• Cochlear implants are medical devices that bypass damaged structures in the inner ear and directly stimulate the auditory nerve. They are surgically implanted to improve hearing in people with severe or profound hearing losses. They can create a range of sound, but do not replace normal hearing.
• Cochlear implants are not indicated for all hard of hearing or deaf people. They are not recommended in people who function well with hearing aids.
• Cochlear implants can be provided for children as young as 18 months old, as well as adults.
• Cochlear implants can be in one ear or both (binaural)
• To be considered for a cochlear implant, you will need to receive an evaluation by a physician and audiologist associated with a cochlear implant clinic.
• Ideal candidates are motivated to work hard in their rehabilitation after surgery. It helps to have good family support and to live close to a clinic in order to conveniently make the follow-up trips for mapping and adjustments.
• Adjustments (called "mapping") are an integral and essential part of cochlear implant rehabilitation. Mapping is done by trained audiologists who adjust the speech processor to help improve hearing.
• Cochlear implant performance varies. People hear better over time with practice. It takes a while to get used to hearing sounds in a new way. Speech processors are computers worn as a behind-the-ear device similar in look to a behind-the-ear hearing aid.
• Use of the phone after implementation varies among individuals. Some people plug into the speech processor directly. Others hold the phone up to the ear, while others are not able to use the phone comfortably after their implant.
• Cochlear implants cost around $30,000. Cochlear implants are covered by most insurance plans. Medicare covers cochlear implants. Research shows that they improve the quality of life and are, therefore, cost-effective interventions.
• A variety of assistive devices can be combined with cochlear implants to improve their effectiveness. For example, patch cords can connect speech processors to assistive listening devices. Also a directional hand-held microphone can be used to improve speech pick-up in noisy environment.

MORE ON COCHLEAR IMPLANTS

Excerpted from “Successful Aging and Our Hearing”
By John K. Niparko, M.D., and Courtney Carver, Au.D., CCC-A
Hearing Loss Magazine, January/February 2009

When a hearing loss is profound (beyond treatable with hearing aids), the hearing loss carries substantial, measurable effects on multiple domains that are important to quality of life (Francis et al, 2001). My colleague, Dr. Howard Francis used a well-tested survey of the things that people consider crucial to the quality of their life. The survey results revealed that impaired communication with others made people vulnerable to low mood and depression, and to some effects on thinking ability. All contributed to a significant reduction in the quality of life experienced by seniors with hearing loss.

For those with more advanced, severe-to-profound sensorineural hearing loss, the cochlear implant provides a physiologically useful code of electrical signals. These signals trigger trains of impulses in nerves within the ear in severe-to-profound deafness. The "cochlear implant" is actually a system of technology. A portion of that system worn on the ear processes information from incoming sound. The processed information is transferred across the skin to an implanted receiver-stimulator, which serves as a control tower that receives coded signals and transfers that code directly to the nerve of hearing.

A cochlear implant is designed for those who do not benefit from powerful hearing aids in a material way (a level of understanding of at least half of the words of every day communications). A large number of clinical studies now document the benefits of the cochlear implant in providing speech and environmental sound recognition.

The critical question for many seniors contemplating a cochlear implant is how to predict what level of benefit might result. A number of studies have applied multivariate statistical testing (assessing the many factors that can influence hearing results) in an effort to analyze cochlear implant results in seniors 65 years of age and older. Studies over the past 20 years document better speech-recognition performance in elderly listeners in a quiet environment with the use of a cochlear implant.

As results from these studies accumulate, two factors have emerged as carrying significant power in explaining how much speech recognition will improve with a CI. Duration of deafness and the word understanding scores achieved in testing before an implant is placed are the main factors that carry significant predictive power in forecasting the benefit of a cochlear implant. A shorter duration of deafness and higher levels of retained speech understanding (for example in the 20 to 50 percent range) predict greater gains in speech understanding. About one-fourth of the overall range of outcome can be explained based on the length of deafness and about one-sixth of depends on the word understanding capabilities prior to implantation. Other patient, ear and device variables demonstrated no significant correlations with the benefit achieved with respect to speech recognition.

A more recent analysis of a large group of patients indicates that age carries a very small effect in determining post-operative outcome and offers encouragement for seniors with advanced levels of hearing loss (Leung et al, 2005). Instead, studies continue to bear out that a more significant factor is the ratio of duration of deafness to age at implantation (Tyler & Summerfield, 1996)

Because duration of deafness and pre-implant speech recognition most consistently predict outcome, a concept of an “auditory foundation” is suggested. An “auditory foundation” appears to reflect the ongoing low-level activity that allows nerves within the hearing pathway to retain their potential to work well (in contrast to completely abolished activity that silences the pathway). The auditory foundation:

• may be considered a form of cognition that reflects an internalized memory of the sounds of speech and the ability to process sensory inputs that are based in sound.
• appears key in predicting the ability to use restored hearing from a cochlear implant to discriminate words, and
• may moderate effects that might occur with senescent changes in elderly implant recipients.

RESOURCES

Download the Cochlear Implant Booklet in PDF.

Articles:

“Reflections on My Cochlear Implant”
by Audiologist Mark Ross, Ph.D. (Hearing Loss Magazine, March/April 2007)

"Cochlear Implant Mapping: What Every CI User and Candidate Should Know"
by Courtney L. Carver (Hearing Loss Magazine, July/August 2007)

“Health Insurance and Implantable Hearing Devices: Guidance for Consumers”
by Donna L. Sorkin (Hearing Loss Magazine, November/December 2007)

"Turned On" - an article about cochlear implants
http://www.csun.edu/cod/conf/1998/proceedings/csun98_056.htm

"Listening to Music through a Cochlear Implant (Part 1)"
by Audiologist Mark Ross, Ph.D. (Hearing Loss Magazine, May/June 2008)

"Listening to Music through a Cochlear Implant (Part 2)"
by Audiologist Mark Ross, Ph.D. (Hearing Loss Magazine, July/August 2008)

"Chronicles of a Bionic Woman"
by Abbie Cranmer (Hearing Loss Magazine, May/June 2008)

"Successful Aging and Our Hearing"
by John K. Niparko, M.D., and Courtney L. Carver (Hearing Loss Magazine, January/February 2009)

“Cochlear Implants, Hope After Hearing Aids"
Northwestern Memorial Hospital’s Alan Micco, M.D., and CI recipient Patrick Condon who are guests of Andrew Schorr on this informative webcast about cochlear implants.

Online:

Chat for parents of children with cochlear implants: http://www.cicircle.org

Cochlear Implant Forum Listserv - contact CI@YorkU.CA

John Hopkin's Listening Center: http://www.thelisteningcenter.com/

HLAA Monday night cochlear implants chats, 8 p.m., EST: http://www.myhearingloss.org/

Programs: Cochlear Americas Launches New Rehabilitation Program for Cochlear Implant Recipients (PDF)