Cochlear Implants: What They Are and Who Qualifies
When hearing aids no longer give you usable speech, a cochlear implant may. Here is how they work, how candidacy is decided, how they compare with hearing aids, and where Floridians find support before and after surgery.
What is a cochlear implant?
A cochlear implant is a small electronic device that gives a sense of sound to a person who is profoundly deaf or severely hard of hearing. It has an external sound processor worn behind the ear and an internal part placed under the skin during surgery, with an electrode array threaded into the cochlea. Instead of making sounds louder the way a hearing aid does, the implant bypasses the damaged parts of the inner ear and stimulates the hearing nerve directly. The brain learns to interpret those signals as sound.
Hearing through an implant is not the same as natural hearing and it takes work. The NIDCD describes the process as a surgery plus significant therapy to learn or relearn hearing, usually with an audiologist and a speech-language pathologist. Most adults who get implants say the effort was worth it, and outcomes are best when the implant is done soon after hearing aids stop helping.
Sources: NIDCD: Cochlear implants · HLAA: Cochlear implants and other implantable devices
Who qualifies for a cochlear implant?
Children and adults with severe to profound sensorineural hearing loss that hearing aids cannot treat effectively are candidates. The FDA has approved implants for children as young as nine months. Candidacy is decided by a cochlear implant team, usually an otolaryngologist (ENT surgeon) and an implant audiologist, after a hearing test with your best-fitted hearing aids, speech understanding tests, imaging of the inner ear and a medical review. Most candidates struggle to understand speech even with well-fitted hearing aids.
Candidacy rules have loosened over the years, and many people who were told no a decade ago qualify now, including people with usable hearing in one ear. If your audiologist says your hearing aids are maxed out, ask for a referral to an implant center for an evaluation. The evaluation does not commit you to surgery.
In Florida, Medicaid covers cochlear implants for recipients age 12 months and older with documented severe to profound bilateral sensorineural hearing loss, and covers replacement processor components and batteries after the warranty ends. Medicare and most private plans cover implants when medical criteria are met; check your plan.
Sources: NIDCD: Cochlear implants · Florida Medicaid Hearing Services Coverage Policy (PDF)
Cochlear implant vs hearing aid
- How they work: a hearing aid amplifies sound and sends it through the ear the normal way. An implant converts sound to electrical signals and stimulates the hearing nerve directly.
- Who they are for: hearing aids work for mild through profound loss when there are enough working hair cells. Implants are for severe to profound loss when amplification no longer produces clear speech.
- How you get one: hearing aids are fitted in a clinic (or bought OTC for mild to moderate loss). An implant requires an evaluation, outpatient surgery, activation a few weeks later, and months of programming visits and listening practice.
- Sound quality: implant users describe sound as different at first, often mechanical, improving over months as the brain adapts. Music is harder than speech for many users.
- Both: many people use a hearing aid in one ear and an implant in the other (bimodal hearing). Both can include telecoils, Bluetooth streaming and, on newer processors, Auracast.
Neither is better in the abstract. The right choice is the one that gives you the most speech understanding, and only an evaluation with your best-fitted hearing aids can answer that.
Cochlear implant centers in Florida
Florida has cochlear implant programs at academic medical centers, children's hospitals and large ENT practices in most metro areas, including the Jacksonville, Gainesville, Tampa Bay, Orlando, South Florida and Southwest Florida regions. A center should have an implant surgeon, implant audiologists, and access to auditory rehabilitation. Each of the three manufacturers sold in the U.S. (Cochlear, Advanced Bionics and MED-EL) lists clinics that work with its devices on its website, and your audiologist or ENT can refer you.
- Ask how many implants the center does each year and whether it treats your age group.
- Ask which manufacturers the center offers; most offer all three and let you choose.
- Ask about follow-up: how many programming visits are included, whether therapy is available, and how far you will drive.
- Ask whether the center accepts your insurance, Florida Medicaid or Medicare, and what your out-of-pocket cost would be.
Manufacturer sites: Cochlear · Advanced Bionics · MED-EL
Support before and after your implant
Talking with people who already have implants is the single most useful thing you can do before you decide. HLAA-FL chapters include many implant users of all ages, and some chapters host implant-focused discussions. HLAA national's cochlear implant pages explain candidacy and the process in consumer language.
The Cochlear Implant Awareness Foundation (CIAF) connects people with donated cochlear implant equipment and parts; it does not pay for surgery, deductibles or insurance costs. Each manufacturer also runs volunteer mentor and community programs where you can talk with an experienced user of that device, and each has a support line for processor problems, replacement parts and insurance paperwork.
Cochlear Implant Awareness Foundation · HLAA: Cochlear implants · Florida chapters and support groups
Cochlear implant questions
Cochlear implant vs hearing aid: which is better?
Neither is better for everyone. Hearing aids amplify sound and work when the inner ear still responds to amplification. Cochlear implants bypass the damaged inner ear and stimulate the hearing nerve directly, so they help people with severe to profound loss who no longer understand speech well with hearing aids. An implant evaluation with your best-fitted hearing aids decides which gives you more.
Who is a candidate for a cochlear implant?
Adults and children with severe to profound sensorineural hearing loss that hearing aids cannot treat effectively. The FDA has approved implants for children as young as nine months. A cochlear implant team confirms candidacy with hearing and speech tests, imaging and a medical review. Criteria have loosened over the years, so a past no may be a yes today.
Does Florida Medicaid cover cochlear implants?
Yes. Florida Medicaid's Hearing Services Coverage Policy covers cochlear implants for recipients age 12 months and older with documented severe to profound bilateral sensorineural hearing loss, with no copayment. It also covers replacement implant components and batteries after the manufacturer warranty or protection plan ends, and requires the manufacturer to provide a loaner processor during repairs.
How long does it take to hear well with a cochlear implant?
The implant is activated a few weeks after surgery. Speech sounds strange at first, and most people improve steadily over the first six to twelve months with programming visits and daily listening practice. The NIDCD describes it as learning or relearning to hear, usually with help from an audiologist and speech-language pathologist. Progress varies with age, how long you were without hearing, and practice.
Meet Floridians who hear with implants
Ask your questions at a free HLAA-FL chapter meeting. Many members have been through the evaluation, the surgery and the first year.