This document will provide you with the following information on the Cochlear Implant Program at the Central Speech and Hearing Clinic (CSHC) in Winnipeg, Manitoba:

• Adult criteria for cochlear implantation
• The Pre-Implant Assessment Process
• The Surgical Procedure
• The Post-Implant Process
• Appointment Schedule

ADULT CRITERIA FOR COCHLEAR IMPLANTATION

1. Severe-profound sensori-neural hearing loss, bilaterally.
2. Postlinguistically deafened (as defined by acquired deafness after the age of five years).
   Prelingustically deafened adults who use oral language as their primary mode of communication.
3. Eighteen years of age or older.
4. Little or no benefit from a hearing aid (as defined by poor open-set speech discrimination when using standardized, recorded tests).
5. Appropriate expectations and motivation.
6. Medical examination should show no contraindications for undergoing the operative or training procedure.
   a. No deafness due to lesions of the acoustic nerve or central auditory pathway.
   b. No active middle ear infection.
   c. No significant cochlear ossification.
   d. No absence of cochlear development..
   e. Radiography should show no contraindications to placing the electrode array in the cochlea or the receiver/stimulator in the mastoid.

THE PRE-IMPLANT ASSESSMENT PROCESS

To determine candidacy for a cochlear implant, we will need the following:

• An Adult Client Personal Information Sheet
• An Audiological report (audiogram) from an Audiologists 

All information should be completed and mailed or faxed to the Cochlear Implant Administrator at:

Central Speech & Hearing Clinic
Unit 2 – 1325 Markham Road
Winnipeg, Manitoba
R3T 4J6
(204) 269-5083 (fax)

Once the information sheet and reports have been received you will be contacted to arrange an Initial Information Meeting. Further meetings and assessments may include the following team members:

• Audiologist(s)
• Auditory Verbal Therapist
• Social Worker
• Speech Language Pathologist
• Otolaryngologist or Surgeon

A CT (coaxial tomography) scan of the client’s inner ears will be performed, if this has not already been done or if a more detailed one is required. An ENG (electronystagmography) or balance test will also be required and in some cases, an MRI (magnetic resonance imaging) of the head.

If you are not already wearing hearing aids, there may be a short trial of hearing aid use that may last anywhere from three to six months.

Throughout the pre-implant process, the team will determine if you meet the criteria for implantation. If you meet the criteria for cochlear implantation, you will be placed on a surgical wait list based upon the date of initial contact. If it becomes clear that you may not be a candidate, this information will be shared with you and other options may be discussed.

THE SURGICAL PROCEDURE

The following are some common questions about the surgery:

How long is the surgery?
The surgery takes about 3 – 4 hours and you usually remain in the hospital until the next day. The recovery time is fairly quick and you may feel back to normal the next day.

What are the risks involved?
As with any surgery, there are risks, which will be explained to you in detail when you meet with the ENT in Winnipeg. Some risks that the audiologist will discuss with you include increased risk of Pneumococcal Meningitis, as well as risks should an MRI be needed after implantation.

When will I start to hear?
It usually takes 2 -3 weeks for the incision to heal. The cochlear implant will be activated at least 4 weeks after surgery to allow for the incision to be fully healed. You will hear sound on the day of activation, but it will not automatically sound like speech. You will have to ‘learn to listen’ with your CI with listening practice exercises that will be provided by the CI Audiologist.

Where does the surgery happen?
Although the pre-implant assessment and post-implant programming is done at the Central Speech & Hearing Clinic in Winnipeg, Manitoba, presently the surgery is being done at various centres outside the province. You will be referred to one of several surgical centres following the candidacy process. Unfortunately, with limited surgery dates, it is not possible for you to choose your surgery location.

Is this covered by Manitoba Health?
Manitoba Health will cover all medical expenses incurred for the purposes of the surgery, as well as reimburse you for your travel costs (air fare for yourself and an escort). The internal and external cochlear implant devices are also covered by Manitoba Heatlh.

You will be required to stay in the city where your surgery is done for up to four days post-surgery to be seen by the surgeon for a post-op follow-up appointment. Accommodations, food, and ground transportation in the city are not covered by Manitoba Health; however, CHSC staff can provide you with information regarding reduced rate hotels and other assistance, if needed.

