What is a cochlear implant?
A cochlear implant is a medical device that is surgically placed into the hearing organ (cochlea) to provide direct electrical stimulation of the auditory nerve.
How does it work?
A cochlear implant is different from a hearing aid. Hearing aids help the majority of individuals with hearing loss by amplifying sound. But even the most advanced hearing aids may not overcome the hearing difficulties associated with severe to profound hearing impairment. A cochlear implant bypasses the damaged areas of the cochlea and may provide improved hearing abilities for speech understanding and the perception of music and environmental sounds.1
A cochlear implant receives sound from the outside environment, processes it, and sends small electric currents near the auditory nerve. These electric currents activate the nerve, which then sends a signal to the brain. The brain learns to recognize this signal and the person experiences this as “hearing”.
The cochlear implant somewhat simulates natural hearing, where sound creates an electric current that stimulates the auditory nerve. However, the result is not the same as normal hearing.2
1“Cochlear Implants-American Cochlear Implant Alliance”. Acialliance.org, 2020. https://www.acialliance.org/page/CochlearImplantMenu.
2 Center for Devices and Radiological Health. “Cochlear Implants”. U.S. Food and Drug Administration, 2019. https://www.fda.gov/medical-devices/implants-and-prosthetics/cochlear-implants.
Parts of the cochlear implant:
A cochlear implant consists of external and internal (surgically implanted) components.
The external components include:
- A microphone that picks up sounds from the environment;
- A speech processor (a computer) that analyzes and digitizes sound signals and sends them to a transmitter;
- A transmitter worn on the head that sends the signal to the surgically implanted internal receiver/stimulator.
The internal components include:
- A receiver/stimulator just under the skin which receives signals from the processor and converts them into electric impulses;
- An electrode array that receives the signal from the transmitter and stimulates the auditory nerve. The transmitted information is then sent to the brain, which “learns” to interpret the signal as meaningful information.3
Who is a candidate to receive a cochlear implant?
A determination of candidacy is made by an audiologist and ear-nose-throat (ENT) surgeon with special training in cochlear implants. As of 2012, an adult with moderate to profound hearing loss may have up to 50% sentence discrimination (i.e. words in sentences) in the ear to be implanted — wearing hearing aids — and be an appropriate candidate.
In general, if someone wearing appropriately fit hearing aids cannot understand speech without seeing the speaker’s face, they should be evaluated for a cochlear implant. 4
3“Cochlear Implants-American Cochlear Implant Alliance”. Acialliance.org, 2020. https://www.acialliance.org/page/CochlearImplantMenu.
4“Cochlear Implants-American Cochlear Implant Alliance”. Acialliance.org, 2020. https://www.acialliance.org/page/CochlearImplantMenu
What are the Benefits of Cochlear Implants?
- Hearing ranges from near normal ability to understand speech to no hearing benefit at all.
- Adults often benefit immediately and continue to improve for about 3 months after the initial tuning sessions. Then, although performance continues to improve, improvements are slower. Cochlear implant users’ performances may continue to improve for several years.
- Most perceive loud, medium and soft sounds. People report that they can perceive different types of sounds, such as footsteps, slamming of doors, sounds of engines, ringing of the telephone, barking of dogs, whistling of the tea kettle, rustling of leaves, the sound of a light switch being switched on and off, and so on.
- Many understand speech without lip-reading. However, even if this is not possible, using the implant helps lip-reading.
- Many can make telephone calls and understand familiar voices over the telephone. Some good performers can make normal telephone calls and even understand an unfamiliar speaker. However, not all people who have implants are able to use the phone.
- Many can watch TV more easily, especially when they can also see the speaker’s face. However, listening to the radio is often more difficult as there are no visual cues available.
- Some can enjoy music. Some enjoy the sound of certain instruments (piano or guitar, for example) and certain voices. Others do not hear well enough to enjoy music.5
5“Center for Devices and Radiological Health. “Cochlear Implants”. U.S. Food and Drug Administration, 2019. https://www.fda.gov/medical-devices/implants-and-prosthetics/cochlear-implants
What does cochlear implant surgery involve?
While this cochlear surgery is a low-risk procedure, patients will receive general anesthesia. The process takes approximately 1- 3 hours and typically occurs as an outpatient procedure.
To begin the cochlear implant surgical process, a surgeon makes a 4-6 cm incision behind the ear and opens the mastoid bone, which leads into the middle ear. Next, they open the hearing portion of the ear (the cochlea) and implant the electrode array. They then place the receiver/stimulator under the skin behind the ear and secure it in place. To finish, the surgeon closes the incision and applies a head dressing to protect the wound.
After surgery, doctors will observe the patient before discharging them. Patients receive instructions on how to care for the incision, how to change the dressing, and when to return for a follow-up appointment. 6
What are the risks and potential side effects of this surgery?
- Loss of residual hearing ability in the implanted ear
- Bleeding and/or swelling at the incision site
- Infection in the implant area
- Ringing (tinnitus) in the implanted ear
- Dizziness or vertigo (typically resolves within a few days after surgery) • Change in taste/dry mouth (typically resolves within a few weeks or months after surgery)
- Numbness around the incision site
- Injury to the facial nerve (extraordinarily rare)
Will there be pain after surgery?
