The American Cochlear Implant Alliance Continuum of Care. Please click to enlarge.
Resources
What is a Cochlear Implant?
Cochlear Implantation involves the surgical placement of an electrode array into the cochlea of the inner ear to provide direct electrical stimulation of the auditory nerve. Cochlear implants are different from hearing aids. While hearing aids amplify sounds to facilitate sound detection by impaired ear structures, cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. This type of stimulation improves clarity and speech understanding.
Advances in the technology, including combining hearing aids with CIs, have expanded candidacy to include individuals with usable residual hearing.
- Surgery is performed by an otolaryngologist specializing in hearing implants
- Evaluation and follow-up is carried out by a multidisciplinary team that includes an ENT surgeon and an audiologist
- Since development in the 1980’s, cochlear implants have evolved to provide sound that allows clear speech. Most recipients can converse on the phone (without seeing the speaker)
- Dramatically improves quality of life, even beyond that of many typically performed medical procedures such as knee or hip replacement
- 100,000 Americans have received cochlear implants, a utilization rate among adults who may benefit of 5 percent
- Low utilization is due to a lack of awareness about candidacy and outcomes
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.
Kindly reproduced from the National Institute on Deafness and other Communication Disorders (NICD) Visit the NIDCD website at https://www.nidcd.nih.gov to read, print, or download publications.
Kindly reproduced by the American Cochlear Implant Alliance (ACIA) www.acialliance.org/page/cochlearimplantfaq
Level of Awareness of CIs
Click here to download a PowerPoint presentation that includes the findings from this category, clinical summaries and takeaways. This PowerPoint is designed for you to edit and present. All content included in the document has been referenced appropriately.
A Lancet Commission to address the global burden of hearing loss. Blake S Wilson et al. 2019.
Action for Hearing Loss – Cochlear Implants. If you have severe to profound deafness and get little or no benefit from hearing aids, a cochlear implant may help you to hear. This factsheet explains what a cochlear implant is, how it works, who can receive one and how it is fitted.
Action Plan on Hearing Loss. NHS England.
Clinical Practice Guildelines: Cochlear Implants. Prepared by the American Academy of Audiology (the Academy) Task Force on Cochlear Implant Practices. July 2019
Cochlear Implant PCMP Clinical Practice Recommendations. Department of Defense Hearing Center of Excellence
Cochlear implantation outcomes in adults: A scoping review. Isabelle Boisvert , Mariana Reis, Agnes Au, Robert Cowan, Richard C. Dowell
Published: May 5, 2020 https://doi.org/10.1371/journal.pone.0232421
Hearing loss overview. National Institute Health and Excellence. 2019.
It’s time to talk about Cochlear Implants. BAA Service Quality Committee.
Joint Strategic Needs Assessment Guidance. NHS England. 2019.
Roadmap for Hearing Health. Australian Hearing Health Sector Committee
What makes someone choose cochlear implantation? An exploration of factors that inform patient decision making. Briony Dillon & Helen Pryce (2020) International Journal of Audiology, 59:1, 24-32, DOI: 10.1080/14992027.2019.1660917
To link to this article: https://doi.org/10.1080/14992027.2019.1660917
What Works: Hearing Loss and Healthy Ageing. NHS England.
WHO Addressing the Rising Prevalence of Hearing Loss. World Health Organization. 2018
WHO Basic Ear and Hearing Care Resource. World Health Organization
WHO Global estimates on prevalence of hearing loss. World Health Organization. 2018
Hearing 101: What Happens to Hearing as We Get Older
Johns Hopkins Cochlear Centre for Hearing and Public Health
Pindrop Foundation NZ
Hearing loss is not just about the absence of sound. It’s about the far reaching consequences on a person’s life; from communication challenges, to isolation, loneliness, increased risk of depression, mental health issues, cognitive decline and dementia.
Over the past thirty years, advancements in cochlear implant technology have changed the lives of many adults affected by a severe or profound hearing loss, giving them access to hearing in a real world setting, with improved health and quality of life outcomes. Yet this life changing technology is being under utilized for New Zealand adults.
