What is a cochlear implant?
A cochlear implant is a device that provides stimulation directly to the auditory nerve, bypassing damaged hair cells in the cochlea that prevent sound from reaching the nerve. An implant does not result in “restored” hearing for the recipient, but does allow him or her to perceive sounds.
How long have cochlear implants been available?
The U.S. Food and Drug Administration (FDA) first approved cochlear implant devices for adults in 1985 and for children in 1990. According to the National Institute on Deafness and Other Communication Disorders, as of December 2010 approximately 70,000 individuals—over half of whom were children—had received cochlear implants in the United States. More than 219,000 individuals have received cochlear implants worldwide. During recent years, an increase in early hearing detection and intervention (EHDI) programs as a result of legislation and advocacy efforts by organizations such as the American Speech-Language-Hearing Association (ASHA) has allowed for the identification of more children who may benefit from cochlear implants.
Who is eligible to receive an implant?
In general, adults who have severe to profound hearing loss in both ears and have benefited only minimally from hearing aids may qualify as candidates for cochlear implantation. Children as young as 12 months of age who have severe to profound hearing loss in both ears and who demonstrate little progress in the development of auditory skills may also be considered candidates for some implant devices. It is very important that the implant recipient (and the family, in the case of a young child) have an understanding of cochlear implants and realistic expectations regarding the use of the device.
What results can be expected from a cochlear implant?
As with any medical procedure, the results of implantation cannot be predicted prior to surgery and recipients may experience a wide range of outcomes. For individuals who lost their hearing after learning to speak, the perception of speech and sounds after implantation may initially seem quite different from what they remember. After using the cochlear implant for several months or more, these individuals often report that they perceive speech to be more natural or closer to their memory of familiar sounds.
While many factors affect outcomes for both children and adults, typically, the younger a child who was born deaf is implanted, the greater the benefit achieved in the areas of speech perception and speech and language development. A predictive factor for implant performance for adults who are deaf is the length of time between the onset of deafness and implantation; those with the shortest duration of deafness tend to experience better outcomes.
Where can one receive an implant?
There are various centers around the country where teams of professionals work with individuals to determine implant candidacy, perform surgery, and provide follow-up care. Because of the level of commitment required, implant candidates should consider several factors in choosing an implant center, including the level of experience of the staff in working with implant recipients and the center’s proximity and accessibility (as numerous trips to the facility may be required).
Once an individual receives an implant, is she finished with the process?
Wearing a cochlear implant is a lifetime commitment, and requires the recipient to maintain and care for the implant. After an individual receives the implant, he or she must return to the center for a number of follow-up services, including the fitting of the external components of the implant; activating and programming of the implant and its microphone, speech processor and transmitter; necessary adjustments and reprogramming, and annual check-ups. In addition, recipients must undergo rehabilitation services with members of the team. Children often require years of extensive aural rehabilitation whereas adults who have been implanted due to acquired deafness may need fewer aural rehabilitation sessions.
What types of professionals compose the implant team?
Among the professionals who may work as part of the cochlear implant team are audiologists, speech-language pathologists, educators, surgeons, medical specialists, psychologists and counselors.
What role do audiologists and speech-language pathologists perform in the implant process?
Audiologists are involved in many of the components of the cochlear implant program, including determining the candidacy of an individual for implantation, as well as activating and programming of the speech processor after surgery. Both audiologists and speech-language pathologists provide aural rehabilitation services to implant recipients to facilitate their ability to detect and understand speech with the cochlear implant. Aural rehabilitation services may include processes to enhance communication, auditory training and speechreading, training on the use and care of the implant, and support of the needs of the recipient and family.
How much do implants cost?
The costs of cochlear implants vary widely depending on a number of factors, including the duration and extent of a patient’s hearing loss prior to surgery. The average cost for the entire procedure, including the post-operative aural rehabilitation process, exceeds $40,000. However, cochlear implantation consistently ranks among the most cost-effective medical procedures ever reported, according to research completed by the Johns Hopkins University and the University of California-San Diego. These studies indicate that cochlear implantation can result in a net savings of more than $53,000 per child versus the more than $1 million average expected lifetime cost of a child who has profound hearing loss prior to language development.
Do insurance companies cover implants?
Health insurance coverage for cochlear implant services has improved greatly in recent years, with the majority of commercial health plans and managed care organizations now providing some level of benefits for the procedure and related services, including programming and aural rehabilitation. The increase in coverage is largely due to increased education regarding the costs and outcomes of cochlear implantation, and federal and state laws (such as the Americans with Disabilities Act) prohibiting exclusionary insurance policies that deprive cochlear implant candidates from the only opportunity to alleviate their hearing loss.
Medicare, TRICARE, the Veteran’s Administration, and all other federal health plans provide benefits for all cochlear implant services. Federal law requires that all state Medicaid agencies provide coverage for cochlear implants for children under 21 years old, and most provide benefits for adults as well. Vocational rehabilitation, maternal and children’s health services, and other combined federal-state programs also often provide benefits.