Hearing aids provide important benefit for the majority of people with hearing loss. Cochlear implants provide meaningful access to sound for those with more severe hearing loss. Only 5% of US adults who could benefit from CIs have them. The
average primary care medical practice includes 8 adult patients who would benefit from a cochlear implant.
Adults who could benefit from CIs typically do not know they are candidates nor what the expected outcomes are
Age is not a contraindication for CI in otherwise healthy people
Hearing loss is often progressive
Hearing acuity declines may be due to noise exposure, genetics, disease, trauma, or ototoxic medications
Impacts of Undertreated Hearing Loss
Impairs communication at work, in social settings, and with family
Interferes with medical treatment and in carrying out activities of daily living
Associated with social isolation, depression, all-cause dementia, and declines in mental flexibility in older adults
Cochlear Implantation involves the surgical placement of an electrode array into the cochlea of the inner ear to provide direct electrical stimulation of the auditory nerve. Cochlear implants are different from hearing aids.
While hearing aids amplify sounds to facilitate sound detection by impaired ear structures, cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. This type of stimulation improves clarity and
speech understanding. Advances in the technology, including combining hearing aids with CIs, have expanded candidacy to include individuals with usable residual hearing.
Surgery is performed by an otolaryngologist specializing in hearing implants
Evaluation and follow-up is carried out by a multidisciplinary team that includes an ENT surgeon and an audiologist
Since initial approval by the FDA in 1985, CIs have evolved to provide sound that allows clear speech. Most recipients can converse on the phone (without seeing the speaker)
Dramatically improves quality of life, even beyond that of many typically performed medical procedures such as knee or hip replacement, 217,000 (as of 2019) Americans have received cochlear implants, a utilization rate among adults who may benefit
of 5 percent
Low utilization is due to a lack of awareness about candidacy and outcomes
When to Refer a Patient for a Cochlear Implant Evaluation
Based upon a practice size of 2,000 patients for a primary care provider (http://www.aafp.org/fpm/2007/0400/p44.html), it is estimated that there
are 8 adult patients (4/10 of one percent prevalence) in your practice who could benefit. Individuals may not learn of their candidacy from their hearing care professional. A patient may be a CI candidate, if when using
hearing aids, they still struggle to understand speech. Referral considerations:
Has difficulty understanding you or your staff on the telephone
Family members routinely make telephone calls for the person
When you are not facing your patient, (s)he is unable to understand you or doesn’t hear you
Asks that you face them while speaking or positions them to see your face
Noise in the room (i.e., outside traffic, running water, rustling paper) affects speech understanding
Family members note that your patient has difficulty hearing at home, at work, or in other situations.
Insurance Coverage
Unlike hearing aids, which are typically not covered by health insurance, cochlear implantation is covered for appropriate candidates by most private health insurance plans, Medicare and Medicaid.
Referrals for a cochlear implant evaluation should be made to a CI center or clinic. Such specialized centers may be found on our website or on the websites of the three FDA approved manufacturers – Advanced Bionics, Cochlear, and MED-EL.
More Information on cochlear implantation and clinical guidance can be found here, and a printable version of the paper can be found here.
This workshop was originally offered in Spring 2021 and designed for parents, adult consumers and family members interested in learning more about cochlear implants. Presenters discussed recent scientific advances, answered questions, and reviewed (re)habilitation options for patients across the life-span. The workshop is captioned and available for free after filling out a brief survey. Click here to access the workshop.
The mission of the American Cochlear Implant (ACI) Alliance is to advance access to the gift of hearing provided by cochlear implantation through research, advocacy and awareness.
