The Flinders Medical Centre, located in Adelaide’s suburbs, is a public hospital coupled with the Flinders University medical centre and a private clinic. Within their department of Speech Pathology and Audiology, they have had a small cochlear implant centre for 25 years. Precisely since 1986, when the first cochlear implantation in South Australia was performed with Shirley Ackehurst as the recipient.
The government’s authorization currently allow this public centre to do 10 cochlear implant surgeries every year, free of charge for the recipient. This small number means they have to go through a drastic selection to operate only the most possibly successful applicants.
Once application submitted, with all medical exams comprised, currently you have to wait for around two and a half years before having the surgery – and this only if you fulfil the demanded requirements and if your application is accepted.
1) You must be 18 years or older at the time of surgery
Younger children, including childrens less than twelve months of age may be seen for assessment at the Women’s and Children’s Hospital.
2) You must have little or no hearing in both ears
The cochlear implant device products partial hearing : it does not return normal hearing or ‘cure’ deafness. Only totally, profoundly or severely hearing impaired people are considered for the operation. The device would not be expected to provide any benefit if you had more hearing. Both standard audiometry and computerised techniques may be used to test your hearing.
3) You must gain little or no benefice from the use of hearing aids.
It is important to establish whether or not you are likely to gain more benefit from a proprely fitted hearing aid or from the cochlear implant device. Assessment of your performance using hearing aids also helps in deciding which ear to operate on. The ear with the least useful hearing will usually be selected for surgery, however, other factors may be taken in consideration.
4) You have good verbal communication skills
The development of listening, speech and language is a very complicated process. Because of this, we can only be confident that a cochlear implant will provide meaningful information if you have developed language using residual hearing.
5) Your ear must be free of infection
You will be seen by an Ear, Nose and Throat Surgeon (ENT) who will check for any external or middle ear disease. If there is any sign of disease, this needs to be treated before implant surgery is considered, to avoid the spread of infection at the time of implantation. It may also be possible that a pre-existing condition may make you unsuitable for the cochlear implant operation.
6) Your inner ear must be properly formed
The electrode array of the implant needs to be inserted into the shell-like bone in your inner ear called the cochlea. If your cochlea is not properly formed, the successful implantation of the electrode array may not be possible. Some causes of deafness can result in abnormal bone growth inside the cochlea, which may also make an ear unsuitable for the cochlear implant operation. CT scans (a type of X-ray) of both your ears are taken to determine the state of your inner ears. In some cases an MRI scan (Magnetic Resonance Imaging) may also be required.
7) Your auditory (hearing) nerve must be intact
In order for the implant device to work successfully, the electrical pulses from the implant must be passed along the auditory nerve from the ear to the brain. The brain will then register the pulses as sound. By electrically stimulating the hearing nerve and asking you to describe the sensation, it is possible to establish whether or not your hearing nerve is still working. This test is called the promontory stimulation test, an dit involves passing electrical signals to your hearing nerve via an electrode placed in your hear. This test may need to be performed in some cases.
8 ) You must be medically suitable to undergo an operation
The cochlear implant operation requires a general anaesthetic, so you will need to undergo a medical check-up before the operation.
9) You must be motivated to use the device
Adjusting to the new sound provided by the cochlear implant device can take many months and often be frustrating. You and your family are expected to participate in a post-operative rehabilitation program. Through perseverance and practice your listening and communication skills will be optimised. Your family will also learn what you are able to hear and what you cannot hear.
10) You and your family must have realistic expectations of the device
you and your family need to realise that the device will not return your hearing to normal. The sounds produced by a cochlear implant may not be the same as you remember them. However, with time and practice they should be recognisable . Before you decide to proceed with surgery, you should be aware of the limitations of the device. Your audiologist will be happy to answer to any queries and will arrange for you to meet people who have had the operation. Unrealistic expectations can lead to disappointment later on.
11) You need to be aware of the impact of the device on you and your family.
Clinicians will discuss the broad implications of the operation with you and the many adjustements issues which are associated with the procedure. You and your family may like to see a social worker to discuss expectations of the device and how these may affect your lifestyle as well as theirs.
As part of the assessment process, you and your family will be put in contact with CICADA SA. This will provide you and your family with the opportunity to meet other people who have already received the cochlear implant. It will also allow you to discuss outcomes and any issues or concerns which you may have.
Necessary assessments and selection procedures :
New referral received
> Referrals screened by audiologists to allocate priorities (Urgent/High/Medium/Low)
> Initial Assessment :
– preliminary questionnaire and written information
– hearing test and hearing aid asessment
– Medical consultation – ENT
– CT scan
> Further Assessment / Review Appointment (offered if the initial one is successful)
– Speech perception testing
– Evoked potential testing
– Expectations counselling
– Aural rehabilitation assessment
This part of the procedure takes between three and twelve months in routine cases, and is done sooner for urgent cases.
> TEAM decision + PATIENT decision = YES or NO
If YES : – Placed on waiting list for surgery
– Final pre-op appointments (audiology and ENT)
The length of this part of the procedure depends upon the public waiting list.
> Switch-on – approximately 2 to 4 weeks post-operative
> Ongoing support for around one year, continuing programming, mappings and support.
The implantees benefit from a close follow-up until one month post-operative, then the follow-up care looses until a minimum check-up every year, or every year and a half. All mappings are done at the cochlear implant centre, but the aural rehabilitation is done by the university centre, in the upper floor as the building is half-hospital half-university.
The implant centre’s team is composed of 3 audiologists and 2 surgeons, who take the final medical choice for the applicants, of 2 secretaries and one coordinator. This team currently follows 80 patients, but the great majority of the previous implantees has now moved in another city or a private clinic.
The university medical centre has also a clinic for children – Speech and Language Clinic, and early intervention for children from 18 months to 6 years.
The patients successfully implanted with a first cochlear implant and wanting to have a second one to be bilateral implantees have to do the surgery performed in a private clinic, as the Australian government consents to support the cost of only one implant by person. In this case, the costs can be supported either by the soon-to-be bilateral implantee himself or his health insurance, depending on the terms of the contract. The same conditions apply for someone who wants to receive his first cochlear implant in a private clinic. Some implantees choose this way to avoid the long waiting time before receiving the implant surgery in public medical centres.
In a nutshell, the possibility for deaf adults to receive a cochlear implant free of charge is really attractive in the first place. But you have to go through a serious battery of tests and assessments before even knowing that you're eligible, and thus being able to apply. Once done, if the medical team approves your application, you still have to wait a lot of time before having the surgery.
So it can be done indeed, but you'll need lots of time and patience to save a lot of money. If you have a private insurance who can pay for your cochlear implant, that's a good way to secure a return on the money you spent in it, and save a great deal of time.
Interview with the Clinic Secretary and Coordinator, Sandra Pickard.
For further information :
Flinders Medical Centre
Department of Speech Pathology and Audiology
Bedford Park SA 5042
Audiology Clinic Secretary – Sandra Pickard
Ph : (08) 8204 4366
Fax : (08) 8204 8941
email : firstname.lastname@example.org