Cochlear Implants for AdultsDespite increased media coverage and more implant users in Australia every year, there are still many misconceptions about cochlear implants. One of the most surprising incorrect assumptions is that cochlear implants are only for children. Brisbane Audiologist Karen Pedley busts the myths about cochlear implants for adults.

Over half of all cochlear implants (CI) supplied around the world are fitted for adults. And while countries with good funding are experiencing the biggest growth in people over 70 years of age, the sad fact is less than 5% of eligible adults have a CI.

Many Australian recipients are working adults who were struggling to do their jobs as their hearing deteriorated. In most cases, they successfully return to the workforce after their CI. And by their first assessment, they report:

  • increased confidence in social situations
  • less repetition at home, and
  • hearing more speech on TV than with hearing aids.

They also find they hear ‘new’ alerting sounds; such as the phone, car indicators, or the microwave oven beep. They also really enjoy the soft sounds such as birds that they had previously missed. Why is it then, with so many benefits to a CI, we aren’t seeing more Australian adults taking advantage of this life-changing technology?

Here are 10 myths about cochlear implants for adults based on lack of information, out of date information or just misunderstanding – BUSTED!

1. Years ago I was told my hearing wasn’t bad enough

Twenty years ago, eligible CI candidates had to have profound hearing loss (worse than 90dBHL) at all major speech frequencies, in both ears. This, of course, reflected the CI technology of the day.

With constant advancements in technology people with greater levels of remaining hearing can now benefit from a CI. They can also expect improvement over performance with traditional amplification.

These days a typical CI candidate has moderate or poorer hearing loss in the lower pitches sloping to severe-profound in the higher tones. Some hearing aid users find amplification ineffective. Their high tone hearing is almost ‘off the scale’ and can’t be reached by even powerful amplification. This is sometimes called a “ski slope” hearing loss. They may have had too much hearing in the lower tones to qualify for a CI. But hope comes in the form of the ‘hybrid’ CI systems.

These systems combine sound from a hearing aid and a cochlear implant in the same ear; increasing the chance of preserving hearing.

If you have a mild-moderate hearing loss in the lower tones, but a profound hearing loss in the mid to high tones, a hybrid cochlear implant enables amplification of the lower tones with the hearing aid, while the CI component enables the high frequencies to be heard. In short, the CI eligibility criteria updates reflect constantly improving technology and outcomes. What was true yesterday may no longer be relevant next year. Keep asking.

2. It looks too complicated to manage

Most hearing aid users are familiar with placing a device over their ear. The extra step of sliding a transmitting coil over the magnet at the implant site is not difficult. Most people are comfortable with the process within a week. In addition, manufacturers have moved to an ‘auto–on’ system. This means the device switches itself on as soon as a functional battery is attached.

Sound management has also become more automated making it even easier. Still not sure? Ask your Audiologist if you can try the switches and battery changes of the different systems. This may help you choose a device you can manage; especially if you have arthritis or loss of sensation in your fingertips.

3. I’m too old

Cochlear Implants for Adults

In 2010, at ninety-nine years young, US citizen Hedwig Christoph was the oldest recorded recipient of a CI. (pictured with Otologist Jed A. Kwartler, MD)

Cochlear implants for adults have been increasing with many receiving their first CI in their 70’s, 80’s and 90’s. This has enabled robust statistical analysis revealing that elderly recipients are at no greater risk of medical problems during surgery. They are able to manage the device, report significant improvement in quality of life and have outcomes equal to younger recipients for hearing in quiet situations.

There is still some debate about whether older recipients have more difficulty hearing in noise with a CI than younger users. Some researchers report no difference and some suggest older recipients should be counselled to expect only moderate improvement for hearing in noisy conditions.

Increasingly CI clinics work with psychologists to assess cognitive functions; such as memory, new learning ability and problem-solving as part of the preparation for implantation. The results help the implant team create an appropriate support program. They can also adjust the management and training to avoid compromising progress.

4. Loud noise is unbearable with my hearing aid – I can’t cope with more sound!

In many cases, the uncomfortable loudness experienced with hearing aids is the result of cochlear damage. Because a CI bypasses the cochlea, sending the signal straight to the hearing nerve, the CI may in fact be more comfortable with loud sounds. Many recipients report previously unbearable sounds more acceptable with their CI than with their hearing aid.

5. Hearing aid programs are complicated I’m not sure I’ll cope with a CI and remote

CI processors have a variety of in-built technology to keep the level of sound comfortable and to automatically reduce noise. Like some hearing aids, new CI processors have ‘scene classifiers’. These monitor your listening environment and automatically select the best microphone directional pattern (focused or hearing all around), and noise reduction technology. This is all achieved in one program. While the remote control is handy for troubleshooting it is not essential for everyday use.

