Cochlear Implants

Child wearing a cochlear implant looking out the window

Cochlear implants take up a lot less of the audiological spotlight than hearing aids do. Even if you don’t have one or know anyone who has a hearing aid, you probably know roughly what they look like, and what they can accomplish – in short, they can make hearing far easier for people with hearing loss.

But this is only the case for certain levels of hearing loss – when hearing loss is severe enough, it might be too much for a hearing aid to counteract. In these cases, the patient might need a cochlear implant – a more digitally powerful piece of hearing equipment.

Don’t just take it from us though. We had an interview with Oslo-based cochlear implant expert Nora Serres – a researcher focusing on cochlear implants and their impact on children. We asked her about some of the subjects we’ve covered in this article, and here’s what she had to say.

To learn more about cochlear implants, you might want to talk to a professional rather than reading an article – after all, the line between needing a hearing aid and needing a cochlear implant can’t be defined without a hearing test. To book a free hearing test, fill out our form today!

What are cochlear implants?

So how are they different to hearing aids? Well, like we mentioned, cochlear implants are intended for only the most severe cases of hearing loss. These levels of hearing loss are known as severe and profound hearing loss. If you suffer from either of these classifications, a cochlear implant is likely to be the solution for you.

But what actually are they? Well, they’re devices that are surgically inserted into the inner ear (which is a few inches into your head), and wired back to an electronic device on the exterior of your head. If this sounds confusing, check out this picture.

Closeup of a cochlear implant

So the interior half of the device essentially does the job of the cochlea – hence the name – while the exterior half of the device rests outside the head and receives sound. The sound is then sent to the interior, where it is translated into electricity and sent to the brain, where it is processed as sensation.

Q: In your opinion, how dangerous is this type of procedure?

Researcher Nora Serres: With any surgery, there are risks both during and post-operation. In smaller children and older adults, the risks can be higher. Doctors must be trained well for the procedure and the whole medical team in agreement with the procedure and follow-up.

However, the outcomes are generally very successful from a medical perspective. In my opinion, the ‘danger' stems more from other factors – learning to hear with CIs takes consistent training and effort, and some people may feel that the CI highlights their hearing difference.

You have probably also come across this, but people who are a part of the Deaf (capital ‘D') community that do not see hearing loss as a disability and that CIs are sometimes even considered a sort of ‘genocide' to their community. The film Sound and Fury is a powerful narrative that goes more in depth.

How does a cochlear implant work?

How does this process happen exactly? Let’s start from the beginning of the whole cochlear implant experience. After an audiologist diagnoses the patient’s hearing loss as severe or profound, a cochlear implant evaluation is performed to determine whether the patient is a candidate and surgery is scheduled.

The idea of surgery can sound very daunting, we’ll admit. However, it’s not as bad as it might seem. Bear with us as we go over the exact process:

  1. The surgeon makes an incision behind the ear and then opens the mastoid bone.
  2. The surgeon finds and opens the cochlea – after which the implants are inserted.
  3. The surgeon puts the receiver under the skin behind the ear, making sure it’s fixed to the skull.
  4. The surgery spots are closed, and the patient is then observed, hopefully being discharged in around two hours.

After the operation, your doctor may prescribe medication for pain or infection, as well as instructions on how to behave and take care of yourself over the coming weeks, regarding physical activity or bathing.

But maybe the idea of getting your head cut open isn’t the most enticing prospect in the world. If you’re at all concerned about something going wrong, you should know the rates of complication are very low.

Minor complications occur roughly 12% of the time, with major issues only occurring around 3% of the time.

So once the device is in, let’s look at how it works. The system itself, comprising both the interior and exterior halves, has five main parts:

  • Microphones to pick up incoming sound
  • A processor to help prioritize speech over environmental noise
  • A transmitter to send both power and the processed sound signals to the internal device
  • An interior receiver to receive the sound signals and convert them to electric impulses
  • An electrode array inside the cochlea to send impulses to the brain

Cochlear Implant Diagram

In those brief definitions, we’ve essentially told you how these devices work. The exterior microphone picks up incoming sound, while the speech processor isolates and focuses on noises that sound like human speech.

This processed sound is then sent by a transmitter, via a small radio signal, to the internal device. This signal is picked up by the receiver and converted into electric impulses. These impulses are sent through an array to the auditory nerve, then sent to the brain, where the sensation of sound occurs.

This five-step process may sound like it takes a while. Keep in mind, then, that this happens instantaneously and constantly, and hopefully the science and process manages to impress you as much as it should.

Q: How does a cochlear implant differ from or improve on a standard hearing aid?

Researcher Nora Serres: Cochlear Implants (CIs) are surgically implanted devices that address sensorineural hearing loss (SNHL) – hearing loss due to injury/ defect in the inner ear. This device does not restore hearing, but it turns auditory stimuli (sound waves from speech and environmental sounds) into signals that the brain can interpret.

This video gives a basic overview with visuals.

Who needs a cochlear implant?

Any medical device that requires a surgery to be prescribed isn’t going to be given out willy-nilly, so the guidelines on who needs an implant instead of a hearing aid are going to be pretty firm.

Before you resign yourself to booking a procedure as soon as you can, you should make sure you meet the candidacy requirements. Otherwise, you might just benefit from a regular hearing aid.

