Cochlear Implant Surgery and Commonly Asked Questions

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A cochlear implant is a small and complex electronic device that can assist a person in developing a sense of sound when they are otherwise profoundly deaf or hard of hearing. The implant is comprised of two portions; an external portion that sits behind the person's ear, and another portion that is surgically placed underneath the person's skin. A cochlear implant has several parts.

One of the parts of the implant is a microphone that picks up sounds from the person's environment. The implant also contains a speech processor that both selects and arranges sounds that have been picked up by the microphone. There is a transmitter and receiver/stimulator in the implant that receives signals from the speech processor and converts these signals into electric impulses. There is also an electrode array in the implant, comprising a group of electrodes that collect impulses from the stimulator and sends them to various regions of the person's auditory nerves. The cochlear implant itself does not restore the person's hearing to an average level; instead, it provides person's who are deaf with a useful representation of sounds in their environment and assists them with understanding speech.

Cochlear implants are different from hearing aids that amplify sounds so they may be heard by ears that have experienced damage. Unlike hearing aids, cochlear implants bypass damaged portions of a person's ear, directly stimulating their auditory nerve instead. Signals that have been generated by a cochlear implant are sent through the person's auditory nerve to their brain, which then recognizes these signals as sound. The experience of hearing through a cochlear implant is different from the hearing experienced by people with average hearing, it takes time to either learn or re-learn. Use of an implant allows a number of people to recognize things such as warning signals and additional sounds in their environment, as well as gaining the ability to enjoy conversations with others either in person or through a telephone.

People Who May Use Cochlear Implants

Both children and adults who are either deaf or severely hard of hearing may choose to pursue cochlear implants. In the year 2006, according to the Food and Drug Administration (FDA), there were more than one-hundred and twelve thousand people around the world who had received cochlear implants. In America alone, approximately fifteen-thousand five-hundred children and twenty-three thousand adults have received them. Adults who have lost most or all of their ability to hear at a later point in their life may benefit from cochlear implants; they can learn to associate signals that the implant provides with sound they have experienced before. Having had prior experience with sound, many of these adults are able to understand speech solely by listening through the implant and do not need visual clues such as lipreading or sign language.

The use of intensive post-implantation therapy in conjunction with a cochlear implant can assist a young child to acquire speech, language and social skills. Many children who receive cochlear implants are between the ages of two and six. Receiving an implant at an early age can help a child to develop these skills through exposure to sounds while they are in the midst of a time in their life that is critical to the development of them. The FDA lowered the age of eligibility for receiving an implant to twelve months in the year 2000.

Receiving a Cochlear Implantation

Receiving a cochlear implant involves a surgical procedure, as well as a significant amount of therapy in order to either learn or re-learn how to, 'hear,' with the device. The decision to pursue an implant can be an expensive one, and should involve discussions with medical specialists, to include an experienced cochlear implant surgeon. Health insurance may or may not cover the procedure, or the therapy required. While the surgery itself is nearly always safe, there are risk factors with any surgical procedure. Something else to consider is the process of learning how to interpret the sounds created by the implant itself, a process that takes both time and patience. The process of learning to use a cochlear implant frequently involves speech-language pathologists and audiologists.

Cochlear Implant Surgery

Before Surgery:

A person's primary care physician will commonly refer them to an ear, nose and throat doctor (ENT) or otolaryngologist, who will then test them to find out if they are a candidate for a cochlear implant. There are a number of different tests that an ENT or otolaryngologist may perform. An examination of the person's external, middle or inner ear may be examined for signs of an infection or other from of abnormality. The person's hearing may be tested, perhaps through an audiogram. Their middle and inner ear structures could be examined through use of a CT scan, a kind of X-ray that helps a doctor so see if their cochlea has an average shape. A CT scan is particularly important if the person has a history of meningitis because it helps to see if there is new bone growth in the cochlea that might interfere with the insertion of the implant itself. A CT scan can also show a doctor which ear they should place the implant in. A doctor may also use an MRI scan. There may be a psychological examination done to find out if the person is able to cope with a cochlear implant. Finally, a doctor may perform a general physical examination in order to determine how the person will do under a general anesthesia.

During Surgery:

While a person is going through the surgery for a cochlear implant, a doctor or other member of the hospital staff may insert some intravenous lines. They may either shave or clean the person's scalp around the site where they are going to surgically place the cochlear implant, and attach cables, monitors, and patches to the person's skin in order to monitor their vital signs. An anesthesiologist will place a mask on the person's face to provide oxygen and anesthetic gas to them. The person will have medications administered to them through the intravenous lines and the face mask, causing them to sleep and general anesthesia. The person will awake in the operating room once the procedure is over, and will then be taken to a recovery room until they have recovered from the effects of the anesthesia.

After The Surgery:

Right after the surgery is over, the person may feel pressure or discomfort over their implanted ear, as well as some dizziness. They might feel some nausea, disorientation, or confusion for a period of time. The could also have a sore throat for a while because of the breathing tube used during general anesthesia.

The person can expect to have bandages on for awhile, which may be stained with some fluid or blood. They may have some stitches, and will receive instructions regarding the care of these stitches. They can expect to go home about a day after the surgery, with instructions to return in about a week to have the stitches removed, as well as to have the implant site examined. About three to six weeks later, the cochlear implant will be activated.

Common Questions About Cochlear Implants

• Will I be able to hear right after the operation?

  No - without the external transmitter portion of the implant you will not. You will receive the external components about a month after the implant surgery, during your first programming session.

• Why do I have to wait three to six weeks after the operation before I receive the external transmitter and sound processor?

  The waiting period is necessary so that the incision from the operation can heal completely; it usually takes about three to six weeks. Once the swelling is gone, fitting and programming can proceed.

• What happens during the initial programing session?

  During the initial programming session, an audiologist adjusts your sound processor to fit you. They also test to make sure the adjustments are correct, determine what sounds you hear, and give you information about how to care for and use the device.

• Should my family members be involved in the training program?

  Yes! They can provide assistance, and they should know how to manage the operations of the sound processor.

• Do people have more than one implant?

  People usually have only one cochlear implant, although a few people do have implants in both ears.

• How can I help my child get the most benefit from their implant?

  There are a number of things you can do! You can try to make hearing and listening as fun and interesting as possible, and encourage your child to make noises. You can speak with them about the things you are doing as you do them. You can show your child that they can consciously use and evaluate the sounds they receive from their implant. Understand that the more committed not only you, but your child's teachers and health care professionals are to helping your child, the more successful they will be.

• What can I expect a cochlear implant to do for my child?

  Children are often more adaptable and able to learn than adults, and can benefit more from an implant because of it. Significant hearing loss slows a child's ability to learn to talk; the vocal quality and intelligibility of speech from children using cochlear implants appears to be better than from children who have hearing aids.

• How important is active participation on my part, as a patient?

  Incredibly important. Your participation and willingness to participate in an auditory training program are essential to the success of the implant process.

Author Credentials:

Thomas C. Weiss is a researcher and editor for Disabled World. Thomas attended college and university courses earning a Masters, Bachelors and two Associate degrees, as well as pursing Disability Studies. As a Nursing Assistant Thomas has assisted people from a variety of racial, religious, gender, class, and age groups by providing care for people with all forms of disabilities from Multiple Sclerosis to Parkinson's; para and quadriplegia to Spina Bifida.

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