Cochlear Implants

What is a cochlear implant?
How does a cochlear implant work?
Who is a candidate for cochlear implantation?
What benefits can I expect from the cochlear implant?
The cochlear implant evaluation.
Do insurance companies pay for the cochlear implant?

A cochlear implant is a sophisticated electronic device designed to help moderate to profoundly deaf individuals who gain little or no benefit from hearing aids or other amplification devices.

The cochlear implant consists of two main parts: an internal implanted portion called the implant or electrode array, and an external portion known as a speech processor.

Electrode array (internal portion) Speech processor (external portion)

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The processor as it is worn behind the ear

1. Sounds are picked up by a microphone and turned into an electrical signal.
   
   This signal is sent to the speech processor where it is turned into a pattern of electrical pulses. This process is called coding.
   
2. The coded pulses are sent to the coil and then transmitted across the skin to the implant.
3. The internal implant converts the signal into electrical energy and sends it to the electrode array inside the cochlea.
4. The auditory nerve picks up these tiny electrical pulses and sends them to the brain. The brain, after training, recognizes these signals as sound.

Both children and adults can use cochlear implants effectively, whether they are born deaf or whether hearing loss occurs later in life.

Cochlear implants are primarily appropriate for moderate to profound hearing losses caused by a problem in the inner ear. They are exclusively intended for people who are unable to gain sufficient speech information through conventional hearing aids or other forms of amplification.

You may benefit from a cochlear implant if your deafness is moderate to profound in both ears and if you meet the criteria listed below:

Young children: 12 months to 2 years

• Profound sensorineural hearing loss (deafness) in both ears.
• Lack of progress in development of auditory and speech skills with hearing aids.
• High motivation and realistic expectations from the family.

Children:  2 to 17 years

• Severe to profound sensorineural hearing loss (deafness) in both ears.
• Receive little or no useful benefit from hearing aids.
• Lack of progress in the development of auditory skills.
• High motivation and realistic expectations from the family.

Adults: 18 years and over

• Moderate-to-profound sensorineural hearing loss (deafness) in both ears.
• Receive little or no useful benefit from hearing aids.
• High motivation for rehabilitation and realistic expectations.

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There is a wide range of benefits obtained from cochlear implants. Benefits can range from hearing environmental sound and an aid to lip-reading, to understanding speech without lip-reading. S ignificant benefit can be realized from a cochlear implant even if a user continues to rely on visual cues as an aid to speech understanding or utilizes sign language following implantation.

There is no test available at this time that predicts how much benefit any particular person will receive from a cochlear implant. While many factors affect the benefits of a cochlear implant, the following points are widely acknowledged:

• The shorter the period of deafness prior to implantation, the greater the benefit that is likely to be derived.
• Children who are born deaf will have the greatest benefit if they obtain an implant before the age of 5, but preferably by the age of 3.
• If a person has auditory memory of speech and language they may have more benefit from a cochlear implant.

Hearing everyday sounds

Virtually all users benefit by being able to hear more environmental sounds. This helps to keep in touch with the surroundings. It is also an important safety consideration as it enables people to hear traffic, sirens, and alarms.

Hearing and understanding speech

Almost all cochlear implant users will hear speech sounds through the cochlear implant. It takes time and training before a user begins to understand speech sounds, especially with child recipients. Being able to hear the sounds of speech will be of great assistance to those users who lip-read, as it makes everyday communication much easier for the majority of cochlear implant users. In some cases, people with cochlear implants may go on to understand speech without lip- reading.

Improving the user's own speech

Hearing one's own speech sounds and the speech of others will often help cochlear implant users to refine their own speech.

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In the cochlear implant evaluation we need to insure that recipients and their families are well informed about all aspects of the cochlear implant process. Additionally, we will make sure that patients are appropriate candidates for a cochlear implant, this being that they will obtain more benefit from a cochlear implant than from traditional hearing aids.

Audiological

• Hearing levels with and without hearing aids, for tones and for speech
• Demonstration and discussion of device choices
• Establishing existence of any significant additional conditions or needs
• For children, discussion of educational placement
• Establishing appropriate expectations

  Medical

• Evaluation of cause of hearing loss
• General health
• Condition of the ears
• Establishing existence of any significant additional conditions or needs
• Establishing appropriate expectations

Radiological

• CT and/or MRI scan of the head

Occasionally, a need for additional evaluations is determined. These will be conducted on a case-by-case basis, and may include:

Psychological

• Ability to cope with operation
• Ability to cope with follow-up program
• Establishing existence of any significant additional conditions or needs
• Establishing appropriate expectations

Speech & Language

• Assessing stage of speech & language
• Establishing existence of any significant additional conditions or needs
• Establishing appropriate expectations

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Because the cochlear implant is recognized as a standard treatment for moderate to profound sensorineural hearing loss, they are covered by most insurance companies. University Ear, Nose and Throat will take the responsibility of obtaining prior authorization from your insurance company. We will continue to work with you and your insurance company following implantation to assure continued coverage for ongoing rehabilitative services.

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