Cochlear implant and possible compromised auditory nerve

Cochlear Implants
#1

As a 10 year wearer of HA’s ( approx 3 years each of Rexton, Costco and currently Oticon) I find my left ear hearing lessening over the past couple of years. This has coincided with (but not necessarily caused by) the compression of the #7 and # 8 cranial nerves by the left anterior cerebellar artery. I was experiencing a left "eye twitch’ that was finally diagnosed via MRI that showed the compression of the #7 cranial nerve (which controls facial muscles) and the #8 (which controls hearing and balance). Testing of my hearing indicates that I am a candidate for a cochlear implant on the left side. Right side is not so bad. I’ll post the audiogram when I pick it up after my next visit.

The neurosurgeon, that I consulted could do surgery to “decompress” these nerves, tells me that he does not believe that decompression would improve my hearing. My question has been: is the compressed #8 nerve compromised, so as to affect/minimize the effectiveness of the proposed cochlear implant? I will pose this question to the neurotologist when we meet on 8-31-23. Your thoughts and comments are valued and most welcome

#2

Not that I know anything…but the CI “talks” to the inner ear and nerve. If your nerve is compromised then yes a CI will be impacted.
A few questions you may want to ask: Is the compression increasing, going to get worse? - if so, what is the long term prognosis for hearing, eyes, and balance? Would a decompression surgery need to be repeated? - if so when and how often? What are the risks involved with the surgery? - could things get worse?
Glad to hear that one side is ok! and wishing you the best!
Dave

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#3

Thanks so much all good things to ask

#4

How long has the compression been an issue? Nerve damage can heal, but after ~12-18 months the probability of full recovery diminishes greatly. I had decompression for a spinal nerve and covid prevented prompt surgical intervention. I had the procedure at not quite ten months from the injury, and there are still minor issues 18 months after the surgery. The surgeon says “maybe” about full recovery. You never know.

I had the surgery mostly because I didn’t want any more damage, but was delighted in what was recovered. Perhaps you don’t want any more damage either.

Weigh you risks and benefits carefully.

WH

#5

Have you considered a chiropractor or exercises to strengthen the #8 spinal area?
Is there something that can be temporarily done to prove this compression affects your hearing?

Good luck with this.

#6

Has your auditory nerve been damaged by any of your #7 or #8 compression?
Part of the evaluation process is having an MRI and a CT scan. These 2 procedures check to see if the auditory nerve has been damaged. It also checks the position of other nerves in that region are in the correct position. Along with the structure of your ear.

You would need to speak to your CI Otologist to get precise answers to your questions. I hope you get all your answers from your specialist.
Good luck.

#7

Thanks for the responses

Hemi facial spasms (eye twitch) started about 2 years ago and I assume that compression of auditory nerve started then also - hard to gauge exactly if this was when left ear hearing started to diminish.

The C-8 spinal nerves have to do with hands, finger flexion, fore arm so likely not related

MRI says the “anterior inferior cerebellar artery causes the posterior displacement of the cisternal segment of the 7th and 8th cranial nerves are displaced” for which I was referred to the neuro surgeon who tells me that this displacement means compression and he can surgically decompress them. And that he does not believe that decompression will help my hearing. no mention of damage.

CT says unremarkable ossicles, middle ear cavity, facial nerve canal, cochlea, vestibule and semi circular canals and clear mastoid air cells

yes will wait for chat with otologist
patience is everything

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#8

While awaiting meeting with surgeon on Thursday I had additional tests yesterday with the audiologist which provided and opportunity to ask some questions about rehab etc.

I currently wear Oticon HA’s and I expect that if I decide to get a CI I will continue to wear the HA in my Right (good ear). I understand that there is not a way to “pair” my HA to the CI except if I were to get a Resound HA.

Questions: I have traditional Medicare with a Type “G” Supplemental plan will Medicare pay for that single Resound HA ? I am told that a single Resound HA is around $2.5k. Is it worth the investment (+ the cost of the shotgun and ski mask to rob the bank)?

Can I still use my HA and not have it paired with the CI?

Thanks for your sage advice

#9

Yes, you can do this. I currently use a Lexie (formally bose) hearing aid in my “good” ear. It does not pair in any way, and can be a pain, but it gets the job done without having to rob a bank…
Kind regards,
Dave

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#10

Using Cochlear America you are correct about Resound hearing aids. With the Resound aid you can stream in stereo and control both the processor and the aid with the Cochlear Nucleus Smart App. With your Oticon aid you can still hear from it and the processor but you will only be able to stream from one of the other using it’s particular phone app.

