What is a cochlear implant?
A cochlear implant is a small device that provides a sense of sound to the profoundly deaf or severely hard of hearing. The device has two main parts: an external sound processor and the implant itself.
You can see the external sound processor on the side of someone's ear while they're wearing it. It might look similar to a hearing aid. There's a computer inside that external piece that determines how much stimulation the recipient will need to hear the sound. Meanwhile, the second part, the actual implant, rests under the skin, behind a person's ear.
A cochlear implant is different from a hearing aid. A hearing aid works much like an amplifier, making sounds louder so that it's more likely that the inner ear will respond to speech or environmental sounds.
But sometimes you get to the point where you can't make sounds loud enough with a hearing aid because the hearing loss is so severe — or there's so much damage in the inner ear that even if sounds were louder, it's stimulating a damaged or impaired part of the inner ear. Thus, the signal sent to the auditory nerve would be distorted.
By using a cochlear implant, you're bypassing that damaged part and stimulating the auditory nerve directly. The cochlear implant can restore access to low-pitched and high-pitched sounds, which can improve the clarity of what a person hears.
What's the surgery like?
A surgeon makes a small cut in the crevice where the ear attaches to the head. The surgeon then folds the skin back and places the implantable component of the cochlear implant to the skull. To do this, the surgeon might burrow out part of the skull and then suture down the implant.
A tiny electrode wire is then routed down to the inner ear or cochlea behind the eardrum. The lead wire is inserted into the cochlea, right next to the auditory nerve. Overall, the surgery generally takes about two hours and is typically outpatient.
What are the risks?
As with any surgery, there's a risk that you won't react well to anesthesia. For most people, the risk is low.
Specifically with a cochlear implant surgery, you run the risk of suffering injury to the facial nerve, which goes through the middle ear. You might also suffer from a fluid leak through the hole that was created to place the implant in the ear. There's also a risk of dizziness, vertigo, ringing in the ear and numbness around the ear.
Also, once the implant is placed, you could lose your residual hearing. You might also notice that you hear sounds differently. Some describe the sounds that they hear from the implant as “mechanical.”
It's important to talk with your doctor about the device that they'll be installing and the specific risks and technical difficulties that could come with that device, which often vary.
What's the recovery time?
Recovery from the surgery itself can be short. Some people can return to school or work within a few days. However, your device likely won't be turned on yet. Your device isn't generally activated generally until two to four weeks after surgery.
You may need rehabilitation once your implant is activated. Auditory training can be expensive and is not always reimbursed by insurers.
Also, many health plans don't include specific benefits to cover repairs and replacement of parts for implants. You might have coverage, though, if your policy includes durable medical equipment benefits.
Before you get a cochlear implant, you should talk with your doctor about what level you might benefit from the device. Not everyone receives the same benefits, and the devices themselves can be expensive, ranging from $40,000 to more than $100,000.
Some insurance plans cover the devices, including Medicare and the Veteran's Administration. However, for adults who are uninsured, it can be hard to obtain access to the devices.
Sources: Jace Wolfe, the director of audiology at Hearts for Hearing; National Institute on Deafness and Other Communication Disorders; the Mayo Clinic; the U.S. Food and Drug Administration