ENT; Prevention

Cochlear implants for hearing loss: Myths vs. reality

ENT; Prevention

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Hearing loss affects a lot of people, and cochlear implants are among the major audiology advancements that can help improve a patient's communication and quality of life.

Hearing loss is among the most common health-related obstacles in the U.S., affecting approximately 18% of adults, with nearly two men affected for every woman. One in eight people in the U.S. age 12 and older have double-sided hearing loss (in both ears).

Among these patients, nearly 1 million could benefit from cochlear implants – a surgically implanted device that can restore up to 80% word recognition and substantial hearing sensation in patients with severe to profound hearing loss. The U.S. Food and Drug Administration has approved cochlear implants for a wide range of patients, including those with:

  • Double-sided hearing loss, since the mid-1980s
  • Single-sided hearing loss, as of July 2019
  • Poor speech comprehension scores while using properly fit hearing aids 

Unfortunately, myths about the cochlear implant abound. Many patients don't know the device is an option for them, or they might be nervous to have surgery or transition from hearing aids (even if their hearing aids have become insufficient).

The result? Too many people with hearing loss are missing out on opportunities to communicate better with loved ones and colleagues.

It's time to set the record straight – let's debunk the top five myths about cochlear implants, derived from the many questions our team receives from patients.

But first, a quick explanation of how cochlear implants work and what to expect from the procedure.

How do cochlear implants work?

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Cochlear implants are positioned to stimulate the auditory nerve.

Cochlear implants bypass the damaged parts of the ear to directly stimulate the auditory nerve, which connects to the area of the brain responsible for processing sound. Because of this, patients cannot go back to hearing aids after the surgery.

What to expect from surgery

The device is surgically implanted in the ear and activated by an attached component that sits behind the ear. Implantation is typically an outpatient procedure, and patients are placed under general anesthesia.

The surgeon will make an incision behind the ear on the mastoid bone, which leads to the middle ear. Then the surgeon will create an opening in the cochlea, the “hearing” part of the ear, to insert the implant electrodes that will stimulate the auditory nerve. After testing to ensure the device is aligned and functioning properly, the surgeon will close the incision.

It's important to note that the device will not be turned on until after the incision is healed – approximately two to three weeks after surgery. During this time, the doctor will check in regularly with the patient to ensure they are recovering as expected.

Most patients can return to work within two weeks if their job does not require hearing in the affected ear. After the device is turn on, the audiologist will program the cochlear implant according to what the patient is hearing and will teach the patient how to use the external component. 

5 cochlear implant myths busted

1. Cochlear implants only amplify sound.

Cochlear implants actually are designed to improve speech comprehension when hearing aids are no longer providing speech comprehension. During a preliminary exam, an audiologist doctor will test the patient’s hearing and speech comprehension in their best aided condition – this means with their hearing aids on. If the patient has poor speech comprehension even while wearing hearing aids, cochlear implants might be an option.

2. The implants will restore your hearing back to normal.

Although the implants can improve your quality of life through better speech comprehension and recognition of environmental sounds, the devices cannot fully restore hearing. Today, there is no way to return the cochlea to normal.

However, there have been breakthroughs in recent years, such as research into the regrowth of sensory hair cells in the inner ear and the potential to use certain proteins to restore damaged sound-detecting cells in the ear.

3. Cochlear implants will provide immediate benefits.

After the implant is activated, the brain needs time to rewire and learn to hear with the implant through cumulative daily hearing and listening activities. It can take three to six months for the brain to adapt, which means patients won't experience full benefits right away. 

Hearing loss, even temporary situations, can lead to social isolation and symptoms of depression. Because of this, we recommend that patients who want cochlear implants gather a strong support network of loved ones and colleagues for moral support and to help manage social and professional experiences that require hearing.

4. The devices are just for children.

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More adults than children have cochlear implants in the U.S.

Actually, cochlear implants have been available for adults longer than for children. Adult devices were approved by the FDA in 1984 – the devices were approved for children ages 2 to 12 in 1989. 

It wasn't until 2000 that cochlear implants were approved for patients 12 months and older.

More than 41,000 adults and nearly 26,000 children in the U.S. have cochlear implants, according to the National Institutes of Health (NIH). Even patients in their 80s and 90s can receive cochlear implants. 

If a patient is healthy, meets the requirements, is motivated, and has a support system and realistic expectations, there’s no reason not to do it.

5. Taking a bath and swimming are not allowed with a cochlear implant.

The internal processor (the part implanted in the ear) is waterproof because it is covered by the patient's skin. However, the external processor might not be waterproof and should be removed or covered with a waterproofing accessory before getting in the water.

The newest cochlear implant models are designed to seal away more debris and moisture from the device. An audiologist can help pick out the best device for patients who enjoy the water. 

Advancements in cochlear implants

In recent years, we have seen impressive advancements in cochlear implant technology. Some of the highlights include: 

  • Ability to connect to your iPhone or Android via Bluetooth. Patients can use their phones to control the implant’s volume and stream music directly into the implant. In June 2017, the first implant manufacturer received FDA approval to release a model that could connect to Apple iPhones. Today, a variety of manufacturers have models that can be paired to smartphones via Bluetooth.
  • Rechargeable batteries. Many cochlear implants can now be fitted with rechargeable batteries that are cost effective and can be conveniently charged while you’re sleeping – ensuring your implant is powered up for the day ahead.
  • Smaller size. Compared to original models, some cochlear implants today are 50% of their original thickness or less. This means they are lighter and stick up less from the skull, reducing noticeability and potentially helping to boost patients' self-confidence. 

At UT Southwestern’s Department of Audiology, patients can choose from a range of cochlear implants. We will discuss the pros and cons of each model with patients – including durability, functionality, and accessorizing – to find the device that works best for their lifestyle.  

Whether a patient is born with severe or profound hearing loss – or developed it later in life due to illness, injury, or aging – cochlear implants are a major audiology advancement that can greatly improve communication and quality of life.

To visit with an otolaryngologist, call 214-645-8898 or request an appointment.