Question 1

What is the lifespan of the cochlear implant? Does it need to be replaced at any stage?

Dr. Dilpreet Bajwa · Accepted Answer

The internal device is designed to last a lifetime and does not normally require replacement, barring a major accident. The external processor is upgradeable and generally lasts 5 to 7 years, and patients tend to upgrade whenever a company introduces new technology, such as AI-based features.

Question 2

Can the implant be done for those who develop hearing loss later, in adulthood?

Dr. Dilpreet Bajwa · Accepted Answer

Yes, and we are now implanting more adults as well. Someone who was born with adequate hearing, developed language and then gradually lost hearing accepts a cochlear implant beautifully; there is no contraindication to adult implantation. If a person was born deaf and is now 40, an implant can still be done, but whether that person will learn to talk meaningfully is questionable: implanting someone who has never heard, after the age of 30 or 40, does not guarantee that outcome. Adults who use hearing aids but do not get adequate benefit from them can definitely proceed to a cochlear implant and do extremely well.

Question 3

Take a child born with a hearing disability who is now 10 years old, or someone in their late teens or early 20s. Since the neuroplasticity window has closed, what benefit can they expect from a cochlear implant?

Dr. Dilpreet Bajwa · Accepted Answer

The definition of a successful implant changes with age. When a 2 or 3-year-old comes to us, parents want the child to hear and then to talk, and that can be achieved up to about four and a half or five years of age. For a 20 or 30-year-old who has never heard, success is often sound awareness alone: parents want their child to be safe, for example to notice someone honking from behind on the road. I would not expect a 20-year-old to talk, but with adequate rehabilitation the brain can understand loud sounds and the person may understand what the parents are saying, without developing adequate language. A 10-year-old is somewhere in between and may or may not develop good language. That is why we counsel parents on what outcome to expect: for speech to develop the brain has to be pliable, and that happens best below 3 years of age. A different scenario is a 10-year-old or a 20-year-old who lost hearing after an infection: having heard throughout life, they hear very well after an implant.

Question 4

Is the reason later candidates cannot learn spoken language neuroplasticity, or is it that language simply cannot be developed later if it did not develop early?

Dr. Dilpreet Bajwa · Accepted Answer

It is because of neuroplasticity that language will not develop. These patients will definitely benefit from an implant and will be able to hear, but communication is something they will probably lack, and even if they can communicate, their language may not be very clear. Otherwise there is no contraindication: a 40-year-old can get an implant, but we need to set expectations that the person will require a good amount of rehabilitation and their language may still not be as good as that of a typical 40-year-old.

Question 5

Apart from children, what are the treatment options for adults with no prior medical conditions who develop hearing problems later in life?

Dr. Dilpreet Bajwa · Accepted Answer

Presbycusis, age-related hearing loss, is a common cause in people aged 80 to 85. The first option is always a hearing aid. If it gives adequate, meaningful hearing, meaning the person can discriminate between different words, the hearing aid is enough. If the hearing aid gives no clarity and all the person hears is noise, a cochlear implant can be done at any age. In a person with no prior medical history, the loss is probably sensorineural, because other causes leave a history: perforations produce ear discharge, and otosclerosis starts early in life.

Question 6

Will a cochlear implant be useful for adults with hearing loss due to cancer, such as chronic myeloid leukaemia?

Dr. Dilpreet Bajwa · Accepted Answer

Yes, absolutely. Patients with CML, and even with chronic kidney disease or other chronic conditions, can undergo cochlear implantation, because CML is a very indolent disease that does not cause the problems an acute leukaemia does. Their life will be much better, because they will be able to talk and interact socially. Anybody with a chronic condition can undergo implantation, but we vaccinate every implant patient against pneumococcus first, because implant recipients have a higher risk of meningitis: we will not proceed with a cochlear implant without vaccination.

Question 7

For international patients, for example from an African country, how is long-term follow-up and device calibration handled if there is a local shortage of professionals?

Dr. Dilpreet Bajwa · Accepted Answer

Programming is now available online because most modern devices have built-in Bluetooth. An audiologist can connect through an app on a laptop or phone and wirelessly program or calibrate the device remotely, in much the same way as this Zoom masterclass, without the patient needing to travel back.

Question 8

How affordable is a cochlear implant? Is it covered by insurance, and what does surgery with the device cost a family paying out of pocket?

Dr. Dilpreet Bajwa · Accepted Answer

Cochlear implants are not covered by insurance for Indian families, and the device is expensive, so CSR funds and government programmes are used to support them. Nothing equivalent is available for international patients at present. Three major companies produce cochlear implants, each with several models; we explain the pros and cons of each and let the parents choose what suits their budget. Implants have been in use for about 40 years, and every device works, whether inexpensive or expensive. Cost is driven by three things. First, MRI compatibility: the internal and external parts communicate through magnets, and the more expensive devices are 3 Tesla compatible while the cheaper ones are only 1.5 Tesla compatible. Second, programming: expensive devices scan the listening environment every 3 seconds and switch programs automatically between quiet and noisy settings. Third, built-in Bluetooth that connects to a phone, tablet or computer. As a rough estimate, surgery including the device starts at about 14,000 US dollars and goes up to 36,000 US dollars for high-end implants. Whatever the parents decide is best for their child: a basic device is fine, because the external component will be upgraded within about 7 years anyway, and small children do not need highly sophisticated features. Features such as Bluetooth matter once the child reaches school age.

Question 9

If technology keeps changing, does the internal implant become a limiting factor over time?

Dr. Dilpreet Bajwa · Accepted Answer

No. Implant companies design the internal device to stay compatible even as external technology advances. The first person implanted with a cochlear device, in 1984, is still using that original internal component 42 years later, having only upgraded the external processor along the way.

Live Discussion with Dr. Dilpreet Bajwa