When hearing aids fail, cochlear implants may help

Hearing loss can have a profound impact on one’s quality of life. Those who struggle to hear are limited in their ability to communicate with family and friends, and that can cause a person to feel isolated, which can quickly lead to feelings of loneliness and depression. Because hearing loss limits a person’s ability to understand a doctor’s advice or hear sirens and alarms, it also poses safety concerns.

According to the National Institute on Deafness and Other Communication Disorders, one in three people older than 60 and half of those older than 85 have hearing loss. Hearing aids provide benefits for many people, but for those not helped by them, cochlear implants might be a solution.

“Cochlear implants can be an option for individuals with severe to profound permanent hearing impairment who receive limited benefit from well-fit, traditional hearing aids,” said Dr. Kathy Holtman, an audiologist at Central Institute for the Deaf in St. Louis. “There are FDA guidelines regarding who is considered a candidate for cochlear implantation. … Both a medical and an audiologic evaluation are necessary to determine whether FDA guidelines have been met.”

The implant device consists of an internal component and several external components that are surgically implanted by an ear, nose and throat (ENT) surgeon. The surgeon places the internal piece beneath the skin behind the outer ear and threads its array of electrodes through the inner ear into the bends of the cochlea.

External components – which include the magnet/transmitter, a cable, speech processor and a battery source – look similar to a behind-the-ear hearing aid.

Cochlear implant surgery takes about two to five hours, and there is an outpatient, post-surgery hospital stay of 24 hours or less, Holtman said.

“The patient typically leaves the hospital with a dressing on the incision site and returns to the surgeon within approximately two weeks for a post-operative check-up,” she said. “The surgical site swelling must subside and healing begin prior to the activation of the implant. For this reason, the external components are not delivered – and no sounds are activated – until two to four weeks post-surgery.”

After a post-operative visit with the surgeon, the implant user begins a series of appointments with an audiologist who programs the electrodes, and that is when results become apparent.

“The programming of the electrodes is called ‘mapping’ and consists of listening for the electrical pulses until audible and comfortable,” Holtman said. “The first mapping is a productive one, and after about an hour of listening, the person does leave with an active map. In other words, this is when the patient first hears sounds.”

There are several more mapping appointments over the course of several weeks, and follow-up visits might include auditory rehabilitation appointments to teach the individual how to listen with the new implant.

Asked about limitations for cochlear implant users, Holtman said there are surprisingly few.

“Depending on which internal implant is placed, the internal magnet may need to be removed in the (surgeon’s) office prior to Magnetic Resonance Imaging (MRI) and then replaced,” she said, adding that the external device should be removed at airport security checkpoints, and the ENT’s recommendation should be sought regarding contact sport activities that might cause head injury.

The cost of getting a cochlear implant is more than $30,000, but the bulk of that is rarely out-of-pocket, Holtman said. Payment is requested through insurance companies or other third-party payers, and Medicare and Medicaid have policies in place regarding coverage.

While a cochlear implant does not restore normal hearing, “it does help to re-establish audibility of soft sounds and ease spoken communication,” Holtman said.

For the person who strains to hear on a daily basis, that sounds pretty good.