Cochlear implant candidacy

Adults may be a candidate for a cochlear implant if they have:

  • Moderate to profound sensorineural hearing loss in one or both ears
  • Difficulty understanding speech, even with appropriate hearing aids
  • Difficulty with understanding over the telephone in one or both ears

Cochlear implant device

A cochlear implant consists of two parts, an external portion and an internal portion. The speech processor and headpiece make up the external portion of the device. The speech processor is worn behind the ear and looks like a behind-the-ear hearing aid. The headpiece is worn on the scalp. The internal portion consists of the implant and electrode array. The headpiece is held to the implant by magnets on both pieces, and the electrode array is surgically placed in the inner ear (cochlea).

How a cochlear implant works

  • The microphone on the speech processor captures sound and the processor converts the sound to a digital signal.
  • The microphone on the speech processor captures sound and the processor converts the sound to a digital signal.
  • The speech processor sends the digital signal across the skin rto the internal implant.
  • The internal implant converts the signal to electrical energy and transmits that energy to the electrode array in the cochlea.
  • The electrode stimulates nerve cells of the auditory nerve and the brain interprets this stimulation as sound.
  • The cochlear implant user can adjust the loudness of sound with controls on the speech processor. In addition, the user can choose from a number of different individualized listening programs stored in the speech processor.

In the Adult Cochlear Implant Program at Washington University, we implant the Advanced Bionics, Cochlear Americas Nucleus, and Med El implant systems. Information about all available implant systems will be provided during the initial visits.

Factors affecting benefits of a cochlear implant

Length and degree of hearing loss

Adults who have had hearing loss for a short period of time may learn to understand speech with the cochlear implant more quickly and more easily than those who have had severe to profound hearing loss for a long time. Likewise, those still receiving some benefit from their hearing aid(s) at the time of surgery may transition to a cochlear implant more quickly and more completely than those patients who may no longer wear hearing aids. However, every patient is different and we cannot predict how much speech understanding a patient will receive from a cochlear implant. Based on each individual’s hearing history, we will discuss the benefits that an implant can provide.

Status of the cochlea

The presence of cochlear ossification (bone growth in the cochlea) or the presence of unhealthy auditory neural tissue can affect a person’s ability to understand speech with a cochlear implant. A pre-operative CT scan will offer some knowledge about the status of an individual’s inner ear prior to surgery.

Motivation and commitment

Success with a cochlear implant requires consistent use of the device; proper care of the equipment; involvement in a rehabilitation program; and regular follow up appointments for device programming and evaluation of device function.

Insurance coverage

Medicare and many private insurance companies provide coverage for cochlear implantation. Our surgical coordinator works with your insurance provider to determine coverage (this is only necessary for patients with private insurance or Medicare replacement plans).  Even if a cochlear implant is a covered benefit, the patient will be responsible for copayments, deductibles, or out of pocket charges as outlined by their individual insurance policy.

Cochlear implant process

The CI process includes pre-implant visits with the surgeon, implant team and radiology.  Following surgery, patients return to have the device activated and optimized over several weeks, during which device programming and aural rehabilitation occur.

Ongoing care includes routine, periodic evaluations to assess and monitor performance and verify program settings and proper device functioning.

Pre-implant steps

  • Physical exam with the surgeon to determine medical/surgical candidacy
  • CT scan of the inner ear to identify any contraindications to implantation
  • Evaluation with a CI audiologist to:
    1. Determine audiologic candidacy for a cochlear implant, based on speech understanding using appropriately fit hearing aids
    2. Discuss how the implant works and how it can benefit you
    3. Discuss vaccinations and MRI considerations, choice of implant ear, and choosing a device


Cochlear implant surgery takes 2-3 hours and is considered an outpatient procedure.  Two to three weeks after surgery, the patient will return to the clinic for the initial activation. This is the first time the patient will hear sound through the implant.


The goal of our post-implant process is to provide optimal benefit with the cochlear implant through device programming and aural rehabilitation.  Device programming is patient-specific to ensure the best possible sound quality and speech understanding.  The aural rehabilitation component is designed to maximize communication functioning; it is tailored to each patient’s needs and communication goals.      

  • Following the initial activation, the patient returns over several weeks for device programming and aural rehabilitation.  The number of post-op visits is patient-specific and based on patient need
  • Device programming focuses on determining the speech processor settings and options that provide optimal speech understanding in daily life.
  • Rehabilitation focuses on achieving each patient’s communication goals with auditory training, communication strategy training and hearing assistive technology.  Patients also receive exercises and resources for practice at home. 
  • Continuing care includes periodic evaluations 1, 3, 6, and 12 months post-initial activation and annually thereafter.  These evaluations include a CI program check, a hearing aid check (if a hearing aid is worn in the opposite ear), and speech testing to monitor performance and proper functioning of equipment and accessories.

Research and patient care

As new CI technology becomes available, we invite patients to participate in research studies that evaluate their benefit.  Likewise, when important questions arise that affect patient candidacy and outcomes, we research these questions and invite patients to participate in studies that may improve our understanding of how CIs work or improve CI outcomes for recipients.  

Alternative treatments

If it is determined that you are not a candidate for a CI, you may benefit from our aural rehabilitation program. Program highlights include:

  • Training with appropriate communication strategies
  • Consultation on available hearing assistive devices
  • Tips for music appreciation
  • Training on telephone usage
  • Auditory training