What you need to know about:

Cochlear Implant Surgery

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Average Cost:
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Recovery Period:
1 week
Permanence:
Lifetime of the device
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Time it takes:
2 - 4 hours
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Overview of

Cochlear Implant Surgery

in Thailand

A cochlear implant is an electronic medical device that replaces the function of an inner ear that has become impaired due to damage of the sensory hair cells. The implant uses a microphone and directly stimulates the cochlea and cochlear nerve, using electricity to provide sound signals to the brain and enable the brain to perceive sound. Cochlear implant surgery is an effective treatment for severe hearing loss in children and adults. It is recommended for people whose ability to hear does not benefit from the use of hearing aids. Implants can augment hearing sufficiently enough to improve the understanding of speech and environmental sounds.

Goals of

Cochlear Implant Surgery

A cochlear implant isn’t suitable for everyone. Babies, children, and adults may be good candidates if they have:

-severe hearing loss in both ears

-not found benefits from hearing aids

-no medical conditions that could increase surgery risks

As an adult, you might also be an ideal candidate if you:

-have hearing loss that disrupts spoken communication

-lost all or most of your hearing later in life

-depend on lip reading, even with hearing aids

-are willing to commit to rehabilitation

-understand what cochlear implants can and can’t do

Price of

Cochlear Implant Surgery

Average Cost

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Price Range

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Pros and cons of

Cochlear Implant Surgery

Pros

-Hearing improvement: Cochlear implants can improve hearing and speech perception for patients. People with cochlear implants may still use lip reading and sign language to enhance speech perception and communication.

-Speech Development: Cochlear implants help improve the clarity of the patient's speech and future development of listening and spoken language skills.

-Safety: One of the most notable benefits of a cochlear implant is the ability to hear potential dangers or alerts such as sirens and other important sounds.​

Cons

-Surgery:  As with any surgical procedure, there are risks and limitations associated with cochlear implant surgery.

-Background noise: Patients will still need support hearing and communication in background noise. Assistive devices can help hearing in places with lots of background noise (classroom, car, zoo, etc)

-Maintenance: Cochlear implants require ongoing support and maintenance. This can include monitoring and replacing equipment, changing batteries daily, and following up with programming appointments.

-Outcomes and hearing levels differ for everyone: The benefit of a cochlear implant is not immediate, and each child will have varied performance. Early intervention programs help improve the outcomes for children with cochlear implant devices.

-Childhood Activities: Children with cochlear implants can participate in almost all common childhood activities. It is important to utilize waterproof cases or remove the device when the processor could get wet or be submerged under water (i.e., swimming or in the bathtub). Precautions are recommended to protect the device from damage, on plastic slides, playgrounds, and ball pits. It is also recommended that the child use a helmet while bicycling or playing other sports.

How It Works:

Cochlear Implant Surgery

There are 2 cochlear implantation approaches to cochlear implant surgery:

Mastoidectomy with Posterior Tympanotomy Approach (MPTA)

Suprameatal Approach (SMP)

Cochlear implant surgery is conducted under general anesthesia and lasts between 2-3 hours. The procedure may require an overnight stay at the hospital, but is usually an outpatient procedure. During surgery, an incision is made behind the ear. The electrode array is inserted into the cochlea (inner ear) through a small opening. Finally, the incision is closed and a pressure bandage is applied for 24-48 hours to help reduce swelling. The majority of the swelling will subside within 3-5 weeks after implantation. Discomfort after surgery is minimal. However, if pain is present, over-the-counter pain medications can be utilized to reduce discomfort.

Preparation before

Cochlear Implant Surgery

Pre - treatment

The cochlear implant evaluation is completed by a multidisciplinary team of surgeons, audiologists, speech-language pathologists, developmental psychologists and an educational liaison.  Many factors must be taken into consideration in determining whether a child is a candidate for the procedure. Candidates will most likely receive an audiological evaluation, Auditory Brainstem Evoked Response/Auditory Steady State Response Test, speech perception test battery, balance testing, speech-language evaluation, developmental evaluation, educational evaluation, medical evaluation with CT and MRI scans, vision testing, vaccinations, and genetic testing.

