Indiana Lions Speech and Hearing

Cochlear Implant Program

What Is a Cochlear Implant?
A cochlear implant is a small electronic device that provides a sense of sound to children and adults who have severe to profound hearing loss and who cannot hear and/or understand speech with hearing aids. While hearing aids make sound louder and clearer, cochlear implants provide useful sound by directly stimulating undamaged nerve fibers in the inner ear.

What is normal hearing?
For people with normal hearing, sound travels from the outer ear into the ear canal and causes the eardrum to vibrate. The eardrum is attached to three small bones in the middle ear that begin to move and carry the vibration from the eardrum to a fluid-filled part of the inner ear called the cochlea. Movement in the fluid causes hair fibers, or cells, in the cochlea to move. The movement of these hair cells sends an electrical current to the hearing nerve; then, the nerve sends the current to the brain, where the electrical stimulation is recognized as sound.

How do cochlear implants work?
When a person has a hearing impairment due to a defect or damage to the tiny hair cells in the inner ear, it is called nerve deafness because the sound cannot reach the nerve normally. A cochlear implant bypasses the damage and directly stimulates the nerve to send information to the brain.

What does the cochlear implant look like and where is it placed?
A cochlear implant consists of three parts: receiver, headpiece, and speech processor.

1.  Receiver. The receiver is the part that is implanted. It looks like a magnetic disk about the size of a quarter. It is placed under the skin behind one ear, and a wire that leads from the receiver to an electrode is placed in the fluid of the cochlea in the inner ear. Surgery to implant the receiver may be done as an outpatient or may require a short hospital stay. It is performed by otolaryngologists (ear, nose, and throat specialists). For adults, the surgery usually takes between 2 and 3 hours; for children, the surgery may last as long as 5 hours and usually requires an overnight stay in the hospital.

2.  Headpiece. A small headpiece is worn just behind the ear and contains the microphone that picks up sound in the environment and the transmitter that sends sound through the system. After recovery from surgery (approximately 4 to 6 weeks), the headpiece is fitted during a return visit to the implant center. During the fitting, the microphone and the transmitter, placed on the head behind the ear, are held in place over the implanted receiver by small magnets in both the transmitter and the implanted receiver. During this visit, instruction is given in the care and maintenance of the system and on how to obtain training in listening to sound through the implant.

3.  Speech processor. The speech processor, which shapes and amplifies the sounds picked up by the microphone, is worn on the body, either behind the ear or on a belt. It is attached to the transmitter by a special cord.

What happens after the implant is in place?
Once in place, the implant system works as follows: Sound waves enter the microphone located in the headpiece. Sound is sent through the transmitter and along a wire to the speech processor. The speech processor converts the sound into a special signal that is sent to the implanted receiver. The receiver sends the signal to the brain, where it is interpreted as sound. Working with the team at the implant center, the speech processor of the cochlear implant system is adjusted as hearing improves. These adjustments are called "mapping." The time involved to complete the "mapping" of the speech processor varies among users and cochlear implant systems. It is performed often during the first months of implant use, with fewer visits required after that. Cochlear implant users should return to the clinic at least once a year for adjustments of the speech processor.

Will training be needed on how to use the implant?
Both child and adult users can benefit from training to teach them how to use their cochlear implant. Working with audiologists, speech-language pathologists, and teachers of the hearing impaired will help with identifying sounds, recognizing and understanding speech, and using lip-reading. Training can also help the user to speak more clearly and produce good voice quality. Instruction for practicing at home can also help. For children, rehabilitation and education are very important and are more intense because they need vocabulary and language development and must learn to associate meaning with unfamiliar sounds. All of these skills are necessary to learn to read and to obtain a foundation for success in school.

What can I expect from a cochlear implant?
Cochlear implants do not provide normal hearing - they provide an improvement in the use of sound. Most people who are totally deaf are able to detect medium to loud sounds, including speech at comfortable listening levels. Most can learn to recognize familiar sounds. For some, cochlear implants aid in communication by improving the person's ability to understand what is being said and to read lips. Implant users often do better understanding sentences rather than isolated words. Much of the success depends upon the individual person's ability to use the new sound and their motivation to hear and communicate. Results will vary depending on age at the time of deafness, age at the time of surgery, how long the person has been deaf, the condition of the nerve fibers, the person's general health, and so on. Before the surgery, the cochlear implant surgeon and staff will explain what is reasonable to expect for each person.

How many people have received a cochlear implant?
Cochlear implants were first approved by the Food and Drug Administration in the United States in 1985 for adults and in 1990 for children. Today, over 20,000 individuals have received cochlear implants, including over 8,000 children.

Who is a candidate for a cochlear implant?
Adults and children can benefit from a cochlear implant if they meet the following criteria:

Adults (18 years of age and older):
Severe to profound hearing loss in both ears
Limited benefit from hearing aids
No medical contraindications
A strong desire to be part of the hearing world

Children (18 months of age to 17 years of age):
Profound hearing loss in both ears
Little or no useful benefit from hearing aids
No medical contraindications
High motivation and appropriate expectations (both child and family)
Placement in an educational program that emphasizes development of auditory skills after the implant

An evaluation will be performed at the implant center to determine if a person is an appropriate candidate for a cochlear implant. Some of the tests that may be performed include an ear examination, a hearing evaluation, an x-ray evaluation, a psychological evaluation, and a physical examination.

Is the implant done in both ears?
Currently, surgery is done on one ear only. The surgeon will decide which ear is preferred based upon pre-surgical tests. Research is now being conducted on the benefits of doing both ears, and this will probably be an option in the near future. Cochlear implant surgery can be performed on both ears of a person during the same operation. A few "bilateral" surgeries have been performed. As the success rate is evaluated on these people, decisions will be made about operating on both ears for others.

How much will it cost and will my insurance company pay for it?
The cochlear implant procedure costs between $30,000 and $50,000. This is the total cost, which includes pre-surgical testing, medical personnel services, surgery and hospital fees, and the implant device itself. Insurance covers the costs in almost all cases. The costs also may be covered by Medicare, the Veterans Administration, and Medicaid in some states. Other services that cover the implant in some states are Tricare (formerly Champus), Children's Special Services, and State Vocational Rehabilitation Services.

Source: Cochlear Implant Association
For more information visit the Cochlear Implant Association at www.cici.org or the Alexander Graham Bell Association for the Deaf at www.agbell.org