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Medical and technical risks and possible psychological consequences

Parents are often poorly informed about the course of a cochlear implantation (CI), risks are only inadequately addressed or explained too medically.

Medical risks of CI surgery

The cochlear implant requires a 2mm deep recess in the child's skull. In young children, the skull bone is just 2 mm. For very small babies (3-4 months) only 0.6 mm. In order to give the implant the necessary stability (it must not slip or wobble because of the electrodes that are pushed into the cochlea), the skull of small babies must be milled down to the hard meninges (dura mater). This hard meninges is not a bone, it is tough and one of the soft tissues. If this hard meninges is infected with bacteria, it can lead to inflammation of the meninges. Usually antibiotics are given after the operation. These antibiotics cover i. d. Usually only non-resistant bacteria from, rarely there are, but also resistant bacteria that can cause an infection. Explantation would be necessary.

Here you can see a video of a CI operation on an adult.

On the risk of meningitis (meningitis), even after the operation, here are the reports from the Hanover CI Society (note: document was removed from the hcig) The electrodes of the CI can conduct bacteria into the inner ear and on to the meninges. Vaccinations are only partially a protection. After the implantation, inflammation of the inner ear, implant and / or meninges can develop. Vaccinations against pneumococci and Haemophilus influenzae type B are strongly recommended. Here is the vaccination recommendation from the Hannover Medical School. (Note: Document has been removed from the hcig).

The FDA, (American health authority) published figures on meningitis after cochlear implantation. The reported cases also include the deaths worldwide. The risk is so significant that a larger study was conducted in the US that went beyond 24 months after the implantation. Here is the English original. Here is the German translation. Meningitis can cause a wide variety of disabilities, and in the worst case the patient can die.

German translation of the list of risks in cochlear implants - OP

1. Risks during and after the CI operation

• Injury to the facial nerve: This nerve runs through the middle ear and controls the facial muscles. It is close to where the implant has to be inserted and can therefore be injured during the operation. If this is the case, the facial muscles on the side of the implant may slacken temporarily or permanently. But it can also lead to complete paralysis.

• Meningitis: inflammation of the meninges. People with an abnormal inner ear structure may be at higher risk for this rare but dangerous complication. For more information about the risk of meningitis in patients to receive a cochlear implant, see the link below from the American Food and Drug Administration (FDA).

• Leakage of cerebrospinal fluid: the brain is surrounded by a fluid that can leak out as a result of the operation. There may be a hole in the inner ear or a hole in the soft meninges that surround the brain.

• Leakage of perilymph fluid: there is a fluid in the inner ear (cochlea). This can seep out through the hole that has to be created for the implant during the operation.

• Infection of the skin wound (this often means explantation)

• Accumulation of blood and wound water in the wound area

• Spells of dizziness

• Tinnitus: these are ringing or buzzing noises in the ears

• Disorders in the sense of taste: The nerve for taste perception on the tongue also runs through the middle ear and can be injured during the operation.

• Numbness around the wound on the ear

• Reparative granuloma: This is the result of local inflammation that can develop when the body rejects the implant. (means explant)

• Long-term implants can lead to further unpredictable complications that cannot be predicted at the moment.

2. Risks for implant recipients when using the cochlear implant

• The auditory impressions can be alienated. According to reports from CI users who were able to hear before they became deaf, hearing impressions from CI differ from hearing impressions with normal hearing. First of all, CI users describe the sound as “mechanical”, “technical” or “synthetic”. Over time, however, this impression changes, and most CI users no longer perceive this artificial sound quality after a few weeks.

• The existing hearing can be lost. The implant can destroy the residual hearing in the ear in which the implant is inserted.

• CI wearers can feel effects, the causes of which are not known and cannot be determined. The cochlear implant stimulates the nerves directly with electrical current impulses. While this stimulation seems safe, the long-term effect of the electrical impulses on the nerves is unknown.

• The hearing success may be worse than with others who achieve good hearing success with the CI.

