Introduction to Hearing

Hearing is one of mankind’s 5 primary senses; the others being sight, smell, taste and sensation. The organs of hearing are formed during intrauterine development. A newborn baby is fully able to appreciate sound.

The ear is divided into 3 parts; the external ear (1), the middle ear (2) and the internal ear (3). The function of the external and middle ear is to locate, channel and amplify the sound that reaches the inner ear. The cochlea part of the inner ear converts the sound waves into electrical impulses which is transmitted to the brain by the cochlear nerve.

Hearing Impairment in Children

Hearing impairment can be divided into mild, moderate, severe and profound. There are 2 types of hearing impairment:

• Conductive Deafness – due to disease in the external or middle ear.
• Sensorineural Deafness – due to disease of the cochlear or cochlear nerve

What are the signs of hearing impairment?

1. Delayed Speech
   • Cannot babble at 6 months
   • Cannot say ‘dada’ or ‘baba’ at 12 months
   • Speaks less than 3 meaningful words at 24 months
2. No response to call or environmental sounds
   • Don’t respond to things said to them or don’t notice that you have spoken to them.
   • Request to repeat things (for older children).
   • Can’t say words or sentences properly or difficulty to hear in noisy environment.
3. Abnormal behavior

What is a cochlear implant?

A cochlear implant is an electronic medical device to provide or restore hearing to children with profound sensorineural hearing loss.

The device consists of 2 parts; an internal part which is surgically implanted; and an external speech processor which is worn behind the ears.

What is the cost of the device?

The cost of the implant cost and surgery range between RM70, 000.00 – RM100, 000.00 depending on the specification needs and manufacturing costs. Additional costs for battery, maintainance and additional spareparts may be required.

Who will benefit from a cochlear implant?

1. Children born with severe to profound sensorineural hearing loss (congenital), below the age of 4.
2. Children at any age with speech who lose their hearing secondary to post intracranial insults such as meningitis, trauma, tumour and surgery or from drugs which damage the cochlea (ototoxic).

Is the surgery safe?

The surgery is safe, if performed by those who are trained. Uncommon complications including meningitis, dizziness and injury to the facial nerve.

Will a child who has received an implant be able speak immediately?

No. After the implant, an intensive period of habilitation or rehabilitation by the audiologist and speech therapist is required to develop speech and language. This process takes months to years and requires commitment by the parents or caregivers.

Will all deaf children benefit from a cochlear implant?

No. The child has to be examined and assessed. Some causes of deafness require other forms of medical or surgical treatment (example fluid in the ear). Children with mild to moderate hearing loss may benefit better from a hearing aid.

In the Ministry of Health, Malaysia, candidates from all the regional centres will undergo final candidacy selection of cochlear implantation by the National Cochlear Implant Central Committee in Putrajaya comprising of expertise from various disciplines such as ENT surgeons, paediatricians, radiologists, audiologists, speech therapists, child psychologists, Medical Social Officers and others.

What are the options available for a child who will not benefit from a cochlear implant?

Speech is one mode of communication. Severe to Profound Hearing loss children who are not suitable candidates or will not benefit from cochlear implant will require to learn other modes of communication such as Total Communication, cued speech, lip reading, sign language etc.

Where can I go for further information?

1. All Ministry of Health hospitals with ENT or audiology and speech therapy services.
2. Designated Cochlear Implant Centers
   • Northern Zone
     • Hospital Sultanah Bahiyah, Alor Setar, Kedah.
     • Hospital Raja Permaisuri Bainun, Ipoh, Perak.
   • Central Zone
     • Hospital Kuala Lumpur, Wilayah Persekutuan.
     • Hospital Sungai Buloh, Selangor.
     • Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur.
     • Pusat Perubatan Universiti Malaya, Kuala Lumpur.
   • Southern Zone
     • Hospital Sultan Ismail, Johor.
     • Hospital Tuanku Ja’afar, Seremban, Negeri Sembilan.
   • Eastern Zone
     • Hospital Raja Perempuan Zainab II Kota Bharu, Kelantan.
     • Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu.
     • Hospital Queen Elizabeth, Kota Kinabalu, Sabah.
     • Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan.