What is cochlear implant surgery?

If a person has severe hearing loss, a cochlear implant may help. A cochlear implant is different from a hearing aid. A hearing aid makes sounds louder and helps someone who has some hearing loss. But a cochlear implant can help a person with very little or no hearing (partial or complete deafness).

A cochlear implant is a small electronic device that electrically stimulates the cochlear nerve. This is the nerve for hearing. The device has 2 parts. One part sits behind the ear. It picks up sounds with a microphone. It then processes the sound and sends it to the second part of the implant. The second part is put through the skin and implanted in the inner ear during a surgery. A thin wire and small electrodes lead to the cochlea, which is part of the inner ear. The wire sends signals to the auditory nerve. This is the nerve that sends sound impulses to the brain. A cochlear implant helps give a person a sense of sounds. It doesn't restore hearing to normal. But it can help a person understand speech and noises around them.

Why might I need cochlear implant surgery?

You and your healthcare provider may think about a cochlear implant if your hearing hasn’t improved after using a hearing aid for at least 6 months. You also must have severe hearing loss from an auditory nerve conduction disorder in both ears (sensorineural hearing loss).

How cochlear implants help is different for each person. Some people can hear many sounds. But some people will have no change in hearing. A person may be able to:

• Notice different sounds, such as footsteps, a door closing, a phone ringing

• Understand speech without lip reading, or be helped with lip reading

• Understand voices over the phone

• Hear the TV

• Hear music

Before thinking about a cochlear implant, it's important to understand certain facts. These include:

• A cochlear implant requires training and therapy after surgery. During this time, you will learn how to care for the implant. You will also have aural rehabilitation (rehab) to help with coping with hearing loss. This will help to improve your use of the implant. How long you have aural rehab depends on your age and your hearing before surgery.

• Cochlear implants don't restore hearing to normal. And in some people, they may not help with hearing at all.

• You may lose the rest of your natural hearing in the ear where the implant is placed.

• You may need to use new or recharged batteries every day.

• You will need to remove the external part of the implant when bathing or swimming

• The implant may irritate your skin. In some cases, it may need to be removed.

• Static electricity may harm a cochlear implant. You will need to take care around computer and TV screens, manmade fabrics, carpeting, and other things that make static electricity.

• An implant can set off security systems, such as metal detectors. Implants may be affected by cellphones and radio transmitters. They must be turned off during takeoff and landing in a plane.

• You may not be able to have certain medical tests or treatments. These include MRI, electroconvulsive therapy (ECT), and ionic radiation therapy.

• The implant can be damaged during an accident or while playing sports. Or the implant can fail. Fixing the implant or replacing a damaged part may be expensive. In some cases, a new surgery may be needed to replace the implant.

What are the risks of cochlear implant surgery?

Risks of cochlear implant surgery include:

• Bleeding

• Swelling

• Infection in the area of the implant

• Ringing in the ears (tinnitus)

• Dizziness or vertigo

• Numbness around the ear

• Changes in taste

• Leaking cochlea fluid

• Leaking spinal fluid

• Injury to the facial nerve, which can cause movement problems in the face

• Infection of the membrane that covers the brain (meningitis)

• Chronic inflammation around the implant (reparative granuloma)

• Risks of general anesthesia

• Need to have the implant removed because of an infection

There may be other risks, depending on your health condition. Discuss any concerns with your healthcare provider before the procedure.  

How do I get ready for cochlear implant surgery?

A cochlear implant is not right for everyone. To find out if an implant is right for you:

• You will need to meet with hearing and speech specialists. These may include an audiologist, otologist, and speech-language pathologist.

• You will need to meet with a psychologist or other counselor.

• You will have hearing tests and physical exams.

• You may have imaging tests to look at the structure of your ear. These may include X-rays and MRI. These can help show how well a cochlear implant will work in your ear.

• The healthcare staff will help you to shave and clean the scalp around the implant site.

• Your healthcare provider may need other tests or preparation, depending on your health condition.

What happens during cochlear implant surgery?

Cochlear implant surgery is done in a hospital or clinic. The surgery lasts 2 to 4 hours. You are given medicine (general anesthesia) to make you sleep during the procedure.

• The surgeon makes a cut (incision) behind the ear to open up the mastoid bone.

• Then the surgeon makes a small cut in the cochlea. They insert the implant electrodes into the cochlea.

• The surgeon places an electronic device called the receiver under the skin behind the ear.

• The incisions are then closed. You will be moved into the recovery area and watched closely.

• You may go home the same day. Or you may need to stay in the facility overnight.

What happens after cochlear implant surgery?

When leaving the hospital, you will be given directions on how to care for the incisions. You’ll also learn how to change dressings and care for your stitches. You will also be given directions on how to wash the scalp and head, and how to shower. You may be advised to make certain diet changes during recovery. A follow-up appointment is made for about 1 week later to inspect the incisions and remove the stitches.

You should report increased pain, drainage, or fever to your healthcare provider after the procedure.

You will have some time to heal after the initial surgery before the implant process is completed. This lets the swelling go down and the implant to fit correctly. About 4 to 6 weeks after the surgery, the external parts of the cochlear implant will be added. These include a microphone and speech processor. This is where the implant is programmed and activated. The external parts work with the internal part of the implant.

You will also learn the basics of using and caring for the implant. You may need to return for several visits over a few days for adjustments. Further fine-tuning may take place over several months. Learning to use a cochlear implant is a slow process. It will likely require visits with speech-language pathologists, audiologists, counselors, and teachers. But with commitment, you can have an improved quality of life with a cochlear implant. 

People who get an inner ear infection should get medical care until the infection goes away. Untreated middle ear infections can go on to cause meningitis. Vaccines don't end the risk for meningitis. The surgeon or another surgeon experienced in cochlear implants also should check any discharge, pain, or swelling in the ear with the implant. The surgeon should also assess any redness around the processor behind the ear, abnormal ear symptoms, or a watery nasal discharge.

Get a checkup every year by an audiologist to map and reprogram the implant.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much will you have to pay for the test or procedure