Among the causes of complete loss of hearing, chronic ear diseases, typhoid fever, meningitis, measles and other viral infections of the inner ear are more common. Cochlear implants can also be beneficial for those who have lost their hearing due to the use of various ototoxic medications.

3.  Untreated long-term ear infections can lead to inner ear infections and permanent hearing loss, which can also be treated with cochlear implant surgery and restore hearing.

4. After experiencing hearing loss due to age-related changes in the inner ear, specifically in the cochlea, hearing aids are required for better hearing. In case a hearing aid does not improve listening effectively, a cochlear implant becomes an alternative.

5. A cochlear implant can be used to gain the benefits of binaural hearing when one ear is completely impaired for any reason. With hearing loss in only one ear, the person may have difficulty in determining the direction or distance of the sound's source; also the sound cannot be understood properly in crowded or noisy places. A cochlear implant is the only option for getting back binaural hearing in these cases.

6. Other ear problems, such as Auditory Neuropathy Spectrum Disorder (ANSD) and Advanced or Cochlear Otosclerosis, can also be treated with cochlear implants to improve hearing.

Delusion and reality

 There is a misconception in society that a non-hearing and non-speaking child will hear and speak as soon as cochlear implant surgery is performed. A cochlear implant can enable a deaf person to hear, to understand speech and to speak only after he/she undergoes specific and additional training. Without this training, the surgery will be ineffective. Proper fitting of the external sound processor is also crucial in enhancing hearing with cochlear implants.

Some people have also contacted me to inquire if cochlear implants can enable a congenitally hearing-impaired person over the age of 30 or 35 to speak. A cochlear implant does not benefit congenitally hearing-impaired individuals over the age of 30 or 35. After the brain has fully developed, the parts responsible for hearing and speaking cannot be developed further. Therefore, it is better not to encourage such cases for cochlear implantation by showing emotional support.

Current arrangements for cochlear implants in Nepal

Although there are many people in Nepal who need cochlear implants, the number of people who actually use them is very low. Among the reasons for this are the high costs involved and the extensive recovery practice process after the surgery. Apart from this, a lack of technical knowledge and skilled manpower is another reason. For people who were not able to undergo treatment with a cochlear implant due to their low economic situation, there has been support from the Nepal government since 2074/075 BS. According to the current arrangements, the government provides financial support of Rs 650,000 per person who needs to use a cochlear implant.

Conclusion

To get the maximum benefit of a cochlear implant, proper surgery and appropriate and correct mapping with proper training and therapy are equally important. It is teamwork of the service provider, family of the patient and society to make the cochlear implant program a success. The cochlear implant program cannot be successful if the surgery is performed, but mapping and therapy cannot be attended or arranged. It's very important to follow and practice these three-categories of cochlear implant programs to defeat hearing disability.

 
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