When Hearing Aids Are Not Enough Part II

Posted on March 6, 2019 by Pamela Nelson   Welcome to part 2 of our series, When Hearing Devices Are Not Enough.  In part 1 of our series, we discussed assistive listening devices to help bridge gaps where hearing devices fall short.  Options for the telephone, television and listening in noisy situations were discussed. But what do we do for those patients who have severe to profound hearing loss and/or very poor speech understanding abilities?  These patients often struggle in that they can hear environmental sounds, but may not have enough volume to follow a conversation.  Or the patient may have enough volume, but regardless of how loud speech is, it’s just not clear enough to understand what is being said.  For these select patients, many will be candidates for a Cochlear Implant.

What is a Cochlear Implant?

A Cochlear implant is a surgically implanted hearing system that includes an electrode array that is implanted into the cochlea (hearing organ) and an external sound processor that is similar to a behind-the-ear hearing device in style.  The cochlear implant processor picks up sound with microphones, and the sound is transmitted to the hearing nerve via electrodes and electrical stimulation, rather than through sound waves. Is the benefit immediate? The cochlear implant is “activated” or turned on about 4-6 weeks after surgery to allow for healing at the surgical site.  In most cases, the patient will immediately notice they are hearing more sounds.  However, most patients do not understand speech immediately with the cochlear implant.  Because the sound is electrical, it is very robotic and may sound like Donald Duck.  As the patient wears the device and learns to hear with the device, the sound becomes more “natural” and eventually the patient begins to understand speech better.  Auditory Verbal Therapy is often recommended to help the cochlear implant recipient learn to use their new hearing and improve speech understanding.

How is the cochlear implant better than a hearing device?

For patients who are candidates for a cochlear implant, a hearing device cannot, at any point, improve speech understanding.  A hearing device also cannot return hearing thresholds to normal levels if the patient’s hearing loss is severe to profound.  With the cochlear implant, the hearing thresholds are usually in the normal range, and speech understanding will continue to improve for up to 5 years post implant.  The cochlear implant is the only and best option to improve the patient’s ability to understand speech.

Who is a candidate for a cochlear implant?

A cochlear implant has specific criteria, regulated by the FDA, which must be met.  To be considered for a cochlear implant the patient must:

• Have a hearing loss in the moderate to profound range with speech understanding scores of less than 60% (Medicare requires scores of less than 50%) with hearing devices.
• Hearing loss must be in both ears. (Typically the worst ear will receive the implant.)
• Recipient must have worn appropriately fitted hearing devices for at least 12 months.
• Recipient must be in good general health and not have any medical contraindications to surgery.
• There is no age limit, however cognition is an important factor in success with a cochlear implant and should be considered.
• There are some exceptions to the criteria listed and are dependent on the patient’s hearing loss and speech understanding.

If you think you or a loved one may be a candidate for a cochlear implant, ask your audiologist to review the patient’s hearing test.   Once it is determined the patient is a possible candidate for a cochlear implant, an appointment can be made for further testing and surgical consult.   Watch for part 3 of our series in March:  When Hearing Devices Are Not Enough: BAHA