Many great inventions have humble and rudimentary beginnings, as well as considerable resistance from doubters. The innovative cochlear implant is no exception. 

What is a cochlear implant?

A cochlear implant is a small implanted electronic device used in cases of severe to profound hearing loss that can’t be treated with hearing aids. An external portion sits behind the ear with a second element surgically placed under the skin. The external parts includes a microphone, sound processor, and transmission system. The internal device includes a receiver/stimulator and an electrode array. In the U.S., the devices are regulated by the FDA. 

Three companies in the U.S. are the primary suppliers of FDA-approved cochlear implants: Cochlear, Advanced Bionics, MED-EL. The indications for different cochlear implants varies. Your treatment team will recommend and discuss the best option(s) so you can make an informed decision about what will work optimally for your hearing loss.

555,000

people worldwide with severe permanent hearing loss have a cochlear implant

Since the first cochlear implant was approved by the FDA in 1984, hearing outcomes have improved greatly due to advances in electrode design and surgical techniques. In fact, many previously approved devices aren’t marketed anymore due to ongoing improvements.

History of cochlear implants

Since Volta’s discovery, several modern innovations have occurred in the field of hearing technology. Along the way, various versions of the cochlear implant met with resistance from the scientific community and more specifically, from individuals who didn’t believe direct stimulation of the auditory nerve fibers could result in perception of speech. Great advances have occurred in the decades since the first cochlear implants were introduced in the 1970s. Today, more than 550,000 people worldwide with severe permanent hearing loss have received a cochlear implant. Here are a few milestones on this amazing journey:

1957: In France, Andre Djourno and Charles Eyries directly stimulated the auditory nerve using a wire to simulate electrical current. The patient reported perceiving a clear sound, which inspired the search for a treatment for profound deafness.

1961: In the U.S., William House and John Doyle electrically stimulated the auditory nerves of two adults with profound deafness. The loudness changed with the level of stimulation, while the stimulus pitch changed with various stimulation rates. Despite encountering technical challenges and huge resistance, House is widely recognized today as the father of neurotology and instrumental in the development and acceptance of cochlear implants.

1964: In the U.S., Blair Simmons and Robert White placed the first multichannel cochlear implant directly onto part of the inner ear of a patient during brain surgery. The patient could detect changes in duration and perception of tone, inspiring the development of functional, permanent cochlear implant systems.

1972 to Mid-1980s: More than 1,000 people were implanted with early single-channel devices during this timeframe. These cochlear implants were well tolerated and provided many users with significant speechreading enhancement, while others also benefited from limited open set word recognition.

1984: Manufactured by the Cochlear Corporation, a multichannel cochlear implant system called the Nucleus 22 was the first to receive U.S. Food and Drug Administration (FDA) approval.

1990s: From speech perception and music appreciation to discerning speech in noisy settings, great advances were made in cochlear implant research. A notable innovation was spatial separation of the electrodes along the length of the inner ear and non-simultaneous stimulations, resulting in improved understanding of speech.

2019: The MED-EL USA Synchrony cochlear implant system for single-sided deafness and asymmetric hearing loss was approved by the FDA in July. This was the first cochlear implant approved for people with these issues, which impact the ability to hear in certain listening settings (e.g. noisy environments).

FAQs on cochlear implants

How do cochlear implants work?

The device works by bypassing damaged hair cells in your inner ear (cochlea) and directly stimulating the auditory nerve to send information to your brain. While cochlear implants don’t cure hearing loss or restore hearing, they enable people with severe hearing loss or deafness to perceive the sensation of sound. 

Do cochlear implants work for everyone?

Cochlear implants don’t remedy all types of hearing loss. In order to qualify, you need to meet specific medical requirements outlined by the FDA and insurance companies. Amazingly, anyone older than 6 months old who meets the following additional criteria may be a candidate for a cochlear implant:

  • Sensorineural hearing loss
  • Presence of cochlear and cranial nerve VIII with relatively preserved anatomy
  • Bilateral or single-sided deafness
  • Auditory neuropathy (inability to send sound from an intact inner ear to the brain)
  • Reliability to follow up with audiology and otolaryngology team
  • Ability to undergo general anesthesia and surgical procedure

Conversely, a cochlear implant is not appropriate for people with any of the following:

  • Absence of an inner ear (cochlear aplasia) or cranial nerve VIII
  • Intolerance of general anesthesia
  • Conductive hearing loss
  • Hearing loss that can be treated with hearing aids 

What’s the procedure to get a cochlear implant?

