Cochlear Implants | NIDCD Cochlear Implants What is a cochlear implant? Ear with cochlear implant Source: NIH/NIDCD A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin (see figure). An implant has the following parts: A microphone, which picks up sound from the environment. A speech processor, which selects and arranges sounds picked up by the microphone. A transmitter and receiver/stimulator, which receive signals from the speech processor and convert them into electric impulses. An electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve. An implant does not restore normal hearing. Instead, it can give a deaf person a useful representation of sounds in the environment and help him or her to understand speech. How does a cochlear implant work? A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds so they may be detected by damaged ears.

Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn. However, it allows many people to recognize warning signals, understand other sounds in the environment, and understand speech in person or over the telephone. Who gets cochlear implants? Children and adults who are deaf or severely hard-of-hearing can be fitted for cochlear implants. As of December 2012, approximately 324,200 registered devices have been implanted worldwide. In the United States, roughly 58,000 devices have been implanted in adults and 38,000 in children. (Estimates provided by the U.S. Food and Drug Administration [FDA], as reported by cochlear implant manufacturers.) The FDA first approved cochlear implants in the mid-1980s to treat hearing loss in adults. Since 2000, cochlear implants have been FDA-approved for use in eligible children beginning at 12 months of age.

For young children who are deaf or severely hard-of-hearing, using a cochlear implant while they are young exposes them to sounds during an optimal period to develop speech and language skills. Research has shown that when these children receive a cochlear implant followed by intensive therapy before they are 18 months old, they are better able to hear, comprehend sound and music, and speak than their peers who receive implants when they are older. Studies have also shown that eligible children who receive a cochlear implant before 18 months of age develop language skills at a rate comparable to children with normal hearing, and many succeed in mainstream classrooms. Some adults who have lost all or most of their hearing later in life can also benefit from cochlear implants. They learn to associate the signals from the implant with sounds they remember, including speech, without requiring any visual cues such as those provided by lipreading or sign language. How does someone receive a cochlear implant? Use of a cochlear implant requires both a surgical procedure and significant therapy to learn or relearn the sense of hearing. Not everyone performs at the same level with this device. The decision to receive an implant should involve discussions with medical specialists, including an experienced cochlear-implant surgeon. The process can be expensive.

For example, a person’s health insurance may cover the expense, but not always. Some individuals may choose not to have a cochlear implant for a variety of personal reasons. Surgical implantations are almost always safe, although complications are a risk factor, just as with any kind of surgery. An additional consideration is learning to interpret the sounds created by an implant. This process takes time and practice. Speech-language pathologists and audiologists are frequently involved in this learning process. Prior to implantation, all of these factors need to be considered. What does the future hold for cochlear implants? The NIDCD supports research to enhance the benefits of cochlear implants. Scientists are exploring whether using a shortened electrode array, inserted into a portion of the cochlea, for example, can help individuals whose hearing loss is limited to the higher frequencies while preserving their hearing of lower frequencies. Researchers also are looking at the potential benefits of pairing a cochlear implant in one ear with either another cochlear implant or a hearing aid in the other ear. Where can I find additional information about cochlear implants? The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

Use the following keywords to help you find organizations that can answer questions and provide information on cochlear implants: Cochlear Implants | Hearing Loss Treatments | Cochlear™ Aust/NZ Hearing loss treatments Print Cochlear implants & cochlear implant technology A cochlear implant is an electronic medical device that does the work of damaged parts of the inner ear (cochlea) to provide sound signals to the brain. What is a cochlear implant? A cochlear implant is an electronic medical device that replaces the function of the damaged inner ear. Unlike hearing aids, which make sounds louder, cochlear implants do the work of damaged parts of the inner ear (cochlea) to provide sound signals to the brain. Who can they help? Cochlear implants can help people who: have moderate to profound hearing loss in both ears have profound hearing loss in one ear with normal hearing in the other ear receive little or no benefit from hearing aids score 65% or less on sentence recognition tests done by hearing professional in the ear to be implanted Many people have cochlear implants in both ears (bilateral). Listening with two ears can improve your ability to identify the direction of sound and separate the sounds you want to hear from those you don’t. How do they work?

Many people suffer hearing loss because their hair cells in the inner ear or (or cochlea) are damaged. The cochlear implant enables the sound to be transferred to your hearing nerves and enables you to hear. The process is described below: Show All Close All A sound processor worn behind the ear or on the body, captures sound and turns it into digital code. The sound processor has a battery that powers the entire system. The sound processor transmits the digitally-coded sound through the coil on the outside of your head to the implant. The implant converts the digitally-coded sound into electrical impulses and sends them along the electrode array placed in the cochlea (the inner ear). The implant's electrodes stimulate the cochlea's hearing nerve, which then sends the impulses to the brain where they are interpreted as sound. What are the benefits of a cochlear implant? Many adults with cochlear implants report that they: Hear better with a cochlear implant than with a hearing aid A previous study has shown that people with cochlear implant achieve an average of 80% sentence understanding, compared with 10% sentence understanding for hearing aids1. Can focus better when in noisy environments This allows them to have conversations with people across meeting tables, in restaurants and other crowded places.

