Q. How does a cochlear implant work?

A: 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.

Learn more about how a cochlear implant works here.

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 our Find a Clinic page.

Q. I’m not deaf and still have some benefit from my hearing aid(s). Is it possible that I would have improved hearing with a cochlear implant?

A .The only way to know is to be evaluated at a center specializing in cochlear implants. Candidacy criteria today are much broader than they were even 5 years ago because the technology has improved. New devices and surgical techniques allow for preservation of residual hearing. If you struggle with certain speakers, in noise, and on the telephone—even wearing hearing aids—you may be a CI candidate and be able to improve your hearing outcomes with a cochlear implant. A CI evaluation is typically covered by health insurance. For a listing of ACI Alliance Organizational Members specializing in cochlear implants visit Find a Cochlear Implant Clinic.  If you don’t see a center close to your home, email us at info@acialliance.org and we will help you locate an appropriate clinic for an evaluation.

Q. What is a Hybrid or Electric Acoustic cochlear implant?

A. Electric acoustic stimulation (EAS) combines use of a hearing aid and cochlear implant in the same ear. Such devices are for people with usable low frequency hearing who have severe-to profound hearing loss in higher frequencies and perform poorly with traditional amplification alone. Hybrid or electric acoustic devices use a short internal electrode designed to preserve low frequency hearing that can be amplified with a hearing aid while electrically stimulating mid-to-high hearing frequencies with a cochlear implant. The recipient of a hybrid or EAS cochlear implant uses an external device that combines a hearing aid and a cochlear implant processor. When these combined hearing aid-cochlear implant devices were approved for use by the FDA, CI candidacy criteria for adults was expanded to include people with more low frequency hearing.

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. Are there benefits in using a hearing aid on the opposite ear from a cochlear implant?

A. Research confirms that many people with usable residual hearing derive benefit from bimodal hearing (a hearing aid in one ear and a cochlear implant in the other). Having sound on both sides may improve sound localization as well as speech understanding in quiet and in noise. Assistive devices can be programmed to both ears. Bimodal users often report that music sounds better with the combined use of a hearing aid and a cochlear implant.

Q: What is involved in the cochlear implant process?

A: Continuum of Cochlear Implant Care. For further details on the steps involved with cochlear implantation, click HERE.

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 – enjoying music is variable. Many recipients do enjoy music and even play instruments. There are cochlear implant recipients who play professionally. Practice and realistic expectations are helpful. To read more, see the following articles:

AudiologyOnline: Adults Do Enjoy Music with Cochlear Implants! (Webinar; free and captioned)

NPR:  Deaf Jam: Experiencing Music through a Cochlear Implant

Blog Section: Listening to Music with a Cochlear Implant

A Consumer's Perspective: Richard Reed, Rhythm & Blues Musician

Q: Can I wear my cochlear implant processor when swimming or in the bath?

A: Yes—with the appropriate accessories! The manufacturers have all developed solutions that recipients can use to waterproof their equipment. These accessories (and/or special waterproof processors) allow users to swim with sound in a wide variety of conditions including fresh, salt, and chlorine water. Many families enjoy bath time with the waterproof options to keep language learning going. There are ways to ensure that the processor and equipment stays in place while swimming, such as headbands and clips.

Specific details on waterproofing solutions can be found on the websites of each CI manufacturer. Your cochlear implant audiologist will also be able to discuss these options. Before pursuing any deep water activities—with or without the sound processor on—be sure to speak with your surgeon.

Q: Is it safe to have an MRI if I have a cochlear implant?

A: Before having a MRI, you should check with your cochlear implant manufacturer or audiologist to determine if your cochlear implant is compatible for you to undergo a MRI. While each of the three cochlear implant manufacturers with FDA approval in the United States offer MRI compatible cochlear implants, there are specific recommendations and restrictions that should be strictly followed. Furthermore, in the event of an emergency, it is also recommended, that you carry information with you that identifies that you have a cochlear implant with a magnet and that specific precautions should be taken before MRI imaging. Medical alert bracelets or necklaces are also available.

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.