Cochlea Implants:

Johannesburg Cochlear Implant Centre

INFORMED CONSENT

 

Name of child_________________________________________ Date_______________________
Parents______________________________________ Case manager________________________

The evaluations to determine whether your child is a candidate for a cochlear implant have been completed, and the results indicate that, as far as it is possible to predict, your child will benefit from a cochlear implant. The following information is
brought to your attention:

Factors which play a role in the success of a Cochlear Implant:

  • Age at implantation
  • Pre-implant duration of deafness
  • Age appropriate sign or spoken language competence
  • Previous use of hearing aids and listening experience
  • Status of cochlea
  • Family willingness to follow recommendations
  • Enrol in speech, language, and listening therapy
  • Return for follow-up appointments
  • Educational and home environments that are supportive of cochlear implants
  • Additional special needs

A Cochlear Implant CAN:

  • Provide access to sound by bypassing the damaged hair cells in the cochlea
  • Convert sound into electrical signals and send these signals to the hearing nerve and then the brain.
  • Provide more access to speech information than hearing aids
  • Provide improved speech perception for many children with intensive training
  • Allow a significant portion of profoundly deaf children useful hearing and speech

 

A Cochlear Implant CANNOT:

  • Interpret sound
  • Provide full access to spoken language for all
  • Provide enough benefit to allow a child born profoundly deaf to learn spoken language as easily or as quickly as is typical for a hearing child
  • Outcomes will vary for each child
  • Developing effective listening skills is a process

Operation and hospital stay

  • Date of the operation:____________________________________________
  • Hospital:_______________________________________________________
  • Surgeon:_______________________________________________________
  • Time to be at the hospital:_________________________________________
  • Preparations for surgery:__________________________________________
    • Preparation of implant site
    • Extent of operation scar
    • Length of operation
    • Numbness around scar for some weeks
    • Head bandage
    • Slight raised area over internal receiver site
    • Length of stay in hospital usually one or two nights
    • The surgeon will explain about caring of the wound
  • Take along:
    • For yourself: money for your own food and something to drink; toiletries and clothes if you are staying over night
    • For your child: favourite toys, pyjamas with wide necks or that can open in front so that it can easily slip over the head bandage
    • For the hospital: medical aid details (if you have one), authorisation number, CT scans & MRI

 Operation risks

  • General surgical and anaesthetic risks – discuss with surgeon
  • As the surgery is performed in the vicinity of the nerve that moves the muscles of the face, there is the rare possibility that temporary or permanent facial paralysis may occur
  • There may be pain at the wound following surgery – this is typically temporary
  • There is slight risk of taste disturbance, such as having metallic taste
  • Residual hearing in the ear to be implanted will most likely be lost (although with improvements in the technology and surgical procedures, this is not always the case)
  • Following the surgery, dizziness is sometimes noted
  • There is a possible association between cochlear implants and meningitis. There is not a proven causal relationship yet established between the two. Nevertheless, as a precaution, vaccination against meningitis is prescribed.

Restrictions on medical treatments and activities

  • Magnetic resonance imaging (MRI)
  • Scuba diving, physical contact sports, such as rugby

Initial programming of electrodes

  • Initial programming takes place approximately 3-4 weeks postoperatively
  • The basic components of setting a program (also called a MAP), include determining threshold levels (T levels), comfort levels (C levels), and “flagging” (turning off) electrodes that may cause problems. A MAP is determined by setting each of the electrodes to be loud enough for a person to be aware of a sound, but not too loud to cause discomfort.
  • During the initial programming session, an audiologist will seek to determine:
  • The type of speech strategy to use
  • The sensitivity setting
  • Program choices
  • Locks and controls

Programming and assessments

  • Initial programming will be over a period of 2-4 weeks
  • Follow-up programming sessions will be at 3 months, 6 months, 9 months, 12 months, 18 months and 2 years
  • Assessment at the following intervals: 6months and 12 months. Annual or 6 monthly reviews will follow thereafter
  • Assessments include hearing and speech perception testing, and speech and language assessment
  • These visits may require you to be available for a period of 1-2 weeks if you do not stay locally
  • Annual school reports are to be sent to your audiologist
  • If your child receives other therapies, reports are required from these professionals

Costs

  • Travel and accommodation expenses (where applicable)
  • Cables
  • Repairs/ availability of loaners
  • Insurance
  • Battery costs per month
  • Therapy and assessment
  • Income tax

Research projects

The Cochlear Implant centre is actively involved in a number of research projects and training. We see this as an integral and essential part of our programme. Our aims are to improve the greater understanding of the function of the hearing system and to improve our services to our cochlear implant users.

You will be invited to participate in research and training projects, but you are under no obligation to do so. These may involve additional visits.

Realistic Expectations

It is important for families to be realistic regarding their expected outcomes from cochlear implants. While the media often portrays cochlear implants as a “cure” for deafness, those directly involved in the educational process with implanted children are keenly aware of how individualised the outcomes may be for each implanted child.

It is important to acknowledge that although a cochlear Implant provides an opportunity for a deaf child to develop spoken language skills, it is not a guarantee. Deaf children present varied and wide-ranging characteristics related to her age, history, progress, and development that will impact on their degree of success with a cochlear implant.

Any questions?

__________________________________________________________________

__________________________________________________________________

___________________________________________________________________

As a requirement for your child to have a cochlear implant you must undertake to make your child available to attend all necessary electrode programming and evaluation sessions, required speech & language therapy sessions, as well as regular at an appropriate school setting.

I/We have been informed about the financial implications of the long term management and maintenance of the cochlear implant and all its parts.

