Note: In order to understand how the cochlear implant replaces missing sound, it is important to understand how we hear.

Cochlear implants are surgically implanted, and a candidate needs to receive a professional evaluation to discover eligibility. The evaluation is done at a cochlear implant clinic. A group of professionals work together to decide if the patient is eligible. Usually the team includes an ENT surgeon, an audiologist, a social worker, and a psychologist.

The audiologist will test the level of hearing loss. The surgeon will examine the ears and scan the cochlea to be sure that it is suitable for an implant. Also, the surgeon will check to see that there are no ear infections. In the case of children often others are on the team doing the evaluation. An educational assessment might be added.

In addition, the general health of the candidate is analyzed. The person must be able to undergo surgery. Naturally, in any surgery there is a risk. The implant team will review the results. The candidate must be strong enough to undergo surgery with anesthesia. The cochlear implant surgery usually takes two to three hours, and most hospitals require a hospital stay of two or three days.

The program involves not just the initial surgery, but a rehabilitation period as well. First the surgery takes place. Then there is a healing period. Once the surgery has healed, then the next step can follow. Cochlear implants have external and internal parts. The internal part is placed under the skin behind the ear.

This is implanted during the surgery. Once the surgery is done there is no hearing in that ear. The surgery cuts off any prior hearing that existed. There is a healing period before the next stage. The healing period could be a month to six weeks or more.

The second stage includes connecting the external parts which includes a microphone, a speech processor, and a transmitter. The microphone looks like a behind-the ear hearing aid. It picks up sounds and sends them to the speech processor.

The speech processor is a computer that analyzes the sound signals, and sends them to a transmitter worn on the head behind the ear. The speech processor takes the signals and codes the sounds electrically. The signals are sent to electrodes, and they are transmitted across the skin via radio waves to the implanted device. The electrical signals stimulate the auditory nerve, and then the brain is able to interpret the sounds. It is the brain that must do the interpretation. The normal ears are the microphones for hearing. In the case of the damaged ear, the implant attempts to bypass the nerve endings that no longer work. Cochlear implants have improved the communication skills of clients who have lost the ability to hear.

Naturally, there are risks involved. Surgery could lead to infection and there is no guarantee how effective the implant will be. Also, once the surgery is performed, any partial hearing in that ear is destroyed. The patient needs to know this in advance. The process is time consuming, costly, and there is no way of knowing in advance the total results. On the positive side, many successful implants have been done, and the benefits to children allow them to lead a more normal life in school and among their friends.

Most insurance companies will help pay for all or part of the cochlear implant surgery including the mapping. During this period the audiologist tries to work with the patient to see what external connections work best for hearing. In essence they need to map out a plan for the most effective connections. This mapping period is costly and it involves a series of appointments to discover the best results. The total cost of the implant varies based on where the surgery is done. It is much more expensive than a hearing aid, and the total cost which includes the rehabilitation could include from $80,000 to $100,000 (as of 2008). Insurance may cover most of the surgery, but the mapping period required later for connecting the implant is not covered. It is time consuming and expensive.

Cochlear implant research is ongoing. Presently there are several companies in the United States that produce the product, and one or two in Europe as well. Generally the longer a person has been deaf, the slower the progress. Children as young as 12 months can receive the implant, These children usually do well, and are able to enter special educational programs that foster their hearing development.

Implant surgery does require both research and commitment. There still are problems that need to be addressed. For example, Advanced Bionics, a United States company that produces the equipment, just announced that they have a reimbursement program for vaccination for bacterial meningitis. This program just recently came into effect, and they are hoping to remove any potential problems that could result. New research is ongoing, and each manufacturer will provide information and videotapes in advance to patients in advance. It makes sense to contact them to learn your options.

Research has shown that cochlear implants can help many people. Today there are support groups of implant users and their families. These groups are growing, and by sharing information they act as a support system for each other. If you are considering getting an implant, it is possible to go to some of the meetings before you make your final decision.

Like any subject getting an education before you make your plans does make sense. So far it does appear that children who have the implant are more apt to be mainstreamed in schools, and as a result they have a more normal social adjustment as well.

This new device could be called the bionic ear ,since it has had a major impact on hearing problems for humans. Time and research are needed to discover what will work best for the patient. Each case is different, and one must carefully evaluate the risks and rewards to make an intelligent decision.