Cochlear Implants

When hearing aids no longer provide you or a loved one with speech clarity, a cochlear implant may be the solution to improving hearing and quality of life

What is a cochlear implant?

A cochlear implant system is an electronic medical device designed to restore the ability to hear and understand speech by individuals who get insufficient benefit from properly fitted hearing aids. Adults who are not sufficiently helped by hearing aids may benefit from cochlear implants. Unlike a hearing aid, which delivers amplified sound acoustically, a cochlear implant directly stimulates the auditory nerve cells with an electrical current, bypassing the damaged hair cells in the cochlea.

In Australia, there are four manufacturers of cochlear implant systems that are registered for use with the Australian Register of Therapeutic Goods;

How does a cochlear implant work?

A cochlear implant system is divided into two parts - an external sound processor and an internal implant:

The external sound processor detects sounds in the environment via microphones. These sounds are then analysed by a tiny computer and then transformed into digital signals. These digital signals are then transmitted to the internal component.

The internal implant is a prosthetic implant which is surgically placed into the cochlea by a specialised Ear, Nose, and Throat surgeon. The implant has a receiver stimulator package that converts the digital signal from the external sound processor into an electrical signal and this electrical signal is then sent down the electrode array directly stimulating the auditory nerve providing a signal the brain then learns to understand.

 

How do I know if I am a candidate?

Contrary to popular belief, cochlear implants aren’t only for people who are “stone deaf” and even those who get partial benefit from hearing aids may receive significant improvements with a cochlear implant. Criteria for cochlear implantation is regularly changing due to significant advancements in technology and most adults who are candidates for a cochlear implant do not know that they are. Your GP or usual hearing health professional may not be aware of the benefits of a cochlear implant.

 

Common signs that you or someone close to you might be a cochlear implant candidate include:

  • Limited benefit with appropriately fitted hearing aids

  • Difficulty on the telephone

  • Reliance on visual cues for successful communication

  • Family and friends report that you experience communication difficulties even with the use of appropriately fitted hearing aids

  • You need someone else to make appointments for you

  • Reports that noise significantly impacts speech perception

How do I get a cochlear implant?

Cochlear implants involve a team of professionals with a range of skills working together to achieve a holistic outcome. Typically this team also involves your close family, your general practitioner, your usual audiometrist or audiologist, a specialist Ear, Nose, and Throat Surgeon (ENT) and can occasionally include a speech language pathologists, and psychologists or social workers.

 

At a minimum, to determine if someone is a candidate they require an assessment with an audiologist with specialist training in cochlear implants as well as an ENT surgeon who performs the operation.

 
 

The cochlear implant journey

While not everybody's cochlear implant journey is the same, there is a typical pathway that an adult follows to getting a cochlear implant.

1. Candidacy Assessment

The first step is referral for a candidacy assessment. Often your usual audiologist will refer you for an assessment or they may have training in cochlear implants. A candidacy assessment typically includes;

  • Comprehensive case history and diagnostic testing

  • Functional and Quality of Life assessment

  • Ensuring optimisation of hearing aids

  • Assessment of aided speech perception

  • Counselling regarding outcomes and expectations

  • Discussion of funding pathways

  • Referral to ENT specialist for one or both ears

 

If you are determined to be a candidate you will then be referred for a review with a specialist ENT.​

2. Pre-Op Medical assessment

The second step is a specialist evaluation with an ENT specialist that performs cochlear implantation. This typically includes;

  • Medical and hearing case history

  • Physical ENT examination

  • Radiological investigations (e.g. MRI & CT scans)

  • Counselling about expectations and outcomes

  • Counselling about CI surgery and related costs

3. Surgery 

If you are an audiological and medical candidate then the next step is surgery. Typically during surgery;

  • The implant is inserted into the cochlea

  • The implant is tested to ensure functionality

  • Post operative recovery

4. Post-Op Appointments

Following successfully surgery;

  • Post op review with ENT Specialist

  • Implant activation and counselling with audiologist

  • Ongoing device management and appointments

  • Auditory rehabilitation program and training

  • Annual follow-up appointments after first year to include mapping, device evaluation, and speech perception testing

5. Ongoing management and Care

Holistic patient care will be ongoing;

  • New technology and review of external speech processors including non-implanted ear

  • Replacement of batteries

  • Additional listening devices and equipment

  • Quality of Life and functional outcome reviews

  • Holistic patient review with primary communication partners

Funding Pathways for cochlear implants in Australia

 

How much does a cochlear implant cost?

Cochlear implantation includes a number of necessary medical services and procedures that are provided over time by a team of clinicians. The overall cost is made up of different components;

  • Audiologist appointments

  • ENT specialist appointments and associated medical imagining

  • Surgery expenses and post-operative care

  • Cochlear implant device cost

  • Post-operative appointments and sound processor activation

  • Ongoing care and maintenance of a cochlear implant sound processor

In Australia, Medicare helps to fund the consultations with all specialists and in some instances may cover the entire appointment. Medicare however does not cover the cost of a cochlear implant system.  

The cost of a cochlear implant is generally funded in the following ways;

1. Private Health Insurance

​If you have a private health insurance (hospital) policy covering implantation of hearing devices, the cochlear implant system may be fully reimbursed. Exact coverage of hospital and surgical procedures will depend on your level of cover and it is best to ask the following questions to your fund directly:

  • Does my policy cover cochlear implant surgery and the prosthesis?

  • Are there any restrictions or waiting periods?

  • Are there any known out of pocket costs?

  • What is the sound processor replacement policy?

2. State Government Funding

A limited number of cochlear implants are funded in each state per calendar year. There are usually more restrictive eligibility criteria due to the limited funding as well as a waiting list. For more information please speak to your hearing care professional directly or contact Hearing Implants Australia.

3. Department of Veterans Affairs

DVA may cover the costs associated with cochlea implants, including implantation and sound processor upgrades. For more information please contact Hearing Implants Australia or DVA for further information (www.dva.gov.au)

4. Self-Funded

You may be able to self-finance the cost of a cochlear implant system, as well as the associated specialist and surgical costs. It is important that you discuss this option with your clinical team so you are aware of all of the costs involved.

Ongoing care and maintenance

Cochlear implant sound processors will require ongoing maintenance and repairs. External speech processors are generally covered by a standard manufacturer warranty, however it is recommended that the sound processor is insured against loss through your home and contents insurance.

As technology improves and new innovations become available the external sound processor will be able to be upgraded without any additional surgery.

 

There are a number of potential funding pathways for this which may include;

  1. Private health insurance

  2. DVA

  3. Self funding

  4. National Disability INsurance Scheme (NDIS)

    • N.B. The NDIS does not cover the costs of a cochlear implant system or surgery. However, funding may be allocated for ongoing auditory rehabilitation, assistive listening devices or for upgrades of speech processors. For more specific advice please talk to your hearing health provider.

To request additional information or a prioritised referral to the HIA Professional Network

 

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