Learn about cochlear implants and the differences between hearing aids and cochlear implants.
What are cochlear implants?
A cochlear implant is a medical device that mimics the natural hearing function of the inner ear. Unlike hearing aids, which simply amplify sound, cochlear implants bypass the damaged part of the inner ear and send electrical signals directly to the hearing nerve. Since cochlear implants stimulate the hearing nerve directly, sound can be heard more clearly than what some people experience with hearing aids.
Who can they benefit?
Cochlear implants are a good solution for people with moderate to profound hearing loss in both ears who no longer get much or any benefit from hearing aids.
What do they look like?
A cochlear implant system has two parts: an internal cochlear implant and external sound processor.
The internal cochlear implant is placed behind the ear and just under the skin by the implant surgeon. Attached to the implant is a tiny electrode array, with as many as 22 electrode contacts in the array. The surgeon inserts the electrode array into the snail-shaped cochlea in the inner ear.
There are two types of sound processor: behind-the-ear and off-the-ear.
A BTE sound processor looks much like a BTE hearing aid and is worn on the ear. Attached to the processor is a small coil, which transmits signals from the sound processor to the internal implant. The coil is held in place next to the skin with a small magnet. An example of a BTE sound processor is the Cochlear™ Nucleus® 7 Sound Processor.
An OTE sound processor is an all-in-one unit that also contains the coil and magnet. An example of an OTE sound processor is the Cochlear Kanso™ Sound Processor.
What else should I know?
Hearing aids vs cochlear implants
Although hearing aids can help most people with hearing loss, they can’t help everyone. This is because even the most powerful and advanced hearing aids simply make sounds louder, not necessarily clearer. By directly stimulating the hearing nerve, cochlear implants allow for clearer sounds and better overall hearing than is possible with hearing aids.
Cochlear implants can help when hearing aids are no longer enough, and they also deliver fast improvements. A Cochlear-funded study showed that adult cochlear implant users demonstrated, on average, more than 60 per cent improvement at three months and more than 70 per cent improvement at 12 months in quiet post-implantation when compared to their pre-operative hearing aid performance.1 Another user study showed that adults with cochlear implants understand sentences on average almost seven times better than they could with hearing aids.2
Unlike hearing aids, cochlear implants are also typically covered by most private and government health insurance plans.
A treatment for ‘nerve deafness’
A cochlear implant can help both adults and children with severe to profound sensorineural hearing loss - a condition that is commonly incorrectly referred to as ‘nerve deafness’. Most people who have been told they have nerve deafness actually suffer from damage to the cochlea, not the hearing nerve. If you have been told you have nerve deafness, a cochlear implant may be an option for you because it bypasses the damaged part of the ear and stimulates the hearing nerve directly.
How cochlear implants work
1. The microphone in the external sound processor picks up sound from the environment and turns it into a digital signal.
2. The external sound processor then sends this digital signal through the coil and across the skin (via radio frequency) to the internal cochlear implant system.
3. The internal cochlear implant system changes the digital information into electrical signals and sends them to an electrode array that sits gently inside your hearing organ (cochlea or inner ear).
4. The electrical signals stimulate the hearing nerve, thus allowing the brain (and the cochlear implant user) to “hear” sound.
1. The Nucleus Freedom Cochlear Implant Surveillance Trial Results. 2008 June.
2. Balkany T, Hodges A, Menapace C, Hazard L, Driscoll C, Gantz B, et al. Nucleus Freedom North American clinical trial. Otolaryngol Head Neck Surg 2007;36(5):757-762.
- Steps to get one
Steps to getting a cochlear implant
Getting a cochlear implant can be a transformative journey, and is easier than you may think. From your initial evaluation through to your reintegration into the world of sound, getting an implant is an established and straightforward process. Your hearing specialist will guide you through each step, and you can also reach out to other people with a cochlear implant for practical and emotional support. Having realistic expectations and being actively involved in your rehabilitation are key to making a quick and smooth journey back to hearing with your new cochlear implant.
The process of getting a cochlear implant starts with a screening by your hearing specialist. If initial tests suggest you may benefit from a cochlear implant, you will be referred for more tests, which are typically done at a cochlear implant clinic. If these tests confirm you are a good candidate for a cochlear implant and you choose to proceed, you will talk with a specialist about the procedure, the benefits, and possible risks before scheduling the procedure.
2. Implant procedure
The implant surgery is typically an outpatient procedure, but some people may stay overnight. The procedure is typically done under general anaesthesia and usually takes only a couple of hours. Most people are able to return to normal activities in less than a week.
You will wait approximately 3 to 6 weeks to activate your cochlear implant, to allow time for the implant site to heal. Your audiologist will activate the device at your next meeting, and will work with you to fine-tune the settings over subsequent sessions. Once activated, everyone’s first experience with a cochlear implant is different. Most cochlear implant users say that the sound changes over time and gets better with consistent use every day.
Daily practice is an important part of the cochlear implant process as you need time to adjust to the new way of hearing sound. Your rehabilitation program will involve developing new listening skills through daily activities, which may include:
- using your implant system for as many hours a day as possible
- reading aloud to yourself and with your family and friends
- listening to audio books while you read along with a printed copy
- listening to songs that are easily recognised.
