Best Cochlear Implant Companies

What are the components of a hearing implant?

Cochlear implants and other hearing implants might look complicated, but they are relatively simple tools. Nearly all available devices feature the same basic components, though they process sound differently.

• Microphone: The microphone is located on the part of the device that sits above the ear or is worn on the head.
• Processor: The processor is also external and converts sounds picked up by the microphone to digital information (in cochlear implants) or to sound waves (in BAHAs and middle ear implants).
• Receiver: The receiver is implanted under the skin behind the ear. In cochlear implants, digital information is passed from the processor to the receiver, where it is converted into electronic impulses. In acoustic implants such as BAHAs and middle ear implants, the receiver is fused to the bone or cochlea to receive sound waves.
• Electrode array: Cochlear implants and auditory brain stem implants use a small wire called an electrode array to transmit electronic impulses and stimulate the auditory nerve or brain stem.

What does the process involve?

Understanding how the procedure is done can help you feel more confident in making a decision for you or your loved one. The various types of hearing implants involve a similar process.

• Surgery: For a cochlear implant, “the surgical process takes about one to two hours,” Dr. Briggs says. An incision is made behind the ear to insert the receiver. Some people are able to undergo the procedure and return home that day, while others need a few days in the hospital to recover.
• Recovery: The surgery recovery period is usually several weeks, during which time scar tissue forms over the incision. During this time, you will not be able to hear because the external part of the device, the processor, is not yet connected to the receiver. “Some patients also experience vertigo for about 48 hours after surgery,” Dr. Briggs says. “This is caused by fluctuation in inner ear fluid, and it resolves on its own.”
• Activation: About a month after surgery, you will have an appointment to activate your implant and hear sound through it for the first time. The sound processor will be adjusted to the correct level of stimulation.
• Post-operative care: You should plan for many follow-up visits to your hearing specialist to monitor your progress and continue to adjust the processor settings. You will also need rehabilitative care, usually including speech therapy, as your brain learns to process sounds. Even people who recently became deaf require rehabilitative care because the brain needs help to adjust to the device. If you receive auditory brain implants, you can expect even more post-operative appointments.
• Possible complications: According to Dr. Briggs, “Fewer than 0.1 percent of patients have problems with cochlear implants. These implants rarely fail, and if they do, they must be reimplanted.”

What style of processor do you prefer?

Cochlear implants and other hearing implants come in a variety of styles.

• Behind-the-ear: Behind-the-ear sound processors look similar to hearing aids. The microphone sits on top of the ear and connects with a wire to the processor, which attaches with a magnet or abutment to the internal receiver in the skull.
• Off-the-ear: Off-the-ear devices look like the processor of a behind-the-ear implant without the earpiece and connecting wire. The processor is round and about the size of a quarter. These usually come in neutral colors that can be hidden with hair, making this the most discreet option.
• Body-worn processor: Some implants feature processors that can be clipped to the wearer’s shirt, belt or pants. Some manufacturers make waterproof covers for these processors so they can be worn while swimming.
• Single or double implants: Most specialists recommend a cochlear implant for each ear for people who have bilateral hearing loss, since sound processing works best when receiving information from both sides. However, some people opt to try only one first to see if they can tolerate the process or because one is more affordable. Many people, especially children, wait a year or more before receiving a second implant.

What rehabilitative services are needed?

Recipients of hearing implants derive the most benefit when they receive ongoing services to help them adjust to the implants. “It takes a lot of patience and learning to get it programmed correctly,” says Dr. Briggs. “You can expect to work with an audiologist for up to six months to get your programming right.”

• Implanted babies and children: Most experts agree that young children who receive implants have the best chance for success because the young brain can adapt and quickly relearn how to process information. Still, families must be able to commit to regular speech therapy and appointments with hearing specialists for many years in order to help children make the most of their hearing.
• Congenitally deaf adults: People who have been deaf since birth and opt for implants as adults may need the most rehabilitative support services to help familiarize their brains with sound processing.
• Adult onset hearing loss: Adults who experience hearing loss and opt to receive implants will need support from hearing professionals but may have less difficulty adjusting to sound processing than others.

What other options are there?

If a cochlear implant or different hearing implant is not right for you, there are several other options you can choose from to give you access to sound.

