You’ve probably seen one of the many videos showing a young child being fitted for a cochlear implant and hearing for the first time. The little one’s smile lights up as he hears what his parent’s voice sounds like…or if she is a bit older, she may cry tears of joy. These moments are touching to watch and life-changing for the patient. But the truth is that for every child with a cochlear implant, dozens more adults could benefit from this technology. Older adults, in particular, stand to make impressive gains not just in their hearing but also in their overall wellness, since physical and mental health are significantly impacted by hearing loss. Cochlear implants are no longer considered a “last resort” to be considered only when hearing aids fail to help. We now know that the sooner potential adult patients are identified—and the more residual hearing they still have when they get the implants—the more successful their hearing will be.
It Is Not Just About Sound
In the US, more than half of people over age 60 and more than two-thirds over age 80 suffer from hearing loss. They may turn the TV volume higher or ask loved ones to speak up or repeat themselves. But missing out on the sounds of life has far-reaching implications beyond these. The third most common chronic health condition among older adults, hearing loss is linked to…
Cognitive decline. Hearing loss is one of the most modifiable risk factors for cognitive decline in middle age. A 2020 study in The Lancet found that mild hearing loss doubles the risk for dementia…moderate hearing loss triples it. It may be that hearing loss causes the brain to atrophy faster than usual…or it may be because people who struggle to hear withdraw from loved ones, and social isolation is a risk factor for dementia.
Increased fall risk. Hearing impairment compromises your awareness of your surroundings and forces the brain to spend so much energy on hearing and speech interpretation that it has fewer resources to spend on balance, per the American Speech-Language-Hearing Association.
Longer hospital stays…higher hospital readmission rates—hearing loss compromises a person’s ability to understand the health-care provider’s instructions.
Hearing aids—small electronic devices that amplify sound—have long been the most common solution for mild-to-moderate hearing loss. But despite their widespread availability (boosted by the FDA’s recent move to allow hearing aids to be sold over the counter), fewer than 20% of adults with hearing loss report using them. There also often comes a point when aids lose effectiveness because even though sounds may be louder, they’re no longer clear due to evolving hearing loss. When hearing aids are no longer enough, cochlear implants may be the right option to make sounds understandable.
Utilization rates for cochlear implants are even lower than those for hearing aids—somewhere between 3% and 12% of people who could benefit from them actually use them. The number of cochlear implant–eligible adults over age 60 is predicted to double by 2060, to nearly four million.
But cochlear implants face significant challenges, including misconceptions about who they can help…lack of awareness by providers…patients’ fear (mistakenly) that the procedure is overly invasive…and more.
How They Work
Hearing aids work by making sounds louder as they pass through the inner ear. Cochlear implants bypass the inner ear altogether and electrically stimulate the auditory nerve, sending signals to the brain that are interpreted as speech or sound. There are two main components in cochlear implants…
Internal processor: This surgically implanted component includes electrodes inserted in the cochlea (the hollow bone in the inner ear) and electronic components implanted behind the ear, along with a magnet.
External processor: There are two styles of external processor. One has a sound processor that sits behind the ear, like a hearing aid. It contains a microphone (to detect sound) and attaches via a wire to a coil that sticks to the magnet implanted under the skin. In the “off the ear” style, all the components are in one unit that attaches to the magnet.
The implant surgery typically is an hour-and-a-half-long outpatient procedure usually done under general anesthesia. The surgeon makes a small c-shaped incision behind the ear and then drills into the mastoid bone to access the cochlea, where the implant electrodes are inserted. Then the surgeon places the implant under the skin behind the ear and closes the incision.
You will heal for two to four weeks before an audiologist turns the devices on. At first, sounds will seem a bit foreign. Patients often describe speech as sounding mechanical and high-pitched. It takes time to learn to interpret the signals—how long depends on how severe the hearing loss has been. Nearly everyone hears more on the first day than they could with hearing aids, and better speech understanding usually can be measured in the first month. Within a few months, hearing with the cochlear implant will become your new normal. You’ll meet with your audiologist several times to facilitate the process, and auditory therapy or at-home listening exercises speed progress. Depending on the starting hearing level, how long the hearing loss has been severe and the cause of the hearing loss, progressing from a hearing aid to a cochlear implant may double a person’s speech understanding and significantly improve his/her ability to hear in noisy environments.
The health benefits are notable, too. In a French study in JAMA Otolaryngology–Head & Neck Surgery, hearing-loss patients between ages 65 and 85 were evaluated before getting a cochlear implant…six months after…and again at 12 months. Before implantation, 44% of the patients were experiencing cognitive issues that affected attention span, mental processing speed, executive functioning and more. The majority of those patients showed improvements in cognition after one year with an implant.
More People Are Candidates
In September 2022, Medicare expanded coverage for cochlear implants, paving the way for millions more Americans to improve their hearing. Medicare used to require less than 40% sentence recognition when using hearing aids in order to qualify for implant coverage. Now Medicare requires less than or equal to 60% sentence recognition when using hearing aids to qualify for implant coverage. The updated rule is particularly advantageous considering that this technology shines when a patient gets an implant early in his hearing loss trajectory.
Implants are FDA-approved for those with hearing loss in one or both ears. Some people receive an implant on the side with more significant loss but continue using a hearing aid on the other—this is called bimodal hearing. For others, a cochlear implant with amplification (like what a hearing aid provides) in each ear is prescribed. In nearly all cases, hearing is best when both ears are stimulated effectively. The hearing implant team, including the implant surgeon and programming audiologist, will recommend the combination of devices that will provide the best hearing in each ear.