Rehabilitation Services

Our multidisciplinary team provides expert care and follow-up for children with hearing loss who are candidates for cochlear implant.

Each year, two to three of every 1,000 babies born in the United States are diagnosed with hearing loss. For some of these children, a cochlear implant is the right tool to help them communicate through listening and spoken language.

Our multidisciplinary cochlear implant team provides guidance and education to patients and families before, during and after placement of a cochlear implant. We work together with you and your child to create and maintain an appropriate long-term care plan that will help your child benefit as much as possible from the cochlear implant.

The cochlear implant team includes members from pediatric audiology, speech-language pathology, social work services, pediatric otolaryngology, family and child services, deaf educators, and other specialists as needed.

How a cochlear implant works

A cochlear implant is a device used to help those with severe to profound hearing loss who do not benefit from hearing aids. Hearing aids make sounds louder, but for some infants and children, even the most powerful hearing aids don’t make sounds loud and clear enough for some children to learn spoken language through listening. Early and ongoing assessment is important because the earlier a child receives adequate auditory information, the more likely he or she is to succeed in learning to listen and speak.

A cochlear implant system includes a surgically implanted portion and an external speech processor. The speech processor captures sound and codes it to be sent to the internal device. Electrical contacts on the implanted portion send information directly to the hearing nerve, which then transmits the signals to the auditory centers of the brain.

We currently offer cochlear implant systems from two manufacturers, which both provide videos you can view to learn more about how an implant works: Cochlear Americas and Advanced Bionics.

Who is a candidate for a cochlear implant

Children and young adults up to age 21 may be candidates for a cochlear implant at Johns Hopkins All Children’s. Families must be able to provide appropriate support and expectations, as not all children benefit equally from an implant. The child must be enrolled in individualized therapy with an auditory-based component with direct parent involvement before being considered for evaluation.

Assessment may begin as early as birth. Children who are candidates for cochlear implants are:

• Diagnosed with severe to profound sensorineural hearing loss (present at birth or progressive) or auditory neuropathy spectrum disorder
• Have worn appropriately fitted hearing aids consistently for at least three to six months
• Have been unsuccessful in auditory development despite intensive auditory-based therapy and consistent hearing aid use
• Deemed medically appropriate for cochlear implant surgery by their medical team, including the pediatric otolaryngologist

What to expect at your child’s appointments

Evaluation

To determine if a cochlear implant is right for your child, our team uses a multidisciplinary approach to consider the whole child, including auditory, linguistic, social and emotional aspects of their development.

During your child’s initial appointment, we will take a detailed history, complete a full hearing evaluation with and without hearing aids, and discuss your family’s expectations based on several factors that can affect the success of a cochlear implant. These factors include:

• Age of the child and length of auditory deprivation.
• Consistent use of amplification.
• Participation in auditory based therapy and carryover of goals at home.
• Any additional medical or developmental concerns.

If your child is not currently a patient with the Johns Hopkins All Children’s audiology or speech-language departments, please send current records such as an audiogram and therapy records. Records may be faxed to 727-767-8998.

Please also fill out a case history form for your child and bring it with you to your child's appointment. You can find the form online here, or contact us to receive one by calling 727-767-8989.

After your child’s evaluation, we will discuss:

• What to expect on the day of surgery and the hospital stay. Additional information to help you prepare for your child’s stay is available in our Inpatient Stay Guide.
• All available device options specific to your child’s needs.
• Any questions or concerns of the family. Please feel free to bring anyone who has an interest in the child’s care.
• Packet of information provided for each manufacturer, if further review of material is desired.
• A list of recommendations if candidacy criteria for a cochlear implant is not met.

Each family will establish with one of our cochlear implant surgeons in the pediatric otolaryngology program, if they are not already followed. Surgeons with the private practice Pediatric Ear, Nose & Throat Specialists provide cochlear implant surgery services at Johns Hopkins All Children's.

Meet our cochlear implant team

Cochlear implant stimulation

Three to four weeks after surgery, your child’s cochlear implant external equipment is programmed. What to expect from this visit is as variable as the children themselves. Typical responses include laughing, ignoring, and crying upon first hearing with the implant processor.

We request that you only bring two adults into the room for this appointment, but additional family members are welcome to wait in the waiting room to see you right after activation. We encourage you to take a walk around the building to explore sounds and ensure the child’s comfort before leaving. We will also explain the equipment and give you a backpack full of accessories and instructions, including an extra processor that can be used as a backup.

The first mapping is typically followed by three appointments over a month to gradually increase the amount of current your child needs to get the most from his or her implant. This may be adjusted based on how quickly your child adapts to his or her new way of hearing.

Mapping visits

Once your child has passed the initial stimulation and immediate follow-up, routine mapping is required. These visits are typically scheduled three to six months apart, depending on the age of the child, stability and reliability of responses, and support needs of the family.

When children are young, this visit is similar to a hearing test. We will hook the implant equipment up to a computer, check the internal device, and play a game with your child to obtain information about how soft the sound that can be detected on each channel of the implant. Depending on the child’s age and ability, we will measure how he or she responds to speech in each ear.

Forms

When you arrive for your child's cochlear implant evaluation appointment, please bring a completed case history form with you.

Medical records may be faxed to 727-767-8998.