Cochlear Implants

Cochlear implants are electronic devices that help manage hearing loss. The device can’t restore your hearing. But it can improve your ability to understand speech and hear other sounds.

Your healthcare provider may recommend this treatment if you have moderate, profound or severe hearing loss in one or both ears. It’s also an option if you use hearing aids, but you still can’t understand speech as well as you would like. Children as young as 9 months may have this treatment. You have surgery to put the implants in place.

Cochlear implants have two parts:

1. The external part includes a microphone, a sound processor and a transmitter. You may wear the device on your ear or the side of your head. A device on your ear connects to a disc on the side of your head.
2. The internal part contains electrodes and a receiver. The electrodes are placed in your inner ear. The receiver is placed behind your ear, under your skin. Both steps are part of cochlear surgery.

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

Cochlear implants create a new pathway for sounds to reach your brain if you have sensorineural hearing loss. This hearing loss happens when something damages the tiny hair cells in your cochlea in your inner ear. Here’s how a cochlear implant may improve your hearing:

1. The mic and sound processor capture sound signals from your outer ear.
2. The sound processor sends the signals to the transmitter on your scalp. A magnet keeps the transmitter in place.
3. The transmitter changes the sound signals into electrical impulses that travel to the receiver.
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 nerve.
6. Your auditory nerve carries the impulses to your brain.
7. Your brain perceives the impulses as speech, music or other noises.

What are the benefits and potential risks?

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

The device can:

• Improve your hearing so you can do things like take part in conversation
• Ease tinnitus (ringing in your ears)
• Help children with hearing loss learn to speak as soon as children who don’t have hearing loss

That said, all surgeries come with risks. Some rare but potential risks 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

What happens during a cochlear implant?

Cochlear implant surgery is the first step in your treatment. Your surgeon 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.

This surgery is typically an outpatient procedure.

The next step is a follow-up appointment with your audiologist that will happen about two weeks after your surgery. At this appointment, your audiologist will:

1. Place the external part of the device on your head. Put the mic and sound processor in place and adjust the fit.
2. Check the device to be sure all the parts work.
3. Turn on the device and check what you can hear.
4. Adjust the device so you can hear as well as you can.

You’ll have auditory-based therapy, working with your audiologist or speech-language pathologist. Remember that the implant helps sound signals move from your outer ear to your inner ear and on to your brain. Auditory-based therapy helps your brain process the signals and turn them into sound. This treatment will help you get the most benefit out of your implant.

How long will I need a cochlear implant?

You’ll need it for the rest of your life to have improved hearing.

You’ll have regular appointments, so your care team can check your device and device settings. The device’s internal parts last forever. The external parts typically last five to 10 years.

Your team will also check your skin at the part of your scalp where the magnet holds the receiver in place.

How long will it take for me to feel better?

It may take several months for your brain to relearn how to process sounds. Most people have improved hearing about a month after their audiologist activates the implant. It may be three to six months before you reach your full hearing potential.

When should I call my healthcare provider?

Contact your surgeon right away if you have infection symptoms, like fever, redness, swelling or pus draining from the surgery site. Ear pain and hearing changes are other reasons to contact your care team.

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.
• Protect your implant. Remove the external part of your device when you swim, take a shower or take a bath. You may need to avoid some contact sports. Taking a hit to the head could dislodge 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.

Can a deaf person hear with a cochlear implant?

You won’t hear as you would if you didn’t have inner ear damage. But a cochlear implant can help you access sounds that help you understand what others say. Working with an audiologist or speech-language pathologist 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?

You may. Improved surgery techniques and implant design mean about half of people retain hearing ability after surgery.