A cochlear implant is an assistive hearing device that converts sound waves in a person’s environment into electrical impulses that stimulate the auditory (hearing) nerve, essentially bypassing damaged parts of the ear. While hearing aids make sounds louder, they still need sensory cells in the inner ear to receive and send the sounds to the nerve. A cochlear implant bypasses these cells to stimulate the nerve directly, which can improve clarity of speech.
Cochlear implant surgery is typically performed in a hospital. While the patient is under general anesthesia, the surgeon makes a small incision behind the ear and places the implant inside. The implant includes an electrode array, which is placed inside the cochlea, a shell-shaped bone in the inner ear that transmits sound information to the brain. The surgeon then closes the incision. The procedure typically takes less than two hours, and the patient can typically return home afterward on the same day, according to Oliver Adunka, M.D., professor of otolaryngology at the Ohio State University Wexner Medical Center and president of the American Cochlear Implant Alliance.
Types of Cochlear Implants
Three manufacturers make cochlear implants in the U.S. that are approved by the Food and Drug Administration (FDA): Cochlear Americas Corporation, Med-El Corporation and Advanced Bionics Corporation. All cochlear implants have the same basic components: an internal implant, an electrode array and an external sound processor, says Dr. Jones.
“They all work, no matter what brand you choose, but the three manufacturers do have a different approach to how they design their implants and what they specialize in,” explains Marquitta Merkison, Au.D., associate director of audiology practices at the American Speech-Language-Hearing Association (ASHA).
Cochlear Americas Corporation is the largest manufacturer of cochlear implants in the U.S. Its internal implant is premade with a curve to hug the natural structure of the cochlea, which can be particularly helpful for patients with anatomical needs in their cochlea, explains Dr. Merkison. The company is also known for setting the trends in external component design as well.
Meanwhile, Mel-El Corporation designs its internal implants to be both long enough to cover the full length of the cochlea and gentle, prioritizing the health of the structures of the inner ear, says Dr. Merkison. It also focuses on the long term and whether the technology is going to be backward and forward compatible for current and future users, she adds.
Lastly, Advanced Bionics Corporation designs its internal implant with a focus on sound quality that’s going to best meet the user’s needs, says Dr. Merkison. While it doesn’t necessarily specialize in an internal part that’s going to be gentle, stiff or rigid, it focuses on maintaining a robust signal once the internal is implanted and meeting the specific needs of its users.
Determining the best cochlear implant for a given individual requires a collaborative conversation between the patient, their surgeon and their audiologist. “If you have anatomical needs, your surgeon might select a certain brand for you,” explains Dr. Merkison. “Or if you have a cochlea that has a lot of ossification, or hardening, your surgeon might select a specific company because they make the type of device that your anatomy requires. More commonly, if there isn’t a surgical preference or anatomical need, the patient can talk to their surgeon and audiologist about whether they have professional experience with all three manufacturers. It’s becoming more common for cochlear implant centers to offer all three to meet the needs of their patients and switch between manufacturers if there’s a need for a specific device.”
“It’s really important—and everyone benefits—when the patient can actually connect with someone from the manufacturers, learn about the companies and connect with people currently implanted with each company to learn about their experiences,” she adds.
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