Cochlear Implant Program

Initial evaluation with cochlear implant specialists

Your child will first meet with a team of specialists for a hearing and communication evaluation. The team includes an audiologist, speech-language therapist, ENT consultant, family consultant, social worker, immunization specialist and radiologist.

The evaluation helps our specialists and your family decide whether your child would benefit from cochlear implants. During the process, we make sure each specialist is available to answer any questions you have about cochlear implant device options, the implantation process or post-implantation therapy. Our focus is on helping your family make the best decision for you.

In some cases, evaluation appointments may take place over the course of a few days. You may need to visit multiple Children's Colorado locations depending on the testing and services your child needs. We work with your family to find convenient appointments and locations.

Initial consultation with audiology

If we determine that your child is a good candidate for a cochlear implant, you will have a cochlear implant consultation. Our team clearly explains the process, so you and your child understand what to expect.

Our specialists will help your family learn about all of your implant options. If a cochlear implant isn't right for your child, we’ll work with your family to find the best therapies, support and treatment.

During your initial consultation, the cochlear implant team will also discuss and help you plan for:

• Using the new technology
• Participating in audiology appointments to fine-tune the device and ensure that your child is receiving all sounds
• Participating in aural habilitation therapy
• Working with your child at home
• Testing with and without hearing aids

After the initial consultation, you can expect to spend two to three weeks on follow-up testing and appointments. Follow-up testing may include labs and imaging, such as MRIs or CT scans, as well as consultations with neurologists, occupational therapists or physical therapists.

Speech-language and communication evaluation

Our speech-language pathologists (SLP) specialize in working with children who are deaf or hard of hearing. They help evaluate your child’s speech, language and communication skills. The SLP looks at different options for communication, with the focus of finding the communication mode that best fits with the child’s family. The SLP will also make recommendations and discuss expectations for therapy after they receive their cochlear implant to help your child get the best results.

Family consultation

Our program includes family consultants who have personally experienced hearing loss. They have the experience and empathy to best help children in the same situation.

Family consultants participate in the candidacy appointments and cochlear implant evaluations for personal perspective and emotional support for families. This position is unique to our program and is a great resource for families who are exploring device options.

Children and families will also meet with our hospital’s social work specialists and ENT consultants to ensure your child’s overall health and their readiness for surgery. These specialists will also discuss risks and benefits with you and your child.

Expert pediatric cochlear implant surgery

Cochlear implant surgery has two steps:

1. Using preoperative imaging as a guide, our experienced pediatric otolaryngologists (ear, nose and throat doctors) make a small incision and place the cochlear implant under the skin, behind the ear. This is the part of the device that transmits signals to the auditory nerve. The procedure typically takes a couple of hours and most children go home the same day.
2. About two weeks after implant surgery, the speech processor (the piece worn on the head), is activated by the audiologist. This is the first time that your child will hear sound through the cochlear implant.

Most children recover quickly at home after surgery with pain relievers and antibiotics. Your child will wear an ear wrap to protect the area while it heals.

Expert cochlear implant programming by a pediatric audiologist

Two to three weeks after implantation surgery, your child returns to the hospital for cochlear implant activation. At this appointment, we fit and program the external receiver and teach your family how to use the device.

Your family returns again two to three weeks later for further programming and then again at 1, 3, 6, 9 and 12 months for fine-tuning of the device.

After the first year with a cochlear implant, we see children every six months for the next few years and then every year after that. At these appointments, we perform hearing and speech understanding tests, program device changes, monitor the equipment and discuss technology advances. We also collaborate with a child’s educational team when kids go to school.

Aural habilitation and speech-language therapy

Children require focused therapy and support to learn how to understand the new sounds from the cochlear implant and how to use those sounds.

The Cochlear Implant Program offers a number of therapy services, including aural (hearing) habilitation (ways to improve daily skills) and speech-language therapy. Our team of speech-language therapists offers support in sign language, total communication and auditory-verbal techniques. We continue to provide speech and language support in the years following a cochlear implant.

