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Cochlear Implants
This cochlear implant primer was prepared by Hearing Loss Association of Washington.
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Behind the Ear (BTE) |
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Cochlear Implant Elements
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 that the sounds can be understood by the brain as speech. Speech reception programs in the processor 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 a BTE model that has become generally available since year 2000. Body packs continue to be employed because of bone structure or other special circumstances.
Who can get an implant?
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 . They are installed for totally deaf individuals including infants as young as 12 months, as well as persons of all ages with a severe to profound hearing loss who retain some residual speech understanding. Individuals in their 80s and early 90s have received implants.
For young children, the earlier, the better to facilitate normal development of speech which depends on hearing, research has shown. Adults who learned to speak before their hearing declined generally do better than deaf individuals or others with severe hearing impairments that occurred before they learned to speak.
For deaf individuals who desire to communicate with “main stream” speakers, implants provide a supplement, or an alternative to sign language.
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 simple day surgery unless there is some bone structure irregularity (rare) or other special condition that may require more extensive surgery. The implant is likely to eliminate any 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 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. There were several hundred dual installations by 2005. Many implant wearers wear a hearing aid in the other ear to make use of any residual hearing in that ear.
Devices in both ears, whether hearing aids or implants, or a combination of the two instruments, enable the wearer to locate the direction of sound and to deal more effectively with speech interfering background noise.
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. Speech threshold levels (understanding sentences) have been established by the FDA and by Medicare.
Federal standards
Strict Federal standards enforced by the Food and Drug Administration (FDA) govern eligibility for implant surgery. These standards, as promulgated in 2005, require 60% sentence or less discrimination in the best aided condition, with 50% or less sentence discrimination in the ear being implanted.
Medicare, with somewhat stricter standards for reimbursement of most of the costs, requires speech understanding ability of 40 % or less in the best aided condition.
The surgery is quite costly, many times more expensive than a pair of top-of-the-line hearing aids. However, many health insurance policies and Medicare underwrite a substantial portion of the implantation costs under “medical necessity” provisions.
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 the receptivity of the recipient to the new sounds the implant provides. Some patients find that implants restore improved levels of speech understanding within a day or two without therapy, but others may take weeks or months to reach acceptable levels, sometimes assisted with speech-language therapy.
Remarkably, the brain’s ability to accommodate electronic speech signals keeps improving over time. Although first sounds heard may resemble Donald Duck talk, they soon become accepted as “normal.” As one veteran implant audiologist put it, “That old brain continues to learn new tricks.”
Implant manufacturers
Implants are produced by three highly competitive worldwide manufacturers who vie in marketing instrument capabilities, design, and special features. Essentially, they 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 market place are:
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Cochlear Corp. (Cochlear Americas), maker of Nucleus system devices - www.cochlearamericas.com.
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Advanced Bionics, maker of High Resolution devices - www.advancedbionics.com.
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Med-El Corp., makers of Pulsar and Combi 40+ devices - www.medel.com.
Titanium is the primary product used by the Cochlear Co for its inserts, while ceramic inserts are used by Advanced Bionics and Med-El.
Information sources
Professional assistance with cochlear implants may be obtained at the following centers in Washington State:
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Puget Sound Hearing & Balance Center, Seattle
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Seattle Ear Clinic, Seattle
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Tacoma Ear and Balance, Tacoma
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Madigan Army Medical Center, Tacoma
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Spokane Ear, Nose & Throat, Spokane
Sound Waves, the quarterly newsletter of Hearing Loss Association of Washington (formerly WASA-SHHH) has two pages on cochlear implants in each issue. All issues can be found on this website under "newsletters". Browsing the web can produce additional information about implants. Type “cochlear implants” in any search engine or use the links above to investigate manufacturers.
The US Government Food and Drug Administration has a reference page on Cochlear Implants.
Web Resources -- check out this MS Word document listing web resources provided by one of our HLA-WA members.
Email contacts
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N22Mary@comcast.net (Mary Steinmeyer)
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mandelbaum@olympus.net (Emily Mandelbaum)
Note: CIAI (Cochlear Implant Association, Inc) has been absorbed into Hearing Loss Association of America. Its Washington affiliate, Pacific Northwest Cochlear Implant Association, has disbanded. Its final newsletter can be found on this web site: CIAI Newsletter.
Implantee stories -- living with a cochlear implant
An eclectic collection of paragraphs about cochlear implants (CIs), from Washington State cochlear implant users. Below you'll find information about getting an implant and how they learned to hear again.