6. I’ve read cochlear implants cost $30,000

Most Australian states have both public and private cochlear implant centres. There may be a wait to access a CI free of charge in the public system. So, it’s a good idea to ask your GP for a referral as soon as you think your communication needs are not being met by your well fitted, recently reviewed hearing aids.

If you have private health cover and have been in top hospital cover for at least a year, your fund is likely to cover the cost of the implant system itself and contribute to hospital, surgeon and anaesthetist costs. While there may be out of pocket expenses in a private clinic, the cost is generally less than a pair of premium digital hearing aids.

7. A CI would be more expensive to run and maintain than my hearing aid

Current CI systems come with a battery charger and 3 rechargeable batteries as well as a disposable battery holder for when mains power is not available. Each rechargeable cell lasts about a year before needing replacement. Kits also come with some spare parts, so most recipients don’t need to start purchasing replacement components until the third or fourth-year post-implant. Manufacturers supply an electronic drying box with the implant kit to reduce corrosion from moisture and hence repair costs.

Like any device worn on the head, most cochlear processors need a service during the warranty period. This is free of charge if the device is under warranty. While being serviced you are usually supplied with a ‘loaner’ speech processor.

Your implant team will teach you how to maintain your device, make suggestions to reduce kinking in your coil cable, optimise battery life and protect the processor from harmful chemicals to reduce wear and tear. Adults eligible for a government Office of Hearing Services voucher receive essential replacement parts supplied for their CI, as well as repairs, at no cost.

8. I’m worried I’ll have to keep having surgery to update the CI

A cochlear implant involved two components: the internal (implant) part and an external speech processor. The implanted part should last a lifetime and is unlikely to ever need replacing.

This doesn’t mean you miss out on technology advancements for improved hearing, however. The manufacturers have developed these internal parts to be compatible with advancing external speech processor technology.

External speech processors generally last between five to ten years. Replacement of these involves only fitting and programming appointments with your audiologist. Check with your health insurance company about whether they will cover the cost of upgrades.

9. I can still hear when I really concentrate. Do I need a CI?

As hearing deteriorates, hearing aid users tend to employ a variety of tactics to compensate for the loss of information through hearing. For example

  • watching faces more,
  • trying to anticipate what will be said,
  • talking all the time to avoid having to listen,
  • going off to do the washing up or other activity to avoid struggling to follow visitors’ conversation,
  • making excuses not to go out,
  • nodding and saying “yes”, even when they haven’t understood, to avoid asking for yet another repeat.

This can become a way of life and many recipients say that they didn’t realise how much effort they were putting into everyday listening until they had a CI. The effort had become habitual.

If, when using hearing aids, you answer yes to 3 or more of the statements below it may be time to talk to your hearing professional about a CI assessment:

Cochlear Implants for Adults check boxMy family have to repeat the sentence when talking to me more than half of the time.

Cochlear Implants for Adults check boxI tend to avoid answering the phone, it’s become too hard to work out who the caller is.

check boxI really can’t follow group conversation anymore and just sit there and let the others talk.

Cochlear Implants for Adults check boxMy family are always telling me I talk too loudly, especially when we are out.

Cochlear Implants for Adults check boxWhen watching TV, I miss a lot of the plot. I have to ask family members what’s happening.

check boxI rarely hear my phone ring, and I can’t hear the microwave beep or car indicators with hearing aids on

10. It looks like a lot of effort, especially after the implant. I don’t know that I’d have the time.

Two to four weeks after surgery you will have your speech processor switch-on appointment. This is when your brain takes over; learning to match up the new sounds with its stored memories of how sounds used to be. If you lost hearing as a child your brain may need to make new pathways.

If you’re receiving a CI after a recent hearing loss, this process can occur very quickly. You could be talking with greater ease with the family within the first week or two. The more speech you hear, the quicker your brain learns and the less artificial (robotic or high pitched) and more natural the sound becomes.

You can help this process along by making lots of opportunities for conversation, trying to listen without looking for some of the time, and with listening practice at home. This practice also helps the family to learn the best way to communicate with you. Even 30 minutes a day, 5 days a week in the first month can increase confidence with the device and improve speech understanding.

If you don’t have a listening practice partner at home your implant audiologist can explain ways to make listening opportunities in your everyday life to enhance your progress.

Cochlear implants have changed the quality of life of many hearing-impaired adults and their families for the better. They are effective, accessible and increasingly easy to use. If your hearing aids no longer provide functional daily communication, talk with your family doctor about a referral to your local cochlear implant centre.

This article on Cochlear Implants for Adults originally appeared in Hearing HQ August 2014 edition.