Whether you call it a coil, magnet, or headpiece, here are answers to your questions about the part of the cochlear implant processor that sticks to your head to communicate with the internal part of your device.
The magnet of a cochlear implant serves to (non-permanently) attach the headpiece to your skull so it can line up with the internal implant. When sounds come in to your processor’s microphone, they are coded (to put it simply, the computer chip in the CI says, “To make this sound, let’s stimulate electrodes #1, 3, and 5) and then it sends that message up the wire. When the external and internal magnets are close enough to each other, they can communicate this information across your head to tell the internal implant what to do to recreate the sound so you can hear. One important thing for people to understand is that for the CI to work properly, the magnet has to be on the head, not just the processor be on the ear (sometimes caregivers who are more familiar with hearing aids make this mistake). In fact, as long as the magnet is attached, the processor can be dangling in the wind. However, for best microphone position, it is better to wear the processor on the ear as intended, if that’s where the microphone is located.
What if your or your child’s magnet will not stay attached, or comes off very easily? First, consider where you are in the CI process. At the initial activation, audiologists will often choose a very low (weak) setting for the magnet, as your incision site is still healing and we don’t want to put extra pressure on the skin. If you’re in the early days, this may be the cause of some of your magnet-falling-off issues. Many parents of very young children who have just received CIs use some sort of retention device, like a headband or pilot cap, anyway to keep the child from playing with the processors, and this can also help to keep the magnets on. You can also try a small piece of toupee tape if the skin over the magnet area is healed and strong enough that this won’t irritate it. Regardless of how long you’ve had your implant, it’s best not to add strength the magnet yourself without speaking to your audiologist or surgeon. Even though it seems like an easy fix at home, you want to protect your skin at that incision site, so get the go-ahead from a medical professional before you start to make adjustments on your own. They may tell you it’s fine to either add more magnets, change out the magnet for a higher strength, or twist the magnet to a higher strength (the adjustment method will depend on what brand of CI you have), but it’s always good to check first.
What about hair and cochlear implant magnets? Other ways of keeping the magnets on include braiding the magnet into place with hair or pulling the hair over the magnet to hold it on. For CI users with especially coarse, thick, or frizzy hair, you may need to shave down the magnet area slightly to get a better connection. If you’re braiding your hair (think cornrows), be sure to take the magnet site into consideration. I’ve had little girls sit for hours getting a beautiful hairstyle only to have to redo it all when they put their devices back on and realize there’s a braid right over the magnet site!
What if I’m seeing redness or swelling around the magnet site? Contact your surgeon. It could be nothing, it could be something as easy as going down in magnet strength, or it could be something that requires medical attention. Always play it safe and seek medical advice. If you’re seeing just slight irritation at the magnet site, you can put moleskin (available at any drugstore, some people use it for blisters) on the back of the magnet to make it a softer connection with the skin, or lower the magnet strength.
What about the magnet placement? No two CI magnets are placed exactly the same. Each patient’s head shape, size, growth, and the decision of their surgeon will affect where the magnet is located on the head. In surgery, your doctor will use a template to make sure the magnet will not be placed too close to the other parts of the external processor (you’ve got to be able to comfortably wear both parts and not have them overlap!), but other than that, it varies. If you’re having sequential surgeries (one ear done after the other), you can ask the surgeon to try his or her best to get the magnets even on your head. Usually they’ll measure and use a surgical marker to note where it should be. It’s nice to have symmetry and not look lopsided, especially for people with shorter hair where the magnets are more visible, but ultimately, it’s not essential for hearing. You’ll enjoy sound just the same either way. If your magnet position seems to have “slipped” or changed over time, contact your surgeon. This could mean that the internal implant has moved and may require a revision surgery.