Download the roadmap to learn more about the process of cochlear implant surgery:

Download the roadmap (.pdf) – In English

Download the roadmap (.pdf) – In Spanish (en Español)

How can my child be referred for a cochlear implant evaluation?

Your primary care provider, treating otolaryngologist or healthcare professional managing your child’s hearing loss can refer your child to our cochlear implant team for evaluation.

What is a cochlear implant?

A cochlear implant is a medical device that provides access to sounds which cannot be helped by a traditional hearing aid. A hearing aid increases the volume of sounds going into the ear to overcome the level of hearing loss, and depending on the level of the hearing loss, may not provide clear sound or speech understanding. A cochlear implant bypasses the damaged portions of the inner ear (cochlea) by stimulating the hearing nerve via electrodes, or small wires. A cochlear implant electrically stimulates the hearing nerve. A cochlear implant can be very helpful for people whose hearing loss is beyond hearing aids.

What are the benefits of a cochlear implant?

While the benefits may vary between children, the biggest benefit of a cochlear implant is access to sound not attainable with hearing aids. With auditory training and speech therapy, many children receiving cochlear implants become successful listening-speaking communicators. Cochlear implants will help speech understanding in a quiet place, and many experience improved hearing in background noise. Children often report good benefit with regards to music as well. Current technologies allow for streaming from tablets and phones, which allow children to access the same cultural references as their hearing peers.

How is a cochlear implant different from a hearing aid?

In children with severe to profound hearing losses, hearing aids are often not able to make sounds loud enough to be heard or speech may not be very clear. Even though the hearing nerve may be healthy, the damage in the inner ear (cochlea) acts as a roadblock from sound getting to the nerve clearly. A cochlear implant provides sound directly to the hearing nerve, bypassing the damaged portions of the cochlea.

How does a cochlear implant work?

A cochlear implant consists of an external component (known as a speech processor) and internal component (known as the implant). The sounds are sent into the implant and to the brain via the hearing nerve. This happens instantly, without delays.

The external components include:

• A microphone that picks up sounds
• A processor that converts sound to digital pulses
• A transmitter that sends the signal to the surgically implanted internal receiver

The internal components include:

• A receiver that receives signals from the external transmitter and converts them into electric impulses
• An electrode array that transmits the electric impulses from the receiver to the auditory nerve endings in the cochlea – the auditory nerve then sends this information to the brain for interpretation

It is important to note that the implant does not work or provide sound without the external components. The cochlear implant speech processor must be programmed by an audiologist (who specializes in this technology) for each individual child. The cochlear implant processor must be worn during all waking hours, much like a child uses their hearing during all waking hours. Additionally, the child must learn how to use the sound provided by the cochlear implant. Aural habilitation therapy is critical for a child to understand sounds and associate them with meaning, like a newborn baby does to shape their hearing.

What degree of hearing loss qualifies for a cochlear implant?

Cochlear implants are appropriate for children 9 months and older with severe to profound sensorineural hearing loss. Children with progressive loss in both ears, auditory neuropathy/dyssynchrony, and unilateral profound sensorineural hearing loss may also be candidates for a cochlear implant. Children who are not making anticipated progress in their speech and language development, who are experiencing auditory fatigue and who have very poor speech understanding with lesser degrees of hearing loss may also be considered.

What is involved in the cochlear implant evaluation process?

We are proud to provide a multidisciplinary pediatric cochlear implant team at Children’s Hospital Colorado. Our team of experts in hearing loss and cochlear implants will help to answer questions as well as complete the necessary evaluations to determine if your child is a candidate for cochlear implantation. These evaluations include a consultation with an Ear, Nose and Throat (ENT) doctor, an audiologist, a speech therapist, social worker and others who specialize in family support. At these appointments, your child will have hearing tests with and without hearing aids, a communication evaluation, discussion of therapy required after the cochlear implant and a review of resources and expectations for outcomes. We will also review your child’s immunization records and may vaccinations if needed. Your child will have scans of their ears, which our pediatric radiologists will review. Once these evaluations are completed, your family and the team will determine if a cochlear implant is the next step. If so, the audiologist will work with you to choose a device and surgery date. Typically, we can complete these appointments in one or two days.