You are also correct about standard Medicare with supplemental not paying for the hearing aid. You might ask your audiologist if they would program a used aid to pair with your processor. This could save you a bunch of money.

Good luck

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#11

My wife and I met with the surgeon briefly today and will meet again next Wednesday. His schedule did not allow more time today. He does about 100 implants a year
He addressed my concerns about the auditory nerve by saying: The nerve is working as I can hear in the Left ear AND he stated that the CI signals to the brain will be much stronger that the “native” (regular organic) signals that the inner ear transmits to the brain.

Thoughts? comments?
Thanks a bunch

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#12

You may want to consider Advanced Bionics for your CI as well as Cochlear America.

I was just implanted with the AB CI and I received a new hearing aid for my other ear that pairs with the implant. It was what I chose to get with my “points” so it didn’t cost me anything.

Check it out.

#13

100 implants a year isn’t a lot in the scheme of things. A lot of surgeons just specialise in doing CI’s only.
Did you ask what brand he prefers to use? Either Med El, Cochlear, or AB? They are the 3 companies available for CI’s.
If after you talk to the surgeon again and your still unsure, you can always get a second opinion from another CI surgeon.

In the meantime do your research into the 3 companies, to see which brand would suit you best and find out what they offer. Make appointments to see reps from each company, if that is possible. Sometimes it’s due to your location you can’t get an appointment. If this is the case ring or email them and ask all your questions.

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#14

I have a surgery date of 10-24-23 - My surgeon answered most of my surgery related questions.

The surgery will take a couple of hours followed by several months to a year+ of rehab. Yes?

I have an appointment on 9-19-23 with the audiologist to go over selection (leaning toward the Cochlear Nucleus 8) and for to answer my rehab questions.

Also planning on attending a local Cochlear Americas CI support group on Thursday 9-14-23. This is at the Adult Loss of Hearing Association (ALOHA) facility which has a general CI meeting monthly also.

I’ve some investigation on line re: rehab both in some of the otolarnygology literature/articles (NIH and via the Cochlear website); as well as starting to put together a glossary of some of the technical terms bantered about here and elsewhere.

Some of the literature points to 5 themes that influence rehab outcomes:

  1. pre-implant expectations of postoperative performance,
  2. personal motivation,
  3. social support,
  4. specific rehabilitation strategies, and
  5. patient‐perceived role of the audiologist

I would greatly value your sage suggestions and advice regarding rehabilitation. Such as:

  • Strategies that have worked for you and why
  • How to set realistic expectations via the Audi and with family
  • success in eliciting family support in rehab
  • keeping yourself motivated
  • things that you found helpful
  • how much daily effort did you put into your rehab
  • has your rehab plateaued? how did you get past that plateau?

Again much thanks for all your input

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#15

Follow up and question or 2 - and a Resource
I had a real good meet with my audiologist who graciously and thoroughly answered all of my questions (2 pages worth) and I feel much better about the rehab process, setting reasonable expectations. I have chosen to go with the Nucleus 8.

I have Medicare A & B and a Plan G supplement and have met my annual deductible. To date all my costs have been covered. Question: is it reasonable to assume that I will be similarly covered going forward with my 10-24-23 surgery? Any one with similar coverage been down this road?

The single Re-Sound HA for the good ear. I do not remember if it was here or elsewhere that some one may have been successful with the purchase (via ebay I think) My Audiologist tells me that she is willing to program the re sound HA that I would bring in with the caveats, based on her experience, that the Costco one’s don’t work (as noted in another post here) and the HA can’t be registered to someone else’s name/account. Any thoughts on seeking a used resound HA?

I found that my local paper has as part of their online edition the capacity to “Listen to Articles” A resource for those in rehab I think

Thank a bunch for all your help

#16

This is the same insurance I use. Both of my cochlear implants were 100% paid for minus the $200/year deductible. I have zero complaints about this insurance.

Knowing your audiologist will program the Resound aid you bring in is a wonderful thing on their part. Buying used or even new hearing aids on eBay can be a huge money savings.

First you need to know which Resound aids are compatible with your N8 processor. Then you need to know if it is the correct aid for your hearing loss. Forum members can help you with this if you need it. And the last thing is to talk with the hearing aid seller to make sure the Resound hearing aid is as your audiologist describes.

You are doing great.