Cochlear Implants FAQ

​​​​​​​​How Is a Cochlear Implant Different from a Hearing Aid?

Hearing aids acoustically amplify sound and rely on the responsiveness of sensory cells in the inner ear to receive and transmit the sound to the brain. For those individuals with severe to profound sensorineural hearing loss, the sensory cells of the inner ear are often damaged or destroyed, making it difficult for hearing aids to provide benefit. Cochlear implants convey sound by converting acoustic signals into electrical patterns, which are then delivered directly to the auditory nerve fibers, bypassing sensory cells.

What Happens to the Hearing Aid on the Opposite Ear?

In most cases, continuing to wear a hearing aid in the non-implanted ear provides:

• Better localization of sound
• “Balanced” or “in stereo” perception or feeling
• Continued stimulation of your auditory nerve
• A more natural sound quality

Your audiologist can help you determine appropriate hearing aid use for your individual needs.

What Should I Expect During Surgery?

Cochlear implant surgery is conducted under general anesthesia and lasts between 2-3 hours. The procedure may require an overnight stay at the hospital, but is usually an outpatient procedure. During surgery, an incision is made behind the ear. The electrode array is inserted into the cochlea (inner ear) through a small opening. Finally, the incision is closed and a pressure bandage is applied for 24-48 hours to help reduce swelling. The majority of the swelling will subside within 3-5 weeks after implantation. Discomfort after surgery is minimal. However, if pain is present, over-the-counter pain medications can be utilized to reduce discomfort.

What are the Risks Involved With Cochlear Implant Surgery?

All surgical procedures involve certain risks. The risks involved in cochlear implantation are comparable to the risks associated with any standard ear surgery that is performed under general anesthesia. One major consequence of cochlear implant surgery is that any residual acoustic hearing will be lost in the implanted ear. Other more rare risks of cochlear implant surgery include temporary or permanent disruption to the balance system, taste disturbance, or facial nerve weakness or paralysis. At Boys Town National Research Hospital, facial nerve monitoring is used throughout the duration of the surgery to reduce the likelihood of damage to the facial nerve. As with any surgery, there is also the risk of infection.

Your surgeon and anesthesiologist can answer questions and discuss additional concerns prior to surgery.

Should My Left or Right Ear Be Implanted?

During the candidacy process, the potential candidate meets with members of the cochlear implant team and with the surgeon to gather information and to discuss expectations and outcomes of the procedure. The information gathered at this time is essential in determining if the individual is indeed a cochlear implant candidate, and if so, what ear should be implanted. The following are a number of factors to be considered when deciding which ear to implant.

Considerations for each ear are:

• Severity of hearing loss
• Hearing aid use
• Aided-speech understanding
• Medical and / or anatomical considerations
• Etiology or cause of hearing loss
• Additional considerations (example: physical limitations)

How Much Time Will I Need to Take Off From Work/School After Cochlear Implant Surgery?

Recovery times differ widely across individuals. Some people feel well enough to go back to work or school within 2 or 3 days, whereas others need roughly one week to feel fully recuperated. However, recipients should refrain from engaging in strenuous physical activity for at least 6 weeks following surgery.

How Often Will I Need to Come Back For Follow-Up Care After Surgery?

The cochlear implant recipient’s first visit back to our center after surgery is the day of initial stimulation/activation. Initial stimulation typically occurs about 1 1/2 weeks after surgery and usually involves appointments on two consecutive days. This is because speech processor programming levels can change dramatically from day 1 to day 2. After initial activation the individual is evaluated 6-7 times in the first year. After two years of device use, children are typically evaluated every 6 months. Adults are seen annually for the life of the implant. However, certain circumstances may indicate a need to return to your center for follow-up prior to your next regularly scheduled appointment. The following is a brief list of such circumstances:

• General listening has become more difficult
• changes in sound quality (i.e. distortion)
• Decrease in speech perception ability
• You hear a buzzing, clicking, or other noises which were not present earlier when using the processor
• Pain, twitching, or other physical sensation in your ear or face
• No sound when the processor is used
• Intermittent sound

Specifically for children, parents may notice:

• Lack of progress over a period of time
• Decrease in speech production skills
• Responses to environmental sounds or indications of speech awareness have diminished

A device check should be performed if you or your child experiences any of the above listed factors. A device check ensures that the external equipment (speech processor, cables, microphone) is functioning properly and that equipment malfunction is not contributing to the problem. Contact your audiologist for additional information.

Click here for more information about follow-up visits at Boys Town National Research Hospital for children or adult recipients.

What Makes a Cochlear Implant Success or Failure?

It is important to realize that there is a wide range of outcomes across cochlear implants recipients. Several key factors have been identified as influential in an individual’s potential performance with a cochlear implant. Additionally, understanding these factors may be helpful in establishing reasonable expectations for performance with a cochlear implant for that individual. The following is a brief list of factors that may influence an individual’s performance with a cochlear implant:

• Age at onset of hearing loss and/or previous auditory experience
• Duration of hearing loss
• amount of hearing loss prior to cochlear implantation
• Age at implantation
• Cause of the hearing loss
• Presence of other learning and/or physical disabilities
• Appropriate aural (re)habilitation
• Family support
• Appropriate educational support

Will I Be Able to Talk on the Phone With My Cochlear Implant?

Phone use is a challenge for anyone with hearing loss. This is certainly true for most cochlear implant users as well. With practice, some cochlear implant users are able to make phone calls and understand familiar voices over the telephone. Yet others are not able to use the phone at all. Your audiologist can discuss tips and additional tools that may assist in making phone use easier.

Are Cochlear Implants Covered by Insurance?

Many health insurance companies cover the cost of cochlear implantation. Cochlear implants may also be covered by Medicaid and Medicare. At Boys Town National Research Hospital, we have specialists who help you secure prior authori​zation and/or appeal claims that have been initially denied. Individuals interested in pursing a cochlear implant should investigate their insurance carrier’s reimbursement policy for potential restrictions placed on the center site, surgeon, and the amount of follow-up services required. It may be helpful to determine out-of-pocket expenses that are unique to your carrier and policy.

What Kind of Warranty Comes With A Cochlear Implant?

Warranties vary by manufacturer. Warranties for the internal portion of the implant are typically much longer than warranties for the external equipment (i.e., speech processor, headset, etc.). Presently, internal device warranties are typically for about 10 years and warranties for speech processors are typically for about 5 years. Additionally, speech processor warranties are typically limited to one-time loss or damage. Please check with the manufacturer for specific details. After the expiration of the manufacturer-issued warranty, it is recommended that the recipient secure additional coverage for the external equipment. Three potential avenues to explore include: (1) an independent insurance company that covers cochlear implant equipment, (2) purchasing extended coverage through the manufacturer, and (3) your homeowner’s insurance policy. Contact your audiologist for additional information.​