Signed by parent/ caregiver______________________________________________
Witnessed by__________________________________________________________
Case manager_________________________________________________________
Date_________________________________________________________________

Adult Cochlear Implant Communication Form (Anaesthetic)

Good day. I am Dr ……………………………………………………. and I will be giving you the anaesthetic for your cochlear implant operation. Please read this form and make notes where necessary so that we can talk about any possible problems. It will make our pre-operative assessment easier.

I would like to ask you some questions about your health:

Allergy
Do you have any allergies or sensitivities? Please be as specific as you can. Common allergies include:
Antibiotics
Pain killers
Foods
Iodine
Other

Previous operations and anaesthetics
Have you had any operations in the past?
Date_______________              Operation__________________________________________
Date_______________              Operation__________________________________________
Date_______________              Operation__________________________________________

Did you have any side effects from the anaesthetic?

Does any family member have side effects from anaesthetics?

Does anybody in your family suffer from
Porphyria
Malignant Hyperpyrexia
Scoline problems

Medicines

What medicines are you currently taking?

Heart pills
Blood pressure pills
Chest medication/inhalers/nose sprays
Pain killers
Diabetic medication
Thyroid pills
Cortisone
Sedatives/sleeping pills/epileptic/stroke medication
Blood thinning medicines (especially aspirin, Plavix, Warfarin)
Alternate/herbal medication

Any other medicines, supplements or preparations:

Level of fitness

How do you judge your level of fitness at the moment and for the past month?
I am in good shape_____________________
I am not feeling as good as I normally do______________________
I am feeling quite unfit at the moment________________________

 

Chronic diseases or conditions

Level of any chronic disease (such as heart disease, chest conditions and diabetes)
Please list these:
My condition is well controlled and at its best_________________
My condition is not perfectly controlled and has been better__________________
My condition is not very good at the moment______________________

Heart disease:
Have you ever had a heart attack, chest pains, irregular heartbeats, heart failure, rheumatic fever, heart valve problems or any heart surgery?
What medications are you taking?

 

Do you find that you are more short of breath at the moment?
How far can you walk before you get short of breath?
How many stairs can you climb before you get short of breath?
Do you wake up at night feeling short of breath?
How many pillows do you like to sleep on at night?
Do you get short of breath when you lie flat?

Venous thrombosis and pulmonary embolus:
Have you ever had a venous thrombosis (clot in the legs) or a pulmonary embolus (clot on the lungs)?
Date: ______________________________
Treatment: __________________________

Blood pressure:
Do you have high blood pressure?
What treatment are you on?
Do you take your medication regularly?

Chest and breathing problems:

Do you have a cough at the moment?
Do you suffer from asthma?
What medications do you take?
Do you take them regularly?
Is your asthma well controlled at the moment?
Is your chest ever that bad that you have to be in hospital for treatment?

Do you have emphysema or bronchitis?

Have you had a cough, cold or flu in the past two weeks?

Have you ever had lung surgery?

Do you have any sinus problems, post nasal drip or post nasal cough?

Do you smoke?
If so, how much, and for how many years?

Diabetes:
Are you diabetic?
What medications are you on?
Pills?
Insulin injections?

 

Thyroid:
Do you take any thyroid medication?

Liver:
Have you ever had jaundice or hepatitis?
If so, is your liver back to normal?

Stomach and bowels
Do you suffer from heartburn, reflux, hiatus hernia or peptic ulcers?
Do you take any stomach medicines?
Do you have severe problems with constipation or diarrhoea?

Kidney and bladder disease
Have you ever had kidney failure?
Have you got any problems with passing water?
Have you got any bladder infection at the moment?

Muscles and joints
Muscle weakness, rheumatism, arthritis, auto immune disease (like lupus)
Do you suffer from any of the above conditions?
Are there any joints that are badly affected?
Neck
Jaw
Spine
Hips/knees
Arms/ shoulders

What medications are you taking for this?

Are you able to lie comfortably on your back?

Epilepsy, strokes and blackouts

Have you ever had any of the above conditions?
Have you got any problems as a result of any of the above conditions?
Dates: ____________________________________
Treatment: ________________________________

Do you get dizzy when you turn your head to look back?

Bleeding
Are you a bleeder? (haemophilia/Von Willebrands/other)
Are there any bleeders in your family?
Do you bruise easily and bleed for longer than normal?
Do you have any blood disorder like lymphoma or leukemia?
Are you on any treatment for these conditions?

Teeth
Do you have any crowns, bridges, loose teeth or false teeth?

General

When did you last see your doctor (GP or physician)?

Was he/she satisfied with your health?

Were any tests done?
Dates:

What were these?

Lung function tests:
ECG:
Blood tests:
CT scan:
MRI:

Vaccination: have you had your vaccination?
Date:

Have you got any infection or ay open wounds at the moment?

Is there any other information you feel the anaesthetist should know?

The Day of the Operation

If your operation is in the morning you must not eat or drink after midnight on the day before the surgery. For an afternoon operation please only have a light breakfast at 6 in the morning and nothing after that.

You may take all your regular medications on the morning of the operation, with a small sip of water. Please don’t take any medication for diabetes. This will be prescribed separately. All asthma medicines should be taken as usual.

If necessary a calming medication may be prescribed.

If there are chest problems you may be given a nebulizer and the physiotherapist will give you some therapy.

The operation can take from 4 to 7 hours.

After the operation you will be observed in the high care unit or the ward, for about 48 hours. You will be given pain medication and any other therapy that is necessary. There is not usually much pain with this operation. You may experience some dizziness and nausea; please call for a nurse if you need to get up.

The implant will only be switched on after about three weeks, so don’t expect to be able to hear immediately after the operation.

Your questions

Is there anything that is worrying you and that you would like to ask about?