A cochlear implant is an electronic device that partially restores hearing in people who have severe hearing loss due to damage of the inner ear and who receive limited benefit from hearing aids. The system is comprised of two central pieces: a processor that fits behind the ear and an internal piece implanted under the skin.

The processor captures and processes sound signals, which are transmitted to the receiver implanted behind the ear. The receiver sends the signals to electrodes sitting in the snail-shaped inner ear (cochlea). These signals are then received by the auditory nerve and directed to the brain.

The brain interprets those signals as sounds, though these sounds won't be just like normal hearing. It takes time and training to learn to interpret the signals received from a cochlear implant, though after a year of use most implant patients make considerable gains in speech understanding.

Although results vary from person to person, most find that cochlear implants help them communicate better and improve their quality of life. They report improved:

  • Ability to hear speech without needing visual cues
  • Recognition of normal, everyday environmental sounds
  • Speech reading
  • Ability to hear soft sounds
  • Ability to find where sounds are coming from
  • Skilled teams. Each Mayo Clinic location has a specialized team for evaluating, treating and rehabilitating hearing loss. These teams include ear, nose and throat (ENT) specialists, audiologists, and speech-language pathologists.
  • Experience. Each year, Mayo Clinic cochlear implant teams implant more than 150 Food and Drug Administration-approved cochlear implant systems in adults and children.
  • Long-term support. Mayo Clinic providers are committed to the long-term support of people who receive cochlear implant, from the initial fitting and programming of the devices, through rehabilitation, to ongoing management of device performance.
  • Continuous improvement. Mayo researchers are continually trying to improve cochlear implant technology and care, with a special focus on hybrid devices that blend hearing aid and cochlear implant technologies.

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Eligibility criteria

Criteria to be a candidate for a cochlear implant:

  • People who have sensorineural hearing loss that is so severe it interrupts spoken communication
  • Limited benefit from hearing aids as determined by specialized audiologic testing
  • No medical or radiologic conditions or factors that increase the risks associated with cochlear implants
  • High motivation to participate in rehabilitation sessions and to be part of the hearing world
  • Clear understanding of what cochlear implants can and cannot do for hearing

Mayo Clinic has performed cochlear implants in children as young as 6 months of age and in adults as old as 96.

Evaluation

You undergo many tests during several outpatient visits, including:

  • Hearing test
  • Hearing aid evaluation
  • Speech understanding with appropriate hearing aids
  • Balance assessment
  • MRI or CT scan
  • Medical evaluation
  • Insurance consultation
  • Audiologic consultation
  • Psychology consultation
  • Speech pathology consultation

Surgery

Surgery is performed while you're under general anesthesia. The ear, nose and throat surgeon makes an incision behind the ear and forms a slight depression in the mastoid bone, where the internal device rests.

The surgeon then creates a small hole in the cochlea and threads the electrode array of the internal device through this hole. The incision is closed so that the internal device is beneath the skin. Most people feel well enough to return home the day of surgery.

Activation

One to four weeks after surgery, the external components of the device can be programmed and activated. There's no hearing ability from the implant until this is done.

The activation comprises:

  1. Fitting the headset. An audiologist attaches a headset that consists of a transmitter and a microphone and speech processor. The transmitter sends sound signals across the skin to the internal receiver-stimulator.
  2. Cochlear implant check. Every component, including each electrode, is checked to make sure it's working properly.
  3. Programming the speech processor. An audiologist creates a "hearing map," an individually designed set of instructions that tells each electrode how to stimulate the nerve endings in the cochlea.
  4. Trying it out. The speech processor is turned on, and you hear through the cochlear implant for the first time. On this first day, speech usually sounds garbled or high-pitched. Environmental sounds may be difficult to identify. Over time, speech and environmental sounds become clearer and more natural.

    The audiologist will verify that you can tolerate a range of sounds, such as soft speech, conversational speech, loud speech, hand clapping, coughing or doors shutting.

  5. Instruction. The audiologist shows you how to wear and operate the speech processor and its accessories and how to maintain the device.
  6. Fine-tuning. You will return several times over a year to program the device for optimal performance.

Rehabilitation

Rehabilitation involves training the brain to understand sounds heard through the cochlear implant. Speech and everyday environmental noises will sound different from what you remember; the brain needs time to recognize what these sounds mean. This process is ongoing and is best achieved by wearing the speech processor continuously during waking hours.

You may be given listening exercises to do at home. The difficulty level of these exercises varies, and some people may need weekly rehabilitation therapy to help retrain the brain to hear. Speech therapy may be recommended for people whose speech has been significantly affected by hearing loss.

Bilateral cochlear implants

Bilateral cochlear implants are increasingly accepted as standard care for the treatment of severe hearing loss. This is particularly true for infants and children who are acquiring speech and language. Bilateral implants can be done in one or two surgeries.

Bilateral cochlear implants have been documented to provide significant hearing benefit for children and adults, related to quiet, noise, reverberation and localization of sounds. There's also evidence that bilateral cochlear implants significantly improve the quality of life in people with severe hearing loss and that the cost of the second implant is offset by its benefits.

Hybrid cochlear implants

Hybrid cochlear implants stimulate the area at the base of the cochlea electrically, while also providing the acoustic amplification of a hearing aid. Hybrid devices preserve residual hearing in an ear by using both cochlear implant technology and a traditional hearing aid apparatus in the same ear.

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Cochlear implants are available for children and adults. Care is provided by specialists in audiology and otorhinolaryngology (ENT) at the Phoenix campus of Mayo Clinic. Cochlear implant surgery is performed at Mayo Clinic Hospital on the Phoenix campus.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

Specialists in audiology offer cochlear implants for children (age 12 and older) and adults. Cochlear implant surgery is performed at Mayo Clinic Hospital. Pediatric specialists at Nemours Children's Clinic in Jacksonville, Florida, provide the pre-evaluation and post-surgical treatment of children with cochlear implants.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

Specialists in audiology offer cochlear implants for children and adults. Cochlear implant surgery is done at Mayo Clinic Hospital, Saint Marys Campus in Rochester, Minn. The contact number for the cochlear implant program is 507-266-1965.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Research on cochlear implants has focused on current and future implant technology, bilateral cochlear implantation in adults and children, and speech perception and psychoacoustic properties of hearing in cochlear implant recipients.

Researchers at Mayo Clinic are currently evaluating electrodes designed for hearing preservation and the use of combined acoustic and electric hearing technology. Mayo Clinic researchers are also studying the use of cochlear implants among adults and older children who have hearing loss in one ear or who have differing hearing loss in each ear.

See a list of publications on cochlear implants published by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine.

March 19, 2015