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What Is a Cochlear Implant? Cochlear Nerve Function and Stimulation Explained

A cochlear implant is an electronic device that partially restores hearing to damaged parts of the ear. It uses internal and external systems to help deaf people process sounds and speech. In this article, Flo explains how cochlear implants work and provides some useful tips on wearing a cochlear implant.

A cochlear implant is a device used to help restore hearing caused by severe damage to the inner ear. People who need a cochlear implant often find regular hearing aids to be of no use. This is mainly because the two devices work differently. 

Hearing aids amplify sound, and cochlear implants communicate directly with the auditory nerve to produce sound and restore hearing.

Cochlear implants consist of two main components: one inside and one outside the ear. 

One component acts as a transmitter, picking up sounds and sending them to the receiver part implanted behind your ear. The external part or transmitter can be worn behind the ear or be carried in a pocket, harness, or belt pouch. This receiver then sends sound waves to electrodes implanted in the cochlea, activating the auditory nerve responsible for hearing. The cochlear nerve sends messages straight to your brain, where they are interpreted as sound patterns, not unlike regular hearing.

Cochlear implant surgery is often recommended for people with severe hearing loss due to inner-ear damage.

Cochlear implants are recommended for adults and children with severe nerve damage and extensive hearing loss. Cochlear implant surgery can be an expensive but life-altering procedure. 

For people with mild to moderate hearing loss, hearing aids might be a better solution than a cochlear implant. If you have trouble hearing everyday sounds and conversations, then you could benefit from a hearing aid. Consult with an experienced audiologist who can help you find the right hearing aid.  

Unlike cochlear implants, hearing aids are not surgically implanted. They are worn inside or behind the ear and consist of a microphone, amplifier, and speaker to help you hear better.

A cochlear implant interprets sound via electronic messages received from the outer device worn behind the ear. These messages are processed and transmitted to the inner component located at the auditory nerve. From here, the cochlear nerve sends electronic sound patterns to the brain, where they can be recognized as speech and partially restore hearing. 

Just like with a new language, the implant recipient has to learn these sound patterns to understand them as speech and experience them as regular hearing.

The cochlear implant enables hearing via the normal pathways of natural hearing. By creating an electric impulse that stimulates the auditory nerve, it produces a sound.

Cochlear implant procedures involve general anesthesia, so your health care provider will give you some specific instructions to follow to prepare for the surgery. These may include:

  • Temporarily stop taking certain medications or supplements.
  • Avoid eating or drinking hours before surgery.

Your health care provider will give you complete instructions and will make sure there are no contraindications.

Before the procedure, a specialist will review your options and determine if cochlear implants are right for you. 

Your health care provider will give you a full medical examination, including:

  • Testing your hearing, speech, and sense of balance
  • Physical exam of your inner ear
  • CT or MRI imaging to find any damage to your cochlea and examine the structure of your inner ear
  • Psychological testing to gauge your ability to learn to use cochlear implants

During the cochlear implant procedure, the surgeon will make a small incision behind your ear to create a slight depression under the skin where the internal device will sit. They will insert the internal device in your inner ear through a small hole in the cochlea before stitching up. 

After the procedure, you might feel pressure or discomfort around the area of the implant. This could be accompanied by dizziness and nausea. Most people feel well enough to go home the same day as the surgery or the day after. Your health care provider will make a follow-up appointment with you to remove your stitches in about a week. 

You’ll need about two to six weeks of recovery after the surgery. Once you’re recovered, you will visit an audiologist to activate your cochlear implant. During this appointment, your audiologist will run through a few tests and procedures:

  • Adjusting the external device for a comfortable fit
  • Testing all the components to make sure they’re working
  • Determining which sounds you are able to hear
  • Telling you about the proper care and use of the device

During the rehabilitation process, you will begin to learn the language of your device so you can understand and interpret sounds correctly. It will be a new sound, unlike any you may have previously recognized as speech and everyday ambient noises.

It can take up to a year for the brain to adapt to these new sounds, so you’ll need a lot of patience and practice. 

Many factors can affect how well you adapt to your new cochlear implant, such as how old you were when you lost your hearing and how long you’ve been without hearing before the procedure. 

Young children respond well to cochlear implant surgery and develop better hearing and speech compared to children of a similar age who use hearing aids.

For adults, cochlear implant surgery works best for people who have experienced hearing loss for a shorter period of time. Having a memory of sound and speech is a benefit, and adults with lifelong hearing loss find cochlear implants less helpful.

You can easily remove the external system of your cochlear implant, much like a hearing aid, when you need to sleep or bathe. The internal system is under your skin, so you don’t need to worry about getting it wet or being uncomfortable. 

If you enjoy swimming, you might prefer a waterproof device. You can discuss this option with your cochlear implant audiologist.

The cochlear implant can make sleeping uncomfortable, and it could fall off or get damaged, so it’s best to remove the device before bed. You can use other assistive listening devices to keep you safe at night.

Cochlear implant surgery is considered to be generally safe; however, there are a few risks to be aware of: 

  • Possible loss of residual hearing 
  • Possible meningitis, especially in children (vaccinations are recommended)
  • Occasionally, additional surgery to fix a faulty device

In rare cases, post-surgery cochlear implant risks include:

  • Paralysis of the face
  • Infection at the incision
  • Problems with balance

Cochlear implant surgery is an expensive procedure involving hearing tests, surgery, the device itself, and follow-up medical exams. The average cochlear implant costs between $30,000 and $50,000, and some people pay as much as $100,000. Some medical insurance plans cover cochlear implants.

Cochlear implants can help partially restore hearing and are often most beneficial for younger children. To determine whether a cochlear implant is right for you or your child, discuss your options with an audiology specialist and ask them the following questions:

  • How does a cochlear implant enable the deaf to hear?
  • How does a cochlear implant work?
  • What is the cochlear implant procedure?
  • What are the cochlear implant risks?
  • How much does the cochlear implant cost?
1.https://www.mayoclinic.org/tests-procedures/cochlear-implants/about/pac-20385021

2. FDA: What Is a Cochlear Implant? Feb 4, 2018.

3. American Speech-Language Hearing Association: Cochlear Implants.

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