The campaign to end silence follows the World Health Organisations mission to make early detection and treatment of hearing loss a priority.
Hearing loss is lonely but it doesn’t have to be that way.
We need your help.
Please take a minute to tell your MP that you want all adults who need a cochlear implant to get one.
Best Practice Clinical Pathway for Diagnosis
Click here to download a PowerPoint presentation that includes the findings from this category, clinical summaries and takeaways. This PowerPoint is designed for you to edit and present. All content included in the document has been referenced appropriately.
How to Counsel Hearing Aid Users About Their Prospective Candidacy for a Cochlear Implant. Professor Teresa Zwolen
CI Candidacy for Adults
In this video, you will hear from University of Miami audiologist Meredith Holcomb and gain insight into cochlear implant candidacy for adults.
To learn more about cochlear implant candidacy for adults, click here.
Best Practice Guidelines for Surgery
Click here to download a PowerPoint presentation that includes the findings from this category, clinical summaries and takeaways. This PowerPoint is designed for you to edit and present. All content included in the document has been referenced appropriately.
Cochlear Implant Surgery
ACI Alliance presented by Professor Oliver Adunka, Professor and Director of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center.
Clinical Effectiveness of Cochlear Implants
Click here to download a PowerPoint presentation that includes the findings from this category, clinical summaries and takeaways. This PowerPoint is designed for you to edit and present. All content included in the document has been referenced appropriately.
Cochlear implant – state of the art. Thomas Lenarz Department of Otolaryngology, Head & Neck Surgery, Hannover Medical
School, Hannover, Germany
Cochlear Implantation in Candidates With Moderate-to-Severe Hearing Loss and Poor Speech Perception. Ulrich Hoppe, PhD; Thomas Hocke, PhD; Anne Hast, PhD; Heinrich Iro, MD, PhD
Investigating Attitudes Toward Hearing Devices. Professor Frances Rapport
More awareness needed on cochlear implant benefit for seniors. Hear from Professor Cathy Birman, medical director of the Sydney Cochlear Implant Centre (SCIC)
What works: hearing loss and employment. NHS England. 2017.
My Cochlear Implant Journey
My cochlear implant journey courtesy of Pindrop Foundation NZ: A year in the life of Charlotte. A year in the life of Charlotte, follows teacher, entrepreneur and mum, Charlotte De Jong, on her cochlear implant journey from pre-surgery, surgery, rehab and beyond.
Factors Associated with Post-Implantation Outcomes
Click here to download a PowerPoint presentation that includes the findings from this category, clinical summaries and takeaways. This PowerPoint is designed for you to edit and present. All content included in the document has been referenced appropriately.
Watch Dakota Bysouth-Young (Audiologist, B.BehavSci(Psych)., M. AudSA., AA (CCP).) from Hearing Implants Australia in discussion with adult cochlear implant recipients on the importance of wireless programming remotely.
The Relationship Between Hearing Loss and Depression, Cognition, and Dementia
Click here to download a PowerPoint presentation that includes the findings from this category, clinical summaries and takeaways. This PowerPoint is designed for you to edit and present. All content included in the document has been referenced appropriately.
About dementia. Dementia terminology. Dementia Australia
Hearing Care, cognitive decline and dementia: A public health challenge, or an opportunity for healthy ageing? Brian Lamb OBE and Sue Archbold PhD.
Hearing loss and cognition: a discussion for audiologists and hearing healthcare professionals. Journal of Otolaryngology-ENT Research. Douglas L Beck1, Sarah Bant2, Nathan A Clarke3
1Vice President of Academic Sciences, Oticon Inc., Adjunct Professor of Communication Disorders and Sciences, State University of New York at Buffalo, USA
2Principal Clinical Scientist, Betsi Cadwaladr University Health Board, UK
3Candidate & Clinical Audiologist, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK
Healthy aging in elderly cochlear implant recipients: a multinational observational study. Marx et al 2020. BMC Geriatrics. https://doi.org/10.1186/s12877-020-01628-2
Hearing loss in adults: A common condition associated with cognitive decline. Melville Da Cruz MSc, MD, FRACS
Hearing Well to Train Your Brain. Amplifon, Lin and Kramer.
