Why don’t some people benefit from hearing aids? Many people have severe or profound hearing loss due to damage to the thousands of tiny nerve endings inside the cochlea. Hearing aids may allow them to hear some sounds, but may not let them hear enough to understand speech and learn to talk.

Are there any hearing aids that can help the profoundly deaf? Some profoundly deaf people can hear better with a frequency transposer hearing aid than with a conventional hearing aid. This amplifies the low and mid frequencies and shifts the high frequencies to the lower frequency range where the individual typically has some residual hearing. Sometimes a child is fitted with a transposer aid to help assess their response to sound and to help predict their response to a cochlear implant. Patients who receive little benefit from hearing aids can be evaluated to see if they are candidates for a cochlear implant.

What is a cochlear implant? A cochlear implant is a computerized device that a doctor surgically implants in the bone behind the ear. It delivers an electrical signal to the cochlear and bypasses the damaged nerve endings. This is done through a series of electrodes that are placed inside the cochlea. The undamaged fibers of the auditory/hearing nerve carry the electrical impulse to the brain.

Can a cochlear implant be used on individuals with nerve deafness? Yes. The cochlear implant was designed specifically for individuals with nerve deafness.

What is the best age for an individual to receive a cochlear implant? Children as young as twenty four months can be implanted. In general, the brain learns most quickly when it is young. The younger the child is when implanted the more advantage can be taken of this rapid learning stage. Since speech and language develop in the first several years of life, it is important to allow the implanted child these same years for learning to talk. Although many children are getting an implant during their school years, it presents different management issues and challenges for leaning to talk and receiving an education.

Older school aged children and teenagers are evaluated for a cochlear implant on an individual basis. Factors such as previous hearing and speech, use of hearing aids, extent of speech therapy received prior to the implant evaluation, use of sign language, and type of educational programs available are all considered in determining an older child’s candidacy for an implant.

Can adults have a cochlear implant? Yes. Adults who have had hearing and speech and lost their hearing due to an injury or illness are frequently good candidates for the implant. The cochlear implant evaluation team can determine if there are any reasons why a particular patient may not be eligible. Adults who have been hearing impaired throughout their lives, have worn hearing aids and use speech to communicate may be considered a candidate. Adults who have been deaf all their lives and are comfortable in the Deaf community frequently are not considered good candidates for the procedure. Any interested person should be evaluated and obtain the opinion of the professionals in a cochlear implant center.

Can a person with just one deaf ear have a cochlear implant? No. A person must be deaf in both ears in order to be implanted.

If someone is deaf in both ears, do they receive two cochlear implants? No. Surgery is only done on one ear. Some people wear a hearing in the non-implanted ear, but other people do not.

How much can a person hear with an implant? Each person responds differently to the cochlear implant. Many are able to hear pitches spanning from the very low pitch sounds to the very high pitch sounds and can hear loud and soft sounds. Many children and adults hear enough to hear their own voices and the voices of others and develop clear speech. Some can talk on the telephone and follow the dialogue on the television and at the movies. Others cannot understand speech with their cochlear implant without the help of lip-reading. Many factors affect a person's use of the implant: these include the condition of the auditory pathway, the brain's ability to use sound in a meaningful way, the functioning of the implanted device, the quality and quantity of the aural rehabilitation program, etc.

What does speech sound like with an implant? Some adults who heard before going deaf have described it as sounding very low pitched; others say it is very high pitched. Over the first weeks and months of continuous use of the implant, many patients say it sounds more and more natural, like the way they remember things sounding.

Who does the surgery? A physician who has received special training can surgically implant the device. Nearly all the major cities in the US have a cochlear implant center and many major university hospitals are doing the procedure.

Are there different brands or makes? Yes. The Nucleus-22 and Nucleus-24 are distributed by Cochlear Corporation and the Clarion is distributed by Advanced Bionics. Different implant centers use different devices. Other brands are available in Europe.

What happens after surgery? A healing period of four to six weeks follows surgery. During that time, the patient cannot hear through the device. When the doctor determines the healing is complete, a ‘hook up’ session will be scheduled with the audiologist on the implant team. The externally worn pieces of the device are fitted to the patient: these include a tiny microphone worn near the ear, a cord that takes the signal to a speech processor which is about the size of a small walkman, and a transmitter that is held to the head with a magnet worn at the ear. After fitting the pieces, the audiologist activates each of the electrodes and establishes their appropriate levels of electrical stimulation. It can take several visits to set the optimal levels for all the electrodes. Periodic checkups are done and adjustments are made thereafter.

Can a child talk after getting it turned on? When the device is turned on, a child who was born deaf will not understand the signal right away. Similar to a hearing person's move to a foreign country, he can hear a language being spoken, but cannot understand or speak it. It takes time to learn to about sounds in the environment and the sounds of a language. A highly trained therapist is needed to teach a young implant user to understand talking and to speak. With the appropriate aural rehabilitation, many children can learn to talk and understand spoken language.

Where will my child go to school after getting a cochlear implant? That depends on your community. Some schools offer educational services that allow the child to learn to hear in the classroom and with support staff such as the speech/language therapist, the itinerant teacher, the rehabilitative audiologist and the resource teacher. Other schools do not have staff who understand the auditory and speech-language learning needs of the implanted child and only offer sign language instruction and minimal therapy and auditory training services. Some parents decide to home school their children and teach them to talk at home before enrolling them in school. Others enroll their children in private schools.

Should sign language be used with the cochlear implant? The use of sign language is determined on a case by case basis. Many factors are involved. However, many children who received their implant at a young age have learned to talk and have not needed signs. A number of these children are fully integrated into their neighborhood schools, socialize with normally hearing children, talk on the telephone, learn popular words and slang from watching and hearing their videos, and in general are living lives as hearing and speaking children. There are too many individual situations to discuss here, but factors such as the age of the patient, whether the person already uses sign language for communication, presence and severity of multiple disorders, availability of trained specialists, preference of the parents are all considered in this decision.

What does the family have to do after the implant surgery and hook up? The long term management consists of extensive speech/language therapy and auditory training, involvement in the child’s educational program, and visits to the audiologist to maintain and reprogram the device. Many parents also attend conferences for parents and professionals to educate themselves in the most recent management issues surrounding children with cochlear implants.

Can multi-handicapped children get an implant? This is determined on an individual basis. Many children with mild associated disorders have been implanted and are receiving significant benefit. Many are talking and do not need sign language. Other multiply-involved children who have been implanted have more limited benefit from it and are unable to understand speech and talk. As you know, many children have severe speech and language disorders and auditory processing disorders even though their hearing sense is normal. Children who have severe speech/language/auditory processing problems in addition to deafness may hear with the implant but the extent to which they benefit from it is limited by their neurological condition. In addition, many children with normal hearing and receptive skills can understand speech but cannot talk due to expressive delays and disorders. As a general rule, the implant only electrically stimulates the hearing nerve: the brain can only learn to interpret it if it is capable of doing so. A team of specialists usually is involved in determining whether or not to implant a child with multiple problems.

How much does it cost and how can we pay for it? The entire procedure is approximately $40,000. Most insurance companies provide coverage once the doctor determines that it is a medical necessity. In some states Medicaid and Medicare also pay for it. There are also nonprofit organizations that help families raise money if need be.