Adult requirements (18 years and above)

  • Must suffer from moderate to profound hearing loss
  • Must gain insufficient benefit from a hearing aid – this is defined by < 50% sentence recognition in the ear in question, and < 60% in the opposite ear

Children requirements (2 years to 18 years)

  • Must suffer from severe to profound sensorineural hearing loss in both ears
  • Limited benefit from binaural hearing aids (hearing aids in both ears)
  • A score equal to or below 30% on the Multisyllabic Lexical Neighborhood Test (MLNT) or the Lexical Neighborhood Test (LNT)

Babies (12-24 months)

  • Must have profound sensorineural hearing loss in both ears (this is the highest level of hearing loss severity)
  • Limited benefit of binaural hearing aids

Evidently, your hearing loss needs to be at a considerable level to warrant a cochlear implant. This is somewhat good news, because they can be a bit expensive under certain circumstances.

How much do cochlear implants cost?

We won’t beat around the mastoid – if you aren’t effectively covered by your insurance, cochlear implants can cost a fair amount of money. Since we don’t know you or your individual insurance situation, we can only give you the raw costs of the procedure.

The cost of the surgery, plus the cost of the implant itself, averages around $30,000 to $50,000. The external pieces of the device – i.e. the transmitter and speech processor – can cost an additional $6,800–$9,000.

Pre- and post-surgery visits can also cost a few hundred dollars each, adding around $3,000 more to the total. This brings the rough uninsured cost of the entire cochlear implant experience to an estimated total of $50,000 to $80,000. Not exactly pocket change, we’ll admit.

With the right insurance conditions, however, the cost can be as low as $1,000. We’re sure we don’t have to tell you this, but if you’re interested in a cochlear implant, make sure you’re 100% confident of your insurance company’s rules.

Obviously insurance guidelines vary drastically on your state, provider, and your condition, so we won't be able to give you the exact requirements for coverage. All we can say is that your hearing loss will need to be of the sensorineural variety, and of the highest level (profound or in very rare cases, severe).

What are the best cochlear implants?

The world of hearing aids is made up of all kinds of brands and models. Does the same variation apply to cochlear implants? And if so, what are the best ones?

Well, the good news is that the variety in the cochlear implant world is a lot smaller than that of the hearing aid world, so you won’t have to worry about making the wrong choice. There are really only three options for cochlear implants in the US: Cochlear Limited, Advanced Bionics, and MED-EL.

It’s a bit trickier to say which of these three is the best – there was a study done to look at this exact topic, but in the interest of keeping the market competitive, the authors of the study kept the company names a secret.

All you need to know is that all cochlear implants work, and they all work well. And, on top of this general standard of quality, the choice might not even be up to you!

Since cochlear implants are less customizable than hearing aids, with fewer features, the choice isn’t usually made by the patient. Each surgeon will usually only offer one kind of implant, but since they’re all effectively on the same tier, you won’t have to worry about them picking the wrong one for you.

All this long section to say – there are small differences between cochlear implant manufacturers, but not nearly enough to be concerned about the model you may end up with.

Q: Are you aware of any quality difference between the manufacturers producing these implants?

Researcher Nora Serres: I have not explored the quality differences between manufacturers. However, I could imagine that insurance coverage, warranty, and size availability (younger children will receive smaller than adults) might influence a decision to choose one over the other!

What are hybrid cochlear implants?

If you’ve done research prior to reading this article, you might have heard whispers of “hybrid cochlear implants.” You may also have no idea what this means, which is fair enough.

A hybrid cochlear implant combines a hearing aid and a cochlear implant into one device. It uses the acoustic amplification of the hearing aid to improve low frequency hearing, while using electrical stimulation of the cochlear implant to improve high frequency hearing.

Clinics have been creating their own form of a hybrid implant for years by using a cochlear implant with a shorter, partially inserted electrode array, and wearing an in-the-ear hearing aid at the same time. Now, companies have combined the two devices into one system and, as of 2014, it is approved by the FDA for use in adults.

As for whether these are “better” or “worse” than any hearing aids or regular cochlear implants, it again depends on the needs of the user. If your hearing loss is necessitates a hybrid cochlear implant, then you may be prescribed one – but if you aren't, don't feel like you're missing out!

Q: Where would you say the industry is heading, what do you think the future of cochlear implants look like? 

Researcher Nora Serres: CIs are a technological medical device, and as this industry advances, I believe that CIs will evolve as well. Due to the variety of reasons for deafness as well as the amount of people losing hearing in old age, I do not see the industry disappearing or dwindling.

And, although technology continues to improve and we rely more heavily on it daily, our need and want for communication remains strong. I am excited to see where the industry and medical profession will go!


There you have it – by now, hopefully you consider yourself more informed on the procedures and costs behind cochlear implants. They’re less common than hearing aids, so the information across the internet is a bit thinner and more spread out, meaning it’s not a problem if you felt uninformed.

If you think you might need a cochlear implant, then your first step should absolutely be a hearing test, as you’ll need to make sure that you can only benefit from a cochlear implant (and not a straightforward hearing aid). Either way, fill out our form and book a free hearing test near you!

Written by:

Duncan is an Australian-born American-raised creative writer with a passion for healthy ears. He continues to build upon his audiology qualifications with research and various courses.

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