Reconnect with missed sounds that they could not hear before their cochlear implant. Feel safer in the world as they can hear alarms, people calling out and approaching vehicles. Talk and hear on the phone Enjoy music What factors can affect these benefits? The benefit of cochlear implants is often different for different individuals. This difference is often due to: how long they have had hearing loss before receiving a cochlear implant how severe their hearing loss is condition of their cochlea (inner ear) other medical conditions What is a Cochlear Implant? What is a Cochlear Implant? What other sources of information are there? What is a cochlear implant? A cochlear implant is an implanted electronic hearing device, designed to produce useful hearing sensations to a person with severe to profound nerve deafness by electrically stimulating nerves inside the inner ear. These implants usually consist of 2 main components: The externally worn microphone, sound processor and transmitter system. The implanted receiver and electrode system, which contains the electronic circuits that receive signals from the external system and send electrical currents to the inner ear. Currently made devices have a magnet that holds the external system in place next to the implanted internal system.

The external system may be worn entirely behind the ear or its parts may be worn in a pocket, belt pouch, or harness. [ back to top ] Who uses cochlear implants Cochlear implants are designed to help severely to profoundly deaf adults and children who get little or no benefit from hearing aids. Even individuals with severe or profound "nerve deafness" may be able to benefit from cochlear implants. What determines the success of cochlear implants? Many things determine the success of implantation. Some of them are: How long the patient has been deaf--as a group, patients who have been deaf for a short time do better than those who have been deaf a long time How old they were when they became deaf--whether they were deaf before they could speak How old they were when they got the cochlear implant--younger patients, as a group, do better than older patients who have been deaf for a long time How long they have used the implant How quickly they learn [ back to top ] How does a cochlear implant work? A cochlear implant receives sound from the outside environment, processes it, and sends small electric currents near the auditory nerve. These electric currents activate the nerve, which then sends a signal to the brain.

The brain learns to recognize this signal and the person experiences this as "hearing". The cochlear implant somewhat simulates natural hearing, where sound creates an electric current that stimulates the auditory nerve. However, the result is not the same as normal hearing. Why are there different kinds of implants? Current thinking is that the inner ear responds to sound by at least two separate ways. One theory, the place theory, says the cochlea responds greater to a simple tone at one place along its length. Another theory is that the ear responds to the timing of the sound. Researchers, following the place theory, devised implants that separated the sound into groups. For example, they sent the lower pitches to the area of the cochlea where it seemed more responsive to lower pitches. And they sent higher pitches to the area more responsive to high pitches. Thus, they used several channels and electrodes spaced out inside the cochlea. Since there were also timing theories, researchers devised implants that made the sound signals into pulses to see if the cochlea would respond better to various kinds of pulses. Most modern cochlear implants are versatile, in that they are somewhat capable of being adjusted to respond to sound in various ways.

Audiologists try a variety of adjustments to see what works best with a particular patient. [ back to top ] How long have cochlear implants been available? The first commercial devices were approved by the FDA in the mid-1980's. However, research with this device began in the 1950's. What other sources of information are there? cochlear implant manufacturers and their websites support groups for cochlear implanted patients and their caregivers organizations supplying information on hearing loss Cochlear implant: MedlinePlus Medical Encyclopedia URL of this page: //medlineplus.gov/ency/article/007203.htm Cochlear implant A cochlear implant is a small electronic device that helps people hear. It can be used for people who are deaf or very hard of hearing. A cochlear implant is not the same thing as a hearing aid. It is implanted using surgery, and works in a different way. There are many different types of cochlear implants. However, they are most often made up of several similar parts. One part of the device is surgically implanted into the bone surrounding the ear (temporal bone).

It is made up of a receiver-stimulator, which accepts, decodes, and then sends an electrical signal to the brain. The second part of the cochlear implant is an outside device. This is made up of a microphone/receiver, a speech processor, and an antenna. This part of the implant receives the sound, converts the sound into an electrical signal, and sends it to the inside part of the cochlear implant. WHO USES A COCHLEAR IMPLANT? Cochlear implants allow deaf people to receive and process sounds and speech. However, these devices do not restore normal hearing. They are tools that allow sound and speech to be processed and sent to the brain. A cochlear implant is not right for everyone. The way a person is selected for cochlear implants is changing as the understanding of the brain's hearing (auditory) pathways improves and the technology changes. Both children and adults can be candidates for cochlear implants. People who are candidates for this device may have been born deaf or become deaf after learning to speak. Children as young as 1 year old are now candidates for this surgery.

