Dr. Jacob Hunter on Cochlear Implants

Dallas neurotologist Dr. Jacob Hunter answers questions about cochlear implants.

How do you identify hearing-impaired patients who may be good candidates for a cochlear implant?

While a simple hearing test cannot identify patients who may be cochlear implant candidates, various measures from the test can hint at which patients should receive a cochlear implant evaluation.

In addition, hearing-aid users who have hearing difficulties, despite complete optimization of their hearing aids, also warrant a cochlear implant evaluation.

While many patients qualify for a cochlear implant, those who do not may benefit from other technology until their hearing loss becomes severe enough to receive a cochlear implant.

Recognizing that quality-of-life studies show adults with significant hearing impairments benefit enormously from a cochlear implant, indications for implantation are ever expanding, even those who still have some low-frequency hearing.

Even so, cochlear implants are extremely underutilized in the U.S. Only about 50 percent of children who need the devices get them, and fewer than 10 percent of adults who could benefit from cochlear implants get them.

Adult cochlear implant candidates may have hearing loss as the result of progressive, age-related deterioration or from decades of work in extremely noisy environments. Whatever the cause, anyone who is not able to participate fully in his or her normal life due to hearing loss warrants a hearing evaluation.

What is the procedure for getting evaluated for cochlear implant?

If you are experiencing hearing loss, or find it difficult to understand people, your first step is to schedule a hearing evaluation. It takes about 30 minutes.

If your audiologist or physician believes your loss is severe enough that you might benefit from a cochlear implant, a more comprehensive evaluation will be scheduled, usually lasting about two hours. Your hearing is tested in varied settings, from those that are very quiet to those with the sound and noise levels you tend to find in places such as crowded restaurants.

If the results of your cochlear implant evaluation don't qualify you for a cochlear implant, there are other emerging technologies and clinical trials that you may qualify for to assist you with your hearing, or the hearing test is repeated in about one year. But while there is no simple test or measure to determine cochlear implant candidacy from home, failure to repeat the hearing test after your hearing has continued worsen may mean you are missing out on technologies that can help you hear again and improve your quality of life.

Technically, you can’t qualify for a cochlear implant without at least trying a hearing aid first. Unfortunately, there’s a stigma around hearing loss. People don’t want hearing aids; it makes them feel old. Admitting that you have difficulty understanding speech is the first and biggest hurdle.

How do you help patients get the best outcome following cochlear implant?

Success with cochlear implant depends on the patient’s hearing to begin with. We essentially turn on the sound in that ear again and the brain starts to refigure things out. Frequent use of the implant helps; we want patients to use it daily. The more they use it, the better outcomes they tend to have.

Younger cochlear implant patients, not surprisingly, often do very well and make quick progress. If profoundly deaf patients who have been deaf for a long time receive a cochlear implant, they may not do as well. Some of that has to do with brain plasticity.

And, as I noted, an increasing number of people with some residual low-frequency hearing are now viewed as eligible for cochlear implant. There are numerous studies looking at all sorts of variables – such as insertion techniques, steroid use, the types of electrodes put into the cochlea, and so on – to learn how to maximize benefits for all cochlear implant patients.

It’s also important to emphasize that motivation is a key factor in the success a patient will have with a cochlear implant.