Are children with developmental disabilities or other health concerns eligible to receive a cochlear implant?

Yes. Our hearing loss team evaluates the whole child, not just their hearing loss. We consider each child’s unique circumstances to help provide families appropriate expectations regarding the potential benefits of cochlear implantation, as well as the anticipated outcomes or ways that your child might benefit.

Does my child need to be involved in speech and aural rehabilitation therapies before evaluation by the hearing loss team?

We recommend an amplification trial and participation in speech therapy if you and your child are considering a cochlear implant.

Does insurance pay for a cochlear implant?

Because cochlear implants are recognized as standard treatment for severe-to-profound hearing loss, most insurance companies cover them. Cochlear implant centers usually take the responsibility of obtaining insurance approval before proceeding with surgery. In addition, cochlear implant manufacturers have departments to assist with this issue. The cochlear implant candidacy evaluations will help to serve as documentation for insurance to review in making a decision regarding coverage.

What are the risks associated with a cochlear implant?

As with any surgical procedure, there is a risk of infection. It is important that the child’s immunizations are up to date, and the operative site is protected through the healing process. The cochlear implant surgeon will discuss the surgical risks during your child’s appointment.

How long is cochlear implant surgery?

The average surgery time is 2 to 3 hours for unilateral surgery. There may be conditions that would prolong the surgery, such as an additional procedure or bilateral implantation.

How long is the recovery after cochlear implant surgery?

Immediately following the surgery, children spend time in the recovery area, where you can be while they wake up. While some children go home the same day, others spend one night in the hospital. The bandage on your child’s head must stay in place for a few days after the procedure. Most kids feel close to normal the day after surgery, although there may be some initial dizziness that is usually self-resolving.

When can my child resume school or daycare after surgery?

Although this may vary between patients, after a few days of activity restrictions, a child can resume activities as soon as they feel able. While for some children this may be a couple of days, others may take longer to feel comfortable returning to their daily activities. It is important that the school or daycare is aware of the surgery and allows your child to temporarily refrain from activities such as physical education class or playground activities.

What is the follow-up appointment after receiving a cochlear implant?

Approximately two weeks after surgery, your ENT surgeon will assess the incision site, and an audiologist will fit the external portion of the device and activate the internal device. This is your child’s hearing birthday! The initial programming of the device (mapping) occurs over several appointments, allowing your child to adjust to the new stimulation. Mapping sessions will transition to three-month intervals during the first year, then every 6 to 12 months thereafter. Speech therapy and aural rehabilitation therapy can begin as soon as your child is fitted with the external device.

Can I swim or bathe with my cochlear implant processor in place?

Most likely, but with the appropriate precautions and accessories. The manufacturers have all developed methods to waterproof their external equipment for both pool and bathtub or shower water exposures. Details are available on the websites of each cochlear implant manufacturer, as well as from your cochlear implant audiologist.

Can I wear the cochlear implant while playing sports?

Probably. Most implants are durable enough to allow playing sports. Avoiding repetitive or potential high levels of trauma to the cochlear implant site is recommended. If the cochlear implant is exposed to high levels of perspiration, waterproofing precautions should be implemented as well.

Is it safe to have an MRI with a cochlear implant in place?

It is recommended that families check with their cochlear implant manufacturer or cochlear implant audiologist to determine if your cochlear implant is compatible with an MRI. While current FDA approved cochlear implants offer some degree of MRI compatibility, there are specific recommendations that should be strictly followed. In the event of an emergency, it is important to notify the care team about the presence of the cochlear implant as soon as possible.