Although criteria are slightly different for adults and children, they are based on similar guidelines: The person should be completely or almost completely deaf in both ears, and get almost no improvement with hearing aids. Anyone who can hear well enough with hearing aids is not a good candidate for cochlear implants. The person needs to be highly motivated. After the cochlear implant is placed, they must learn how to properly use the device. The person needs to have reasonable expectations for what will occur after surgery. The device does not restore or create "normal" hearing. Children need to be enrolled in programs that help them learn how to process sound. In order to determine if a person is a candidate for a cochlear implant, the person must be examined by an ear, nose, and throat (ENT) doctor (otolaryngologist). People will also need specific types of hearing tests performed with their hearing aids on. This may include a CT scan or MRI scan of the brain and the middle and inner ear. People (especially children) may need to be assessed by a psychologist to determine if they are good candidates. HOW IT WORKS Sounds are transmitted through the air. In a normal ear, sound waves cause the eardrum and then the middle ear bones to vibrate.

This sends a wave of vibrations into the inner ear (cochlea). These waves are then converted by the cochlea into electrical signals, which are sent along the auditory nerve to the brain. A deaf person does not have a functioning inner ear. A cochlear implant tries to replace the function of the inner ear by turning sound into electrical energy. This energy can then be used to stimulate the cochlear nerve (the nerve for hearing), sending "sound" signals to the brain. Sound is picked up by a microphone worn near the ear. This sound is sent to a speech processor, which is most often connected to the microphone and worn behind the ear. The sound is analyzed and converted into electrical signals, which are sent to a surgically implanted receiver behind the ear. This receiver sends the signal through a wire into the inner ear. From there the electrical impulses are sent to the brain. HOW IT IS IMPLANTED To have the surgery: You will receive general anesthesia so you will be asleep and pain free. A surgical cut is made behind the ear, sometimes after shaving part of the hair behind the ear. A microscope and bone drill are used to open the bone behind the ear (mastoid bone) to allow the inside part of the implant to be inserted.

The electrode array is passed into the inner ear (cochlea). The receiver is placed into a pocket created behind the ear. The pocket helps keep it in place, and makes sure it is close enough to the skin to allow electrical information to be sent from the device. A well may be drilled into the bone behind the ear so the implant is less likely to move under the skin. After surgery: There will be stitches behind the ear. You may be able to feel the receiver as a bump behind the ear. Any shaved hair should grow back. The outside part of the device will be placed 1 to 4 weeks after surgery to give the opening time to heal. RISKS OF SURGERY A cochlear implant is a relatively safe surgery. However, all surgeries pose some risks. Risks are less common now that the surgery is performed through a small surgical cut, but may include: Wound healing problems Skin breakdown over the implanted device Infection near the implant site Less common complications include: Cochlear Implants | Hearing Loss Association of America Go to our Online Community section to connect with others online.

HLAA Monday night cochlear implants chats, 8 p.m., EST: Chat for parents of children with cochlear implants: Cochlear Implant Experiences on Facebook. Email the group for an invitation to join in the conversation. ciexperiences@groups.facebook.com Ask Yourself the Following Questions Even with powerful hearing aids, do you: Hear but don't understand? Have to ask people to repeat themselves during one-on-one conversations, even in a quiet room? Need captions displayed to understand TV programs? Avoid social activities because you don' t know what's being said and are afraid you will respond incorrectly? Depend on speechreading to understand a conversation? Find yourself exhausted at the end of the day because communication requires such a high degree of concentration? Have a hard time keeping up at work? Do you find communication at work to be difficult and to interfere with carrying out duties on the job? Have trouble hearing on the phone? Avoid making and answering phone calls? No longer enjoy listening to music? When tested by an audiologist with your hearing aids on, do you score less than 60 percent on your ability to repeat sentences? If you answered yes to any of these questions, you may be a good candidate for a cochlear implant.

Excerpted from “Successful Aging and Our Hearing” By John K. Niparko, M.D., and Courtney Carver, Au.D., CCC-A Hearing Loss Magazine 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. These observations are further underscored by assessments of ultimate outcome. Implant recipients report significant satisfaction expressed as improvements in quality of life after receiving a cochlear implant. While some reports indicate that elderly people achieve the same or nearly the same level of benefit in speech-recognition as do younger recipients, elderly cochlear implant users may have a slower learning curve. For people over the age of 70, the cochlear implant may produce, on average, slightly lower speech-recognition scores than younger people. These differences may reflect some limits in processing information that is presented at a rapid rate by the cochlear implant. Fortunately, however, these effects appear to be small. Cochlear Implants | American Academy of Otolaryngology-Head and Neck Surgery Patient Health Information News media interested in covering the latest from AAO-HNS/F can find information on embargoes, Annual Meeting press registration and more below.