• The CI wearer may not have a good understanding of the language. There is no pre-operation test that can determine how good your speech understanding will be after the operation.

• The implant may need to be removed temporarily or permanently if inflammation develops after the implant surgery. However, this complication is rare.

• The implant may not work. In this case, the CI patient would have to undergo another operation so that the problem can be resolved. This would expose him to the operational risks again. • Newly developed external accessories may not work. The implanted components are usually compatible with enhanced external accessories. In this way, implant users can participate in technological advances by simply replacing the external accessories. However, in some cases this will not be possible and the implant will have to be replaced.

• Some medical examinations and therapies are no longer possible. This includes:

• Magnetic resonance imaging (magnetic resonance imaging). MRI is increasingly being used routinely in diagnostic work-up for the early detection of diseases. It is already dangerous for CI wearers to even stay near the examination room, because the CI can rotate or shift or the implant magnet can be demagnetized. However, the FDA has approved certain MRI exams for some implants, taking precautionary measures into account.

  • Neurostimulation
  • Electrical surgery
  • Electroconvulsive Therapy
  • Ionizing radiation therapy

• Implant users rely on batteries if they want to hear. Some accessories require new or recharged batteries every day.

• Implants can be damaged. Sports with physical contact, car accidents, falls or other impact injuries in the ear area can damage the implant. This means that a new implant and thus a new operation may be necessary. It is uncertain whether the new implant will work as well as the old one.

• Implants can be costly. Replacing damaged or lost accessories can be expensive.

• An implant wearer is dependent on the CI for the rest of his life. However, the case may arise that the CI manufacturing company will cease operations while the CI wearer is still alive. It is not guaranteed whether the CI wearer can then continue to receive spare parts or use customer service.

• CI users may need to change their lifestyle as the CI affects electronic devices. An implant o can set off an alarm for commercial anti-theft devices. o can trigger alarms in metal detectors or other security systems.

  • can be interfered with by other people's cell phones or other transmitters.
  • may need to be turned off during take-off and landing when traveling by air.
  • may have unpredictable interactions with other computer systems.

Implant wearers must be careful of electrostatic charges. An electrostatic charge can temporarily disrupt the cochlear implant or even destroy it completely. It is best to make it a principle to take off the speech processor and the BTE set before touching statically chargeable materials such as children's plastic toys, the screens of televisions or computers, and textiles made of synthetic fibers. For more information about static electricity in connection with the CI, contact the manufacturer or a CI center.

• The ability to perceive quiet and loud auditory impressions may be restricted if a certain sensitivity setting has been selected on the speech processor and the setting is not adapted to the changing listening environment. With normal hearing, the brain always adapts hearing sensitivity to changing hearing impressions. However, a cochlear implant is designed in such a way that the wearer must manually adjust the sensitivity setting on the speech processor when the listening environment changes.

• Skin irritation may occur if parts of the external accessories rub against the skin. Then these parts may not be used temporarily.

• The external accessories must not get wet. In the event of water damage, repairs can be expensive. In addition, you cannot hear during this time. Therefore, all external accessories should always be taken off before bathing, showering, swimming or doing water sports. • In the immediate vicinity of magnetic fields, for example in the case of metal detectors at the airport, CI wearers occasionally perceive strange noises. Source: FDA

As described above, the taste nerve also runs in the surgical area. If the taste nerve is severed, the taste for sweet, salty and / or sour is affected. Since the fibers from the Chorda Tympani supply the front 2/3 of the tongue with a sense of taste, the taste for sour and completely for salty and completely for sweet on the damaged side accordingly falls out. How many patients are affected is not listed or mentioned in any public statistics. Younger children cannot tell whether they have lost their sense of taste. Parents usually only notice it in the changed eating behavior of the children.

A vein (sigmoid sinus) runs in the surgical area and is a collection vessel for the blood flowing back from the hemisphere of the brain. If something is disturbed here, headaches are the result, it can be temporary, but it can also last for a lifetime.