Pain tolerance is different for everyone, but in general the pain is mild-to-moderate and can be controlled with oral pain medications, if needed, for a few days.
What can I expect after cochlear implant surgery?
Full recovery for cochlear implant surgery generally takes 3-4 weeks. That said, most patients return to routine activities (such as work and school) after a week. Mild to moderate pain may last up to a week after surgery but can be controlled with oral pain medications.
Patients should avoid sports and exercise for at least 1-2 weeks following surgery (and swimming for 4-6 weeks). However, cochlear implantation recovery and rehabilitation can differ between patients. Consult a professional about your recovery plan.
Once the incision site heals fully, your audiologist will program the external receiver and activate the implant. Cochlear implants require regular care.7
6“Cochlear Implants-American Cochlear Implant Alliance”. Acialliance.org, 2020. https://www.acialliance.org/page/CochlearImplantMenu
7“Cochlear Implants-American Cochlear Implant Alliance”. Acialliance.org, 2020. https://www.acialliance.org/page/CochlearImplantMenu
Can a patient hear immediately after the operation?
No. Without the external transmitter part of the implant a patient cannot hear. The clinic will activate the external components 2-4 weeks after the implant surgery in the first programming session.8
What happens during the initial programming session?
Two to four weeks after surgery, the patient is fit with the external part of the cochlear implant, which is called a sound processor. A cochlear implant audiologist uses a computer to adjust each of the individual electrodes to levels that allow the recipient to best hear sounds. The process is similar to a hearing test in which a patient listens to tones to determine the most comfortable and effective level of sound for the individual. These levels are stored on the speech processor; this data is often referred to as a “map.” After the audiologist measures and saves this data, the sound processor is turned on and the person hears with a cochlear implant for the first time.
Several appointments may be needed after this initial activation to adjust the program as patients adapt to sound and practice listening with the device. The number of appointments needed varies by person but is typically 3 to 6 appointments the first year and one appointment per year after that.9See the attached appointment timeline for more information.
What does the cochlear implant sound like?
Patients may hear sounds differently. Sound impressions from an implant differ from normal hearing, according to people who could hear before they became deaf. At first, users describe the sound as “mechanical”, “technical”, or “synthetic”. This perception changes over time, and most users do not notice this artificial sound quality after a variable period of time.
The amount of benefit that a patient receives from a cochlear implant depends on several factors. Research has shown that adults who acquired their hearing loss after learning to talk receive greater benefit than those who had significant hearing loss before learning to talk.10
8“Center for Devices and Radiological Health. “Cochlear Implants”. U.S. Food and Drug Administration, 2019. https://www.fda.gov/medical-devices/implants-and-prosthetics/cochlear-implants
9“Cochlear Implants-American Cochlear Implant Alliance”. Acialliance.org, 2020. https://www.acialliance.org/page/CochlearImplantMenu
10“Center for Devices and Radiological Health. “Cochlear Implants”. U.S. Food and Drug Administration, 2019. https://www.fda.gov/medical-devices/implants-and-prosthetics/cochlear-implants
What auditory rehabilitation is involved following surgery?
The process of learning to hear through the cochlear implant is like learning a new language. You must be consistent in wearing the device and practice listening exercises 30-60 minutes a day. This involves training your brain to understand the sounds you hear through the cochlear implant. At first speech and everyday noises around you won’t sound the same as you might recall them.
Your brain needs time to understand the new sounds and to understand speech. This process is ongoing. It’s best to wear the speech processor anytime you’re awake. You do have to take it off while swimming or showering.
Regular, often lifelong, follow-up visits will help you get the most from your cochlear implants. Follow-up visits include checking your hearing, programming the device and doing other testing.11
What results should I expect post cochlear implantation?
The results of cochlear implant surgery vary from person to person. The cause of your hearing loss can affect how well cochlear implants work for you.12 A systematic research review from 2020 indicated the following results:
- Cochlear implantation can be considered an effective treatment of hearing loss for adults of any age who have limited speech perception. Based on this scoping review, 75% of adults using a cochlear implant obtained ≥42% on word perception and ≥60% on sentence perception in quiet.
- Approximately 82% of patients with post lingual hearing loss, and 53% of patients with prelingual hearing loss will have improved speech perception.
- Very few patients (5–8%) will obtain poorer speech perception with their cochlear implant in comparison to their preoperative performance, but a number may experience no significant change or limited improvement.
- The greater the preoperative speech perception performance, the smaller the postoperative change. While cochlear implants are highly effective in most cases, there is significant variability in outcomes, and some adults will not obtain benefit from them.”13
11 Mayo Clinic. “Cochlear Implants- Mayo Clinic”. Mayoclinic.org, May 10, 2022. https://www.mayoclinic.org/tests-procedures/cochlear implants/about/pac-20385021
12Mayo Clinic. “Cochlear Implants- Mayo Clinic”. Mayoclinic.org, May 10, 2022. https://www.mayoclinic.org/tests-procedures/cochlear implants/about/pac-20385021
13 Boisvert, Isabelle, Mariana Reis, Agnes Au, Robert Cowan, and Richard C. Dowell. “Cochlear Implantation Outcomes in Adults: A Scoping Review.” PLoS ONE 15, no. 5 (May 5, 2020): e0232421. https://doi.org/10.1371/journal.pone.0232421.
