Cochlear Implant

We help families whose children have received a cochlear implant, and follow these children until they reach age 18.

About

The cochlear implant option

A cochlear implant may be an option if your child:

Has a bilateral severe to profound sensorineural hearing loss
Has restricted or no useful (limited) benefit from hearing aids

Criteria

The following criteria are considered in determining a child’s candidacy for cochlear implant surgery of one ear (unilateral) and follow-up at BC Children's Hospital:

Age range of 12 months through 18 years. The earliest age a child can receive a cochlear implant is 12 months of age.
A bilateral severe to profound sensorineural hearing loss
Little or no benefit from consistent use of appropriately fitted hearing aids worn at least 3-6 months as shown through minimal
progress in auditory development
Inner ear which can accommodate the implant device/ integrity of auditory nerve, as determined by MRI/ CT Scan
No medical contra-indications, including active middle ear disease or ossification of cochlea, which would interfere with implant surgery or the post-implant (re)habilitation process
Family and/or child with good motivation and realistic expectations about the cochlear implant
Family prepared and committed to the time and travel costs associated with cochlear implant follow-up as well as the continuing costs of sound processor supplies and upgrades
Enrolment in an appropriate educational program with emphasis on development of auditory/oral skills

Bilateral cochlear implants

There are many benefits to having two (bilateral) cochlear implants such as localization (knowing where a sound is coming from) and listening in noise. The clinic has been providing bilateral cochlear implants since 2008.

A second cochlear implant may be offered to all children who meet all the following conditions:

Meet BC Children's Cochlear Implant Services criteria for unilateral cochlear implantation
Fall under one of the following categories:

Have had meningitis
Have visual impairment

Young children with bilateral profound hearing loss who get little benefit from a hearing aid in the non implanted ear
Children with sudden onset or progressive hearing loss that results in poorer or limited hearing aid benefit.
Have no other conditions that would prevent the expectation of benefit with a second implant (e.g., lack of progress in speech-language and auditory development)

Older children who have had their first implant for many years may be offered a second implant if:

They have received their first implant prior to 3 years of age
They are 10 years of age or younger
They demonstrate significant benefit from the first implant shown by a minimum of 60% open set speech discrimination.
They do not have any other conditions which would prevent safe implantation or suggest limited benefit from a second cochlear implant.

Our team

Kelly Allison

Social Worker
Kelly has been a social worker at BC Children's Hospital since 1997. She has worked in the Intensive Care Unit, the Child Protection Services Unit and on the Cleft Palate/Craniofacial team. She graduated with her Master’s degree from Wilfrid Laurier University in 1994 and then moved to BC to work with the Ministry for Children and Family Development for 2 years before coming to Children’s. Kelly began working with the Cochlear implant team in 2008.

Raegan Bergstrom

Cochlear Implant Coordinator
Raegan has worked as an audiologist, primarily in the area of cochlear implants since graduating from Western Washington University in 2004 with her M.A. in Audiology. Raegan has also recently completed her Doctor of Audiology (Au.D.) degree from Salus University in October of 2010. She began her career working with the adult Cochlear Implant Program with the Calgary Health Region for two years, and then went on work with Cochlear Americas as the Clinical Applications Specialist for Western Canada for 5 years. She recently joined the Cochlear Implant Team in August 2011.

Ruth Chia

Audiologist
Ruth has worked as a pediatric audiologist for the past 6 years after completing her M.Sc. in Audiology and Speech Sciences from the University of British Columbia in 2002. Ruth recently joined the team at Children’s in October 2008, primarily working in the Cochlear Implant Services. Prior to this, she was at The Hospital for Sick Children in Toronto working on various teams including the Cochlear Implant Program.

Samantha Gill

Audiometric Technician
Samantha has worked as an Audiometric Technician for over 6 years. She worked at the Western Institute for the Deaf and Hard of Hearing for over 5 years before joining the BC Early Hearing program in November 2011 at Children’s & Women’s. She divides her time between Screening newborns and assisting the audiologists in the Cochlear implant program and Audiology department.

Lorna Gurat

Administrative Assistant
Lorna is the Administrative Assistant for Cochlear Implant Services, in addition to the Physiotherapy and Occupational Therapy Department at BC Children's & Women's. She originally started with Sunny Hill Health Centre for Children in 1996 and has worked in various clinics and departments within BC Children’s Hospital and Sunny Hill including the Visually Impaired Program, Communication Development Department, Child Life, and Sexual Assault Services.

