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It is estimated that nearly 50 million people worldwide suffer from severe hearing loss. The majority of that burden is due to sensorineural hearing loss (SNHL). Current therapies for SNHL include hearing aids for milder hearing loss and cochlear implants as hearing loss advances. While hearing aids function to amplify sound through the traditional auditory pathway, cochlear implants directly stimulate spiral ganglion neurons which can enhance hearing even in patients with advanced hearing loss. Cochlear implants are often considered to be the most successful implanted sensory device in the world having restored hearing to thousands of individuals.
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Pre-operative evaluation involves a detailed hearing assessment to identify the relative benefit of well-fit hearing aids compared to cochlear implants. Insurance coverage is usually provided for patients who have bilateral SNHL that is moderate-severe at low frequencies and profound at high frequencies even when using hearing aids. It is common for the ear with the worse hearing to be selected for implantation first, thereby allowing the patient to retain the hearing aid in the contralateral ear.
Cochlear Implantation Podcasts
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Dr. Joe Walter Kutz talks with Dr. Jed Grisel about practice patterns treating patients with hearing loss, as well as the correlation between hearing loss and cognitive decline, and how best to screen these patients.
The classic surgical approach is a facial recess/posterior tympanotomy approach which is used in both pediatric and adult patients. Such an approach allows for a relatively direct route to the round window membrane through which the cochlear implant electrode is inserted. Alternative approaches are often reserved for patients with unique anatomic considerations that necessitate deviation from the facial recess approach.
Cochlear Implantation Articles
Read our exclusive BackTable ENT Articles for quick insights on cochlear implantation, provided by physicians for physicians.
Cochlear implant risks include infections of the middle ear, injury to the dura causing CSF leaks, and facial nerve injury. Certain cochlear implant precautions can be taken to ensure that these risks and complications are minimized.
There are many considerations to keep in mind when screening pediatric cochlear implant candidates. Certain diagnostic testing can help aid in management with special importance given to pediatric cochlear implant mapping.
Dr. Jacob Hunter provides his insights on cochlear implant surgery in adults, potential cochlear implant side effects, and special considerations for elderly populations.
Indications for cochlear implantation are typically bilateral severe-to-profound sensorineural hearing loss with little to no benefit from appropriately fit hearing aids. The journey of implantation has many steps and requires proper screening and evaluation.
The cochlear implant itself is typically not activated until 2-4 weeks following the procedure. The decision to undergo implantation in a second ear is often dictated by patient response to the first implant. Cochlear implant surgery is relatively low-risk and is often performed as an outpatient surgical procedure. Complications can include infection, hematoma, surgical site pain, and facial nerve paralysis. Additionally, nearly half of patients who undergo CI lose their pre-operative residual hearing ability, known as acoustic hearing, and become reliant on electrical stimulation. However, new technologies are being developed to mitigate this loss.
 Naples JG, Ruckenstein MJ. Cochlear Implant. Otolaryngol Clin North Am. 2020 Feb;53(1):87-102. doi: 10.1016/j.otc.2019.09.004. Epub 2019 Oct 31. PMID: 31677740.
 Carlson ML. Cochlear Implantation in Adults. N Engl J Med. 2020 Apr 16;382(16):1531-1542. doi: 10.1056/NEJMra1904407. PMID: 32294347.
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