Please direct any interview requests or policy questions to our media and public relations staff at newsroom@entnet.org . A cochlear implant is an electronic device that restores partial hearing to individuals with severe to profound hearing loss who do not benefit from a conventional hearing aid. It is surgically implanted in the inner ear and activated by a device worn outside the ear. Unlike a hearing aid, it does not make sound louder or clearer. Instead, the device bypasses damaged parts of the auditory system and directly stimulates the nerve of hearing, allowing individuals who are profoundly hearing impaired to receive sound. What is normal hearing? Your ear consists of three parts that play a vital role in hearingthe external ear, middle ear, and inner ear. Conductive hearing: Sound travels along the ear canal of the external ear, causing the ear drum to vibrate. Three small bones of the middle ear conduct this vibration from the eardrum to the cochlea (auditory chamber) of the inner ear. Sensorineural hearing: When the three small bones move, they start waves of fluid in the cochlea, and these waves stimulate more than 16,000 delicate hearing cells (hair cells).

As these hair cells move, they generate an electrical current in the auditory nerve. The electrical signal travels through inter-connections in the brain to specific areas of the brain that recognize it as sound. How is hearing impaired? If you have disease or obstruction involving your ear canal, tympanic membrane (ear drum), or middle ear, your conductive hearing may be impaired. Medical or surgical treatment can probably correct this or a hearing aid can be used in certain instances. An inner ear problem, however, can result in a sensorineural impairment or nerve deafness. In most cases, the hair cells are damaged and do not function. Although many auditory nerve fibers may be intact and can transmit electrical impulses to the brain, these nerve fibers are unresponsive because of hair cell damage. Since severe sensorineural hearing loss cannot be corrected with medicine, it can be treated only with a cochlear implant. How do cochlear implants work? Cochlear implants bypass damaged hair cells and convert speech and environmental sounds into electrical signals and send these signals to the hearing nerve. A cochlear implant has two main components: An internal component that consists of a small electronic device that is surgically implanted under the skin behind the ear, connected to electrodes that are inserted inside the cochlea.

An external component, usually worn behind the ear, that consists of a speech processor, microphone, and battery compartment. The microphone captures sound, allowing the speech processor to translate it into distinctive electrical signals. These signals or "codes" are transmitted across the skin via radio waves to the internal electronic stimulator. The internal stimulator then sends the signals to the implanted electrodes in the cochlea. The electrodes signals stimulate the auditory nerve fibers to send information to the brain, where it is interpreted as meaningful sound. Cochlear implant benefits Cochlear implants are designed only for individuals who attain almost no benefit from a hearing aid. They must be 12 months of age or older (unless childhood meningitis is responsible for deafness). Otolaryngologists (ear, nose, and throat specialists) perform implant surgery, although not all of them do this procedure. Your local doctor can refer you to an implant clinic for an evaluation. The implant team (otolaryngologist, audiologist, nurse, and others) will determine your candidacy for a cochlear implant and review what you may expect as a result of the cochlear implant.

The implant team will also conduct a series of tests, including: Ear (otologic) evaluation: The otolaryngologist examines the ear canal and middle ear to ensure that no active infection or other abnormality precludes the implant surgery. Physical examination: Your otolaryngologist also performs a physical examination to identify any potential problems with the use of general anesthesia needed for the implant procedure. Hearing (audiologic) evaluation: The audiologist performs extensive hearing tests to find out how much you can hear with and without a hearing aid. X-ray (radiographic) evaluation: Special X-rays are taken, usually computerized tomography (CT) or magnetic resonance imaging (MRI) scans, to evaluate your inner ear anatomy. Cochlear implant surgery Cochlear implant surgery is usually performed as an outpatient procedure under general anesthesia. An incision is made behind the ear to open the mastoid bone leading to the middle ear space. Once the middle ear space is exposed, an opening is made in the cochlea and the implant electrodes are inserted. The electronic device at the base of the electrode array is then placed under the skin behind the ear. Is there care and training after the operation?