Cindy Gustin

Audiologist

Cindy has worked as a clinical audiologist for 35 years since graduating from the University of British Columbia in 1980. Over the course of her career in BC and Ontario, she has worked as an educational audiologist, in a centre for special needs children and adults providing diagnostic and rehabilitation services and in hospital settings with both children and adults. Cindy previously worked at BC Children’s Hospital from 1988 to 2000 with the Visually Impaired, Neonatal Follow-up, Cleft Palate and Craniofacial and Cochlear Implant teams. During that time she taught the Pediatric Audiology course for the School of Audiology and Speech Sciences at UBC. For the past 14 years, Cindy has worked at St. Paul’s Hospital in Vancouver , most recently as the Professional Practice Leader in Audiology and Co-ordinator of the BC Adult Cochlear Implant Program with clinical work in Cochlear Implants. She has a particular interest in cochlear implants, visual impairment and assessment of difficult-to-test children. She is delighted to be returning to Children’s in a clinical capacity and to be working with people who are shorter than she is.

Fred Kozak

Head, Division of Pediatric Otolaryngology
Medical/Surgical Director
Dr. Frederick Kozak is the Pediatric Cochlear Implant Surgeon for the province of British Columbia. He received his BSc. in Anatomy
from the University of Saskatchewan and his M.D. from McMaster University. After completing resident training in Otolaryngology from the University of British Columbia he undertook a Pediatric Otolaryngology Fellowship at Seattle Children’s Hospital. Dr. Kozak has been on staff at BC Children’s Hospital since 1992 and has been Head of the Division since 1996. Over the past several years Dr. Kozak has trained several fellows (surgeons in training) from around the world, cochlear implantation and otologic surgery.

Donna Myer

Audiologist
Donna has been with Children’s since 1993; first on a part-time basis and full-time since January 2002. She has also worked in a private practice hearing aid clinic and in the Neuro-otology Clinic at VGH since graduating with her Master of Science from McGill University in 1993. She obtained a Bachelor of Nursing degree from University of Manitoba in 1989 and worked as a nurse for three years before returning to university. She enjoys all aspects of working in pediatrics, but her special area of interest is cochlear implants.

Prepare

Evaluation process

Once the Cochlear Implant Team has received a referral for your child, the team coordinator will contact you and send you an information package. If you are interested, a family meeting with the team coordinator will be arranged.

At the meeting with the team coordinator you will be provided with information about cochlear implants. The coordinator will also explain the assessment process and answer any questions you may have.

Following this, if you wish to proceed, several appointments will be booked with different members of the interdisciplinary team to help determine if a cochlear implant is an option for your child.

The Candidacy Assessment includes:

Audiology review to measure the child’s hearing levels, and evaluate hearing aid benefit
A review of the early intervention services that the child has received, and how the child has progressed
Medical review to ensure that the child does not have any medical conditions that might prevent the use of an implant.
Vaccination evaluation
Social work appointment
A CT and MRI scan of the inner ear (similar to x-rays) to ensure the inner ear is suitable for insertion of the electrode array

Families can expect a minimum of 6 appointments for the evaluation process.

For out of town families we try to coordinate appointments so that there is less travel.

Once these assessments are complete, the Cochlear Implant team will discuss the results, and determine whether a cochlear implant is recommended. If your child is a candidate for implantation, your family can then decide whether to go ahead.

Surgery

The surgery is done in the operating room at BC Children’s Hospital under general anesthetic. Dr. Kozak is the pediatric cochlear implant surgeon of B.C.

The surgery usually takes about 4 hours and the children usually stay one night after the surgery for monitoring.

One week after surgery there is a follow-up appointment with Dr. Kozak.

It generally takes 3 to 5 weeks for the surgical incision to heal, but most children resume normal daily activities within days after the surgery. However, no active sports or climbing is recommended for 6 weeks after surgery.

Patient handouts

Follow-up

After surgery

Approximately 1 month after the surgery, the child will return to BC Children’s Hospital to have the implant activated.

At the time of activation, your Cochlear Implant audiologist will set up one or more listening programs for your child. This process is called “mapping”. For the first year after surgery, the child will need to be closely followed every 3 months. These appointments will occur at BC Children’s Hospital.

Follow-up appointments

Generally, families can expect 6-8 follow-up appointments for the first year after the child receives the cochlear implant. After the first year, it is 2-3 appointments per year and then later once a year.

In addition to these appointments, participation in early intervention services is an essential part of the process of learning to hear with a cochlear implant. Early interventionists are qualified professionals with experience working with babies newly identified with hearing loss. They provide families with the information they need to help their child develop early communication (including listening, language, and speech).

We encourage you to work with your early interventionists and cochlear implant audiologist to discover what communication approaches work best for your own baby and family however, it is important to have an emphasis on auditory training.

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Provincial Health Services Authority