A cochlear implant is a device that provides stimulation directly to the
auditory nerve, bypassing damaged hair cells in the cochlea that prevent
sound from reaching the nerve. An implant does not result in "restored"
hearing for the recipient, but does allow him or her to perceive sounds.
The U.S. Food and Drug Administration (FDA) first approved cochlear
implant devices for adults in 1985 and for children in 1990. According
to the National Institute on Deafness and Other Communication Disorders,
approximately 14,000 individuals have received cochlear implants in the
United States, about half of whom are children. More than 30,000
individuals have received cochlear implants worldwide. An increase in
early hearing detection and intervention (EHDI) programs as a result of
legislation and advocacy efforts by organizations such as the American
Speech-Language-Hearing Association (ASHA) has allowed for the
identification of more children who may benefit from cochlear implants
during recent years.
In general, adults who have severe to profound hearing loss in both ears
and have benefited only minimally from hearing aids may qualify as
candidates for cochlear implantation. Children as young as 12 months of
age with profound hearing loss in both ears and who demonstrate little
progress in the development of auditory skills may also be considered
candidates for some implant devices. It is very important that the
implant recipient (and the family, in the case of a young child) have an
understanding of cochlear implants and realistic expectations regarding
the use of the device.
As with any medical procedure, the results of implantation cannot be
predicted prior to surgery and recipients may experience a wide range of
outcomes. For individuals who lost their hearing after learning to
speak, the perception of speech and sounds after implantation may
initially seem quite different from what they remember. After using the
cochlear implant for several months or more, these individuals often
report that they perceive speech to be more natural or closer to their
memory of familiar sounds.
While many factors affect outcomes for both children and adults,
typically, the younger a child who was born deaf is implanted, the
greater the benefit achieved in the areas of speech perception and
speech and language development. A predictive factor for implant
performance for adults who are deaf is the length of time between the
onset of deafness and implantation; those with the shortest duration of
deafness tend to experience better outcomes.
There are various centers around the country where teams of
professionals work with individuals to determine implant candidacy,
perform surgery, and provide follow-up care. Because of the level of
commitment required, implant candidates should consider several factors
in choosing an implant center, including the level of experience of the
staff in working with implant recipients and the center's proximity and
accessibility (as numerous trips may be required).
Wearing a cochlear implant is a lifetime commitment, and requires the
recipient to maintain and care for the implant. After an individual
receives the implant, he or she must return to the center for a number
of follow-up services, including the fitting of the external components
of the implant; activating and programming of the implant and its
microphone, speech processor and transmitter; necessary adjustments and
reprogramming, and annual check-ups. In addition, recipients must
undergo rehabilitation services with members of the team. Children who
are implanted often require years of extensive aural rehabilitation
whereas adults who have been implanted due to acquired deafness may need
fewer aural rehabilitation sessions.
Among the professionals who may work as part of the cochlear implant
team are audiologists, speech-language pathologists, educators,
surgeons, medical specialists, psychologists and counselors.
Audiologists are involved in many of the components of the cochlear
implant program, including determining the candidacy of an individual
for implantation, as well as activating and programming of the speech
processor after surgery. Both audiologists and speech-language
pathologists provide aural rehabilitation services to implant recipients
to facilitate their ability to detect and understand speech with the
cochlear implant. Aural rehabilitation services may include processes to
enhance communication, auditory training and speechreading, training on
the use and care of the implant, and support of the needs of the
recipient and family.
The costs of cochlear implants vary widely depending on a number of
factors, including the duration and extent of a patient's hearing loss
prior to surgery. The average cost for the entire procedure, including
the post-operative aural rehabilitation process, exceeds $40,000.
However, cochlear implantation consistently ranks among the most
cost-effective medical procedures ever reported, according to research
completed by the Johns Hopkins University and the University of
California-San Diego. These studies indicate that cochlear implantation
can result in a net savings of more than $53,000 per child versus the
more than $1 million average expected lifetime cost of a child who has
profound hearing loss prior to language development.
Health insurance coverage for cochlear implant services has improved
greatly in recent years, with the majority of commercial health plans
and managed care organizations now providing some level of benefits for
the procedure and related services, including programming and aural
rehabilitation. The increase in coverage is largely due to increased
education regarding the costs and outcomes of cochlear implantation, and
federal and state laws (such as the Americans with Disabilities Act)
prohibiting exclusionary insurance policies that deprive cochlear
implant candidates from the only opportunity to alleviate their hearing
Medicare, TRICARE, the Veteran's Administration, and all other federal
health plans provide benefits for all cochlear implant services. Federal
law requires that all state Medicaid agencies provide coverage for
cochlear implants for children under 21 years old, and most provide
benefits for adults as well. Vocational rehabilitation, maternal and
children's health services, and other combined federal-state programs
also often provide benefits.
Additional information on cochlear implants can also be found through
the Alexander Graham Bell Association
for the Deaf and Hard of Hearing, Hearing
Loss Association of America, and the National
Institute on Deafness and Other Communication Disorders.
Reprinted with permission from "Cochlear Implants Fact Sheet." Available
© Copyright 2013. American Speech-Language-Hearing Association.
All rights reserved.