To date, doctors have not been able to accurately depict the auditory nerve. It means that the auditory nerve can be tested, it can be shown whether the auditory nerve is conducting, but not to what percentage it is conducting. But this is important for the hearing result. If the auditory nerve only conducts 10 or 20 percent, there is not much left of the transmission of the few electrodes. If the auditory nerve is not intact, a good hearing result will not be achieved with a cochlear implant either.

Children's hearing results can be divided into 4 groups:

The 1st group doesn't hear anything with the implant
The 2nd group hears environmental noises
The 3rd group can recognize voices
The 4th group can pick up and process speech through their ears.

The MDS assumes 3 to 5 reimplants in the course of the life of an early implanted child.

For language acquisition of children with CI, please read the brochure from Prof. Szagun.
You can also read the book “How Language Is Made” by Prof. Gisela Szagun. It comes to the result that more than 50% of the implanted children do not have any language acquisition of similar hearing children.

Cochlear implantation is an optional operation, you can choose for it or against it. It is not a vital operation as children can learn spoken language without hearing or knowledge and within the limits of their abilities.

Parents are often scared of their child's deafness. If the family learns sign language with their child, but normal development and a normal life will still be possible, just with sign language. If a deaf child is supported in his family in the same way as deaf parents do, there need not be any disadvantages in communication with the family. If a deaf child is enabled to live and learn with sign language in society, it will not have any disadvantages in its communication and thus also not in its education. The German sign language is now recognized.

Children with multiple disabilities often have a much higher risk during the operation. You may have a heart defect or several life-sustaining operations behind you. Doctors and parents should carefully consider whether they want to take the risk of the operation for learning to hear and speak (according to Sagun approx. 50:50). Every anesthetic means a lot more risk for the child. Accepting the risk and the associated stress for the child can lead to a further deterioration in the general condition.

The latest studies show that general anesthesia in small children permanently worsens memory. The memory of children who are given general anesthesia early in life is reduced by up to 25 percent throughout their lives. The anesthetics affect the communication between nerve cells.

After a cochlear implantation, any residual hearing loss and thus the possibility of using hearing aids is usually lost.

Exemplary CI statistics are updated and published every year in Switzerland. The absolute numbers are of course much lower than in Germany, but the conditions are presumably easy to compare with Germany. Unfortunately, no statistical figures are published in Germany. Here you can get an idea for yourself:

Swiss Cochlear Implant Register (CI database)

Possible psychological consequences

A cochlear implant does not make hearing normal, the CI wearers are still hard of hearing. Many feel at home neither in the society of the hearing nor in the society of the deaf. The result is strong identity problems. Many children have been banned from using sign language. The spoken language has absolute priority in the upbringing of children. The children are mostly still dependent on the reticle. Communication with hearing people is difficult and communication with deaf people is also not possible due to the lack of sign language. This is why many teenagers take off their CI after years of wearing it. Try to integrate into deaf society. Psychosomatic symptoms, suicide risk and autistic behavior in the children are reported. The pressure on the children is immense, they should learn to speak.

Parents should not orientate themselves on the glossy advertising of purely profit-oriented cochlear implant manufacturers and the career thinking of professors, but on reality. When considering implantation, the lowest expected gain should be related to the greatest risk from the surgery.

Here is the report of a young woman who has been wearing the CI for 9 years. She wants to let parents know how she felt before and after the operation.

Here is a link to an English language site called Cochlear War. There is always the latest news about cochlear here.

Why the medical professionals practically ignore the risks and possible unsuccessful implications of an implantation in the education process simply because of the statistical probability (here is a current example) and at the same time strictly advise against the use of completely harmless and helpful sign language is incomprehensible to me and seems downright negligent . Why do you put so much pressure and fear on your parents? Shouldn't medicine openly and widely explain all possibilities and alternatives and let the parents decide?

Note: Ms. Kestner died in 2019