Frequently asked questions regarding Cochlear Implants by   Jan Larky, MA USCF Cochlear Implant Program         What is a Cochlear Implant?   A cochlear implant is an electronic device that provides useful hearing to individuals with severe to profound hearing loss who are unable to hear and/or understand speech with hearing aids. Unlike a hearing aid, which delivers amplified sound to the cochlea or inner ear, the cochlear implant uses electrical signals to stimulate the hearing nerve directly. In the normal hearing ear, hair cells, deep within the cochlea, participate in the delivery of neural impulses to the auditory nerve. In the individual with hearing loss, these hair cells are damaged or destroyed, resulting in significant hearing loss and distortion of speech. The cochlear implant bypasses these damaged hair cells to provide direct electrical stimulation of the hearing nerve. Electrodes inside the inner ear stimulate the hearing nerve with a distinct code and the brain interprets these signals as sound.     How Does a Cochlear Implant Work?   Cochlear implants consist of three parts:   Implantable stimulator - this unit consists of the of the electronic package and electrode array. The electronic package is surgically implanted under the skin behind the ear; the electrode array is inserted into the cochlea to provide direct electrical stimulation to the auditory nerve.   Headpiece & Transmitter - this quarter-sized unit is worn externally and magnetically couples to the implantable stimulator. The microphone receives acoustic information and the transmission system sends the electrical signals across the skin to the implant.   Speech processor - this component is worn on the body, much like a pager, and converts sound into a distinctive code which is transmitted across the skin via radio waves to the implanted component. The signal is carried from the speech processor to the transmitter by a special cable.     Who is a Candidate for a Cochlear Implant?   Cochlear Implants are FDA approved both for children and adults. Adult eligibility for the cochlear implant requires, among other factors, severe-profound hearing loss in both ears, postlingual onset of hearing loss, demonstrate lack of benefit from conventional amplification and demonstrate appropriate expectations and willingness to comply with post-operative rehabilitation. Pediatric patients must be 18 months - 18 years of age, have a profound hearing loss, demonstrate a lack of development of auditory milestones and be enrolled in an educational setting and post-operative rehabilitation that will maximize the use of acoustic cues. Children can be either pre- or postlingually deafened. All potential candidates must be thoroughly tested with a battery of tests designed to assess one's ability to hear and comprehend words and sentences. Different tests are used for the adults than for the children. Based upon the results of the test measures, it is possible to determine how the candidate's performance with appropriately fitted hearing aids compares to the average performance of adults or children with the cochlear implant. A recommendation in favor or against cochlear implantation can then be made   What Does the Evaluation Process Consist Of?   1. Medical Evaluation A medical history is taken and an ear examination is conducted by the surgeon who is an otologist or ear doctor. The doctor will review the radiological studies and discuss the surgical procedure and make recommendations for ear selection and any other medical consultations that are needed prior to surgery.   2. Radiological Assessment Imaging studies (CT Scan or MRI) of the temporal bones and cochleae are required to obtain information on the ear anatomy for the purposes of insertion of the electrode array.   3. Audiological Evaluation Comprehensive auditory testing is administered. A hearing test and a hearing aid evaluation (HAE) using appropriately fitted high-powered hearing aids are conducted. The objective of the HAE is to determine whether a hearing aid might provide greater benefit than that anticipated with the implant. In order to determine hearing aid benefit an extensive series of aided auditory speech reception tests are administered. Otoacoustic Emission Testing is also conducted, and an Auditory Brainstem Response (ABR) test, which is an objective measure, may also be administered.   4. Psychological Assessment The objective of this evaluation is to assess feelings about hearing loss and about the implant. It also helps the implant team understand whether expectations regarding the implant are realistic.   5. Cochlear Implant Counseling/Orientation Session The orientation session serves to: · clarify what the implant can and cannot do · provide detailed information about the implant, its function and design · allow for discussion on realistic expectations of cochlear implant benefit · review the initial device fitting/evaluation sessions and the follow-up evaluation schedule     What is the Process for Surgery and Initial Device Fitting?   Generally, all implant patients follow the step-by-step sequence of events described below:   1. The candidate is evaluated on an out-patient basis over a one - two day period. Based on these results as well as the medical and audiological histories, and educational placement and therapy services available if a child, patients are selected for implantation..   2. The day before surgery the patient meets the anesthesiologist, hospital admitting personnel, and undergoes any additional tests. The following day patients arrive at the appointed time for surgery. Patients generally remain in the hospital over night and are discharged the day after surgery.   3. Following surgery, the patient returns home for four to six weeks. This allows time for all swelling and soreness around the operative site to subside and the incision to completely heal.   4. Following this healing period, the patient returns to the clinic to have the externally worn speech processor programmed. The speech processor converts speech into a special code for each user.   5. Implanted patients are requested to return to the clinic at regular intervals for device checks and re-evaluation. During these visits the implant and equipment are checked and performance is measured.     Are Cochlear Implants Covered by My Insurance?   Cochlear implants are considered medically necessary implantable prosthetics and are covered by most insurance carriers including Medicare and Medicaid.