Suitable Candidates

The majority of cochlear ear implant candidates are those who are profoundly deaf or severely hard of hearing in both ears. Specifically, potential candidates are generally those who:

- Are older than 12 months of age and do not receive significant benefit from hearing aids. This may include those born deaf or those who lost their hearing later in life.

- Have moderate-to-profound sensorineural hearing loss in both ears. Sensorineural hearing loss is caused by damage to the inner ear (cochlea) or auditory (vestibulocochlear) nerve.

- Have a cochlear malformation that prevents benefit from hearing aids.

- Have no benefit from a hearing aid after at least 6 months of consistent hearing aid trials and use. Hearing aids must be fit appropriately and worn consistently for benefit to be judged.

Potential candidates receive an extensive preoperative audiological and medical evaluation. Factors such as cognition, language ability, commitment/motivation, and the cause and degree of deafness are considered to determine candidacy and likelihood of benefit from implantation. Cochlear Implants will not provide benefit for conductive or mixed hearing losses that involve the outer or middle ear.

The Cochlear Implant Surgery

If a patient meets all candidacy criteria, the actual cochlear ear implant surgery can take place. It is typically done as an outpatient procedure that takes 1-3 hours under general anesthesia. The surgery involves making an incision behind the ear to access the cochlea inside the skull. Soft tissues and part of the bone are gently moved aside.

Next, the receiver/stimulator unit is placed under the skin, usually in a pocket created in the bone behind the ear. Its external coil sits flush with the skin. The electrode array is then carefully inserted into the cochlea through a small opening in the bone and skull. Electrodes stimulate specific regions of the cochlea corresponding to different sound frequencies. Correct placement is critical for optimal hearing outcomes.

Finally, the incision is closed with fine sutures or surgical adhesive. Most patients typically experience some mild pain, swelling, or soreness which is treated with over-the-counter medications. Overall recovery time is 1-2 weeks, though sound processing may not occur immediately. Therapy helps the brain and auditory nerve learn to recognize and interpret sounds via the implant.

Rehabilitation and Programming

Once the incision is fully healed, rehabilitation with a cochlear ear implant audiologist can begin. Activation is the initial programming session where small electric currents are sent to individual electrodes to determine which stimulation sites are felt in different areas of hearing. Gradually, sound signals from the outside world can begin to be recognized.

Further programming optimizes the mapping of frequencies to electrodes for best hearing in quiet and noise. Auditory training exercises help develop listening skills, speech perception, and production. Candidates receive therapy for months or years to fully reap the benefits of their implant. Programming adjustments may be needed due to electrode array positioning or nerve changes over time. Auditory verbal therapy is popular for children to establish spoken language.

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