Cochlear Implant for Deafness, Hearing Loss

A cochlear implant is a surgically implanted electronic device that improves hearing and speech understanding for people with significant sensorineural hearing loss in one or both ears. Cochlear implants work very differently from hearing aids.

Hearing aids amplify sound and rely on the ear’s normal hearing system to process those sounds. As hearing loss progresses and the inner-ear hair cells become more damaged, hearing aids provide less benefit. Many people reach a point where they can hear sounds with hearing aids but cannot understand speech clearly.

A cochlear implant bypasses the damaged hair cells in the inner ear and sends sound signals directly to the hearing nerve. When hearing aids are no longer providing enough help, a cochlear implant may be an excellent option.

Although cochlear implants do not “restore” normal hearing, they significantly improve access to sound and the ability to understand speech. For many people, this leads to better communication, renewed social engagement and improved quality of life.

How a Cochlear Implant Works

All cochlear implants have two parts. The internal part (receiver and electrodes) is implanted during surgery, and an external part (sound processor) is worn on the head, similar to a hearing aid.

Together, these parts work to convert sound into electrical signals the brain can understand. Here’s the process, step by step:

• The microphone on the sound processor picks up sounds from the environment.
• The sound processor analyzes and converts these sounds into a digital signal.
• The signal is sent to the transmitter, which sits on the head and attaches magnetically.
• The transmitter sends both the signal and power through the skin to the internal receiver.
• The internal receiver delivers the signal to the electrode array implanted in the inner ear (cochlea).
• The electrodes stimulate the hearing nerve with small pulses of electricity.
• The hearing nerve carries these signals to the brain.
• The brain interprets the signals as sound, such as speech, music, safety signals or environmental sounds.

This technology allows people with significant hearing loss to access sound in a new way and regain meaningful communication.

Who Should Consider a Cochlear Implant

As cochlear implant technology has improved and patient benefits have increased, cochlear implant candidacy has expanded. You do not need to be “deaf” in both ears to get a cochlear implant. In fact, there is evidence to support earlier treatment with cochlear implants – before hearing loss progresses to a profound degree. No one is too old for a cochlear implant, either. Patients can get meaningful improvements in hearing and speech understanding at any age.

You may want to consider a cochlear implant if any of the following apply to you:

• Rely on lipreading to help with communication
• Have hearing loss that makes communication with others difficult
• Ask people to repeat often
• Have a hard time using the phone
• Are dependent on closed captioning when watching TV
• Feel your hearing aids are not helping
• Feel your hearing loss is keeping you from doing the things you want to do or withdrawing socially

Cochlear Implant Process

We strive to coordinate appointments efficiently to reduce the number of clinic visits. Some evaluation steps may be completed via telehealth, if preferred.

Cochlear Implant Evaluation (Before Surgery)

We perform a comprehensive evaluation to ensure that a cochlear implant is the right choice for you. Your evaluation typically includes the following steps:

• Audiology evaluation (about 3 hours): You will undergo a full hearing test and speech-understanding testing with your hearing aids. This allows your audiologist to determine whether you meet candidacy criteria. During this visit, the audiologist will also review how cochlear implants work and answer any questions you may have.
• CT scan (about 30 minutes): A CT scan provides detailed images of your inner ear (cochlea) and other hearing structures, helping the surgeon plan the procedure.
• Medical evaluation (about 30 minutes): You will meet with the surgeon who will perform your cochlear implant surgery. Your surgeon will review your audiology results and CT scan, discuss the surgery and recovery and explain potential risks.
• Device selection appointment (about 90 minutes): An audiologist will review the cochlear implant manufacturers and technology options with you. Together, you will decide which device best meets your needs.
• Scheduling surgery: Once all evaluation steps are complete and you decide to proceed, our team will contact you – typically within 1–2 weeks after your surgical consultation – to schedule your surgery.
• Preoperative medical clearance appointment (about 30 minutes): This visit occurs within 30 days of surgery to ensure you are medically ready for the procedure. At this appointment, you will also receive the Centers for Disease Control (CDC)-recommended pneumonia vaccine due to a very small increased risk of meningitis after cochlear implant surgery.

Cochlear Implant Surgery

Cochlear implant surgery is typically an outpatient (ambulatory) procedure, meaning you can go home the same day. You will receive general anesthesia, and the surgery usually takes about two hours for each implant.

