Medicosnext
Prof. Dr. Bikash Lal Shrestha
He is the Chief Consultant in ENT-Head and Neck Surgery department at Dhulikhel Hospital. He is an ENT surgeon with expertise in otology, neuro-otology, endoscopic ear surgery, cochlear implantation, and hearing rehabilitation. His clinical interests particularly focus on the diagnosis and management of complex ear and hearing disorders, including advanced surgical interventions and comprehensive hearing rehabilitation.
Imagine a child growing up without ever hearing a mother’s voice, the laughter of family members, birds singing, music, or even the simple call of his or her own name. For many children born with severe hearing loss, this is not imagination, it is everyday life.
Today, however, modern medicine offers a remarkable possibility. A cochlear implant can help some children with severe or profound hearing loss gain access to sound and, with appropriate training and rehabilitation, develop listening, speech and communication skills. At Dhulikhel Hospital, we have been working to make this possibility available to more children in Nepal.
A Journey That Began Long Before the First Implant
The cochlear implant program at Dhulikhel Hospital did not begin with the first implant surgery. Its foundation was built over many years.
The ENT Department at Dhulikhel Hospital began its outpatient services in 2002. Over time, the department expanded from basic ear, nose and throat care to advanced ear surgery and specialised hearing and rehabilitation services. Our team developed expertise in a wide range of ear procedures, including surgery to repair the eardrum, improve hearing, treat chronic ear disease, and manage conditions of the middle and inner ear.
Audiology services grew alongside these surgical services. Audiologists became an essential part of the team, helping to identify hearing loss, assess its severity and guide the treatment. An otology fellowship program was also established, providing specialised training in ear surgery for young ENT surgeons.
Together, these developments have created the expertise, teamwork and infrastructure needed to build a cochlear implant service.
What Is a Cochlear Implant?
A cochlear implant is a specialised electronic device that can help people with severe or profound hearing loss who receive limited benefit from conventional hearing aids.
Normally, the inner ear converts sound into electrical signals that travel through the hearing nerve to the brain. When the inner ear is severely damaged, this process does not work adequately. A cochlear implant takes a different approach: instead of simply making sound louder, it converts sound into electrical signals and stimulates the hearing (auditory) nerve directly.
The implant has two main components. One is placed inside the body during surgery, while the other is worn externally near the ear. But the operation is only the beginning. After healing, the external device is fitted and activated, carefully programmed by an audiologist, and followed by regular auditory and speech rehabilitation.
In other words, a cochlear implant is not simply a surgical procedure. It is a long-term journey involving the child, parents, ENT surgeons, audiologists and speech and language therapists.
Why Early Detection Matters
One of the most important lessons in childhood hearing loss is simple: the earlier it is identified, the better.
A baby with hearing loss may otherwise appear completely healthy. Parents may not realise that the child is not hearing normally until several months have passed. During this time, the child may miss the sounds that are essential for developing speech and language.
This is why newborn hearing screening is so important. A simple screening test can identify babies who may have a hearing problem. Those who do not pass screening can then undergo appropriate diagnostic assessment.
Early detection gives families valuable time to consider the right intervention, whether that means hearing aids, auditory rehabilitation or, for children who meet the appropriate criteria, cochlear implantation.
From Screening to Hearing, Speech and Communication
Our vision at Dhulikhel Hospital is therefore broader than performing cochlear implant surgery. We aim to develop a complete pathway for children with hearing loss:
- Detect hearing loss early
- Confirm the diagnosis with appropriate hearing tests
- Provide hearing aids when appropriate
- Identify children who may benefit from cochlear implantation
- Perform the implant surgery
- Activate and program the device
- Provide regular auditory and speech rehabilitation
Every step matters. A cochlear implant cannot work by itself. The device provides access to sound, but the child’s brain must gradually learn to recognise, interpret and attach meaning to those sounds.
What Happens After the Operation?
Many people imagine that once the implant is inserted, a child immediately begins to hear normally. In reality, the process is much more gradual.
After the operation and healing period, the external component is fitted and the device is activated. The audiologist then adjusts the settings according to the child’s responses. At first, sounds may seem strange, unfamiliar or even difficult to understand.
The child needs time and repeated exposure to make sense of these new sounds. Gradually, sounds begin to acquire meaning. A child learns to recognise a parent’s voice, understand words, identify everyday sounds and eventually use spoken language. With regular practice and appropriate rehabilitation, many children can make significant progress in listening and spoken communication.
This learning process takes time, sometimes months or even years. Progress depends on many factors, including the age at which hearing loss is identified and treated, the child’s individual condition, consistent device use and the quality of rehabilitation and family support.
Parents Are Part of the Treatment Team
Parents play a central role in the success of cochlear implantation. They need to bring their child for regular follow-up, ensure consistent use of the device, attend rehabilitation sessions and encourage listening and communication in everyday life.
The hospital team provides the surgery, technology, programming and professional guidance. But most learning happens outside the hospital, in the home, at school and during everyday interactions with family and friends.
For this reason, family counselling and education are essential parts of a cochlear implant program.
The Challenge of Affordability
One of the greatest challenges is cost. Cochlear implants are expensive, and for many Nepalese families, the cost of the device and continuing care can be difficult to afford.
The financial commitment does not end with surgery. Children require regular follow-up and device programming, and external components may sometimes need repair or replacement. Long-term support is therefore essential.
Making cochlear implantation accessible to more children will require collaboration among hospitals, government organisations, charitable foundations, international partners, implant manufacturers and philanthropic organisations. With such support, more families may be able to overcome the financial barriers that currently prevent their children from receiving this life-changing treatment.
More Than an Operation
For an ENT surgeon, a cochlear implant is a sophisticated surgical procedure. For an audiologist, it is a device that requires precise programming. For a speech and language therapist, it marks the beginning of a long rehabilitation journey.
But for a parent, it can mean something much simpler:
“My child may finally hear me.”
The first time a child turns toward a mother’s or father’s voice can be an unforgettable moment for an entire family. The first response to a sound, the first recognised word, the first spoken word and the first conversation may each represent months or years of effort.
These moments remind us why this work matters.
A Future Filled With Sound
Every child deserves the opportunity to communicate, learn and participate fully in society. For children with severe hearing loss, a cochlear implant may provide that opportunity.
But the real achievement is not simply placing an implant in a child’s ear. The real achievement is seeing that child listen, communicate, go to school, make friends and grow into an independent member of society.
At Dhulikhel Hospital, our cochlear implant program is part of an ongoing effort to make that future possible for more children in Nepal. The journey has taken many years, and there is still a long road ahead.
Yet every child who turns toward a parent’s voice, every word spoken for the first time and every family that discovers a new world of sound reminds us that the journey is worth taking.