What is the cost of maintaining the cochlear implant(s)?
For the first three years after the cochlear implants are initially programmed, the implant company provides a free warranty. After the three years, you are provided the opportunity to purchase service agreements (extended warranties). We strongly recommended you purchase the extended warranties if you do not have other insurance to cover the cost of hearing devices.

THE POST – IMPLANT PROCESS

“WE’RE NOT TRAINING THE EARS. WE ARE TRAINING THE BRAIN TO INTERPRET WHAT THE EARS HEAR.”
DOREEN POLLACK, AUDITORY-VERBAL PIONEER

Everyone is different, so your audiologist will need to work with you over several appointments in order to find the right settings for your cochlear implant. The programming is done by connecting your speech processor (the external device that looks like a hearing aid) to the computer and creating a ‘map’ for the cochlear implant.

Initial programming of the speech processor will take place four to six weeks following surgery. This will require 2 consecutive days with the audiologist(s). The speech processor will be programmed frequently thereafter.

Post-implant assessments will occur regularly after initial programming of the device. Please see the Appointment Schedule section for more information on how often you will attend CSHC.

Ongoing listening practice is essential to ensure that you receive maximum benefit from the cochlear implant.

Currently CSHC does not offer listening therapy for adults, but we will provide you with training programs for you to complete at home with family and friends.

The sound you will hear from a cochlear implant will not sound like normal hearing. You will need to train yourself how to hear with a cochlear implant to improve your understanding of speech.

It cannot be predicted how well an individual will progress with a cochlear implant. 

Your progress will depend on many factors:

1. The age at which you became deaf.
2. The length of time the you have been deaf.
3. The level of family involvement and support.
4. Prior use of hearing aids
5. Personal motivation and appropriate expectations
6. Primary mode of communication.
7. Presence of cochlear abnormality 

Please be aware that the cochlear implant:

1. will not provide normal hearing.
2. will not guarantee intelligible speech.
3. will not guarantee educational/vocational success 

However, with consistent use of the cochlear implant(s), enriched spoken language environments and ongoing auditory-verbal therapy, the sound your child hears through the implant(s) will become meaningful and will enhance your child's ability to listen, hear, and speak.

APPOINTMENT SCHEDULE

Pre-Implant appointments:

1. Initial Information Meeting
2. Unaided testing – Standard hearing test with air conduction and bone conduction, as well as measurements of your middle ear (ear drum and muscle reflex)
3. Aided testing for speech understanding – You may be required to wear a pair of high power hearing aids that belong to CSHC during testing, should you own aids no longer suit your hearing loss. You will be required to repeat short words and sentences. Many people find this difficult, but all tests must be completed as part of candidacy.
4. Device Selection – Should you be deemed a candidate following the aided evaluation (and provided you are a medical candidate) you will have a one hour appointment to review the differences between the two companies that manufacture the cochlear implants we use:
   a. Advanced Bionics
   b. Cochlear Corporation
5. Pre-Surgical Appointment – This is generally a brief appointment to review any questions you may have as well as discuss where to stay and the timeline with respect to surgery and activation.

Post-Implant appointments:

1. Initial Stimulation – This is when you will be given the external components and your device will be activated. This is usually 4-6 weeks post-surgery. We will do some testing of your internal device and create your first map.
2. Day 2 – A follow-up to your Initial Stimulation, we will repeat some of the testing on the internal device and go over all the accessories provided in your equipment kit.
3. Week 1 – Regular follow-up to fine-tune your map.
4. Week 2 – Regular follow-up to fine-tune your map.
5. Week 4 – You get a break during your 3rd week of CI use and don’t have to return to the clinic until Week 4, where regular follow-up mapping is done. It may seem repetitive by now, but small adjustments can make big changes with sound quality and speech understanding.
6. 3 Month – Regular mapping. Often at this appointment speech perception testing in the sound booth is attempted in order to obtain baseline results to track progress over time.
7. 6 month – Regular mapping, equipment check and speech perception testing in the sound booth.
8. 9 month – This is an optional appointment, for those who feel extra guidance/mapping is needed.
9. Annual – Once you have reached your annual mark, you will no longer need frequent mapping. You will have a full mapping and speech perception appointment each year to ensure optimal settings are maintained. You will be contacted each year for this appointment, but are free to contact the clinic any time and as often as necessary should there be equipment or sound issues.