Cochlear Implants – A Primer


Cochlear implants are electronic devices with three principal elements: a battery-operated external speech processor that converts sound waves into digital signals, a magnetically attached connector that transmits the signals to the implant, and an internal implant surgically placed under the skin on the skull and linked by a wire array to the hearing nerve.

The speech processor is essentially a mini-computer that processes sound waves electronically and sends them to the implant so the sounds can be understood by the brain as speech. Multiple programs give the user flexibility to adapt to different hearing situations.

Implants come in behind-the-ear (BTE) models and body pack versions. Most wearers choose the BTE model that became available in 2000. Body packs continue to be employed because of bone structure or other special circumstances.

Who Is Eligible for Cochlear Implants?

Increasingly, implants are installed where hearing aids have failed to establish satisfactory speech thresholds. As of mid-2005, an estimated 90,000 persons have received implants worldwide, more than 30,000 in the United States. Implants are installed for infants as young as 12 months, as well as persons of all ages with a severe to profound hearing loss. Individuals in their 80s and early 90s have received implants.

Cost and Insurance Coverage

The surgery costs many times more than even a pair of top-of-the-line hearing aids; however, many health insurance policies and Medicare underwrite a substantial portion under “medical necessity” coverage.

A “medical necessity” letter from a physician or audiologist is required in the U.S. to establish implant eligibility. In effect, the letter certifies that surgery is required to deal with the hearing needs of the patient. Strict Federal standards enforced by the Food and Drug Administration (FDA) govern eligibility for implant surgery. These standards, set up in 2005, require 60% or less sentence discrimination in the best-aided condition, with 50% or less in the ear being implanted. Medicare’s standard for expense reimbursement requires speech understanding of 40% or less.

Surgical Procedure

Surgery is required on the head above the ear to insert a small disc-like device next to the skull. It is usually performed as day surgery unless there is bone structure irregularity (rare) or other special condition. The implant usually eliminates residual hearing in that ear.

The surgeon threads a wire array through the cochlea (hence the name cochlear implant) where it is linked to the hearing nerve and brain. The implanted wire array transmits the signals in their component speech frequencies.

Typically only one ear is implanted, although dual implants have been installed to meet special needs. Many implant wearers use a hearing aid in their other ear. Wearing devices in both ears helps with determining sound direction and dealing with background noise.

Getting Used To An Implant

Auditory therapy may be required as part of the “breaking-in” process, depending on the extent and character of the hearing loss and receptivity to the implant’s new sounds. Some patients find that implants improve speech understanding in a day or two without therapy, but others may take weeks or months to reach acceptable levels, even if assisted by speech-language therapy. Although at first, voices may resemble Donald Duck, with time and training the brain accepts the new sounds as normal. As one veteran implant audiologist put it, “That old brain continues to learn new tricks.”

Implant Manufacturers

Implants are produced by highly competitive worldwide manufacturers who vie in marketing instrument capabilities, design, and special features. The implants operate similarly, although they differ in their formats, appearance and features. All are subject to strict regulatory scrutiny by the U. S. Food and Drug Administration.

The three principal implant manufacturers in the American marketplace are Cochlear, Advanced Bionics and Med-El. Cochlear Americas uses titanium for inserts while Advanced Bionics and Med-El use ceramic.

Cochlear Americas, maker of Nucleus Systems
Advanced Bionics, maker of High Resolution
Med-El Corp., makers of Pulsar and Combi 40+

Washington State Implant Centers

Children’s Hospital and Medical Center, Seattle
Puget Sound Hearing & Balance Center, Seattle
Seattle Ear Clinic, Seattle
University of Washington Otolaryngology Clinic, Seattle
Veterans Administration (VA) Medical Center, Seattle
Virginia Mason Listen for Life Center, Seattle
Tacoma Ear and Balance (counseling only), Tacoma
Madigan Army Medical Center, Tacoma
Spokane Ear, Nose & Throat, Spokane

Washington Email Contacts for Cochlear Americas

Mary Steinmeyer
Emily Mandelbaum

Washington Email Contacts for Advanced Bionics

Kirsten Robbins

Web Resources List

Cochlear Implants (CI) Resources (compiled by member and not updated). Many valuable links worth checking out!