How is a cochlear implant different from a hearing aid?
Hearing aids acoustically amplify sound and rely on the responsiveness of sensory cells in the inner ear to receive and transmit the sound to the brain. For those individuals with severe to profound sensorineural hearing loss, the sensory cells of the inner ear are often damaged or destroyed. Cochlear implants convey sound by converting acoustic signals into electrical patterns, which are then delivered directly to the auditory nerve fibers, bypassing structures of the inner ear. Click here for more information and to view video animations.
Should I continue to wear my hearing aid on the opposite ear?
The answer to this question should be made on an individual basis. Some of the potential advantages for wearing a hearing aid in the non-implanted ear include:
- Better localization of sound
- Feeling “balanced” or “in stereo”
- Continued stimulation of your auditory nerve
- Achieving a more natural sound quality
However, some individuals find that wearing a hearing aid in the opposite ear is more distracting than helpful. One consideration is if you are receiving your cochlear implant in your better-hearing ear or your poorer-hearing ear. If the better-hearing ear is implanted, you may find no added benefit from a hearing aid in the poorer-hearing ear. If the poorer-hearing ear is implanted, you may find some added benefit from wearing a hearing aid in the better-hearing ear. To determine what works best for you, try different listening situations with your cochlear implant alone and then add your hearing aid. Does it help or make things worse? Your audiologist can help you determine appropriate hearing aid use for your individual needs.
What should I expect during surgery?
Cochlear implant surgery is conducted under general anesthesia and lasts between 2-3 hours. The procedure may require an overnight stay at the hospital. Prior to surgery, a small portion of hair is shaved where the internal device (consisting of the receiver stimulator and electrode array) will be placed. During surgery, an incision is made behind the ear. Next the surgeon creates a small depression in the bone located behind the ear that will hold the receiver stimulator portion of the device. Once secure, the electrode array is inserted into the cochlea (inner ear) through a small opening near a structure called the round window. Finally, the incision is closed and a pressure bandage is applied for 24-48 hours to help reduce swelling. The majority of the swelling will subside within 3-5 weeks after implantation. Discomfort after surgery is minimal. However, if pain is present, over-the-counter pain medications can be utilized to reduce discomfort.
What are the risks involved with surgery?
All surgical procedures involve certain risks. The risks involved in cochlear implantation are comparable to the risks associated with any standard ear surgery that is performed under general anesthesia. One major consequence of cochlear implant surgery is that any residual acoustic hearing will be lost in the implanted ear. Other risks of cochlear implant surgery include temporary or permanent facial nerve weakness or paralysis. At Boys Town National Research Hospital, facial nerve monitoring is used throughout the duration of the surgery to reduce the likelihood of damage to the facial nerve. There is also a small risk of temporary or permanent taste disturbance (typically metallic taste). As with any surgery, there is also the risk of infection.
Your surgeon and anesthesiologist can answer questions and discuss additional concerns prior to surgery.
Which ear should be implanted?
During the candidacy process, the potential candidate meets with members of the cochlear implant team and with the surgeon to gather information and to discuss expectations and outcomes of the procedure. The information gathered at this time is essential in determining if the individual is indeed a cochlear implant candidate, and if so, what ear should be implanted. The following are a number of factors to be considered when deciding which ear to implant.
Considerations for each ear are:
- Severity of hearing loss
- Hearing aid use
- Speech understanding
- Medical and / or anatomical considerations
- Etiology or cause of hearing loss
- Additional considerations (examples: handedness or physical limitations)
How much time will I need to take off from work/school after surgery?
Recovery times differ widely across individuals. Some people feel well enough to go back to work or school within 2 or 3 days, whereas others need roughly one week to feel fully recuperated. However, recipients should refrain from engaging in strenuous physical activity for at least 6 weeks following surgery.
How often will I need to come back for follow-up after surgery?
The cochlear implant recipient’s first visit back to our center after surgery is the day of initial stimulation (sometimes called “hookup” or “activation”). Initial stimulation typically occurs about 3-4 weeks after surgery and usually involves appointments on two successive days. This is because speech processor programming levels can change dramatically from day 1 to day 2. During the first year of implant use, at minimum, the individual is evaluated at one, three and six months post initial stimulation. Children are typically evaluated every 6 months after the first year of implant use. It is recommended that adults be seen annually for the life of the implant. However, certain circumstances may indicate a need to return to your center for follow-up prior to your next regularly scheduled appointment. The following is a brief list of such circumstances:
- General listening has become more difficult
- Presence of a change in sound quality of speech (i.e. distortion)
- Decrease in speech perception ability
- The quality of your voice has changed (i.e. loud, flat or nasal)
- You hear a buzzing, clicking, or other noises when the processor is turned on
- Pain, twitching, or other physical sensation in your ear or face
- No sound
- Intermittent sound
Specifically for children, parents may notice:
- Lack of progress over a period of time
- Decrease in speech production skills
- Response to environmental sounds has diminished
A device check should be performed if you or your child experiences any of the above listed factors. A device check ensures that the external equipment (speech processor, cables, microphone) is functioning properly and that equipment malfunction is not contributing to the problem. Contact your audiologist for additional information.
Click here for more information about follow-up visits at Boys Town National Research Hospital for children or adult recipients.
What makes a cochlear implant success or failure?
It is important to realize that there is a wide range of outcomes across cochlear implants recipients. Several key factors have been identified as influential in an individual’s potential performance with a cochlear implant. Additionally, understanding these factors may be helpful in establishing reasonable expectations for performance with a cochlear implant for that individual. The following is a brief list of factors that may influence an individual’s performance with a cochlear implant:
- Age at onset of hearing loss and/or previous auditory experience
- Duration of hearing loss
- Age at implantation
- Presence of other learning and/or physical disabilities
- Appropriate aural (re)habilitation
- Family/educational support
Will I be able to talk on the phone with my cochlear implant?
Phone use is a challenge for anyone with hearing loss. This is certainly true for most cochlear implant users as well. With practice, some cochlear implant users are able to make phone calls and understand familiar voices over the telephone. Some cochlear implant users are even able to understand an unfamiliar speaker, yet others are not able to use the phone at all. Your audiologist can discuss tips and additional hardware that may assist in making phone use easier.
Will my insurance cover the cost of the implant and the surgery?
Many health insurance companies cover the cost of cochlear implantation. However, a growing percentage of carriers have begun to specifically exclude cochlear implants from their coverage. At Boys Town National Research Hospital, we have rehabilitation specialists within our center that that can help you secure prior authorization and/or appeal claims that have been initially denied. Individuals interested in pursing a cochlear implant should investigate their insurance carrier’s reimbursement policy for potential restrictions placed on the center site, surgeon, and the amount of follow-up services required. It may be helpful to determine out-of-pocket expenses that are unique to your carrier and policy.
What kind of warranty comes with the device?
Warranties vary by manufacturer. Warranties for the internal portion of the implant are typically much longer than warranties for the external equipment (i.e., speech processor, headset, etc.). Presently, internal device warranties are typically for about 10 years and warranties for speech processors are typically for about 2-3 years. Additionally, speech processor warranties are typically limited to one-time loss or damage. Please check with the manufacturer for specific details. After the expiration of the manufacturer-issued warranty, it is recommended that the recipient secure additional coverage for the external equipment. Three potential avenues to explore include: (1) an independent insurance company that covers cochlear implant equipment, (2) purchasing extended coverage through the manufacturer, and (3) your homeowner’s insurance policy. Contact your audiologist for additional information.