Here is what happens during the procedure:

• An incision is made behind the ear, about 5 cm in length.
• The surgeon drills a pathway through the mastoid bone (the bone behind the ear) to access the hearing organ, the cochlea.
• The internal receiver is placed on the skull bone under the skin and muscle, just above and behind the outer ear.
• A small opening is made in the cochlea, and the electrode array is gently inserted. Our surgeons use a “soft” surgical technique designed to minimize disruption to the delicate inner-ear structures.
• The implant is tested to confirm that it is functioning properly and positioned correctly.
• The incision is closed using dissolvable stitches, and a temporary bandage (a head wrap) is placed over the surgical area.

Because general anesthesia is used, you will need someone to drive you home after the procedure.

Recovering From Surgery

Patients typically have a smooth recovery following cochlear implant surgery. Here’s what to expect:

• Go home the same day: Cochlear implant surgery is usually outpatient. You will need a responsible adult to drive you home and stay with you for 24 hours.
• Expect some swelling, bruising and numbness around the ear and incision. This is normal and improves with time. Numbness may linger for several months.
• Pain is usually mild to moderate and most often managed with Tylenol or Ibuprofen (if allowed). Narcotic medication, if prescribed, is usually needed only for a few days.
• Keep the incision clean and dry: You may gently wash your hair after 48 hours but avoid scrubbing or soaking the incision. Use a Vaseline-coated cotton ball in the ear bowl to keep water out.
• Do not use antibiotic ointments like Neosporin or Bacitracin on the incision unless instructed. This can cause a rash. Instead, use unmedicated white petroleum jelly (e.g., Vaseline).
• Some dizziness, ear fullness, popping or noise sensations (such as crackling or pulsing) are common and usually improve within days to a few weeks. This should not be a cause for concern.
• Taste changes or a metallic taste may occur temporarily and usually resolve on their own.
• Avoid heavy lifting, strenuous activity and contact sports for about 4 weeks. Light walking is strongly encouraged as soon as you feel able.

As with all surgeries, there are some risks that come with having cochlear implant surgery. These are rare but can include:

• Infection at the incision site
• Dizziness and/or balance problems
• Change in taste (temporary or permanent)
• New or worse tinnitus (ringing, buzzing or other sounds in the ears)
• Pain and/or numbness
• Loss of residual hearing in the ear that is implanted. This means that you may not have hearing in the implant ear after surgery (when not using the sound processor).
• Facial weakness (temporary or permanent)
• Cerebrospinal fluid (CSF) leakage

Cochlear Implant Activation: Turning on the Cochlear Implant

You will see your audiologist about 7 to 10 days after surgery to turn your cochlear implant on. At this appointment, your audiologist will:

• Fit the sound processor (outer part of your implant) including adjusting the magnet strength to be appropriate for you.
• Complete initial programming. The audiologist will play sounds (like beeps) through your cochlear implant and ask you to rate the loudness.
• Make sure the sounds you are hearing are at a comfortable volume so you can wear your implant during all of your waking hours.
• Go over how to use and take care of your sound processor.

You will also be seen by a member of the medical team for your postoperative check to make sure you are healing well.

Cochlear Implant Follow-Up

Because the cochlear implant is a new way of hearing, it takes your brain time to adjust over the weeks and months following surgery. Adjustments to the programming (settings) of your cochlear implant are also important to ensure you have good access to sound and to help improve sound quality and speech understanding. Our current cochlear implant follow-up schedule is:

• 2-week post-activation (90 minutes)
• 1-month post-activation (90 minutes)
• 6-month post-activation (90 minutes)
• 1-year post-activation (90 minutes)
• 2-year post-activation (90 minutes)
• Regular follow-up every 1 to 3 years (90 minutes)

At these appointments, you may have some testing in the sound booth to see how you are detecting sounds with your cochlear implant and how well you are understanding speech. Programming adjustments may be made based on testing results as well as your report about the loudness and quality of the sound.

Cochlear Implant Rehabilitation

Hearing with the cochlear implant is different from normal hearing. When the cochlear implant is first turned on, it will not sound natural. The implant may just sound like noise, or it may sound like speech, but it may not be clear. Patients report that the implant can sound mechanical, robotic or cartoon-like. With time and programming adjustments, the sound quality and clarity will improve.

