Cochlear Implants and Implantable Hearing Devices

Both pediatric and adult patients may present with hearing loss of various types and degrees of severity. Typically, hearing loss is treated through amplification (making sound louder) via hearing aids in one or both ears. However, some patients may have hearing loss that is too severe to be helped by amplification alone. In these cases, a cochlear implant may be indicated.

Cochlear Implant (CI) technology has been around for roughly 50 years. Over the past 20 years, our knowledge regarding cochlear implants has grown tremendously and we as a society have witnessed tremendous advances in both the computing, software, and biomaterials used in these devices. At the time of this writing, it is estimated that over 1 million patients have been implanted worldwide in one or both ears. Based on the outcomes witnessed thus far, CI is widely considered to be the most successful bio-prosthetic device ever created. Currently, three device manufacturers have FDA clearance to sell CIs in the United States; Cochlear Corporation, Advanced Bionics, and Med El.

In adults, a CI is typically indicated in cases where both ears have a degree of hearing loss that is no-longer adequately treated through hearing aids alone. The hearing loss does not need to be equal in both ears; oftentimes one ear hears worse than the other. Patients also do not need to be fully deaf to be considered for CI. The first step in determining whether you may be a candidate for CI is to speak with your hearing health provider. This may be an audiologist, hearing aid expert, primary care physician, or otolaryngologist. Many patients also discover CI through members of their community including friends, family, and neighbors. If it is felt you may be a candidate for CI, you may be referred to our Neurotologic Surgeons (Dr. Stevens and Dr. Whitaker) for a consultation. In some circumstances, patients may also seek consultation independent of a referral.

Cochlear Implants now come in two varieties. For patients with severe hearing loss in both ears, an ‘electrical only’ cochlear implant is used, typically in the worst hearing ear. These ‘traditional’ CIs are the most established technology in the field and allow the inner ear nerves to be reactivated. This leads to tremendous improvements in the hearing of speech, sound, and the environment. Other patients may present with a special ‘ski slope’ pattern of hearing loss (relatively normal hearing in low frequencies, deafness in higher frequencies). These patients may be candidates for a cutting edge version of CI dubbed ‘hybrid’. This device allows for simultaneous electrical reactivation of the cochlea AND acoustic hearing amplification (via hearing aid) in the same ear. Now formally approved by the FDA, hybrid devices have greatly expanded the number of patients who may be a candidate for CI. In patients who meet candidacy criteria, hybrid CI allows for improved appreciation of rich and complex sounds including melodies, pitch range, music, and hearing speech in noisy settings. Both of our surgeons are trained and certified to perform hybrid implantations. These devices are only approved for adults.

Based on recent advances, CI technology can also be coupled to hearing aid technology via wireless connections. This breakthrough, dubbed ‘bi-modal’ hearing, has been shown to significantly improve hearing performance over CI or hearing aid use alone. Both CI and hearing aid technology can also use this wireless link to connect with various smart devices and public media. This includes the ability to transmit phone calls and music through your device, connect to your TV or sound system, link in to conferences, selectively amplify a speaker or teacher’s voice, and/or locate a missing device through GPS. If you have a CI, or are considering pursuing one, our team at AEI are happy to help educate you and help you obtain this new technology.

CI for infants and children with congenital (genetic, inherited, or infectious) hearing loss is approached differently than in adults. The path to a CI is often times begun at the time of early hearing screening. If serious hearing losses are detected or suspected, efforts will be initiated immediately to get the infant/child hearing aids and hearing health support. This process is supported through government mandates and exists due to the extreme importance of hearing health in young children as they develop language and communication skills. The window for this process is short, and hearing health concerns should ideally be addressed no later than age 2-3 years. Most interventions occur even earlier, between 12-24 months.

Similar to adults, some children will be unable to derive enough benefit from hearing aids alone. In such cases, a CI in one or both ears may be indicated. Other children may have hearing loss associated with syndromic disorders that affect multiple body systems. In these complex cases, the child will be cared for through a large, multi-disciplinary team of specialists. This may include various surgeons, medical doctors, cardiologists, speech-language pathologists, audiologists, therapists, and social workers. Our team at AEI is allied closely with specialists at both Phoenix Childrens Hospital and CRS to meet the unique needs of these children.

If you (or your child) have reached the point where you are struggling with hearing despite using hearing aids, or if you cannot derive benefit from hearing aids, the journey to obtaining a CI will begin with specialized hearing testing at AEI. We are proud to deliver the largest CI team in the state of Arizona, comprised of two Neurotologic surgeons (Dr. Whitaker and Dr. Stevens) and three CI-certified audiologist (Dr. Thompson, Dr. Casillo, and Dr. Schultz). As patients embark upon their journey to CI, each individual will be managed at AEI in a unique and patient-centered fashion. Our surgeons will select devices and tailor surgical approaches specifically to meet your hearing needs, anatomy, and medically history. Our audiologists will also establish a deep relationship with you designed to facilitate highly unique programming and maximization of your hearing health. It is our pleasure to serve the state of Arizona and the region with the pinnacle of hearing health technology, excellence in patient care, and the conduct of timely clinical research to further this exciting field.