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Apelian Cochlear Implant Center

Apelian Cochlear Implant Center

1554 Northern Boulevard Manhasset,  NY  11030

Phone: (718) 470-8339

The North Shore-LIJ Health System is a recognized leader in newborn hearing screening, early identification and treatment of hearing loss. The Apelian Cochlear Implant Program at Long Island Jewish Medical Center is a natural extension of this comprehensive and coordinated approach to hearing health care for individuals throughout the life span. The Center provides specialized services for individuals with severe to profound hearing loss who cannot be helped with conventional hearing aids. The implant center provides a full range of services for the evaluation, treatment and rehabilitation of children and adults who may benefit from cochlear implants.

Located on the Queens-Nassau border, the center was established to fill a need for cochlear implant services in the Queens/Long Island area.

The professionals at the Apelian Cochlear Implant Center are highly trained and experienced specialists ready to serve hearing impaired individuals and their families with expert and compassionate care. The Cochlear Implant team includes neurotologic surgeons, audiologists, speech-language pathologists, a social worker, and an educator. This team of experts assists our patients through every step of the cochlear implant process to help them make informed decisions and derive the maximum benefit from the implant. Families and educators are invaluable members of the team providing constant day to day support for the implant recipient.
 

What is a Cochlear Implant?

A cochlear implant is a surgically implanted device designed to bypass damaged sensory cells in the inner ear (cochlea) and provide sound sensation to individuals with severe to profound deafness.

Most sensorineural deafness is caused by damaged or missing hair cells (shown in green in the above illustration). Auditory neurons, however, often survive and can be stimulated by electrical current passed through an electrode that is placed in the cochlea.

The internal device consists of an antenna that receives coded electrical signals from the external speech processor and sends the signals to the electrode within the cochlea where they stimulate auditory nerve fibers.

An externally worn transmitter sends coded sound information to the electrodes which, in turn, stimulate surviving neurons in the cochlea.

External cochlear implant equipment is designed to wear behind the ear like a hearing aid. The speech processor consists of a microphone that picks up sound, a computer chip that processes and digitizes the sound, and a coil that transmits the electrical pulses to the internal receiver that sits under the skin, behind the ear.

The transmitter coil connects to the internal receiver by means of a magnet which holds the coil in place on the side of the head.

Using the cochlear implant, profoundly deaf individuals are able to hear and understand speech. Most children are able to hear conversation without lip-reading and use spoken language for everyday communication. More than 75% of adult cochlear implant patients hear well enough to use the telephone for conversation.
 

About Cochlear Implants

Who is a candidate?

In general, people who receive cochlear implants have severe to profound hearing loss and have had little or no success using hearing aids.

AGE: Profoundly hearing impaired children as young as 12 months of age can be implanted. Severely and profoundly hearing impaired adults of all ages may be candidates for cochlear implants.

The first step in determining candidacy is a comprehensive hearing evaluation that includes specialized tests of speech perception, with and without hearing aids.

The FDA recommends the following guidelines for implant candidacy:

Age Degree of Deafness Other Criteria
12 months to
23 months
Profound
sensorineural
Lack of adequate speech
language development
using hearing aids
24 months to
17 years
Severe to profound
sensorineural
Lack of adequate speech
language development
using hearing aids.
Adult 18 yrs+  Severe or profound
sensorineural
hearing loss
Ability to understand sentences
in background noise while
wearing hearing aids
(HINT:Hearing in Noise Test)

Scores on HINT:

<50% in the ear to be implanted

<60% in the best aided condition
(usually while wearing two
hearing aids).

Adult: Medicare
Criteria

Severe or profound
sensorineural
hearing loss

 Scores on HINT:

<40% in the ear to be implanted

<60% in the best aided condition
(usually while wearing two hearing aids).

 Individuals who meet the audiologic criteria for implants must then be evaluated by the cochlear implant surgeon to determine medical candidacy. Medical evaluation will include a CT scan of the temporal bones of the skull to evaluate the development of the inner ear.

What is involved in the surgery?

The surgery takes approximately 3hours and is performed under general anesthesia. Patients usually stay overnight in the hospital and are discharged the next day. Physical activities following surgery may be restricted for several days. Children are typically allowed to return to school the week after surgery.

Does insurance cover cochlear implants?

Yes. Most insurance carriers, including Medicare and Medicaid, cover cochlear implants and associated rehabilitation services. The staff at the Center will investigate your coverage and obtain pre-authorization from your insurance company before surgery.

