Cochlear implants are small electronic devices that allow people to hear sounds. A cochlear implant is different from a hearing aid. Hearing aids make sounds louder but still rely on the ear’s natural hearing ability, so they don’t work well enough for people with very severe hearing loss. Cochlear implants bypass the part of the ear that doesn’t work, by using electrical current to stimulate the auditory nerve. They can help even when the ear has such severe hearing loss that a person can’t understand speech even with powerful hearing aids.
A cochlear implant electrically stimulates the cochlear nerve (nerve for hearing). It has two parts.
- External processor: This part sits behind the ear and contains a microphone to detect sound and a battery to power the system. It processes sound and transmits power and signals to the internal stimulator.
- Internal processor: This part is surgically implanted. It includes electronics, a magnet, and a set of electrodes. A surgeon implants the stimulator’s electronics and magnet behind the patient’s ear and then inserts the electrodes into the cochlea, which is part of the inner ear. After the system is first turned on a few weeks after surgery, the magnet helps hold the external processor in place, and the electrodes send signals to the auditory nerve. The brain can learn to understand those signals as sound.
A cochlear implant helps give a person a sense of sound. It doesn't restore hearing to normal. However, it can help a person understand speech and noises in the environment.
Cochlear Implant Candidacy
A cochlear implant may be right for you, if you:
Candidates must also understand that after getting a cochlear implant you must undergo activation, programming and rehabilitation.
- Have inner ear hearing loss
- Have trouble understanding speech even with properly fit hearing aids
- Are motivated and have a support system that can help them or loved one understand sounds and speech
- For children with hearing loss severe enough that hearing aids are not adequate, starting cochlear implant use as early as possible leads to better hearing and ability to use and understand spoken language.
Cochlear implants help restore the ability to understand spoken language, which can improve the person’s quality of life when hearing aids do not provide speech understanding.People with cochlear implants report the following benefits:
For babies born with hearing loss or young children with progressive hearing loss, early cochlear implantation provides the opportunity to meet developmental milestones similar to their peers.
- The ability to hear their own voice helping them improve how they pronounce words and the tone of their voice
- Easier communication with friends and family
- The ability to hear the sounds around them for safety and better quality of life
- Cochlear implant surgery is performed as outpatient surgery.
- Surgery is completed under general anesthesia.
- Most surgeries are completed in about two and a half hours.
- A child receives the same implants as adults because the size of internal ear structures does not change with age.
- Surgery is completed using a minimal incision while constantly monitoring the nearby nerves, including the facial nerve which is monitored continuously.
- Make sure you arrive in the pre-surgery area to which you have been assigned two hours prior to your surgery start time.
Learn more about cochlear implant surgery.
Cochlear Implant Rehabilitation
While the cochlear implant provides access to sound, understanding takes more than just hearing. Intensive individualized habilitation (intervention for patients who have never heard before) and rehabilitation (intervention for patients who are learning to hear again) allows for optimal gains for all recipients. Our rehabilitation team consists of highly trained speech language pathologists and educators of the deaf. A unique rehabilitative and patient-centered focus allows for collaboration among the recipient, family, therapist, doctor, audiologist, and other professionals to establish a path to success. Our multi-disciplinary team shares a commitment to providing a complete network of services to help each of our patients use their cochlear implant(s) to achieve their greatest potential.
Once the cochlear implant is activated, sound can be heard but may not be understood. Intensive auditory rehabilitation is necessary in order to attach meaning to the new signal. Children will develop a language system with the new auditory signal provided by the cochlear implant; whereas adults must learn to attach meaning to their established language system. Both children and adults alike require immersion in an auditory-rich environment in order to reach their maximal potential with the cochlear implant.