Physical examination, including a review of the patient’s medical history to identify the cause of the hearing loss, middle ear and external ear examination, blood test, urine test, lung test, and heart test, so as to evaluate the patient’s overall physical health before administering anesthetic for the implant procedure.

Intellectual and mental health assessment, as the efforts involved in learning to speak and listen as part of the development of the patient’s communication skills require high levels of concentration from the patient together with the support of a rehabilitation team and family members. Therefore, the patient’s IQ and mental health are factors in the success of the cochlear implant.

Recovery after

Cochlear Implant Surgery

Post - treatment

The surgical procedure is performed as an outpatient procedure, so patients will be able to return home the same day as their surgery. Usually, patients return to work 1-2 days after surgery. They should not lift more than 5 kg in the first two weeks after surgery.

Post-implantation therapy is required for the patients to adapt to hearing sounds. It takes approximately three weeks for the swelling to resolve before the initial activation of the device. All of the sutures used in the three layers close the incision are resorbable, so there is no need to return to the hospital until the activation. The patient will also undergo a hearing test performed by the rehabilitation team as part of the scheduled follow-up appointment process. The programming of the external sound processor is more frequent in the beginning, but over time these visits may be reduced to once per year or when there are new software updates that would result in improved performance.

Risks & side effects

While the risks during the surgical procedure are considered minimal, the FDA lists the following as possible risks:

-Injury to the facial nerve

-Meningitis

-Cerebrospinal or perilymph fluid leak

-Infection

-Blood or fluid collection at the site of surgery

-Dizziness

-Tinnitus (ringing sound in the ear)

-Numbness around the ear or reparative granuloma.

-Damage to the skin of the ear canal and the eardrum

-Facial spasm while using the device

-Facial nerve damage

-Meningitis

-Implant extrusion caused by postoperative infection

FAQs:

Cochlear Implant Surgery

What kinds of patients are eligible for this procedure?

Children aged 2 years or older

People with hearing loss in both ears, approximately 90+ decibel hearing loss in children and 80+ decibel hearing loss in adults

People gaining little or no benefit from hearing aids

People with no medical reason to avoid surgery

People with no intellectual disability or mental illness

People who are able to undergo post-cochlear implant aural rehabilitation

How Is a Cochlear Implant Different from a Hearing Aid?

Hearing aids acoustically amplify sound and rely on the responsiveness of sensory cells in the inner ear to receive and transmit the sound to the brain. For those individuals with severe to profound sensorineural hearing loss, the sensory cells of the inner ear are often damaged or destroyed, making it difficult for hearing aids to provide benefit. Cochlear implants convey sound by converting acoustic signals into electrical patterns, which are then delivered directly to the auditory nerve fibers, bypassing sensory cells.

What are the components of ear implants?

A cochlear implant has 2 components:

Internal component (receiver)

External component (transmitter)

Does a cochlear implant provide normal hearing?

No. A cochlear implant provides the perception of sound to the hearing system by electrically stimulating the remaining nerve fibers in the cochlea which takes the electrical equivalent of sound up to the part of the brain that will interpret the sound. A patient will need to learn to listen to these new sounds and interpret them. It is important to discuss realistic expectations for cochlear implant use with both your audiologist and your physician.

How long will a cochlear implant last?

The internal device is designed to last for your lifetime, and the manufacturers offer a ten year warranty, with some restrictions. While rare, internal devices can and do fail. For adults who received implants as young children, a device failure offers the opportunity to upgrade the internal device. Contemporary internal devices are now MRI-compatible and the technology is vastly superior than cochlear implants from 15-20 years ago.

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M.D.
Win Lei Phyo
ENT
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M.D.
Wirat Taweekitikul
Ear Nose Throat Specialist
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M.D.
Jintana Assavaroongsakul
Otorhinolaryngology
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M.D.
U Khin Maung Tin
ORL
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