• Hearing aids: If hearing aids provide enough support for you to be able to hear and understand speech, most hearing specialists recommend them over cochlear implants. Because implants are much more expensive and invasive, they are meant for people who do not receive enough support from hearing aids alone.
• Hybrid cochlear implants: People with some hearing in one or both ears might opt for a hybrid cochlear implant. The microphone connects to a processor and receiver as in a typical cochlear implant, but the device also amplifies sound and uses an earpiece to deliver the sound to the inner ear.
• One implant and one hearing aid: If you have some hearing in one ear, you may opt to receive an implant in only one ear. After a month or two of adjusting to the implant, you can use your hearing aid in the other ear. This can provide additional sound cues to help you interpret and respond to sounds.

Cochlear implants

Cochlear implants are primarily used for patients who have bilateral (both ears affected) sensorineural hearing loss that is considered moderate to profound. They are implanted under the skin directly into the cochlea, in the inner ears. Unlike hearing aids, cochlear implants do not amplify sound but instead conduct electricity to stimulate the auditory nerve.

Bone-anchored hearing aids (BAHAs)

BAHAs are surgically-implanted devices that amplify sound waves for people with conductive or mixed hearing loss. They are generally used as an alternative to hearing aids for people who have problems with their ears that make wearing hearing aids difficult, like allergies or ear malformations. The receiver is titanium and is implanted on and fuses to the bone behind the ear. Some BAHAs are transcutaneous, meaning they process sound through intact skin, while others use an abutment system that is placed through the skin to physically connect the processor and receiver.

Auditory brainstem implants (ABIs)

These are an alternative to cochlear implants for people with profound sensorineural hearing loss, particularly those who are completely deaf. ABIs bypass the cochlea and implant directly into the brain stem, so they are considered more invasive than cochlear implants.

Middle ear implants

Middle ear implants are the newest on the market. These are alternatives to conventional hearing aids for people who have allergies to hearing aid earmolds, chronic ear infections, malformed outer or middle ears or other problems that make wearing traditional hearing aids difficult or impossible. The structure and function of a middle ear implant are similar to a cochlear implant but work by amplifying sounds instead of conducting electricity.

Candidacy criteria can vary

Each of the companies that have FDA approval to market their hearing implants in the United States suggest slightly different criteria for implant candidacy. Additionally, insurance providers as well as Medicare and Medicaid each write their own criteria to determine who is a candidate to receive implants. “If you’re on Medicaid or Medicare,” Dr. Briggs says, “you’ll have to show at least 40 percent hearing loss before you’re covered.”

Moderate to profound hearing loss

Adults ages 18 and up with moderate to profound hearing loss may be candidates for implants. The requirements are different for children; kids ages 2 to 18 with severe to profound loss (70 decibels or greater) are often candidates, while toddlers ages 12 to 24 months may be candidates if their loss is profound. The FDA does not approve implants for infants under 12 months, but many have been implanted off-protocol and in other countries.

Bilateral hearing loss

Most people who have unilateral hearing loss, which means hearing loss in one ear, are able to use hearing aids if they want to access sound. People with loss in both ears, called bilateral hearing loss, may be candidates for one or two implants, even if only one of the affected ears has severe or profound loss.

Type of hearing loss

There are two main types of hearing loss: Conductive hearing loss results from damage to the outer or middle ear that prevents sound waves from entering properly, and sensorineural hearing loss results from damage to the inner ear or auditory nerve. People with conductive hearing loss may benefit from middle ear implants or BAHA devices, but don’t benefit from cochlear implants. People with sensorineural loss or mixed loss (both conductive and sensorineural) may benefit from cochlear implants, but not the other types.

Limited speech intelligibility

Most adults are given a speech intelligibility test to see if they are candidates for implants. If a person can already understand sufficient speech, they may not need cochlear implants. However, if a person struggles to hear others or understand speech or cannot use a telephone, they may be a candidate for implants.

Limited benefit from hearing aids

Candidates for implants are not sufficiently supported by hearing aids alone in one or both ears. Some tests require a person to have 50 percent or less speech intelligibility with a hearing aid in the ear to be implanted. People who cannot wear hearing aids may also be candidates for implants.

Realistic expectations

Most people say that sounds heard through a cochlear implant or other hearing implants are different. Still, patients can expect an increase in clarity if they choose to use a cochlear implant than if they choose a hearing aid. “Hearing aids can help people regain about 50 percent of their hearing,” Dr. Briggs explains. “Patients with cochlear implants often regain 75-100 percent hearing.”