Benefits and Risks of a Cochlear Implant

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Whether you’ve been thinking about cochlear implants for a while or your doctor recently suggested them, there’s a lot to learn about the device itself and the procedure before making your decision. Cochlear implants can change your quality of life, helping you gain or regain sound, but they’re not for everyone. Some people are not good candidates for the device and, for others, the benefits of a cochlear implant may not outweigh the possible risks. The decision is easier to make when you know the cochlear implant pros and cons and how they differ from hearing aids.

Improved Hearing

Cochlear implants are devices that are inserted under your skin against your skull, with electrodes leading to your inner ear. They allow sound vibrations to bypass damaged parts of your ear and go directly to the inner ear and the auditory nerve, and ultimately your brain.

Normally, sound enters your ear and causes your eardrum to vibrate. These sound waves move through three tiny bones in your middle ear to your inner ear and a tiny area called the cochlea. Here, the vibrations cause tiny hairs (cilia) to move, which transmits the waves to the auditory nerve. When there is damage to the ear along the sound wave’s path or to the cilia, sound is not transmitted properly or at all.

You don’t have to have complete hearing loss to get a cochlear implant, but your hearing has to be bad enough that hearing aids don’t help and hearing impairment or loss is affecting your quality of life. You also can get an implant on one side only, leaving the other side without correction, or with a hearing aid if that is sufficient.

Cochlear Implants vs. Hearing Aids

Aside from the most obvious difference—an implant and electrode is surgically inserted into your ear while a hearing aid sits in your outer ear—there are other issues to consider when making your decision.

A hearing aid is like a sound amplifier. When you are fit with a hearing aid, it may be self-adjusting to different sound levels or you may be able to adjust it yourself. As an amplifier, the hearing aid amplifies all sounds around you, much like if you turned up the volume on the television. Some hearing aids are very discreet with a small earpiece that fits into your outer ear. Other hearing aids are larger and sit over the top of your ear with a small attached earpiece.

When you use a hearing aid, sound waves travel through your middle and inner ear as usual, but the sound may be difficult to understand, depending on how much you amplify the sound and how much background noise is present. Some people who use hearing aids have difficulty getting used to the feeling of something in their ear. Another possible issue is not being able to focus on a particular sound or voice.

A cochlear implant is not an amplifier. It is a sound processor that sends sound waves directly to the auditory nerve. Although the sounds may not be the same as when you hear them naturally, your brain ‘learns’ what the different sounds are and you get used to the quality of the sound. Your brain does not have to filter out background sound as it does with a hearing aid.

Cochlear implants are more noticeable than some types of hearing aids, which can lead to self-consciousness. In addition to the microphone piece that often fits over the ear as a hearing aid does, you also have the speech processor. This is often attached to the skull with a magnet, but it also may be held in a special pocket or harness.

Cochlear Implant Pros and Cons

For the right person, an implant can help them regain their hearing and perhaps their ability to communicate through speech. Young children and babies with severe hearing impairment who get cochlear implants early in life usually catch up to their naturally hearing peers in terms of language and comprehension. And although the quality of the sound is different than normal processing, it is generally better than the amplified sound provided by a hearing aid.

There are a few cons to cochlear implants. First, an implant requires surgery, usually under a general anesthetic. A surgeon makes an incision behind your ear to insert the device and the electrodes, which go into the cochlea. Any type of surgical procedure has risks, ranging from infections to damage to the facial nerve. Children in particular have a higher risk of developing bacterial meningitis (most commonly the pneumococcal form) compared to people without an implant. Anyone planning on cochlear implant surgery should be vaccinated against pneumococcal meningitis.

Other possible limitations with having a cochlear implant may include:

  • Disappointment that sounds aren’t the same as what you heard before you lost your hearing

  • Failure of the implant (such as device malfunction) or implant damage resulting in another surgery

  • Loss of residual (remaining) hearing

  • Obsolete equipment if upgrades aren’t possible with your device

  • Need to remove external parts of the device during showering or water activities (unless the device is water resistant or waterproof)

  • Inability to undergo some sorts of medical tests or treatments, such as MRIs or radiation therapy

  • Price—the cost of the surgery, implant, and the follow-up therapy can cost up to $100,000 in some cases

  • Loss of the external processor, for example when you take it off to sleep or participate in certain activities

  • Setting off security scanners

Making the Decision

If you qualify for a cochlear implant, the ultimate decision is up to you. Unlike hearing aids that you can remove if they don’t work well for you, an implant can only be removed surgically. So, it’s a more permanent solution. However, most people who have cochlear implants are happy and satisfied or mainly satisfied with the outcome, including a better sense of self-esteem. For those who could hear before losing hearing and who were able to speak, the implants helped them feel confident in their ability to continue to communicate orally.

If you have more questions, it may be helpful to meet others who have had the same procedure so you can ask about their experiences. Ask your doctor or healthcare team if there are groups you can join or people you can communicate with, who can help you make your decision.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 May 11
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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