Several weeks after surgery, your cochlear implant team places the signal processor, microphone, and implant transmitter outside your ear and adjusts them. They teach you how to look after the system and how to listen to sound through the implant. There are many causes of hearing loss and some patients may take longer to fit and require more training due to individual differences. Your team will ask you to come back to the clinic for regular checkups and readjustment of the speech processor as needed. What can I expect from an implant? Most adult cochlear implant patients notice an immediate improvement in their communication skills. Children require time to benefit from their cochlear implant, as the brain needs to learn to correctly interpret the electrical sound input. While cochlear implants do not restore normal hearing, and benefits vary from one individual to another, most users find that cochlear implants help them communicate better through improved lip-reading. Also, 90 percent of adult cochlear implant patients are able to discriminate speech without the use of visual cues.

There are many factors that contribute to the degree of benefit a user receives from a cochlear implant, including:  How long a person has been deaf, The number of surviving auditory nerve fibers, and A patients motivation to learn to hear. Your team will explain what you can reasonably expect. Before deciding whether your implant is working well, you need to understand clearly how much time you must commit. It is rare that patients do not benefit from a cochlear implant. FDA approval for implants The Food and Drug Administration (FDA) regulates cochlear implant devices for both adults and children and approves them only after thorough clinical investigation. Be sure to ask your otolaryngologist for written information, including brochures provided by the implant manufacturers. You need to be fully informed about the benefits and risks of cochlear implants, including how much is known about safety, reliability, and effectiveness of a device; how often you must come back to the clinic for checkups; and whether your insurance company pays for the procedure. Cost of implants More expensive than a hearing aid, the total cost of a cochlear implant, including evaluation, surgery, device, and rehabilitation can cost as much as $100,000.

Fortunately, most insurance companies and Medicare provide benefits that cover the cost. Copyright © 2015 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly prohibited without prior written permission. Cochlear Implant Frequently Asked Questions Cochlear Implant Frequently Asked Questions See also quick facts about cochlear implants . What is a cochlear implant? A cochlear implant is a device that provides stimulation directly to the auditory nerve, bypassing damaged hair cells in the cochlea that prevent sound from reaching the nerve. An implant does not result in "restored" hearing for the recipient, but does allow him or her to perceive sounds. How long have cochlear implants been available? The U.S. Food and Drug Administration (FDA) first approved cochlear implant devices for adults in 1985 and for children in 1990. According to the National Institute on Deafness and Other Communication Disorders, as of December 2010 approximately 70,000 individuals—over half of whom were children—had received cochlear implants in the United States. More than 219,000 individuals have received cochlear implants worldwide.

During recent years, an increase in early hearing detection and intervention (EHDI) programs as a result of legislation and advocacy efforts by organizations such as the American Speech-Language-Hearing Association (ASHA) has allowed for the identification of more children who may benefit from cochlear implants. Who is eligible to receive an implant? In general, adults who have severe to profound hearing loss in both ears and have benefited only minimally from hearing aids may qualify as candidates for cochlear implantation. Children as young as 12 months of age who have severe to profound hearing loss in both ears and who demonstrate little progress in the development of auditory skills may also be considered candidates for some implant devices. It is very important that the implant recipient (and the family, in the case of a young child) have an understanding of cochlear implants and realistic expectations regarding the use of the device. What results can be expected from a cochlear implant? As with any medical procedure, the results of implantation cannot be predicted prior to surgery and recipients may experience a wide range of outcomes. For individuals who lost their hearing after learning to speak, the perception of speech and sounds after implantation may initially seem quite different from what they remember.

After using the cochlear implant for several months or more, these individuals often report that they perceive speech to be more natural or closer to their memory of familiar sounds. While many factors affect outcomes for both children and adults, typically, the younger a child who was born deaf is implanted, the greater the benefit achieved in the areas of speech perception and speech and language development. A predictive factor for implant performance for adults who are deaf is the length of time between the onset of deafness and implantation; those with the shortest duration of deafness tend to experience better outcomes. Where can one receive an implant? There are various centers around the country where teams of professionals work with individuals to determine implant candidacy, perform surgery, and provide follow-up care. Because of the level of commitment required, implant candidates should consider several factors in choosing an implant center, including the level of experience of the staff in working with implant recipients and the center's proximity and accessibility (as numerous trips to the facility may be required). Once an individual receives an implant, is she finished with the process? Wearing a cochlear implant is a lifetime commitment, and requires the recipient to maintain and care for the implant.