How can I keep the magnet on a very young child? The great news is that babies are receiving cochlear implants earlier and earlier, enabling them to learn listening, speech, and language in a developmental way just like their hearing peers. The bad news is… it’s hard to keep anything on a baby’s head, let alone a cochlear implant processor worth thousands of dollars. Strollers, car seats, and high chairs are our prime suspects here. Their headrests, which wrap around the baby’s skull to keep him safe, also tend to knock off CI magnets. Use a retention device like a headband or pilot cap to prevent this. In the car, if one parent can ride in the back seat with the child to make sure the devices stay on, that is great! If you’re a busy family on the go, chances are you spend a lot of time in the car, and removing the CIs each time the child is in the carseat means missing lots and lots of valuable interaction time. Try to keep them on as much as possible. Your child’s brain development depends on it! Some families find that using booster seats or high chairs that hook onto the table rather than stand-alone high chairs works better for them, as the stand-alone models often have higher backs and more head support (which means more chance for the CIs to get brushed off). Some CI models come with an audible alert that will let you know when the magnet falls off. This is a great way to keep an “ear out” for when your child’s device goes off the air. Remember, if the magnet’s off, the external processor is not communicating with the internal implant, so sound is not going to the brain.
Young children often go through phases of pulling the CIs off — because they’re fun and convenient toys (it’s always there to play with!), because it gets a big reaction from mom, because they’re tired/cranky/hungry/a hundred other things. For every time the child takes it off, you put it back on. Use distraction, give the child something else to play with, and make sure that listening is meaningful and fun for your child — give him a reason to want to hear! Whether the child takes off the CIs one time or a thousand times, this phase won’t last forever (though it might seem like an eternity some days), and you are making an investment in your child’s future. Don’t let today’s frustration cheat you out of a lifetime of success.
What about CI magnets and people with mobility challenges or additional disabilities? Regardless of age, some people use wheelchairs, positions, or other devices that have headrests and may interfere with the cochlear implant magnet. Here is where the OT and adaptive equipment specialist become your best friend. Work together to find solutions, whether it’s using a headband, cutting out a piece of foam from the wheelchair’s headpiece to accommodate the CI, or finding another way to position the CI user in bed. Some people with mobility issues may have difficulty placing and replacing the magnet by themselves. A headband can help in these cases, allowing people to access sound without being stuck if the magnet falls off.
What if I have to have the internal magnet removed? Some patients require multiple high-strength MRIs or other treatments that necessitate the removal of the CI’s internal magnet. (Some CI brands are not MRI- approved at all, others can tolerate MRIs of low strength. In any case, regardless of brand, contact your surgeon and CI manufacturer before any MRI procedure.) For these CI users, a headband, hat, or tape can be used to get the external magnet close enough to the internal pieces so that they can still “talk.” It’s not the magnet that’s actually doing the talking (which is why you can remove it and still have a functioning CI), it just serves to get the external and internal pieces close enough together so that they can communicate.
Can I go through metal detectors, airport security, or an x-ray machine with a cochlear implant? Absolutely. Some CI users report hearing a little interference as they pass through metal detectors, but it is completely safe to have cochlear implants (the internal and external parts) when going through various security checks or x-rays.
How can I keep CI magnets on when wearing hats or helmets for sports? It’s very important to use appropriate safety gear when riding bikes, riding horses, skiing, playing baseball, or any other sport or activity that requires the use of a helmet. Modifying a helmet yourself, for example, by cutting out the foam, compromises the integrity of the helmet and makes it less safe. Do not cut the helmet or modify it yourself. Instead, try these tips for finding the right helmet that will keep you safe and keep your CI processors in place:
Don’t buy a helmet off the shelf. Go to a bike/equestrian/ski/sport shop where the staff are trained to fit helmets. Try on a lot of different models and see which one works best for you. What works for one CI user is not necessarily good for the next — because of differences in head shape, size, and surgeon, no two CI magnets are placed exactly the same.
Try a headband, sweatband, do-rag, nylon skullcap, or braiding the magnet into your hair.
Some helmets come with optional foam inserts that you can add for positioning purposes. Play around with these to find the best fit for you. (Remember to follow all instructions and do not cut or remove foam from areas where it’s not option. This compromises the safety of the helmet.)
Some baseball players find that keeping their baseball cap on under the helmet when batting holds their CIs in place.
As for regular hats, you should be able to wear those just as you would without a CI, unless the hat’s edge happens to rub right against your CI magnet, knocking it off. This will vary from hat to hat, so you’ll just have to try out various options and experiment. For CI users, the biggest problem with hats is not so much that they knock off the magnet, but that, if they come down over the ears, they can cover the CI microphone, causing a decrease in the sound quality.