Cochlear Implants Guide

Many Americans are hard of hearing, to various degrees, and some Americans are deaf. For those with moderate hearing loss, hearing aids can be an essential tool to help restore hearing and maintain normal day-to-day functioning. Yet, for those with profound hearing losses, hearing aids may not be enough. These people may require cochlear implants. 

What Are Cochlear Ear Implants? 

A cochlear implant is a medical device that is implanted in a person who has severe damage to their inner ear. The cochlear implant is made up of three key parts. The first part is the sound processor that collects environmental sounds, ranging from speech to other noises. This sound processor is very small and sits behind the ear. The second part of the cochlear implant is the receiver, which collects information from the sound processor. This small receiver is implanted under the skin behind the ear. The receiver’s information is then sent to the third part of the implant, the electrode array. The array is placed in the cochlea. This array sends information to and stimulates the auditory nerve. 

By stimulating the auditory nerve directly, the cochlear implant is able to work around damaged areas of the inner ear and restore hearing. 

Who Can Receive Cochlear Implants? 

Cochlear implants are designed for individuals with profound or full hearing loss who have damage to areas of their inner ear, the cochlea. For these individuals, traditional hearing aids are ineffective in restoring hearing. Hearing aids amplify sound, but the damaged area of the ear cannot process these amplified sounds. 

Adults and Children as Young As One

The U.S. Food and Drug Administration has approved cochlear implants to be used in adults and children over the age of one year. More adults than children have received cochlear implants, perhaps not surprisingly, but research shows that cochlear implants can be life-changing for young children. By offering these implants to young children, medical professionals help them acquire language and sounds at a younger age, which can be beneficial for cognitive and speech and language development.    

For adults, cochlear implants can be used for both those who have previously heard and those who have been deaf since birth. However, the results post-implant are often better for people who had previous hearing. Also, success may be greater in cases when there is less of a time gap between hearing loss and implant surgery.

Before deciding that a cochlear implant is appropriate, doctors will conduct extensive hearing tests to ensure that the patient could not benefit from another option, such as a hearing aid.

What Happens before a Cochlear Implant Surgery?

There are numerous steps that a patient must complete before going through an actual cochlear implant surgery. 

First, a doctor will order specialized hearing tests. These tests are designed to show that other options, such as a hearing aid, will not benefit the patient and that the person is likely to receive benefits from having the implant. Once these results are established, the doctors will also likely order an MRI and/or CT scan so that they have a full picture of the patient’s inner ear damage. Doctors will also conduct other medical tests to ensure that the patient is healthy enough to undergo surgery under general anesthesia and that they are unlikely to have post-surgical complications. 

Also, given that a patient needs ongoing therapy and hearing re-education after a cochlear implant, doctors and support staff will want to make sure that they have a strong support network. 

The Surgery

As noted above, the surgery is performed under general anesthesia. During the surgery, an incision will be made in the skin behind the patient’s ear, where the internal portion of the implant will be placed into the mastoid bone. The other part of the device is placed into the cochlea, the inner ear. 

Generally, patients do exceptionally well during the surgery and experience minimal pain and discomfort. In fact, many patients are discharged from the hospital on the same day of surgery. Other patients may need to stay overnight for additional monitoring. 

Some people may have nausea and/or dizziness after the surgery. Other patients may have localized pain or discomfort afterward.

After the Surgery

It is important to remember that a cochlear implant is not an immediate solution to hearing loss. Regaining hearing after the implant is a time-consuming process.

Approximately two to six weeks after the surgery, an audiologist will turn on the implant for the first time and also fit the external processing unit. The exact timing of this will depend on the individual patient’s healing process. Once the implant is activated, the patient will begin the process of learning how to use the implant effectively. During this initial activation, the audiologist will make sure that the implant is working appropriately and will also assess what sounds the patient is hearing. 

Sometimes the fitting and adjustment process can happen with one appointment, and, in other cases, it may require multiple follow-up appointments.

Intensive Rehabilitation

Once physical recovery from the cochlear implant surgery is completed, the patient will move into the rehabilitation and re-education process. During this process, the patient will work with a trained specialist to learn or re-learn what sounds are. Things sound different with an implant, and the brain must be trained to recognize these new sound impulses. 

This process takes time. It is not immediate, and it takes effort on the part of the patient. 

Are There Drawbacks Associated with Cochlear Ear Implants? 

Yes, there are potential drawbacks. Anybody considering this approach for their hearing loss should meet with their medical professionals to determine if it is a potentially appropriate solution for them. They should also carefully consider the positives and negatives. 

Some of the drawbacks include:

#1 Cost 

Most estimates suggest that cochlear ear implants cost roughly $50,000. Most insurance companies, including Medicare or Medicaid, do cover the costs of this implant. But, some people may end up with out-of-pocket expenses. Therefore, it is important to determine coverage before you move forward with this surgery.  Also, there may be costs after the surgery if it becomes necessary to replace parts. 

Most offices that deal with cochlear implants have insurance specialists who are well-versed in navigating the insurance process. Therefore, make sure to work hand-in-hand with them to figure out a payment plan. 

#2 Surgical Complications

Cochlear ear implants are a major surgery that is performed under general anesthesia and, thus, poses all of the risks of being under general anesthesia. Therefore, it is important to discuss your general health with your surgeon before moving forward with the surgery.  Other potential complications include infections or reactions related to the implant or the potential development of tinnitus, ringing in the ears. However, many people who had experienced tinnitus prior to the surgery see improvements in their symptoms post-implant.

#3 The Need for Therapy

Cochlear ear implants require more than just successfully undergoing surgery. The person who receives cochlear ear implants must work hand-in-hand with a qualified speech and language pathologist, often for months or years, to relearn how to hear. Cochlear ear implant manufacturers have developed comprehensive training guides for people who may be located a long distance from qualified providers, which can help people learn to maximize their devices’ benefits. The more committed people are to the process, the more likely they are to experience success with the implant. 

The Next Generation: Hybrid Cochlear Implants

Additional research continues to be conducted on cochlear implants, expanding the number of patients who could potentially benefit from them. The next generation in this research is hybrid implants. This process is designed to help people who have normal hearing across most frequencies but who struggle with hearing higher frequencies. This hybrid system will allow you to maintain your hearing in frequency ranges where you have normal functioning while simultaneously improving your functioning in other hearing ranges. 

In Conclusion 

Cochlear implants are an important medical device that can help restore hearing to adults and children who are deaf or have profound hearing losses by bypassing damaged areas of the inner ear and sending impulses directly to the auditory nerve. These implants can profoundly improve the quality of life for impacted individuals. But, the decision to get an implant should not be taken lightly. People need to carefully weigh the benefits against potential downsides, such as the high cost of implants and possible complications. Any decisions should be made in consultation with a professional who is experienced in cochlear implants.