Courtney Voelker MD PhD with cochlear implant patient

Cochlear Implants

Cochlear Implant Program for Hearing Loss

Hearing loss is one of the leading causes of overall disability worldwide. Globally, approximately 466 million adults and children (6%) have a disabling hearing loss. This is projected to rise to 630 million by 2030.

While hearing aids are widely prescribed for hearing loss, these are not always the best option. For those whose hearing loss is not improved by the use of hearing aids, or have single-side hearing loss, cochlear implants may represent a better solution.

Impact of hearing loss

Hearing loss has a substantial impact especially in older adults, and when left untreated can result in a multitude of health conditions.

Quality of life

  • Increased feelings of loneliness, isolation, and depression
  • Less inclined to participate in activities they used to love and often “give up” participating in conversation with friends and family

Cognitive decline

  • Hearing loss is associated with accelerate cognitive decline and dementia in older adults

Depression

  • Significant association between hearing impairment and moderate to severe depression

Falls

  • Brain uses sound cues to maintain spatial orientation and can home in on spatial orienting landmarks
  • People with mild hearing loss of 25 dB or greater are 3x more likely to have a history of falling
  • Every additional 10 dB of HL increases the chances of falling by 1.4 times the original risk

Heart health

  • Inner ear is extremely sensitive to blood flow
  • Studies have shown that a healthy cardiovascular system has a positive effect on hearing – conversely, inadequate blood flow and trauma to the blood vessels of the inner ear can contribute to hearing loss

Hypertension

  • Significant association between high blood pressure and untreated hearing loss.
  • Can be an accelerating factor of hearing loss in older adults

Diabetes

  • Hearing loss is about twice as common in people with diabetes as compared to those without disease. 
  • Pre-diabetic adults whose blood glucose is higher than normal have 30% higher rate of hearing loss as compared to those with normal blood sugar

Osteoporosis

  • This is linked by the demineralization of the three middle ear bones which may contribute to or cause a conductive hearing impairment

What are cochlear implants?

The cochlear implant for hearing loss is an electronic device that is implanted into the inner ear (the cochlea) and is used to restore hearing in patients who no longer benefit from traditional hearing aids or have hearing loss in just one ear. Though a cochlear implant does not re-create normal hearing, it can give a hearing-impaired person auditory understanding of the world and help people understand speech again.

For children, cochlear implants are FDA approved for infants as young as 9 months old and can often be approved off-label at even younger ages (which is routine in other parts of the world).

Cochear implants vs. hearing aids

Hearing loss can manifest as either (1) volume reduction or (2) noise distortion. If patients experience noise distortion, hearing aids do not provide appropriate correction.

In the case of volume reduction, hearing aids amplify sound and deliver it to a damaged hearing system. When hearing loss results in noise distortion that hearing aids cannot remedy, the cochlear implant bypasses the damaged inner ear structures to deliver sound directly to the hearing nerve.

It is also important to note that the cochlear implant is not a “quick fix” and involves time, patience, and practice to meet your listening goals. Our team guides patients through their follow up programming visits and rehabilitation program.

How do cochlear implants work?

Cochlear implant

A cochlear implant is made up of equipment worn on the outside of the ear and equipment surgically placed inside the ear. During surgery, an incision is made behind the ear and the internal pieces (receiver and electrode array) are secured under the skin. The electrode array is delicately placed into the cochlea, stimulating the hearing nerve when turned on.

  1. External hardware (includes microphone, speech processor, coil/cable and battery)
    • The microphone captures sound in our environment
    • The speech processor converts the environmental sound into a digital signal
    • The signal is sent through the cable to the transmitting coil
  2. Internal receiver
    • The signal is sent across the skin to the implant, where it is converted to electrical energy and decoded.
  3. Electrode array
    • The electrical energy is sent to the electrode array within the cochlea, where it stimulates the hearing nerve.
  4. Hearing nerve
    • The stimulation of the hearing nerve is perceived as sound in the brain 

Am I a candidate for cochlear implant surgery?

Cochlear implants are recommended when a person cannot hear well with hearing aids or with significant hearing loss in just one ear. The Food and Drug Administration (FDA) has approved the use of cochlear implants for adults who meet specified criteria. Cochlear implant criteria have expanded over the past years. Shockingly, only 5% of patients who would benefit from a cochlear implant receive them.