Children with Implants

The implant team is uniquely qualified to provide the comprehensive range of services needed by infants and children receiving cochlear implants. Each child is carefully evaluated to determine the best rehabilitation and educational plan. Audiologists, speech-language pathologists, educators and social workers provide ongoing care and guidance for the implanted child and his/her family. Emphasis is placed on treating the ?whole child? which is accomplished by establishing a close working relationship with the family, therapists and school.

Which ear should be implanted?

The decision as to which ear will be implanted is made following extensive evaluation of hearing history, hearing aid benefit, inner ear anatomy and patient preferences. Patients are counseled extensively by the audiologist and surgeon and a mutual decision is made. Although ear selection is made on an individual basis, there are general guidelines that are taken into consideration:

  • Length of deafness: In general, the ear with the shortest length of deafness will derive the most benefit from the cochlear implant and be chosen for surgery.
  • Hearing levels: Usually, the most impaired ear is chosen for implantation. An exception to this guideline may be in the case of an ear that demonstrates no response to auditory stimulation. In that case, sufficient neuronal survival needed for implant benefit is questionable. In this case the ear with more hearing may be chosen for surgery.
  • Auditory stimulation: The ear that has had continuous stimulation from hearing aid use is generally a better risk for good benefit from the implant.
  • Hearing aid benefit: The ear that derives the least benefit from a hearing aid is usually chosen for implantation.
  • Inner ear anatomy: Whenever possible, the ear with normal anatomical structure is chosen for the implant.
  • Auditory nerve status: MRI or CT studies may indicate that the auditory nerve is severely compromised or not attached to the cochlea. This condition precludes implantation.
  • Patient preference: When there are no compelling factors that would clearly dictate which ear to implant, the patient is free to make this decision based on personal preference.

One implant or two?

There are many advantages to hearing with two ears (binaural hearing):

  • Sound Localization: The ability to perceive the direction from which sound is coming.
  • Squelch: The ability to pick out the sound of interest (such as speech) in a background of noise.
  • Elimination of Head Shadow: The ability to hear sounds from both sides of the head.
  • Summation: A slight boost (3dB SPL) in the loudness of sounds heard with two ears.
  • Quality: Sound heard by two ears is perceived as fuller, richer and more balanced than sound heard by one ear.

Binaural hearing can be achieved by a cochlear implant recipient in two ways:

  • BIMODAL: In bimodal hearing a cochlear implant is used in one ear and a hearing aid is used in the opposite ear. This arrangement presumes that hearing in the non-implanted ear is sufficient to derive some benefit from a hearing aid and the recipient is willing to continue use of the hearing aid after implantation. Even though the sound from the hearing aid and the cochlear implant are very different, hearing impaired individuals can successfully integrate the sound from the two devices and achieve some benefits of binaural hearing. Whenever possible, the LIJ cochlear implant team recommends continued use of a hearing aid in the non-implanted ear.
     
  • BILATERAL: Bilateral cochlear implants refers to two cochlear implants, one in each ear. Bilateral implants can be implanted during one surgery (simultaneous) or in two surgeries separated by a period of time (sequential). Research evidence as well as anecdotal reports from patients indicates that the advantages of binaural hearing can be achieved with two implants.

Bilateral cochlear implants are becoming more common. Insurance carriers may initially deny reimbursement for a second implant but most companies eventually agree to coverage after an appeal and explanation of the benefits expected for the patient is submitted. As with any cochlear implant surgery, prior authorization is necessary to ensure coverage of bilateral devices.

What happens after implantation?

One month after surgery, patients return to the Cochlear Implant Center for fitting of the external device and programming of the implant by the audiologist. On-going follow up is provided by the cochlear implant team. Fine tuning of the cochlear implant map occurs on a regular basis during the first year and as needed thereafter. The course of post-implant rehabilitation is tailored to the needs of the individual.
 

Apelian Cochlear Implant Team:

Director
Lynn Spivak, Ph.D.

Medical Director/Surgeon
Andrea Vambutas, M.D., FACS

Audiologists
Leslie Wexler Au.D
Barbara Popecki, Au.D.
Stella Gershkovich, M.S.

Speech-Language Pathologists
Diane Saulle, M.S.
Gayle Sorrentino, M.A.
Andrea Mangino, M.A.

Social Worker
Linda Glazer, DSW

Deaf Educator
Carol Whalen, Ed.D.

E-mail: cochlearimplants@nshs.edu

Phone: (718) 470-8339

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