Risk reduction of cognitive decline and demential. WHO Guidelines. World Health Organization.
The hearing brain: The close correlation between hearing and cognition. Amplifon, Laureyns, et al.
What works: hearing loss and healthy ageing. NHS England.
Cost Implications of CIs
Click here to download a PowerPoint presentation that includes the findings from this category, clinical summaries and takeaways. This PowerPoint is designed for you to edit and present. All content included in the document has been referenced appropriately.
Action for hearing loss: Making a sound investment. World Health Organization.
Hearing Loss – Numbers and Costs: Evaluation of the Social and Economic Costs of Hearing Impairment. A Report for Hear-It AISBL. Bridget Shield.
Improving Access to Cochlear implantation: Change lives and save money. Brian Lamb OBE, Sue Archbold PhD Ciaran O’Neil PhD
Spend to save: Investing in hearing technology improves lives and saves society money. The Ear Foundation.
The Real Cost of Adult Hearing Loss: reducing its impact by increasing access to the latest hearing technologies. The Ear Foundation.
What works: hearing loss and employment. NHS England. 2017.
WHO Global Costs of Unaddressed Hearing Loss and Cost-Effectiveness of Interventions. World Health Organization. 2017
Infographics below are sourced from Johns Hopkins Cochlear Center for Hearing and Public Health
The International Federation of ORL Societies (IFOS)
The International Consensus paper background and methodology
World Health Organization Flyer for People with Hearing Loss
Click here to download the World Health Organization’s flyer for people with hearing loss.
Effective Health Care Age Related Hearing Loss
Author Diana Pham: The nominator, American Academy of Otolaryngology – Head and Neck Surgery, is interested in a new evidence review on age-related hearing loss to inform future guideline recommendations and associated quality measures.
Educational Events
CI Futures Forum Webinar Series
Reconfiguring CI services: the ‘new normal’
Covid-19 has necessitated that many patient pathways to be reconfigured due to social distancing as well as personal protective considerations for patients and staff. In this seminar we will consider the patient experience, the public health implications of Covid-19 for hearing healthcare professionals, surgery and anaesthesia risks, and organisational changes needed within a service to facilitate recovery of clinical activity.
No touch CI pathways: will Covid-19 drive innovation?
The need to maintain social distancing during the pandemic has required clinical services to restrict ‘face to face’ contact episodes and thus remote care may become a necessity. We begin with the patient experience and then draw on the field of remote hearing-aid fitting prior to considering clinical experience with cochlear implants. Could intraoperative cochlear neurophysiology inform this approach? We will then consider how the domain of artificial intelligence could be transformative in enabling the wider adoption of remote care.
Assuring early CI intervention post-Covid-19
Outcomes from paediatric cochlear implantation depend on the quality of early intervention and habilitation services to minimise the deleterious effects of auditory deprivation. We plan to start the webinar with the account of a parent’s experience accessing hearing healthcare for their child during Covid-19 and will then examine how the pandemic disrupted hearing screening programmes and imposed delays to the referral pathways for early intervention. We will consider the barriers clinicians encountered and what strategies worked to recover services.
Global Responses of CI Services to COVID-19
The impact of Covid-19 on health-care systems varies considerably and no country, whether high- or low- income has been spared the challenges. Ultimately, all pandemics become local as it falls to local professionals to find solutions that work for the population they serve. Here, we learn from colleagues around the world who have grappled with these challenges and found ways to overcome them that will be of interest to the global cochlear implant community.
CI Research at a Distance: A Post-COVID Challenge
Translational research has driven progress in cochlear implantation. As well as disrupting clinical services, the manner in which research is prioritised, commissioned and executed will change very significantly post-Covid19. What is the appearance of this new research landscape and how should cochlear implant professionals adapt themselves for it?