It’s been determined that a cochlear implant is the best option to treat your hearing loss and you’re feeling nervous. This is a perfectly natural response because you’ve never had this type of surgery. Learning about the surgery will help you know what to expect prior to implantation, during the procedure, and while you recuperate.

  • You’ll undergo hearing and psychological testing, a medical exam, and imaging studies (e.g. CT and MRI) to determine if you’re a suitable candidate.
  • Your implant surgery will be performed under general anesthesia in an operating room at a hospital or surgical center. A team of nurses, anesthesiologists, and the otolaryngology team will talk to you prior to the operation. The procedure generally takes two to four hours and requires a one-night stay in the hospital. When you wake up, you’ll have a bandage on the side of your face where the surgery was performed and some swelling, which is normal.
  • At your 4–6 week post-surgery appointment at the cochlear implant center, you’ll be fitted with the external device that will allow you to hear. That 4-6 week period is often the toughest part of the process for people who get cochlear implants because your hearing will be at its lowest point ever until that external device is turned on. At this appointment, your audiologist will activate the cochlear implant and begin mapping the processor to fit your unique needs. This is when you’ll be able to hear for the first time, which can be an exciting and highly emotional experience.
  • It takes some time to get accustomed to the device. Several follow-up visits may be needed after your initial post-surgery appointment to adjust the mapping of the signals to the electrodes. You’ll work closely with your audiologist to ensure the settings are fine-tuned to meet your needs. As with hearing aids, it’s important to schedule these visits to ensure everything is working well. 

What are the benefits of cochlear implants?

The benefits of cochlear implants are considerable, but it’s important to keep in mind that it takes time to learn how to interpret signals received from your cochlear implant. If you’re scheduled for cochlear implant surgery, you’re likely curious how this will impact your ability to hear sounds. Judging by what other people have reported, you’ll likely be able to perceive different types of sounds such as footsteps, slamming doors, engines, ringing telephones, barking dogs, whistling tea kettles, rustling leaves, light switches being turned on and off, and more. People with cochlear implants have also reported the ability to:

  • Hear speech without needing visual cues such as reading lips
  • Listen in a noisy environment
  • Determine where sounds are coming from
  • Hear television programs and telephone conversations

A 2011 retrospective review of more than 50 previous studies looked at the efficacy of cochlear implants in adults with sensorineural hearing loss. Researchers concluded that unilateral cochlear implantation is an effective hearing assistance method that provides significant gains in speech perception and health-related quality-of-life in adults with sensorineural hearing loss. Results from recently published studies suggest individuals with cochlear implants in both ears hear speech better than individuals with just one cochlear implant with or without hearing aids, especially in noisy settings.

What are the risks of cochlear implant surgery?

While cochlear implantation is a relatively safe procedure, any kind of surgery has some risks and complications, especially with general anesthesia. Many small-scale studies have assessed the complication rates in adults. A long-term study that assessed the risks in 445 older adults ages 60–95 who received their first cochlear implant at Johns Hopkins Hospital from 1999–2011 indicated a relatively low number of complications:

  • Minor complications: 42
  • Major complications: 36
  • Surgical device removal: 17
  • Revision surgery after removal: 15
  • Balance problems: 30 (more than one month post-surgery)
  • Surgical site infection: 7
  • Delayed postoperative facial weakness: 2

According to the FDA, potential risks include:

  • Facial nerve damage
  • Meningitis
  • Cerebrospinal fluid leakage
  • Fluid leakage from surgical holes created in the inner ear or brain
  • Wound infection
  • Blood or fluid collection at the surgery site
  • Dizziness or vertigo attacks
  • Ringing in the ears (tinnitus)
  • Taste changes
  • Numbness around the ear
  • Localized inflammation if the body rejects the implant

Are cochlear implants covered by insurance?

Private health insurance coverage for cochlear implantation has improved greatly during the last 15–20 years. Today, more than 90% of private employer health insurance plans and managed care organizations provide coverage benefits for the cost of cochlear implant surgery and related services. Medicare, TRICARE, the Veteran’s Administration and other federal health plans provide coverage, however, Medicaid coverage for adults varies by state.

If you’ve been told you are a candidate for a cochlear implant, check your insurance policy for coverage and pre-approval requirements. If you don’t see specific mention about cochlear implant coverage in your policy, it may still be covered. It may be listed inaccurately under the hearing aid section. Your cochlear implant treatment center can help you with this process.

The next steps

Cochlear implants are an amazing device that have brought sound to more than a half million people around the world and counting. If you are interested in cochlear implants, talk to a licensed hearing care professional to see if this is a good option for you. 

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