Cochlear Implants Can Improve Hearing Loss in Older Adults

Cochlear implants vs. hearing aids

Hearing aids, devices worn outside or in the ear, work by making sounds louder. They don’t change how your ears or brain handle sounds. Cochlear implants change your hearing in a more fundamental way.

The key difference, Carlson says, is that a cochlear implant bypasses your inner ear nerve endings, called hair cells, that are damaged or missing in people with hearing loss related to aging, noise exposure, genetics or other factors. Instead, it sends sound information, in the form of electrical impulses, straight to one key nerve, called the cochlear nerve, and on to the brain.

Cochlear implants have a transmitter and other parts that you wear outside your ear, and key parts are placed inside your ear. The outer electronics, which include a microphone and sound processor, can look like many hearing aids, Merkison says. A unit that looks “like an upside-down J,” she says, may go behind your ear (or clip to your clothes, if preferred) and have a cord leading to a transmitter. The microphone, sound processor and transmitter may be combined in one unit.

How cochlear implants work

The receiver is implanted behind your ear, under the skin, to get signals from the transmitter. It’s connected to electrodes placed inside the cochlea, the part of your inner ear that contains hair cells.

The electrodes send signals to the cochlear nerve, which sends them to the brain, which — with time and practice — can turn them into recognizable speech and other sounds.

People typically get one implant at first; sometimes they get a second one later.

Three companies make cochlear implants approved for use in the United States. Models can vary a bit, so patients should discuss options with their care team, Merkison says.

A suggestion from Purnick: Ask your surgeon which implants they use most.

Who can get a cochlear implant? 

“A common misconception is that you need to be totally deaf to get one,” Carlson says. In fact, people with moderate to profound hearing loss may qualify if they have working cochlear nerves.

A cochlear implant evaluation makes sense if you’ve tried good, properly adjusted hearing aids and still “can’t understand people, especially when there’s background noise,” Carlson says.

An evaluation starts with an audiologist, who tests how much sound you hear and how much language you understand with and without properly fit hearing aids, in noisy and quiet environments, Merkison says.

If you’re a candidate, a surgeon will assess whether the surgery is safe for you and likely to help. Age alone isn’t a barrier, Carlson says: “The oldest person I’ve implanted was 99.”

Insurers also have a say. Medicare will pay for cochlear implants for people who have moderate to profound hearing loss in both ears; many private insurers will pay when someone has one-sided loss, Carlson says. Medicare also says cochlear implant recipients must understand no more than 60 percent of spoken sentences – a more liberal stance than in the past, Carlson says, when the bar was 40 percent understanding.

Cochlear implant costs

If you were to pay out of pocket, a cochlear implant would be very expensive – more than $50,000 on average, according to recent estimates. But almost no one pays out pocket, Carlson says, because most insurers cover the implants.

Patients may face copays and deductibles. For example, Medicare says that for a hospital outpatient, the copay for the procedure would likely be capped at $1,676 if they have traditional Medicare with no supplemental insurance. Coverage could be different in Medicare Advantage plans.

Cochlear implant surgery

“Another common misconception is that it’s brain surgery or something highly invasive,” Carlson says. “The procedure itself is very low risk,” he says, and involves a cut of about 5 centimeters (roughly 2 inches) behind the outer ear. That’s for placement of the internal receiver and electrodes.

The surgery usually takes less than two hours and sometimes can be done with local anesthesia, though not every center offers that. Most people go home the same day and manage pain without narcotics, Carlson says.

There’s a 1 to 2 percent chance of infection, he says. Other uncommon side effects include chronic incision pain, facial nerve damage and dizziness. Additionally, Carlson says about 3 percent of devices stop working within 10 years, which could mean a repeat surgery, and for a few people, the devices simply don’t help much or at all.

In the past, cochlear implants almost always destroyed the remaining natural hearing in the implanted ear, Carlson adds, but now surgeons can save some natural hearing about half the time.

Rehabilitation after a cochlear implant 

You might wait two to four weeks after surgery to revisit the audiologist to have your device turned on. But increasingly, centers offer quicker activation, within the first week, Carlson says, with similar success.

Initial success, as Purnick found, doesn’t necessarily mean hearing words, though.

“We just have to get you detecting sound first,” Merkison says. “If you are understanding words in that first session, that’s normal and that’s great. But if you’re understanding words like three weeks later, that’s also normal.” The time it takes to understand some speech varies, she says.

Even after that point, “there’s a lot of follow-up and a lot of work,” Merkinson says. That includes repeat visits with the audiologist to program the device. It also includes “aural rehabilitation” to “help your brain practice what to do with this new signal,” she says. A speech therapist or audiologist will give you exercises that help pair sound with language.

For instance, you might read books aloud or watch video speeches with captions.

You’ll also learn to use your equipment in different situations — to make phone calls, for example. If you want, you can pair it with other devices, like your TV or laptop. Purnick uses Bluetooth on her phone to sync her implant with the hearing aid in her other ear when she talks on the phone or online.

Eventually, you’ll just need to see the audiologist once a year, Merkison says.

What to expect long term 

Cochlear implants don’t restore normal hearing. But on average, adult recipients can understand about 60 percent of spoken words and 75 to 85 percent of sentences after surgery and rehabilitation, Carlson says. 

Implants also can “bring your sound level up to normal, so you can hear a bird chirping or the drip of your faucet,” he says.

“No one can make any guarantees,” Merkison says, but “with consistent use, you’re going to see that your performance is better than what you were doing with your hearing aid.”

Studies suggest that cochlear implants can improve quality of life in older adults by boosting their attention and working memory. Implants may also delay or even improve cognitive decline and dementia in adults with severe profound hearing loss.

But there are trade-offs. For Purnick, that includes sound quality. She says voices still sound “a little mechanical” and music, especially the symphonic music she used to love, is frustratingly “dissonant.”

Those are common but not universal complaints. Device makers are constantly working to improve sound quality, Merkison says. And patients can work with audiologists and speech language pathologists to get the best performance from their devices, she says.

Editor’s note: This story, originally published Jan. 13, 2022, has been updated.