Cochlear implants

A cochlear implant is a small electronic device that helps people with severe hearing loss or deafness hear more sounds, including speech. It works by picking up sounds from the environment, converting them into electrical impulses, and sending the impulses to your auditory nerve. You wear an external piece behind your ear and on the side of your head. The internal piece is surgically implanted inside your ear and under the skin behind your ear.

Cochlear hearing devices are different than hearing aids. Hearing aids are externally worn devices that make sounds louder. They’re for people with mild to severe hearing loss who can understand speech fairly well but need amplified sounds. Hearing aids don’t require surgery. Cochlear implants, on the other hand, don’t make sounds louder. They replace the function of your inner ear and help you hear sounds in a different way.

Penn Medicine has been at the forefront of hearing aids and implantable hearing devices for more than 30 years. We’re one of the region’s leading cochlear implant providers and work directly with cochlear implant manufacturers to give our patients access to the latest devices.

Cochlear implants work by doing the job of your inner ear. In a healthy ear, sound waves travel through your ear to your cochlea, a tiny, snail-shaped organ essential for hearing. Cells in your cochlea turn the sound waves into electrical impulses that are sent to your brain. But when you have hearing loss, the cells are damaged and can’t process sound waves properly.

A cochlear implant turns sound waves into electrical signals and sends them directly to your auditory nerve, bypassing the damaged parts of your ear. The external part of the device contains a microphone, speech processor, and transmitter to capture sounds, convert the sounds into digital signals, and send the signals to the internal device. The internal implant contains a receiver attached to an electrode array, a tiny, coiled device that produces electrical signals to stimulate the auditory nerve. The receiver is placed under the skin behind your ear, and the electrode array is implanted in the cochlea.

Cochlear implants are for people with sensorineural hearing loss, which is caused by inner ear damage. This is the most common type of hearing loss. Most people with sensorineural hearing loss try hearing aids before considering cochlear implants. If hearing aids aren’t effective, an implantable hearing device may be an option.

We may recommend cochlear implant surgery if you:

• Are healthy enough for general anesthesia and surgery
• Are six months of age or older
• Are willing to undergo hearing and speech therapy after the procedure
• Have a cochlea (some people are born without a cochlea)
• Have an auditory nerve, known as the eighth cranial nerve
• Have moderate to profound sensorineural hearing loss in one or both ears

People considering cochlear implants undergo a comprehensive hearing evaluation to confirm the underlying cause of hearing loss. It’s important to rule out problems in your middle ear, such as a ruptured eardrum. We also do a CT scan or MRI to examine the structure of your ear and make sure you have a cochlea and auditory nerve.

Once we’ve confirmed your diagnosis and eligibility, we begin the process of selecting a cochlear implant. Penn Medicine audiology specialists can help you choose the right device for your age, lifestyle, and budget.

Cochlear implant surgery is an outpatient procedure, so you go home the same day. The surgery typically takes one to two hours. An otorhinolaryngologist, otologist, or neurotologist performs the operation.

Here’s what you can expect during cochlear implant surgery:

1. You receive general anesthesia. You’ll be asleep for the procedure and won’t feel any pain.
2. The surgeon makes a curved incision (cut) behind your ear and places the receiver in a pocket under your skin.
3. They drill a hole through the bone behind your ear to gain access to your inner ear.
4. The surgeon carefully places the electrode array into your cochlea and connects the array to the receiver.
5. They close the incision behind your ear with absorbable stitches and tape. Then, they place a protective plastic cup over your ear.

You may have mild pain, swelling, numbness, or headaches. in the days after your cochlear implant procedure. Your care team will give you instructions about how to care for the incision.

Avoid strenuous activities for about two weeks. Talk to your doctor about when it’s safe to return to work. Contact your doctor right away if you have heavy bleeding from your ear or signs of meningitis, such as high fever, stiff neck, headache, nausea, and sensitivity to light.

It’s also important to remember that you won’t be able to hear immediately after the surgery. Your audiologist will wait about a month after the procedure to activate and program the external device. This gives your body time to heal.

Your device may need to be adjusted multiple times over a period of several weeks. Getting used to a cochlear implant and the new sounds you can hear takes time and patience. We recommend working with specialists from audiology and speech and language pathology during the rehabilitation process.

Potential complications of cochlear implant surgery include:

• Balance problems
• Bleeding
• Cerebrospinal fluid leak
• Complete hearing loss
• Damage to the brain, skull base, or facial nerves
• Infection
• Meningitis
• Problems with taste

At Penn Medicine, we offer a range of implantable hearing devices, including cochlear implants, bone conduction hearing aids, and auditory brain stem implants. Whichever type of implant is best for you, we provide all the services you need for diagnosis, treatment, and rehabilitation in one place.

Our team includes neurotologic surgeons, implant audiologists, and speech-language pathologists. They provide support, guidance, and expertise throughout the process, from hearing evaluations and implant selection to surgery and device maintenance.