William R. Rinehart Sr., Sequim, about getting implant in 2003: The sounds I heard first through the implant was from Stacey, the audiologist. She said my face lit up like a Christmas tree. After I left Virginia Mason to come home, I asked my son if it was always this noisy. He said yes. I said take me back, I want my old hearing back. I didn’t feel that way very long. I hear things I could never hear before. I can talk on a regular telephone again. That was something I was unable to do for almost fifty years. Now, I’m more confident that I will hear people when they talk to me. I no longer have to avoid people because of my poor hearing.
Myrna Kain , Everett, who received her implant in 2002: I really did not know what to expect after the surgery, mainly because I had forgotten so much of what I could hear or could not hear. After several programming, I couldn't believe the many little things, I was hearing - rain drops on the roof of my car, water in the dishwasher running, grease sizzling in the electric pan or on the stove at a distance, My sister in law told me that they were going to have to whisper, so I couldn't hear what they were saying about me (a tease).
Ben Gilbert, Tacoma, on deciding to get an implant: Moving to a decision, in 2001, I gobbled up everything I could find about cochlear implants. This remarkable thought emerged: an implant would give me back my lost high frequency sounds, the ones that make speech understandable. It is the only device that restores (at least partially) one of the six senses, the sense of hearing. I didn’t need a series of tests to demonstrate that speech was becoming increasingly incomprehensible to me, but Medicare did. The test results confirmed my eligibility for an implant which I got in June 2001 at age 83 and it has worked well for me from Day One. Why did I wait so long? Possibly a reluctance to embark on a voyage into the unknown.
Robbi Bishop, professional audiologist, on a patient’s story: An email from a patient of mine described a recent listening situation she faced with her cochlear implant in which she had difficulty. She ended the e-mail with a summary of all the amazing things she hears on a daily basis, “the clomping of her horse’s feet on the forest floor, the sounds of the birds as they sing their morning song, and the occasional understanding of the TV when not looking." Her expectations for her cochlear implant were beyond realistic, they were inspiring.
Barbara Mladinov, Tacoma, on six years with a CI in 2005: I can’t imagine life without the implant, though my results are average, not spectacular. I hear very well in one-on-one conversations in quiet environments, but if there are two or three, I am not always able to follow. If they talk directly to me, it’s fine, but when they talk among themselves, I'm often lost. I usually hear when clerks talk to me, depending on the noise level in the store.
Deaf education specialist Randy Collins on implants: Deaf culture will continue to exist and adapt to the mainstream. In the future, deaf people who have CIs will wear them at work to become more accessible to English, and ultimately better jobs, but will on returning home, become a member of the deaf community again. About CIs and children, the most successful deaf children have two things in common, ability and parental support. Mode of communication is NOT the primary determinant for children.
Scottie Nix of Renton in 2005 after getting a CI: In the last 4 weeks I have found that I hate to take my CI off for anything – even to go to bed. I love hearing. Was I miserable at first when the CI was turned on? You bet. Can I hear all normal conversation? Not today, but in the future I should be able to get most all of it. I can hear things I have never heard before, I can hear the person in the next room typing on a computer, I can hear a phone ring in the next room. I can hear birds sing – well that is what people tell me they do. I also think that the key concept to a CI is to enjoy each sound you hear; sure you may feel like you are going crazy – but what a way to go!
Dean Olson of Seattle and his 2005 implant: The harm his severe to profound hearing loss did to his dating life was a factor prompting Dean Olson to get an implant. Before implant, he briefly attended sign language classes, but found that wasn’t much use for him. Nor did his hearing aids give him near the benefit he sought. He found that he was losing touch and depending too much on the good will and knowledge of others. So he went for a cochlear implant. He was implanted on February 8, 2005. He reacted impatiently at first; the implant did not provide an instant fix for his hearing loss. He realizes that the first six months are the hardest, and understands more effective hearing may take a while longer. "I hear sounds I have not heard since Bellevue High School , which was eons ago!” he said. I'm able to converse at about the same level as before, but I want more," he added. A romantic benefit? He isn't saying. Dean has written a longer narrative about his implant experience. To read it, click here.
Evelyn Busick, Kitsap, in 2005 - six years with implant: Implant mapping software for both my Esprit 3G BTE and the body processor improves every year, especially for music. The music in the recent movie "Shall We Dance?" was especially enjoyable. Parties, restaurants and public places continue to be too noisy. However, one 3-G program has a noise suppressor I really like. When sound reaches a certain level, it automatically goes down. I have to work a little harder to understand, but I am not trying to overcome an unbearable loud blast of noise. Truly, the implant has been a huge success. No, the sound is not like normal hearing, but it began to sound normal to me. Friends told me that they were "so glad I got the implant", because now they can talk with me. Without this marvel, I am deaf. I survive, but still do enjoy being able to function in the hearing world. People respond more readily to me now.