Your cochlear implant team at Pacific Neuroscience Institute will complete a comprehensive evaluation with optimally fit hearing aids to determine candidacy based on insurance and FDA criteria. 

  • Medicare criteria are the most conservative. Moderate to profound hearing loss and poor speech understanding in both ears. The ACI Alliance is lobbying to improve access for Medicare patients.
  • Hybrid candidacy: Patients who have good low frequency hearing and very poor high frequency hearing benefit from hybrid stimulation (acoustic and electric in the same ear).
  • Single sided deafness / unilateral profound hearing loss: One normal hearing ear and the other ear with profound hearing loss.
  • Asymmetric hearing loss: Hearing loss in both ears with poorer hearing in the ear to be implanted.
  • Traditional criteria for patients 18 years old or older: Limited benefit from amplification defined by aided speech understanding in both ears with poorer understanding in the ear to be implanted.

At PNI we can advocate for our patients if a cochlear implant is requested for “off label” use and authorization (non-FDA approved).

A cochlear implant requires an in-tact auditory nerve to deliver the sound to the brain. Examples of where cochlear implantation may be appropriate include:

  • Sudden sensorineural hearing loss
  • Noise induced trauma to the ears
  • Hearing loss associated with the aging process
  • Ototoxic effects of certain medications
  • Hearing loss due to meningitis or infection
  • Inherited forms of progressive hearing loss
  • Fractures of the skull base that impact hearing
  • Severe otosclerosis (abnormal middle ear bone formation) involving the inner ears

Considering a cochlear implant

You should think of the cochlear implant process as the start of a lifelong relationship with the PNI cochlear implant team! It is strongly recommended to bring a support person to clinic visits, and we urge you to bring questions about any aspects of our process.

Cochlear implant evaluation

The purpose of the cochlear implant evaluation is to obtain a comprehensive view of how an individual is performing with optimally fit hearing aids so we can determine if a surgical approach is best suited for the patient. The evaluation does not mean you must have surgery. During the process we obtain diagnostic information to determine implant candidacy based on FDA criteria. We also work with the patient, the patient’s support system and our multidisciplinary team to determine the best care for individual. We ensure each patient is well informed and comfortable with their decision.

If you decide not to be a cochlear implant candidate at the time of your evaluation, we will create a plan for your hearing healthcare. We are also able to re-evaluate in the future should a patient’s hearing change and/or if FDA criteria expand. Our cochlear evaluation process involves the following protocol:

  1. Audiologic cochlear implant evaluation
    • An initial evaluation lasts approximately 90 minutes
    • You can expect to complete diagnostic testing with and without hearing aids to assess your hearing status
    • You will be provided with counseling and information about hearing loss and cochlear implant benefits and limitations
    • We will discuss each patient’s specific aspirations and goals for their hearing journey
  2. Balance assessment
    • A referral is made for individuals who need to have their inner ear of balance assessed more thoroughly
    • Individuals with a history of balance issues
    • This assessment can also help us choose which ear to implant if both ears hear equally. We would choose to implant the ear with the weaker inner ear of balance
  3. Surgical consultation
    • Our surgeon will assess if you are medically a cochlear implant candidate
    • They will review the recommended surgical approach, surgical risks and answer all questions
    • They will review the structure of your inner ear via MRI and CT imaging
    • The meningitis vaccine can be administered the same day as your consultation as it is indicated for patients undergoing cochlear implant surgery
  4. Brain health assessment
    • We administer cognitive screeners when indicated and will make appropriate referrals to members of our brain health team at PNI. 
    • As one of the leading institutions studying dementia and Alzheimer’s disease, we understand the important role hearing plays in cognition. Our experts can track and correlate cognition changes with cochlear implant outcomes
  5. Cochlear implant manufacturer choice
    • We want our patients to make a well-informed decision about which company they will have a life-long relationship
    • We can connect you with recipient outreach managers from all 3 device companies (or a narrowed down selection) to further review equipment options and resources

Your journey will be organized and guided by our cochlear implant coordinator and cochlear implant surgery scheduler to ensure the process is seamless and efficient.

Cochlear implant surgery

The cochlear implant surgery is a 1- to 2-hour outpatient procedure that involves making an incision behind the ear. The patient will return home the day of the procedure. A small opening is made in the mastoid bone to reach the inner ear. The electrode array within the cochlea, where it will stimulate the hearing nerve. Most patients resume their normal activities within days of the surgery. You will have a post-operative visit with your surgeon 1-2 weeks following surgery. 3 weeks after cochlear implant surgery, the device will be turned on, or activated, by the cochlear implant audiologist. This timing allows for the swelling to subside and the incision to heal. 