Most patients have significant improvements in speech understanding and communication from their cochlear implant. The benefit from the cochlear implant cannot be predicted and vary from person to person. There are things you can do to help ensure you are getting the most benefit from your implant possible:

• Consistent use: We recommend you wear your implant for all your waking hours. We want you to wear your implant for a minimum of 8 to 10 hours per day with the goal of 12 or more hours of daily use. When you go to sleep, remove your implant.
• Listening: The more listening you are doing throughout the day, the better your brain will learn and adjust to your cochlear implant.
• Listening therapy: The cochlear implant is replacing your natural hearing. Your brain will adjust best with regular listening practice. Most patients use home listening programs that involve websites, apps and practicing with a communication partner (such as a friend or family member). Your audiologist will walk you through this and provide you with options.

Adjusting to the cochlear implant is a gradual process. We see the biggest improvements in sound quality and speech understanding over the first 6 to 9 months of implant use but can see ongoing improvements out to 1 to 2 years with the implant.

Benefits of Cochlear Implants

Cochlear implants improve hearing and quality of life for many patients. Benefits may include:

• Improved speech understanding
• Enhanced quality of life
• Reduced listening fatigue
• Improved social engagement
• Better awareness of sounds in the environment, which may have positive safety implications
• Improved ability to locate the source of sounds
• Decreased tinnitus, while wearing the sound processor

It is important to remember that even with the cochlear implant, you may still struggle to understand speech in certain environments. Background noise makes understanding more difficult for everyone and will still be challenging, even with a cochlear implant.

Insurance and Costs

Cochlear implants are covered by most insurance companies if you meet their coverage criteria, including Medicare and WI Medicaid. Some insurance companies have stricter criteria to qualify for a cochlear implant.

At your cochlear implant evaluation with your audiologist, we will be able to tell you if you meet cochlear implant candidacy guidelines. Once you are scheduled for surgery, we can submit your insurance for authorization.

We recommend you reach out to your insurance company to make sure you understand your insurance coverage including your deductible, co-insurance and out-of-pocket maximum. This will help you estimate how much you may have to pay.

In addition to surgery, most insurance companies help cover the costs of repairing and/or replacing your external equipment, including the batteries.

Why Our Team?

Our dedicated team of cochlear implant specialists guide and support families through every aspect of the cochlea implant process, from evaluation to surgery to rehabilitation. We are one of the largest cochlear implant centers in the Midwest and currently care for over 1500 cochlear implant patients.

• Teamwork: Our team includes surgeons who specialize in the ear (neurotologists) and audiologists who focus exclusively on cochlear implants. We work as a team to provide the highest possible level of care for our patients.
• Lifetime care: Cochlear implants are a permanent decision. We support our patients through all stages of the cochlear implant experience, from evaluation to surgery, to long-term follow up. We partner with our patients to best meet their hearing and communication needs throughout their lifetime. This includes programming adjustments, updating external equipment as needed and, potentially, deciding to get a second cochlear implant.
• Cutting-edge care: We use the most current techniques for cochlear implant surgery, device technology and programming methods.
• Research: In addition to our emphasis on clinical care, our team has an active research program. Research projects focus on gene therapy to restore hearing, inner ear drug delivery, new implant design, the impact of cochlear implantation on cognitive performance and minimally traumatic surgical techniques to maximize implant performance. We have participated in numerous clinical trials with other major implant centers in the U.S. and internationally, and our research findings have been presented at national and international conferences and published in numerous peer-reviewed journals.

Cochlear Implant Intake Form

If you prefer, you can download a PDF of the intake form and fill it out. You can fax or mail the filled-out form to the number and address below. We do not support e-mailing your form.

Fax: 414-955-0075
Mailing address:
Department of Otolaryngology
Attn: Audiology
9200 W. Wisconsin Ave.
Milwaukee, WI 53226

Medical Release Forms

We will need your medical records so that we have a complete picture of your health history. Additionally, we need to provide your medical information to our cochlear implant manufacturers for your treatment. You can download the two release forms here. Fill in the fields with the red arrows and sign the forms. 

• PHI Disclosure Authorization to Froedtert & MCW Audiology
• PHI Disclosure Authorization to Manufacturers