Is a cochlear implant covered by insurance?
Cochlear implantation is typically covered by most private health insurance plans for patients that meet candidacy requirements. Pre-authorization is acquired by the surgeon prior to cochlear implantation to ensure coverage. Cochlear implantation is a covered service for Medicare patients. Insurance typically covers evaluation, surgery, and follow-up audiology appointments.14
What is the process for obtaining a cochlear implant?
- Comprehensive hearing test (audiogram) by audiologist.
- Cochlear implant evaluation (determination of candidacy) by audiologist.
- Review CI manufacturers and choose which company you will pursue.
- Complete order form with audiologist or CI representative.
- Meet with surgeon to discuss surgery risks, benefits, prerequisites. • Insurance authorization (requested by surgeon).
- Schedule surgery date with surgical center.
- Schedule an initial activation appointment with Link Audiology once the surgery date is confirmed.
What is the timeline for cochlear implant appointments:
The first year following cochlear implantation involves many appointments with your audiologist and it is crucial to attend all appointments to ensure the best outcomes.
- Initial activation (2 weeks post-surgery)
- 2 weeks post activation
- 1-month post activation
- 3-month post activation
- 6-month post activation
- 12-month post activation
- Annual visit hereafter.
14 “Cochlear Implants-American Cochlear Implant Alliance”. Acialliance.org, 2020. https://www.acialliance.org/page/CochlearImplantMenu
LINK AUDIOLOGY CONTACT INFORMATION:
Interested in cochlear implantation after being determined to be a candidate? Your next step is to contact the surgeon if you haven’t met with them already. Please contact our clinic when a decision is made re: manufacturer and surgery date.
Questions? Contact us at 360-551-4800 or email us at connect@linkaudiology.com
| Cochlear Implant Audiologists: | Clinic Locations Served: |
| o Evan Grolley, Au.D., CCC-A | o Silverdale, University Place |
| o Madeline Henry, Au.D., CCC-A | o Silverdale |
| o Kaitlin Rink, Au.D., CCC-A | o Silverdale, University Place |
| o Hannah Burch, Au.D., CCC-A | o University Place |
| Clinic Locations Offering Cochlear Implant Services: |
| o Silverdale: |
| o Address: 9576 Ridgetop Blvd, Suite 103 Silverdale, WA 98383 |
| o Phone number: 360-551-4800 |
| o Fax number: 360-551-4801 |
| o University Place: |
| o Address: 3560 Bridgeport Way W, Suite 3D University Place, WA 98466 |
| o Phone number: 360-551-4800 |
| o Fax number: 360-551-4087 |
Cochlear implant manufacturers:
There are three cochlear implant manufacturers- Advanced Bionics, Cochlear Americas, and MEDEL.
All have similar outcomes in terms of speech understanding and device reliability. Each manufacturer has a different philosophy, design, features, and accessories. Visit the manufacturer websites or meet virtually with a manufacturer representative (contact information below) to learn more.
See attached comparison chart for further information.
Advanced Bionics:
Website: https://www.advancedbionics.com/com/en/home
Representative name:
Email: hear@AdvancedBionics.com
Phone number: +1-800-693-0706
Cochlear Americas:
Website: https://www.cochlear.com/us/en/home
Representative name: Nicole Grimes
Email: ngrimes@cochlear.com
Phone number: +1-206-753-9054
MEDEL:
Website: https://www.medel.com/en-us
Representative name: Rebecca Ramirez
Email: rebecca.ramirez@medel.com
Phone number: +1-984-327-7779
Bibliography:
Boisvert, Isabelle, Mariana Reis, Agnes Au, Robert Cowan, and Richard C. Dowell. “Cochlear Implantation Outcomes in Adults: A Scoping Review.” PLoS ONE 15, no. 5 (May 5, 2020): e0232421. https://doi.org/10.1371/journal.pone.0232421.
Center for Devices and Radiological Health. “Cochlear Implants”. U.S. Food and Drug Administration, 2019. https://www.fda.gov/medical-devices/implants-and prosthetics/cochlear-implants.
“Cochlear Implants-American Cochlear Implant Alliance”. Acialliance.org, 2020. https://www.acialliance.org/page/CochlearImplantMenu
Mayo Clinic. “Cochlear Implants- Mayo Clinic”. Mayoclinic.org, May 10, 2022. https://www.mayoclinic.org/tests-procedures/cochlear-implants/about/pac-20385021
Sorkin DL. “Cochlear implantation in the world’s largest medical device market: Utilization and awareness of cochlear implants in the United States.” Cochlear Implants International Vol 14 (2013) :(S1):S4-S12. https://doi.org/10.1179/1467010013z.00000000076.