Rehabilitation for children begins shortly after the implant is activated. The Cochlear Implant Center requires families to commit to a minimum of one year of rehabilitation in order to maximize outcomes. One-hour rehabilitation sessions for children occur on a weekly basis. Rehabilitation for adults begins with an adult rehabilitation consultation. This one-time, 120-minute consultation may be scheduled at any time after the patient acquires at least one month of listening experience with the cochlear implant(s). Individualized needs in the areas of auditory therapy, communication management and the adjustment to an auditory environment are determined. Based upon the results of this functional evaluation, the therapist will recommend a treatment plan for follow-up services, which may occur weekly or as needed.
Goals and objectives are tailored to meet the unique needs of the pediatric and adult patients. The rehabilitation program systematically develops one’s ability to detect, imitate and associate meaning with the sounds of spoken language. Through a process of specialized strategies, instruction is provided with analysis and feedback to cultivate the emerging auditory system. Our rehabilitation services will provide the necessary guidance to address these individual needs and empower individuals to meet their optimal potential.
The Johns Hopkins Cochlear Implant Center offers (re)habilitation services tailored to meet the unique needs of adults and children diagnosed with hearing loss. In addition, our (re)habilitation therapists collaborate with hearing aid audiologists regarding functional use of the hearing aid(s).
After cochlear implant surgery, you must allow one month for the area to heal. Once the area is fully healed we can start to program and use the external processor on the ear. You will be scheduled for a series of programming appointments over the course of the four to six weeks.
These appointments are traditionally:
- Initial activation (day 1)
- Second activation (day 2-3)
- One week follow up
- One month follow up
You should continue to expect to be seen for programming every six to 12 months for the life of your implant.
During the first programming appointments, most people do not understand the information the implant is providing them. The goal is to get your nerves and brain used to hearing again. Over the following months, the implant stimulation patterns will be understood by the brain, providing comprehension of speech. As your hearing becomes more sensitive, programming will consist of adjustments to accommodate the changes.
Programming of the cochlear implant is just the first step to successful use of the technology. Retraining of your brain to understand the unique stimulation of the cochlear implant requires some practice and adjustment on the part of all patients. You will work with your audiologist and auditory rehabilitation therapist to get ideas on how this may be best accomplished within your lifestyle.
Cochlear Implant Cost
The first step when considering a cochlear implant is to contact your insurance company. When speaking with your insurance provider, use the following guidelines.
The insurance company will not be able to give an exact dollar cost until Johns Hopkins submits a claim. However, you should clearly understand the portion of the cost you will be responsible for, such as the percentage of coverage and whether you have a co-pay and/or a deductible at the time of surgery. For example, your insurance provider may cover 80 percent of the cost. This means you will be responsible for the remaining 20 percent of the cost. There may also be a co-pay and/or a deductible due at the time of surgery.Johns Hopkins Hospital will contact your insurance company two to three weeks prior to your surgery date to provide documentation of medical necessity and obtain authorization for surgery only. The precertification department at Johns Hopkins will notify you of any out-of-pocket costs at that time.
- Contact the customer service department (listed on the back of your health insurance card)
- Ask, “Is procedure code 69930 a covered benefit under my policy?”
- Your insurance provider may request the following information:
- Diagnosis code is H90.3 (sensorineural hearing loss, bilateral)
- Device code is L8614
- Cochlear implant surgery is an outpatient procedure
All appointments before and after the implant surgery will be billed separately. Activation appointments are not covered in the cost of the surgery.
If your insurance company requires referrals for appointments, it is your responsibility to obtain them before coming to each appointment. If you arrive without a referral and one is required, you will have to pay the full cost of the appointment at the time or service; otherwise the appointment will be rescheduled.
The cost of the internal and external device is covered in the cost of surgery. A separate appointment is scheduled before surgery to learn about the different options and to choose your device.
In some cases, a cochlear implant user may want to upgrade their external processor or need to replace a damaged processor. To replace an external processor, you should contact the manufacturer directly. Johns Hopkins will provide a letter of medical necessity to the manufacturer (you must have received your cochlear implant from Johns Hopkins) and will contact your insurance company. You must still contact Johns Hopkins to schedule your programming appointment.