Cochlear Implants

What are cochlear implants?

Cochlear implants are electronic devices that help manage hearing loss. Your healthcare provider may recommend this treatment if you have moderate, profound or severe hearing loss in one or both ears and you’re not benefiting from your hearing aids. You may also benefit from a cochlear implant if your hearing aids work, but you still can’t understand speech as well as you’d like.

Cochlear implants don’t restore your hearing. But they can improve your ability to understand speech and hear other sounds.

Types of cochlear implants

All cochlear implants include an external part you wear and an internal part that a surgeon will place during surgery:

• External parts include a microphone, processor and transmitter.
• Internal parts include electrodes and a receiver.

How you wear the external parts of the device depends on the type you get:

• One style sits on your ear and has a cable that attaches to a disc on the side of your head.
• Another style attaches to the side of your head and doesn’t require an ear unit.

How cochlear implants work

Unlike hearing aids, which turn the volume up on sounds, cochlear implants bypass damaged parts of your ear. Most hearing problems happen because of damaged sensory hair cells inside your cochlea (sensorineural hearing loss). Your cochlea is inside your inner ear, deep inside your skull. It changes sound signals that enter your ear into electrical impulses your brain interprets as sound.

Cochlear implants create a new pathway for sounds to reach your brain. It works like this:

1. You wear a mic and sound processor that captures sound signals coming into your outer ear.
2. The sound processor sends the signals to the transmitter (usually attached to your scalp with a magnet).
3. The transmitter changes the signals into electrical impulses that travel to the receiver. The receiver is an implant under your skin, opposite the transmitter.
4. The receiver sends the impulses to the electrodes inside your cochlea.
5. The electrodes collect the impulses and send them on to your hearing (auditory) nerve.
6. Your auditory nerve carries the impulses to your brain.

Your brain perceives the electrical impulses as speech, music or other noise.

What happens during treatment?

First, you’ll need cochlear implant surgery to place the internal parts. It’s an outpatient procedure, which means you can go home that same day. Your surgeon (an otolaryngologist) will:

1. Give you general anesthesia that puts you to sleep
2. Make a small cut (incision) behind your ear
3. Create an opening in the bone behind your ear
4. Use the opening to place the internal parts of your device
5. Use stitches (sutures) to close the incision behind your ear

About two weeks after surgery, you’ll have a follow-up appointment to put on the external parts. A hearing specialist (audiologist) will:

1. Put the mic and sound processor in place and adjust the fit
2. Check the device to be sure all parts are working
3. Turn on the device and check what you can hear
4. Adjust the device so you’re hearing as well as you can

How long will I need a cochlear implant?

You’ll have your cochlear implant forever, so you’ll work with audiologists and surgeons for the rest of your life. You’ll have regular appointments so your care team can confirm that:

• The settings on your device are functioning at their best
• Your device is working well (in general, the internal parts last forever, and the external parts typically last five to 10 years)
• Your skin at the site of the magnet (the part that goes on your scalp) is healthy

What are the potential benefits and risks of having a cochlear implant?

The benefits of cochlear implants far outweigh the risks. This is true whether you have complete hearing loss or if hearing aids help, but you want to hear better.

Here’s a snapshot of the benefits:

• Cochlear implants can help you hear phone calls and take part in conversations in groups and in noisy places.
• People with ringing in their ears (tinnitus) related to hearing loss experience improvements.
• Children born with hearing loss often learn to speak as soon as children who don’t have hearing loss. (Children ages 9 months and older may have cochlear implants.)

That said, all surgeries come with risks. Although they’re rare, risks specific to cochlear implant surgery include:

• Damage to the nerves at the surgery site
• Meningitis (your provider may recommend you get vaccinated against meningitis to reduce your risk)
• Loss of residual hearing (the hearing you have despite severe or profound hearing loss)
• Tinnitus (although cochlear implants usually improve tinnitus in most people)
• Cerebrospinal fluid leaks
• Balance issues, like dizziness and vertigo

How long will it take for me to feel better?

It may take some time before you notice a big change for the better. That’s because your brain needs to relearn how to process sounds. In general, people’s hearing improves about a month after their implants are activated. Sometimes, it takes three to six months for people to reach their full hearing potential.

In the meantime, you’ll likely work with an audiologist or a speech-language pathologist (SLP). They can help train your brain to understand what sounds mean. You need to be committed to doing auditory-based therapy to get the most out of your implant.

What does a person with a cochlear implant hear?

Adults who get cochlear implants often say that speech sounds mechanical at first. But eventually, the sounds from your cochlear implant will become natural. In general, the earlier in life you get an implant, the easier it is to adapt to the new way of hearing.

Still, the learning curve depends a lot on the type of hearing loss you have and how severe it is. The time you devote to therapy matters, too.

Is there anything I can do to make having a cochlear implant easier on me?

To get the most out of this treatment:

• Use your implant consistently. This means wearing the external mic/processor while you’re awake and for the appropriate amount of time each day.
• Take part in therapy. Your brain is relearning how to interpret signals. Participating in therapy helps that process.
• Know what you can’t do with a cochlear implant. You’ll need to remove the external part of your device when you’re bathing or swimming. You may need to avoid some contact sports. Taking a hit to the head could dislodge your implant.
• Know what you can do with a cochlear implant. Instead of placing limitations on your life, an implant can help you engage with others like never before. Your audiologist can explain how your new device may improve your ability to understand others and socialize.

When should I call my healthcare provider?

Contact your provider if you notice hearing changes or you have ear pain or discomfort in your ears. Let them know immediately if you or your child has signs of an infection, like a fever and redness, swelling or drainage at the surgery site.

Can a deaf person hear with a cochlear implant?

It depends. A cochlear implant can’t help you hear as you would without inner ear damage. But it can help you access sounds that can help with understanding what others are saying. It can help you perceive noises in your surroundings that alert you to danger. Working with an audiologist or SLP can give you the tools you need to get the most out of your implant.

I have some hearing ability, so will I lose all hearing if I have a cochlear implant?

Not always. Historically, you could expect to lose all hearing after cochlear implant surgery. But improved cochlear implant surgery techniques and implant design mean that about half of people retain their hearing after surgery.