A cochlear implant is a device that provides electrical hearing for patients who no longer have enough useable hearing of their own. There is an internal component that is implanted, and an external processor system that powers and sends commands to the implant. The cochlear implant stimulates the endings of the auditory nerve directly to replace the absent or damaged sensory cells in the cochlea that cause hearing loss.
How Does a Cochlear Implant Work?
The internal device is completely passive without the external processor system. The external processor is powered by a battery, and it is programmed to each unique patient’s needs using specific software. The processor sends digital signals down a connecting cable to the external coil, and that digital signal is then transmitted to the internal coil. It is next sent to receiver-stimulator, down an electrical lead, and to the intra-cochlear electrodes, which stimulate the endings of the auditory nerve. The goal is to achieve speech understanding improvement through these digital signals and electrical auditory stimulation.
Cochlear Implant Services at ENT
- Mapping appointments
- Medical management
- Equipment management
- General support through the process of cochlear implantation
Cochlear Implantation Process
You start with a cochlear implant evaluation to determine if you're a candidate for a cochlear implant. You would then have a pre-operative consultation with one of our cochlear implant surgeons. A CT or MRI scan typically takes place the same day, right before this appointment.
Device choice is decided at that time, and then a prior-authorization is obtained if needed for the procedure.
You may additionally need a vestibular evaluation, and that will be set up prior to your procedure as well. If that information is needed, your surgeon will request it.
Lastly, you work with a cochlear implant scheduler to schedule all necessary appointments, including the procedure. One week after cochlear implantation surgery, you come back to see your surgeon for a post-operative check. One week after that, you have your cochlear implant activation with your audiologist, and any other family members, care team members, or loved ones that you would like to have present for that moment when your device is activated for the first time.
Cochlear implant programming appointments are then scheduled for 2 weeks post activation, then in another 2 weeks, then 1 month, and in another 1 month, then in 3 months, and then 6 months. At that point, pediatric patients are followed every 6 months. Adults choose if they prefer an annual follow up, or if they prefer a 6 month follow up. Follow up is also on an as needed basis.
Am I a Candidate for Cochlear Implantation?
Both audiological and medical information is needed for deciding if you are a candidate. For both pediatric and adult candidates, a trial with hearing aids is necessary prior to considering cochlear implantation.
- For adults - FDA guidelines for cochlear implantation are moderate to profound sensorineural hearing loss or worse, as well as poor speech understanding ability even when listening with appropriately fit, up-to-date amplification.
- For children - FDA guidelines for cochlear implantation start at 12 months of age, and until age 2, guidelines state profound sensorineural hearing loss in both ears with no measurable benefit from appropriately fit amplification. From age 2 to 18, guidelines state severe to profound sensorineural hearing loss or worse in both ears with limited or no benefit from appropriately fit, up-to-date amplification. Speech understanding testing is conducted when children are able to perform this type of evaluation reliably.
- For younger children - for children who are not able to perform speech understanding testing, other assessment tools are instead used.
In addition to audiological guidelines, candidates must also have an attached and functioning auditory nerve that can be stimulated with the device if it is placed, and cochlear structures must physically allow for the placement of the device as well. This medical information is obtained with a CT, and/or MRI scan, and your surgeon will decide with you which is indicated.
Cochlear Implant Insurance Coverage
Health insurance plans do cover cochlear implantation when criteria for medical necessity is met. Some plans follow Medicare guidelines, some plans follow FDA guidelines, and some plans have their own criteria for reimbursement of cochlear implantation. Almost no health insurance plans cover cochlear implantation at 100%. However, prior to your cochlear implantation procedure, our staff will work with you to determine any out-of-pocket expenses so that you are aware ahead of time. Our Patient Financial Assistance department can also work with you to help with out-of-pocket medical expenses once they have been billed to you.