After an individual receives the implant, he or she must return to the center for a number of follow-up services, including the fitting of the external components of the implant; activating and programming of the implant and its microphone, speech processor and transmitter; necessary adjustments and reprogramming, and annual check-ups. In addition, recipients must undergo rehabilitation services with members of the team. Children often require years of extensive aural rehabilitation whereas adults who have been implanted due to acquired deafness may need fewer aural rehabilitation sessions. What types of professionals compose the implant team? Among the professionals who may work as part of the cochlear implant team are audiologists, speech-language pathologists, educators, surgeons, medical specialists, psychologists and counselors. What role do audiologists and speech-language pathologists perform in the implant process? Audiologists are involved in many of the components of the cochlear implant program, including determining the candidacy of an individual for implantation, as well as activating and programming of the speech processor after surgery. Both audiologists and speech-language pathologists provide aural rehabilitation services to implant recipients to facilitate their ability to detect and understand speech with the cochlear implant.

Aural rehabilitation services may include processes to enhance communication, auditory training and speechreading, training on the use and care of the implant, and support of the needs of the recipient and family. How much do implants cost? The costs of cochlear implants vary widely depending on a number of factors, including the duration and extent of a patient's hearing loss prior to surgery. The average cost for the entire procedure, including the post-operative aural rehabilitation process, exceeds $40,000. However, cochlear implantation consistently ranks among the most cost-effective medical procedures ever reported, according to research completed by the Johns Hopkins University and the University of California-San Diego. These studies indicate that cochlear implantation can result in a net savings of more than $53,000 per child versus the more than $1 million average expected lifetime cost of a child who has profound hearing loss prior to language development. Do insurance companies cover implants? Health insurance coverage for cochlear implant services has improved greatly in recent years, with the majority of commercial health plans and managed care organizations now providing some level of benefits for the procedure and related services, including programming and aural rehabilitation.

The increase in coverage is largely due to increased education regarding the costs and outcomes of cochlear implantation, and federal and state laws (such as the Americans with Disabilities Act) prohibiting exclusionary insurance policies that deprive cochlear implant candidates from the only opportunity to alleviate their hearing loss. Medicare, TRICARE, the Veteran's Administration, and all other federal health plans provide benefits for all cochlear implant services. Federal law requires that all state Medicaid agencies provide coverage for cochlear implants for children under 21 years old, and most provide benefits for adults as well. Vocational rehabilitation, maternal and children's health services, and other combined federal-state programs also often provide benefits. Where can I find more information about cochlear implants? What to Consider When it Comes to Cochlear Implants By Jamie Berke Updated August 26, 2016 Do you or your child meet the criteria for receiving a cochlear implant? The basic criteria usually is: A severe hearing loss Little to no benefit from hearing aids Willingness to work hard to receive maximum benefit from an implant (for older children and adults) Improved technology has expanded the number of people who qualify for a cochlear implant. However, not everyone can qualify for a cochlear implant.

Preparing for an Implant When considering an implant, learn the basics , learn how an implant works and understand all the costs involved . If time permits, you may even wish to learn about the history of the cochlear implant. Next, move beyond the basics: Although opposition to implants in the deaf community is less than it once was, it is important to listen to the viewpoints of both sides. In addition, there was once a controversial court case involving foster children and cochlear implants. Check with your insurance company for coverage of implants, and/or post-implant therapy. If there is no coverage, you can try to convince your insurance company to cover it. Implant manufacturers or implant teams may be able to help. Note: Medicare does cover implants. If there is no insurance coverage and all efforts to obtain coverage have failed, you may have to become a fund-raiser as some parents have done. In that case, you will need to research fund-raising and available sources of help . Learn what can happen after an implant surgery, such as extrusion and infection . Learn what is involved in cochlear implant surgery , familiarize yourself with its risks, however small, and the possible side effects. In addition, learn about post-surgical care.

Make sure your expectations are realistic based on the age of the implant recipient and other factors. Implant recipients are still deaf and when an implant is turned off, the implantee is deaf. Talk to others who have had implants, or parents of children with implants. If you are an adult considering a cochlear implant for yourself, you may want to read advice from visitors for adults considering cochlear implants. Research the outcome for implantees with similar conditions. Know what to expect at activation time . It is normal for a young baby to react by crying or otherwise being upset because of the strange noises in their heads. Investigate a single implant versus a bilateral implant , particularly for a child. Research the implant manufacturers ( Cochlear , Advanced Bionics , and Med-El ) and check to see what their record of malfunctioning is. Research implant programs at implant centers and find the one you feel is the best for you. If you have the time, read books on cochlear implants. There are cochlear implant reference books , books about people's experiences with implants , and even children's books on cochlear implants. Prepare for the financial cost of maintaining an implant by learning where to buy batteries for the cochlear implant (if batteries are not provided by insurance).

