How to choose the right cochlear implant - Part 2

Hi everyone, welcome to part two of the series on selecting the best cochlear implant for your child or an adult. In the previous blog, we covered the leading cochlear implant brands available in India. In this post, I’ll dive deeper into the device itself. In this specific blog—we’ll focus on the implant, and I will create Part 3 for the in-depth review of the processor. Before we begin, I want to let you know that I’ll also publish a separate blog explaining how cochlear implants work in more detail. But for now, I’ll provide a brief overview.

A cochlear implant consists of two parts:

1. The implant: Surgically placed behind the ear, under the skin.
2. The processor: This sits outside the ear and transmits signals to the implant.

Cochlear implants bypass the outer and middle ear and directly stimulate the cochlea, transmitting sound signals to the auditory nerve. I’ll cover the anatomy of the ear and how cochlear implants work more thoroughly in a future blog, but this should give you a basic understanding for now.

Let’s get into the first part of this blog: the implant. The implant is incredibly important because, once inserted, you are essentially committed to that brand or company for life. Replacing an implant involves surgery, which is not only expensive but also a traumatic experience, especially for young children. Therefore, choosing the right implant is critical.

Key Questions to Ask About the Implant:

1. What type of electrode is best suited for you?
   It’s important to discuss with your surgeon whether any abnormalities in the cochlea have been detected through MRI or CT scans. If abnormalities exist, certain electrodes may be more appropriate. Cochlear implants have electrodes that wrap around the cochlea, which is a spiral structure. These electrodes can either be positioned close to the auditory nerve or further away. The proximity to the auditory nerve can affect the implant’s performance, so it’s important to ask your surgeon which type of electrode is most suitable for your case.

2. Is the implant MRI-compatible?
   Both Cochlear and Advanced Bionics claim their most advanced implants are MRI-compatible up to 3 Tesla. However, there’s a difference between basic MRI compatibility and “true” MRI compatibility. For example, Advanced Bionics implants are fully MRI-compatible without any conditions, while Cochlear’s may require the head to be positioned at a specific angle for safety during MRI scans. While MRI compatibility may not be a deciding factor since MRIs are not frequent procedures, it’s still something to confirm with your company representative.

3. What is the reliability report for the implant?
   The reliability report shows the success rate of the implant over time—how many implants remain functional after one year, five years, and beyond. This is crucial information because implant failure is the worst-case scenario. Failure means that after surgery, the implant doesn’t work during activation or stops working soon after. Ask for the latest reliability data from the company representative to ensure you’re making an informed choice.

Additional Considerations:

While these are the three main points to focus on, there are other factors, such as how electrodes function and create virtual channels, how much additional capacity they hold to ensure they are compatible with future technology upgrades, how frequently and quickly the electrodes stimulate the nerves, what Db range do they operate in. However, there’s no definitive data showing the superiroity of one implant over another on these factors, so the top three questions should be your primary focus.

Now, let’s briefly touch on the processor. Advanced Bionics claims that their processors, backed by the Sonova Group and Phonak, offer superior sound capture and processing technology. On the other hand, Cochlear emphasizes its long-standing legacy and proven success with processors and they also offer two variations of processors giving users more choice. However, no conclusive data shows one company’s technology is better than another. Therefore, your decision shouldn’t hinge on which processor has better technology, but rather on which implant can give you better results. Every company is innovating and converging on processor technology so current technology differences in processors will not matter much in mid to long run. I will cover more on the processor in part 3 of this series

Stay tuned for Part 3 of "How to select a cochlear implant" to learn more about the processors !!