No, the goal of using a cochlear implant is to allow better speech understanding than what a hearing aid would provide. But there are functional limitations that sometimes still make speech difficult to understand. For example, one of the parts of the cochlear implant is a microphone that goes behind the ear that picks up sound in the same way an actual hearing aid would work. This microphone is not smart enough to know what is background noise versus speech. And in situations where there is distance between speaker and listener or a lot of background noise, the quality of the sound is not always clear enough to understand.

The cochlear implant has two main parts. There are the implanted electrodes that go into the inner ear. The other part looks a lot like a hearing aid and goes behind the ear. Both parts are necessary for the cochlear implant to work.

It may depend on the cochlear implant device. In general, FDA approval is between nine and twelve months.

The first step is to make an appointment with a cochlear implant team. They will perform a hearing test to see how much hearing loss your child has. Then they will administer other tests to see how well your child can hear through a hearing aid. Those results will be compared to performance levels that would be expected with a cochlear implant. The second step is often an MRI or a CAT scan to look at the formation of the inner ear and to identify the hearing nerve and also the facial nerve. The surgeon wants to make sure there are no surprises in the middle of placing the implant electrodes into the inner ear.

Hearing aids are selected first and programmed for the degree of hearing loss. Then intervention begins by teaching the child how to hear. As long as the child continues to make progress in using sound information to listen, associate sounds with different objects (e.g., birds, traffic, particular toys, etc.), and begin to show speech understanding, listening through a hearing aid will often continue. But if your child stops showing progress in developing listening and language skills with the hearing aid, then it is time to consider a cochlear implant.

Cochlear implants can be considered earlier if the hearing loss was caused by some types of meningitis, and your doctor can see evidence of new bone growth in the inner ear, the hearing aid trial can be eliminated in favor of putting a cochlear implant into the inner ear more quickly. The reason for this is two-fold. First, if new bone develops in the inner ear, hearing will not recover. Second, if the doctor waits for an extended period of time and new bone fills the cochlea, it is very difficult to place the cochlear implant electrodes in the inner ear space.

It is a joint decision between you and the surgeon (ear specialist) taking into account the hearing test results, what the MRI or CAT scan showed, and after explaining the surgical procedure, the risks, and the expected benefits of a cochlear implant compared to using a hearing aid.

In the early days of cochlear implantation, the facial nerve could be injured during the surgery causing facial weakness or paralysis. That technically is still a risk, but it rarely happens today because the doctor orders the MRI or CAT scan in order to make sure the location of the facial nerve is known in order to stay away from it.

Meningitis is another possible risk, but that too rarely happens today because a vaccination to prevent meningitis is required before the surgery date.

The basic design of the cochlear implant system - the part that is implanted into the inner ear - is intended to last for a lifetime, or at least many, many years. But it is made by man and sometimes can fail. In that event, the non-functioning implanted portion would need to be removed and replaced with a new unit. That would mean more surgery to remove the old device and put in the new one.

The cochlear implant team and the ear specialist will describe to you the outcome they'd hope for based on their experiences with other children. There are many variables that determine successful outcomes such as age of implantation, the cause of hearing loss, cognitive development and family support and involvement. Many children who receive implants go on to live lives with full access to speech and sound.

Generally, the surgery takes approximately three hours start to finish. This includes the time it takes to get your child to sleep, surgical time and then waking up your child when the surgery is done.

Typically, any pain or discomfort from the surgery can be managed with children's Tylenol or something comparable. Your nurse and/or surgeon will discuss these options with you.

No, there must be a period of healing at the incision site, usually 15-30 days, before the system can be activated or programmed. Once this healing period has passed, you and your child will return to the cochlear implant center to activate and program the cochlear implant system.

Programming/activation of the cochlear implant takes place after a period of healing as outlined by your physician. The programming determines how much current is necessary to just barely "hear" and at what current level will be the maximum comfort level. The programming makes sure that no sounds will be too loud and bothersome to your child.

The implant team will want to see your child back for some minor program changes typically after one or two weeks, possibly at six months, and again at one year. Sometimes the initial program becomes too loud when the hearing nerve becomes more active from the electrical stimulation. The cochlear implant team wants to make sure that your child has good experiences using the implant system and that it is comfortable and appropriate to your child's needs.

Most insurances do cover the cost of the surgery and the cochlear device (internal and external parts). The implant center will typically obtain insurance precertification and prior authorization to ensure payment. If your insurance company or HMO as a copayment or coinsurance requirement, the implant center should let you know before the surgery is scheduled what that cost might be.