Hearing Loss Association of America webinar
Authors present International Consensus Paper on Adult Cochlear Implantation to consumers and explain how minimum CI Standards of Care will improve hearing outcomes world-wide.
Dr. Craig Buchman, lead author of the paper, and Dr. René Gifford, member of the Steering Committee and one of 31 expert co-authors, chose the HLAA’s open access webinar platform for one of the first public presentations following publication on the 27th August 2020. The authors explained to consumers how treatment for adults living with severe to profound sensorineural hearing loss (SNHL) will improve if recommendations in the ICP are adopted in countries, localities and clinics that fall short. The webinar was hosted by Ms. Barbara Kelly, HLAA Executive Director and Co-chair of the Consumer and Professional Advocacy Committee that provided advice to the authors on the CI User perspective throughout the Delphi Consensus Statement process.
Don’t miss this informative and engaging one hour webinar.
https://www.hearingloss.org/webinars/report-adult-cochlear-implantation/
Standard of Care webinar as part of the Trans Tasman Audiology Australia Conference 2020
Holly Teagle, NZ, and Marcus Atlas, Perth Australia, discuss the consensus paper statements in detail with real-life examples of their applicability in modern practice. Hosted by Audiology Australia.
British Academy of Audiology and the British Cochlear Implant Group CI Champions Workshop
Listen to the British Academy of Audiology and the British Cochlear Implant Group CI Champions Workshop webinar held 17th October 2020.
Standard of Care: The relationship between hearing loss and depression, cognition and dementia in adults
Listen to Professor Cathy Birman discuss the relationship between hearing loss and depression, cognition and dementia with her own interpretation of the International Consensus paper guidelines.
Clinical Professor Birman is one of the most experienced cochlear implant surgeons in the world, having performed more than 1,500 cochlear implant procedures for children and adults from three months to well over 90 years. A pioneer in the field of cochlear implants, particularly for children with complex medical conditions, paediatric and adult outcomes. Clinical Professor Birman is the Medical Director of the SCIC Cochlear Implant Program at RIDBC and a board member.
Pindrop Foundation Webinars
Learn about Cochlear Implant surgery with ENT surgeon, Bill Baber
Some people want to know what’s involved in a cochlear implant surgery. In this video, ENT surgeon Bill Baber walks us through CI recipient, Richard Milne’s, transformative surgery.
WARNING: GRAPHIC SURGICAL CONTENT
In this Pindrop Foundation webinar, we hear from NZ G.P and Clinical Director for Primary Care Surgical Services at Auckland Hospital, Kathy McDonald, Julie Ligeti, Global Manager Public Advocacy for Cochlear Ltd, cochlear implant recipient and registered nurse, Josie Calcott, as they discuss some of the challenges relating to cochlear implantation for adults and how healthcare professionals can help identify and refer suitable patients.
Join us as Sue Archbold, Consultant on research, public policy and practice on hearing care and cochlear implantation, discusses health advocacy and empowering community voices, and the role consumers and health professionals can play.
In this Pindrop Foundation webinar, Associate Professor of Audiology at the University of Auckland, Holly Teagle and Cochlear Implant Surgeon, Michel Neeff discuss the pathway to a global standard of care for adults requiring cochlear implants and the beneficial health outcomes that they hope will derive from a standardised care approach.
Dr Lewis Williams discusses advocacy and the CI experience
On our last webinar, cochlear implant user and advocate, Dr Lewis Williams PhD discussed the importance of advocacy and what her own experiences of severe hearing loss taught her.
In addition, Lewis discussed the paper she had published in the New Zealand medical journal last year, entitled ‘Untreated severe-to-profound hearing loss and the cochlear implant situation: how policy and practice are disabling New Zealand society.’
With a concerted and collaborative approach to advocacy, bringing together patient groups, health professionals, organisations and funders change does happen. It might take time, but the power of the patient voice cannot be underestimated in effecting change.
This has been highlighted during the recent elections with promises of increased, sustainable funding for the national cochlear implant programme. The future is looking brighter for the many adults in New Zealand waiting for a cochlear implant.