What happens after cochlear implant surgery?

The cochlear implant is not a “quick fix” and involves time, patience, and practice to meet your listening goals. In fact, recipients usually can’t understand speech at the activation visit and may only hear a robotic quality voice or beeps/static. This is completely normal! Most patients perceive great benefits by 3 months after their cochlear implant activation visit. The sound quality improves with each follow up programming (or mapping) visit, with your audiologist. You will see your audiologist, 1 month post activation, 3 months post activation, 6 months post activation and then annually or as needed. 

Auditory training and rehabilitation techniques are a vital part of being a successful cochlear implant recipient. Our team will provide you with a rehabilitation training plan. We also offer to connect you with our auditory verbal therapist partners to schedule virtual or in-person visits which can put you on a tailored treatment plan for success. 

Cochlear implantation is a journey for you and your support system. Hearing loss and cochlear implantation effects the recipient and their loved ones. Our team will guide you through your post implantation visits and rehabilitation. You will have a lifelong, collaborative relationship with your cochlear implant team at PNI!

Cochlear implant program at Pacific Neuroscience Institute

PNI at Saint John's High Performing Hospital USNWR

Our hearing health experts provide many benefits to our patients.

Experience and expertise: Our team of professionals have extensive knowledge in diagnosing and treating complex hearing disorders.  

Collaborative care: Multidisciplinary approach to comprehensive care is the core value of the PNI. Our cochlear implant surgeon, specialized cochlear implant audiologist, vestibular audiologists, brain health neurologists, auditory verbal therapy and speech therapy partners meet routinely to discuss and tailor treatment for each individual patient.

Accessible care: We can deliver super specialized care at the community-based level. We can deliver same-day services with appointments for audiology, otology, vestibular assessment, vaccine administration, and often imaging.

Support: Our in-house team helps schedule your visits and ensure a timely, seamless protocol where the patient feels well informed and part of the decision process. Our goal is also to create a PNI cochlear implant recipient community where we host gatherings and classes that will range from hearing aid technology, cochlear implants to speechreading and communication strategies. 

Innovation: Our team is involved in research projects to push the envelope of cochlear implant care. We apply the latest research and offer and forward-thinking approach to care.

Second opinions: Our team of experts can offer review of your medical records and meet via in person or virtual platforms. Hearing health issues can feel complex, especially when making a difficult treatment decision. Getting a second opinion can help you make an informed decision about your care.

Frequently asked questions (FAQs)

Are cochlear implants approved by the FDA?

The evolution of cochlear implant technology development began in the 1960s and became FDA approved for adults in 1984 and for children in 1990. If necessary, we can advocate for patients if a cochlear implant is requested for “off label” non-FDA approved use and authorization.

Who is a candidate for cochlear implants?

Qualifying adults and children experiencing hearing impairment can benefit from cochlear implants. Candidacy for this miraculous device has dramatically expanded over the past decade offering better access to speech and language, environmental sounds, and music to those who are struggling. Cochlear implants are approved for infants as young as 9 months old and can often be approved off-label at even younger ages.

How big is the external speech processor?

These are small and discrete, tucked behind the ear. Research and development have improved the sound quality of these devices and created smaller external speech processors over time. As a result, patients benefit from future advancements in technology without subsequent surgeries because the manufacturers ensure the new speech processors are compatible with older internal devices. 

Is there insurance coverage for cochlear implants?

Cochlear implants are covered by insurance policies including Medicare, Medicaid, private insurance carriers and vocational rehabilitation. Candidacy criteria may be specified by specific insurance plans and our team can help guide a patient through that process.

Clinic Location

Pacific Neuroscience Institute – Wilshire
11645 Wilshire Blvd, #600, Los Angeles, CA 90025
310-477-5558

Expert cochlear implant team

For patients who are a candidate for cochlear implants, our ENT surgeons and audiologists are at the forefront of cochlear implant surgery. Dr. Courtney Voelker, Director of Otology/Neurotology-Lateral Skull Base Surgery; and Director, Adult & Pediatric Cochlear Implant Program at Pacific Neurosciences Institute, is among the most highly skilled cochlear implant surgeons in the US and among the first to provide a cochlear implant to a patient after acoustic neuroma removal at the time of surgery. 

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