When authorization is obtained from the insurance company or HMO, the programming and listening therapy sessions are usually included. Sometimes your insurer or HMO will have a limit on the number of listening therapy sessions. You will need to ask the cochlear implant center if they are aware of any restrictions on the number of sessions.

There are occasions when a pediatric cochlear implant center offers only one brand of cochlear implant. In that event, the choice will focus entirely on that brand. Typically choosing the brand will be a joint decision between you, the parent, and the cochlear implant team. The major considerations will focus on the specific features of the external speech processor including Bluetooth capability, remote controls, function indicators and other features. If your child will continue to use a hearing aid on one ear, you may consider an implant system that is compatible with hearing aid use. There are also accessories for TV listening, computer sound input, FM system capability, and other accessories that can influence the decision of which system to choose. It's important to discuss features and options of each cochlear implant system relative to the current and future anticipated needs for your child.

Most often, it is the speech processor (external parts) that break down, not the electrodes implanted in the inner ear. If replacing the cable from the speech processor to the transmitter or a new battery does not fix the problem, the cochlear implant team can check out the system to see what is going on. If the speech processor needs repair, the implant team can send it to the manufacturer for any necessary repairs.

Cochlear implant manufacturers work to ensure new technology is "backward compatible", meaning that newer external technology will continue to work with older implanted devices as time goes on. That said sometimes newer technology can take extra time (sometimes up to a couple of years) to ensure compatibility with older implanted devices. Since insurers typically only allow upgrades to external processors every 3-5 years it isn't likely you will be able to upgrade any sooner than that.

If your child is too young to talk, most cochlear implant systems have a kit that you can use to make sure that the processor (the external part) is working. If the speech processor is working but your child is not responding to sound, it's best to contact the cochlear implant team to troubleshoot the issue.

It depends on your child's needs. Typically, after the first year follow-up appointments are done annually to check out the system and make sure that the program is still appropriate for your child.

Other ongoing periodic expenses could include batteries, cables (from the speech processor to the transmitter), magnets, etc. Most often that can be done directly with the cochlear implant manufacturer. They will know the serial number of your child's device, implanted date, etc. to know exactly what parts you will need.

If this is your child's first implant, the answer is yes. The cochlear implant is not a bionic ear that automatically restores normal hearing. Your child will need to maximize use of the hearing abilities provided by the cochlear implant system by essentially learning how to hear and how to listen. Your child may have had this type of intervention when using a hearing aid, it will need to continue with the cochlear implant. The goal of these sessions is to achieve good listening abilities, excellent speech understanding, a solid foundation of spoken language, and clear, intelligible speech.

There are no easy or simple answers to this question that fits all children equally, it depends. Because no two children with auditory neuropathy are alike, the final decision regarding cochlear implantation should include honest discussion with the cochlear implant team and the ear specialist who would perform the surgery. Typical hearing loss involves damage to the inner ear and loss of hearing sensitivity, auditory neuropathy involves damage to the hearing nerve's ability to transmit information to the brain. The idea behind using either a hearing aid or a cochlear implant with a child who has auditory neuropathy is to overstimulate the hearing nerve in an effort to restore some degree of spontaneous activity. The outcome with regard to speech understanding is quite unpredictable. Some children show good abilities to understand speech, some children show improvement compared to a hearing aid, and some children do not show much benefit.

Generally, honesty is the best policy. The other children typically are more curious than anything. So an explanation that your child doesn't hear well, and the cochlear implant let's your child hear much better is usually all that is necessary. If your child is school aged you might want to help your child educate other children (and teachers) about hearing, different languages, and various amplifications available for those whose hearing is different.

Updated technology focuses almost exclusively on the external part of the cochlear implant system. The implanted electrode device has more capability than can be currently used, so there will not be a need to replace the internal part of the system on a regular basis. When an updated external speech processor becomes available, you will typically be notified by both the manufacturer and the cochlear implant center. The information you receive will describe any updates in functional capability, design features (e.g., Bluetooth capability), and appearance. The decision of whether to seek the updated speech processor is entirely yours. If your child is doing well with the current implant system, there is no hurry to get the new speech processor. On the other hand, if the new design features are desired, the cochlear implant team will assist you. Understanding your current insurance policy on frequency of upgrades will be important. Your cochlear implant team and/or manufacturer can assist with pre-authorization with your insurance provider.

New, updated technology becomes available every three to five years. After development and before being placed on the market, the manufacturer must demonstrate to the FDA that the redesign is safe and does what the manufacturer claims it will do. Once the FDA approves the new technology, it will become available for consumer purchase either directly or through your insurer.