Cochlear Implant Program
Our program is for adults who are cochlear implant or auditory brainstem implant candidates. Appointments require a referral from a physician or audiologist.
We are the designated coordinating site for all Ontario cochlear implant services by the Ontario Ministry of Health & Long-Term Care. We handle funding issues with the Ministry and house the provincial database. We are fully affiliated with the University of Toronto and are partnered, through the University, with the pediatric Cochlear Implant Program at the Hospital for Sick Children.
We are currently the only site for auditory brainstem implant surgery in Canada.
We have been active since 1984, when we were the first centre in Canada to implant patients with a multichannel cochlear implant (Nucleus 22) system. Since that time, we have grown to be the largest adult centre in Canada, and among the largest in North America. In 1995, we performed the first Clarion (Advanced Bionics) multichannel cochlear implant in Canada. We have been participants in many of the major adult clinical trials of new devices and software upgrades from Advanced Bionics (Clarion device) and Cochlear Corporation (Nucleus device) over our 20+ year history.
Our cochlear implant team currently works with two three cochlear implant manufacturers: Advanced Bionics Corporation, Med-El Corporation and Cochlear Corporation. Our team also has experience with the Nucleus Auditory Brainstem Implant (ABI) from Cochlear Corporation.
Eligability for the Cochlear Implant Program
Potential candidates must be referred by a physician. A referral form must be printed, completed and sent to us via mail or faxed to 416.480.5761. An appointment may then be set up for you.
We do not accept referrals for cochlear implant candidates from other Canadian provinces, but do accept out-of-country referrals for non-residents, on a direct-pay contract.
Ontario residents with valid health card numbers are eligible for full coverage under the Ministry of Health’s plan. You only pay for your travel expenses, parking and maintenance costs (i.e. batteries, and repair after the warranty expires).
Candidacy is considered on an individual basis. Current Health Canada and FDA criteria state that an adult (18 years and older) must demonstrate a moderate to severe/profound sensorineural hearing loss and have limited benefit from optimally fitted amplification. Limited benefit is defined as a score in the "best-aided” condition on the HINT Sentence test of less than 60 per cent. Our program considers candidacy for adults who were deafened after learning spoken language (post-lingually deafened) as well as for adults who lost their hearing from birth or in early childhood (pre-lingually deafened). Other factors that we consider in candidacy include the integrity of the auditory nerve and cochlea, a patient's ability to undergo surgery, and patients' expectations and motivation.
To be considered a candidate for an ABI you must be diagnosed with Neurofibromatosis Type 2 (NF2), be at least 12 years old, have appropriate expectations following extensive counseling, and be prepared to participate in an extensive follow-up program including some auditory training.
Cochlear Implant Process
All candidates undergoing assessment will first go through a detailed audiological assessment and counseling. This initial appointment usually takes 1½ - 2 hours. If the results of this initial assessment suggest that an individual is a potential candidate, then further testing is scheduled. This includes a high-resolution CT scan, balance test (ENG) and a follow-up appointment with one of the program’s surgeons. These appointments typically take six to eight weeks to complete. Once they are completed then an individual’s candidacy for cochlear implant surgery can usually be confirmed. If the initial testing does not suggest candidacy at that time, patients are so advised and appropriate follow-up recommendations are made.
Testing for the ABI surgery is more involved and requires more specific radiological imaging studies (MRI) and a consultation with the program’s neurosurgeon.
Confirmed candidates for cochlear implant surgery are placed on a waiting list. Surgery is not scheduled until they have been vaccinated for meningitis and their name comes up on the list. Candidates are given a meningitis vaccination form to present to their family physician for completion. We require vaccination against pneumococcal and meningococcal bacteria as per Health Canada recommendations.
After surgical placement of the implant, a four to six week period is required to allow adequate healing of the incision site. Initial activation of the cochlear implant (hook-up) is typically a 1 ½ hour procedure. During the activation, the device is adjusted and tuned using a computer. Reprogramming, for which the patient must return to the centre, is done approximately one-week following activation, and then periodically over the next few months until stimulation levels stabilize. After the first year, patients will be asked to return to the center at least annually for a reprogramming, an equipment check, and a formal evaluation.