Prepare for surgery Be sure to get vaccinated for meningitis, as a link between implants and meningitis has been found. Prepare your child for cochlear implant surgery. Prepare yourself mentally and emotionally for possible complications or after-effects such as headaches and nausea. After implantation After your child has had their implant for awhile, it may become clearer what type of educational services are needed. Perhaps an oral deaf education program, or a total communication program in a school for the deaf or program for the deaf, will meet your child's needs. If you choose a mainstream program, your child's teacher may not be familiar with deafness and cochlear implants. Join the Cochlear Implant Awareness Foundation or start a chapter in your area. If you don't know sign language , consider learning it because even though you can now hear well with an implant, when the implant is turned off, you will still be deaf and need to be able to communicate. Benefits and Risks of Cochlear Implants Benefits and Risks of Cochlear Implants What are the Benefits of Cochlear Implants? For people with implants: Hearing ranges from near normal ability to understand speech to no hearing benefit at all.

Adults often benefit immediately and continue to improve for about 3 months after the initial tuning sessions. Then, although performance continues to improve, improvements are slower. Cochlear implant users' performances may continue to improve for several years. Children may improve at a slower pace. A lot of training is needed after implantation to help the child use the new 'hearing' he or she now experiences. Most perceive loud, medium and soft sounds. People report that they can perceive different types of sounds, such as footsteps, slamming of doors, sounds of engines, ringing of the telephone, barking of dogs, whistling of the tea kettle, rustling of leaves, the sound of a light switch being switched on and off, and so on. Many understand speech without lip-reading. However, even if this is not possible, using the implant helps lip-reading. Many can make telephone calls and understand familiar voices over the telephone. Some good performers can make normal telephone calls and even understand an unfamiliar speaker. However, not all people who have implants are able to use the phone. Many can watch TV more easily, especially when they can also see the speaker's face. However, listening to the radio is often more difficult as there are no visual cues available.

Some can enjoy music. Some enjoy the sound of certain instruments (piano or guitar, for example) and certain voices. Others do not hear well enough to enjoy music. What are the Risks of Cochlear Implants? General Anesthesia Risks General anesthesia is drug-induced sleep. The drugs, such as anesthetic gases and injected drugs, may affect people differently. For most people, the risk of general anesthesia is very low. However, for some people with certain medical conditions, it is more risky. [ back to top ] Risks from the Surgical Implant Procedure Injury to the facial nerve --this nerve goes through the middle ear to give movement to the muscles of the face. It lies close to where the surgeon needs to place the implant, and thus it can be injured during the surgery. An injury can cause a temporary or permanent weakening or full paralysis on the same side of the face as the implant. Meningitis --this is an infection of the lining of the surface of the brain. People who have abnormally formed inner ear structures appear to be at greater risk of this rare, but serious complication. For more information on the risk of meningitis in cochlear recipients, see the nearby Useful Links.

Cerebrospinal fluid leakage --the brain is surrounded by fluid that may leak from a hole created in the inner ear or elsewhere from a hole in the covering of the brain as a result of the surgical procedure. Perilymph fluid leak --the inner ear or cochlea contains fluid. This fluid can leak through the hole that was created to place the implant. Infection of the skin wound. Blood or fluid collection at the site of surgery. Attacks of dizziness or vertigo. Tinnitus, which is a ringing or buzzing sound in the ear. Taste disturbances --the nerve that gives taste sensation to the tongue also goes through the middle ear and might be injured during the surgery. Numbness around the ear. Reparative granuloma --this is the result of localized inflammation that can occur if the body rejects the implant. There may be other unforeseen complications that could occur with long term implantation that we cannot now predict. Other Risks Associated with the Use of Cochlear Implants People with a cochlear implant: May hear sounds differently. Sound impressions from an implant differ from normal hearing, according to people who could hear before they became deaf.

At first, users describe the sound as "mechanical", "technical", or "synthetic". This perception changes over time, and most users do not notice this artificial sound quality after a few weeks of cochlear implant use. May lose residual hearing. The implant may destroy any remaining hearing in the implanted ear. May have unknown and uncertain effects. The cochlear implant stimulates the nerves directly with electrical currents. Although this stimulation appears to be safe, the long term effect of these electrical currents on the nerves is unknown. May not hear as well as others who have had successful outcomes with their implants. May not be able to understand language well. There is no test a person can take before surgery that will predict how well he or she will understand language after surgery. May have to have it removed temporarily or permanently if an infection develops after the implant surgery. However, this is a rare complication. May have their implant fail. In this situation, a person with an implant would need to have additional surgery to resolve this problem and would be exposed to the risks of surgery again. May not be able to upgrade their implant when new external components become available. Implanted parts are usually compatible with improved external parts.

