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A cochlear implant consists of external and internal (surgically implanted) components.

The external components include:

• A microphone that picks up sounds from the environment;
• A speech processor (a computer) that analyzes and digitizes sound signals and sends them to a transmitter;
• A transmitter worn on the head that sends the signal to the surgically implanted internal receiver/stimulator.

The internal components include:

• A receiver/stimulator just under the skin which receives signals from the processor and converts them into electric impulses;
• An electrode array that receives the signal from the transmitter and stimulates the auditory nerve. The transmitted information is then sent to the brain, which “learns” to interpret the signal as meaningful information.

Hearing aids help the majority of individuals with hearing loss by amplifying sound. But even the most advanced hearing aids may not overcome the hearing difficulties associated with severe to profound hearing impairment. A cochlear implant bypasses the damaged areas of the cochlea and may provide improved hearing abilities for speech understanding and the perception of music and environmental sounds.

For some individuals who have useable residual hearing in one ear there is an opportunity to use a cochlear implant in one ear and a hearing aid in the other. The cochlear implant center teams are able to help patients to be appropriately fit with both devices.

A determination of candidacy is made by an audiologist and ear-nose-throat (ENT) surgeon with special training in cochlear implants. As of 2012, an adult with moderate to profound hearing loss may have up to 50% sentence discrimination (i.e. words in sentences) in the ear to be implanted — wearing hearing aids — and be an appropriate candidate.

In general, if someone wearing appropriately fit hearing aids cannot understand speech without seeing the speaker’s face, they should be evaluated for a cochlear implant.

For children, an assessment of any child with a severe to profound hearing loss should be made as early as possible as outcomes with a cochlear implant are significantly better in children who receive an implant at the earliest possible age.

Cochlear implant candidacy guidelines have changed to include children and adults with more residual hearing as well as other anatomic, health, and learning issues that would have been considered “absolute” or “relative” contraindications in the past.

Utilization of other technologies, in combination with the cochlear implant device, have provided further expansions in outcomes bringing recipients closer to “normal” hearing.

With all of these changes has come a new recognition of the quality of life changes and cost utility made possible when the right device is matched to appropriate patients.

Older adults benefit greatly from cochlear implants. However, widespread misunderstanding exists regarding when older adults should be referred for a cochlear implant and there is a tendency by our healthcare system to overlook hearing as a major health concern. Studies have shown that there is no significant difference in outcomes for older adults.

The only way to know is to be evaluated at a center specializing in cochlear implants. Candidacy criteria today are much broader than they were even 5 years ago because the technology has improved. New devices and surgical techniques allow for preservation of residual hearing. If you struggle with certain speakers, in noise, and on the telephone—even wearing hearing aids—you may be a CI candidate and be able to improve your hearing outcomes with a cochlear implant. A CI evaluation is typically covered by health insurance.

Research confirms that many people with usable residual hearing derive benefit from bimodal hearing (a hearing aid in one ear and a cochlear implant in the other). Having sound on both sides may improve sound localization as well as speech understanding in quiet and in noise. Assistive devices can be programmed to both ears. Bimodal users often report that music sounds better with the combined use of a hearing aid and a cochlear implant.

Cochlear implantation involves a team of people with a range of training and skills. Teams include specially trained ear, nose and throat (ENT) physicians, audiologists, and speech language pathologists. Other members of the team might include a social worker, a teacher of children with hearing loss, and a psychiatrist or psychologist.

As a specialized procedure, cochlear implant (CI) surgery is not performed in all ENT clinics. Cochlear implants are a specialized intervention undertaken by individuals who have chosen to specialize in this device. Unlike other interventions, a cochlear implant is a lifelong process that requires care over a person’s lifetime. The best outcome is dependent upon more than just surgery. Mapping or programming of the external sound processor by a CI audiologist is required every 3 to 6 months during the first year. Typically, after the first few years, annual audiology visits are recommended. Additionally, auditory (re)habilitation services provided by the CI team or a recommended professional outside of the clinic will help children and adults reach their full potential with the CI device.

Yes—with the appropriate accessories! The manufacturers have all developed solutions that recipients can use to waterproof their equipment. These accessories (and/or special waterproof processors) allow users to swim with sound in a wide variety of conditions including fresh, salt, and chlorine water. Many families enjoy bath time with the waterproof options to keep language learning going. There are ways to ensure that the processor and equipment stays in place while swimming, such as headbands and clips.

Specific details on waterproofing solutions can be found on the websites of each CI manufacturer. Your cochlear implant audiologist will also be able to discuss these options. Before pursuing any deep-water activities—with or without the sound processor on—be sure to speak with your surgeon.