The ABCs of cochlear implants

Contributed by , staff writer for Healthy Hearing | Monday, September 8th, 2014

Someone once said “silence is golden” but for the 96,000 deaf and severely hearing impaired Americans who have received a cochlear implant, nothing could be farther from the truth. Thanks to this implanted electrical device, they are now able to recognize sounds in their environment – including speech.

These hearing devices; however, are not without controversy. Not everyone is eligible. They require delicate and expensive surgery which is not always covered by insurance. There’s a lot of follow up therapy required for success. And some members of the deaf community view the devices as a threat to the manual communication they prize as a shared experience.

cochlear implants
Cochlear implants are surgically implanted to 
provide electrical stimulation to nerves in the
inner ear. 

What are cochlear implants?

Like hearing aids, cochlear implants are electronic hearing devices regulated by the Federal Food and Drug Administration (FDA); however, that’s where the similarity ends.

Unlike hearing aids, cochlear implants are surgically implanted to provide electrical stimulation to nerves in the inner ear for those with severe or profound hearing loss. There are two main parts to this device:

  • An external microphone, processor and transmitter, and
  • An implanted receiver and electrode system

Often, a magnet holds the external system in place behind the ear next to the implanted internal system, although the external system can also be worn in a pocket or harness.

The external system receives sound, processes it and sends electrical signals to the receiver near the auditory nerve. The electrically stimulated nerve sends a signal to the brain which it learns to recognize. While this process simulates normal hearing, it is not the same.

How are cochlear implants different from hearing aids?

While hearing aids amplify sounds for damaged ears to hear, cochlear implants actually bypass the damaged part of the ear and provide direct stimulation for the auditory nerve. Because this hearing device bypasses the hearing mechanism in the inner ear, sound quality differs from normal sound.

In other words, hearing aids amplify the sound our ears collect. This sound travels through the cochlea, where sensory hair cells translate the sound into electrical impulses and send them along the auditory nerve to the brain. When hearing loss is severe or profound, amplification doesn't help. It's these patients who may be candidates for a cochlear implant .

Who benefits most from cochlear implants?

Individuals who are deaf or severely hearing impaired benefit most from this technology. The Food and Drug Administration (FDA) estimates that since 2012 58,000 American adults and 38,000 children have received them.

Cochlear implants may be especially beneficial for children. Studies show that children who receive an implant by 18 months of age are more likely to develop speech and language skills equal to that of their normal hearing peers as compared to children who receive implants at a later age.

Your hearing healthcare professional can help determine whether you are a good candidate for cochlear implant surgery and refer you to a surgeon who performs this type of surgery. Most insurance companies, Medicare and Medicaid cover the cost of this surgery. Check with your insurance provider to see if your policy provides this type of coverage.

What is the success rate of cochlear implant surgery?

There are several factors which determine whether or not cochlear implant surgery will be successful. Those who have been deaf a short time typically do better than those who have been deaf longer. Younger patients typically do better than older patients. Those who learn quickly, are intelligent and have a good support system do very well. And, of course, the healthier your inner ear, the better your outcome.

Success includes the ability to understand speech without lip reading, make telephone calls, watch television and even enjoy music. Some patients learn to hear at almost normal ranges and understand speech, while some receive no hearing benefit at all.

Why are cochlear implants so controversial?

There is a certain faction of the Deaf community which prefers to embrace their deaf status. They do not believe their deafness compromises their ability to live a productive life – or that deafness is a medical condition that needs to be corrected. To them, cochlear implants are insulting and disrespectful to the unique cultural experience they share.

Additionally, since cochlear implants do not restore lost hearing, some say those who wear them are neither hearing nor deaf – almost like being a man without a country. Deaf individuals maintain that successful interaction with the hearing world isn’t dependant on knowing sign language or the ability to speak – rather on the deaf individual’s self esteem, grasp of language and communication and their ability to relate to all people in their environment.

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