Q: What is a cochlear implant?
A: A cochlear implant is an electronic medical device designed to restore the ability to perceive sounds and understand speech by individuals with moderate to profound hearing loss. Children and adults who are not sufficiently helped by hearing aids may benefit from cochlear implants. Unlike a hearing aid, which delivers amplified sound acoustically, a cochlear implant bypasses damaged hair cells in the cochlea and stimulates the remaining nerve fibers directly through the application of electrical current. A cochlear implant is a device for people whose hearing technology needs may be beyond hearing aids.
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.
Q: Why not use hearing aids?
A: 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.
For some individuals who have useable residual hearing in one ear there is an opportunity to use a cochlear implant in one ear and a hearing aid in the other. The cochlear implant center teams are able to help patients to be appropriately fit with both devices.
Q: Who is a candidate to receive a cochlear implant?
A: 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. For children, an assessment of any child with a severe to profound hearing loss should be made as early as possible as outcomes with a cochlear implant are significantly better in children who receive an implant at the earliest possible age. Cochlear implant candidacy guidelines have changed to include children and adults with more residual hearing as well as other anatomic, health, and learning issues that would have been considered “absolute” or “relative” contraindications in the past. Utilization of other technologies, in combination with the cochlear implant device, have provided further expansions in outcomes bringing recipients closer to “normal” hearing. With all of these changes have come a new recognition of the quality of life changes and cost utility made possible when the right device is matched to appropriate patients.
For a listing of cochlear implant centers where an evaluation can be performed, please visit the websites of the three companies that manufacture and distribute cochlear implant devices in the U.S. See a list of our partners on this website.
Q. Are cochlear implants appropriate for older adults?
A: Older adults benefit greatly from cochlear implants. However, widespread misunderstanding exists regarding when older adults should be referred for a cochlear implant and there is a tendency by our healthcare system to overlook hearing as a major health concern. Studies have shown that there is no significant difference in outcomes for older adults. Medicare covers cochlear implantation for appropriate candidates. The following free online course LINK provides guidance as to when to refer older adults for a cochlear implant evaluation and the documented benefits and safety of hearing restoration via cochlear implants for those over age 65.
Q: What is involved in the process of cochlear implantation?
A: Continuum of Cochlear Implant Care. For further details on the steps involved with cochlear implantation, click HERE.
Q: What are the barriers to cochlear implantation?
A: Barriers to cochlear implantation can be traced to low awareness among both the general public and the medical community. Further, there are no universally sanctioned medical/clinical guidelines for best practices in cochlear implantation and audiology after care—the data-based, best practices which lead to consistent clinical outcomes. Low reimbursement through public and private payers along with recent reductions in Medicaid payment has only increased the financial burden.
Q: Can cochlear implants provide recipients with an appreciation for music?
A: For many, music is a universal language that unites people when words cannot. But for those who use cochlear implants – technology that allows deaf and hard of hearing people to comprehend speech – hearing music remains extremely challenging. To read more, see the following articles:
UW Today - New Strategy lets Cochlear Implant Users Hear Music
NPR - Deaf Jam: Experiencing Music through a Cochlear Implant