If you have been without hearing for a long time, you may need an auditory development program which will:
- encourage you to practice recognising speech and environmental sounds
- develop techniques to use hearing for communication
- help you and your family develop effective communication techniques.
Find a hearing specialist in your area to learn more about cochlear implant technology and the steps to getting a cochlear implant.
Visit the Cochlear site to learn about the Cochlear Nucleus 7 Sound Processor.
- Cost & insurance
Funding for implants
The NHS fully funds adults and children who qualify for a Cochlear Implant or Baha implantable hearing solution. You should not be concerned about costs. If you fit the criteria then your therapy will be fully funded by the NHS. If you have any questions about funding then the links below should help.
- National Institute for Health and Clinical Excellence (NICE criteria)
- Clinical Commissioning Policy: Bone Anchored Hearing Aids
The Cochlear Implant pathway
Stage of the journey Issues to consider
Information about services available should include cochlear implantation
- Hearing aids fitted
- Prompt referral after diagnosis
- Middle-ear problems considered
- Funding issues addressed
- Multi-disciplinary assessments necessary
- Include discussion of expectations: meet other adults
- Middle-ear problems considered
- Information on assessments shared
4. Shared decision
- Adult and cochlear implant team make decision, sharing information available
- Choice of ear/hearing aid and implant/bilateral implants
- With experienced surgeon and theatre team
- Informed and experienced nursing staff
- Latest technology and techniques available
6. Initial Fitting
- With latest technology and techniques available
- Hearing aid use considered
- Initial adjustment to new sound
7. Learning to use the new hearing provided by the implant
- Being persistent!
- Learning from other users and families
- Access to appropriate rehabilitation and support
8. Life-long support & maintenance
- Access to rehabilitation
- Access to user and family groups
- Ongoing trouble-shooting skills needed
- Availability of spares – parts and processors
- Monitoring of progress – changing needs over time
- Technology available as appropriate: all speech processor functions, FM systems, accessories, upgrades
- Monitoring of functioning – re-implant if necessary
Detailed information on care pathways can be found in Hearing Impairment Integrated Care Pathways with Evidence Base for Patients with Baha and Cochlear Implants, developed by the Hearing Impairment ICP Steering Group, in association with Cochlear Europe, June 2008. Further information on care pathways are contained in Cochlear Implant Commissioning Guidelines (Action on Hearing Loss). Detailed diagrams of the pathway have been produced by the ‘Do Once and Share’ programme that is part of NHS Connection for Health. Care pathways available on www.mapofmedicine.comwww.mapofmedicine.com
- What to expect
What to expect
Reconnecting with the world of sound with a cochlear implant is a huge and exciting journey, and it’s one that you need to fully participate in. Knowing what to expect at each step of the process will help you to get the most out of your implant and better tackle any challenges you encounter along the way. It’s important to have realistic expectations about what you may hear on activation, and to know that your first year of rehabilitation is vital to the long-term success of your cochlear implant. During this year, you will work closely with your audiologist and other hearing and speech specialists to fine-tune your implant and learn how to listen and communicate again.
Cochlear implants – after surgery
You will need to wait up to three to six weeks for the incision site to heal before the external parts of your system can be fitted and activated. Once the swelling is gone, you will meet with your audiologist to have your sound processor, programmed and activated.
Cochlear implants - activation
At your activation session, your audiologist will fit the sound processor and other external parts of your implant. You won’t be able to hear sounds from the implant until it is switched on - a moment many people with cochlear implants describe as a huge breakthrough on their hearing journey. However everyone is different, and your first perception of speech and sounds will depend on the degree of your hearing loss and how long you have been living with it. Most cochlear implant users say that the sound changes over time and gets better with consistent daily use.
Once the implant is activated, your audiologist will test your hearing and make adjustments where necessary. During this session your audiologist will also instruct you on how to best use and care for your device and discuss what will be involved in your rehabilitation program.
Cochlear implants - rehabilitation
Activation is just the start of your entry into the world of sound and daily practice is an important part of the cochlear implant process as you need time to adjust to the new way of hearing sound. You may also undergo aural rehabilitation with a team of hearing and speech specialists, which may include audiologists, speech-language pathologists, educators, surgeons, medical specialists, psychologists and counsellors.
Your rehabilitation program will involve developing new listening skills through daily activities such as reading aloud to yourself and with family and friends, listening to audio books while reading along, and listening to easily recognisable songs. If you have been without hearing for a long time, you may also need an auditory development program to help you recognise speech and environmental sounds and develop new listening and communication techniques.
Your willingness to undergo aural rehabilitation and experience new sounds is crucial to how successful your implant is. A family member should also learn how to operate your sound processor and be included in your training program whenever possible.
Your cochlear implant is for life, so you will continue to visit your audiologist for annual check-ups and for adjustments and reprogramming to meet your changing hearing needs and lifestyle. As a cochlear implant user, you will also have the chance to upgrade your sound processor as the technology advances.
The information on this website is for educational purposes, and is not intended to replace medical advice. Please consult a hearing healthcare professional to diagnose or treat a hearing or health problem.