That way, as advances in technology develop, one can upgrade his or her implant by changing only its external parts. In some cases, though, this won't work and the implant will need changing. May not be able to have some medical examinations and treatments. These treatments include: MRI imaging. MRI is becoming a more routine diagnostic method for early detection of medical problems. Even being close to an MRI imaging unit will be dangerous because it may dislodge the implant or demagnetize its internal magnet. FDA has approved some implants, however, for some types of MRI studies done under controlled conditions. neurostimulation. electroconvulsive therapy. ionic radiation therapy. Will depend on batteries for hearing. For some devices new or recharged batteries are needed every day. May damage their implant. Contact sports, automobile accidents, slips and falls, or other impacts near the ear can damage the implant. This may mean needing a new implant and more surgery. It is unknown whether a new implant would work as well as the old one. May find them expensive. Replacing damaged or lost parts may be expensive. Will have to use it for the rest of life. During a person's lifetime, the manufacturer of the cochlear implant could go out of business.

Whether a person will be able to get replacement parts or other customer service in the future is uncertain. May have lifestyle changes because their implant will interact with the electronic environment. An implant may set off theft detection systems set off metal detectors or other security systems be affected by cellular phone users or other radio transmitters have to be turned off during take offs and landings in aircraft interact in unpredictable ways with other computer systems Will have to be careful of static electricity. Static electricity may temporarily or permanently damage a cochlear implant. It may be good practice to remove the processor and headset before contact with static generating materials such as children's plastic play equipment, TV screens, computer monitors, or synthetic fabric. For more details regarding how to deal with static electricity, contact the manufacturer or implant center. Have less ability to hear both soft sounds and loud sounds without changing the sensitivity of the implant. The sensitivity of normal hearing is adjusted continuously by the brain, but the design of cochlear implants requires that a person manually change sensitivity setting of the device as the sound environment changes. May develop irritation where the external part rubs on the skin and have to remove it for a while. Can't let the external parts get wet.

Damage from water may be expensive to repair and the person may be without hearing until the implant is repaired. Thus, the person will need to remove the external parts of the device when bathing, showering, swimming, or participating in water sports. May hear strange sounds caused by its interaction with magnetic fields, like those near airport passenger screening machines. Cochlear Implants | Michigan Medicine Cochlear Implants Cochlear Implants What is a cochlear implant? A cochlear implant is a small electronic device that can help "make" sound if you have severe or total hearing loss. The implant does the job of the damaged or absent nerve cells that in a normal ear make it possible to hear. Cochlear implants can be programmed according to your specific needs and degree of hearing loss . Who can benefit from a cochlear implant? Cochlear implants may help people with severe or total hearing loss in both ears who do not get any benefit from hearing aids. Cochlear implants have been shown to improve a person's ability to understand speech and speak clearly. Unlike hearing aids, cochlear implants do not make sounds louder but improve how well you hear sound. How does a cochlear implant work?

A cochlear implant consists of a: Microphone worn behind the ear, to pick up sound. Speech processor worn on the body. Some types may be worn behind the ear. Small device placed under the skin near the ear, with electrodes placed in the cochlea . This is the cochlear implant. The microphone picks up sound and sends it to the speech processor, which changes the sound to information the cochlear implant can understand. The implant then tells the nerves in the ear to send a message to the brain. The message is understood as sound. How do I best benefit from a cochlear implant? Speech therapy will help you make the most of your cochlear implant. Training in listening, language, and speech-reading skills (paying attention to people's gestures, facial expressions, posture, and tone of voice) also help you. Do cochlear implants have any complications? Cochlear implants have a low rate of complications, which may include: Risks of surgery, such as infection and medicine that numbs your senses during surgery ( general anesthesia ). The implant moving out of its proper location. You may need a second surgery to relocate the implant. The implant not working.

It may not work because it was made incorrectly or because of an injury to or problem within the ear. Twitching of the face (such as a tic) or not being able to move muscles in the face. This is uncommon and rarely permanent. Bacterial meningitis occurs more often in children with cochlear implants than in children the same age who do not have implants. The Centers for Disease Control and Prevention along with the Food and Drug Administration recommend the following: Your child should have all required vaccinations (shots) for his or her age at least 2 weeks before cochlear implant surgery. After surgery, children need to be up to date with all vaccinations. Watch for signs of meningitis. These include high fever, headache, stiff neck, feeling sick to the stomach or vomiting, difficulty looking into bright lights, and sleepiness or confusion. A young child or infant might be sleepy, cranky, or eat less. If you see any of these signs, contact your doctor. Recognize the signs of an ear infection, including ear pain, fever, and eating less. If you see any of these signs, contact your doctor. It is possible that a cochlear implant can be affected by a magnetic resonance imaging (MRI) scan.

This could cause the implant to stop working. Before you have an MRI, make sure you tell your doctor you have a cochlear implant. By

Question: What does a Cochlear implant help a person do?
Answer: Hear