Cochlear Implant Program

The Cochlear Implant Program at Billings Clinic is team-based and provides high-quality patient-centered care for kids and adults experiencing sensorineural hearing loss. Our Cochlear Implant team works together to care for you from assessment through treatment and beyond. Our team includes board-certified otolaryngologist and cochlear implant surgeon, David Larson, MD, and our specialty trained audiologists.

What is a cochlear implant?

A cochlear implant is a small, complex electronic device that bypasses the damaged cochlea of the inner ear and sends electronic signals to the auditory nerve, and the auditory nerve then sends those signals to the brain. A cochlear implant is not a more advanced version of a traditional hearing aid and it is not a substitute for a hearing aid. Rather, a cochlear implant restores hearing when even the best hearing aids are no longer providing benefit.

Who is a candidate for cochlear implants?

There are two types of hearing loss, conductive hear loss and sensorineural hearing loss, and each can happen at any age. Children and adults with sensorineural hearing loss may be candidates and benefit from a cochlear implant.

Conductive hearing loss happens with something blocks the sound waves in your ear. For example, fluid in your ear, an injured eardrum or middle ear bones that are not normal or damaged. If you have conductive hearing loss, a cochlear implant will not help. Instead, hearing aids, medical treatment or surgery may help improve your hearing.

Sensorineural hearing loss is a result of damage to the cochlea within the ear, your auditory nerve, or in some cases, both. The cochlea sends signals to your auditory nerve which sends the information to your brain. When the cochlea or auditory nerve are damaged these signals are sent which results in hearing loss or deafness. Often when people experience sensorineural hearing loss, the auditory nerve stills works, and a cochlear implant may help you.

You or your child may be a candidate for a cochlear implant if you have:

• Moderate to profound sensorineural hearing loss in both ears
• Little to no benefit with hearing aids
• Clear understanding of cochlear implantation and end results
• Realistic expectations of what the cochlear implant can do
• Commitment to follow-up regime
• Motivated to wear device full-time and complete aural rehabilitation/listening practice

How do cochlear implants work?

A cochlear implant is a system of multiple parts. Parts of the system are placed inside the ear or under the skin and other pieces are worn on the head or behind the ear. Most cochlear implants have a microphone and processor together and this is the piece that is worn behind the ear.

The microphone and processor unit can be taken off when showering or sleeping. There are different features available depending on the model of the cochlear implant, like settings for listening to music versus being in a crowd. Talk with our team to decide which cochlear model best fits your lifestyle.

While models vary cochlear implants follow the below process to allow you to hear:

• Microphone picks up sounds
• The sound processor changes sound into an electrical code
• The code travels to the transmitter. A magnet in the transmitter coil is attracted to another magnet in the internal receiver this holds the transmitter in place on your head.
• The transmitter sends the code to the receiver and stimulator device. Dr. Larson implants this device under the skin behind the ear.
• The stimulator reads the code
• The stimulator sends electrical signals to a small, flexible wire that contains electrodes. This is called an electrode array. Dr. Larson places the electrode array in your cochlea.
• The electrode array does the job of the damaged parts of your inner ear and sends electrical signals to your auditory nerve.
• The signals travel to your brain, which interprets them as sound.

How do I find out if my child or I are a candidate for a cochlear implant?

If you fit the criteria for a cochlear implant and want to move forward to find out if you’re a candidate the next step would be to schedule an appointment for an evaluation. The evaluation process with process includes a hearing test, medical check and consultation.

Cochlear Implant evaluation timeline:

• Hearing Test
  • Our team of audiologists will review and go over your hearing history
  • Perform hearing test with and without hearing aids
  • Test your speech understanding with and without hearing aids
  • Review tests and determine if you meet the audiological candidacy criteria for a cochlear implant. If you meet the criteria you will move onto the medical check
• Medical Check
  • Dr. Larson will go over your medications, health history and review your audiology test results
  • Dr. Larson will chat with you and review if you meet the candidacy criteria for surgery including discussion of surgery procedures, processes and risks.
  • Imaging of the structures of the inner ear will be performed

If your evaluation determines you’re a candidate for cochlear implants our team will work with you to schedule surgery and next steps.

Cochlear Implant Surgery

The cochlear implant surgery is an outpatient surgery performed under general anesthesia. A small incision is made behind the ear to access the mastoid bone. The mastoid bone is partially drilled away to expose the inner ear structures and the internal device is placed. If no complications occur, you can go home the same day.

It’s important to remember all surgery has risks including, but not limited to:

• Bleeding
• Infection
• Risks of anesthesia
• Extra fluid or blood in the area of the surgery

Cochlear implant surgery risks include:

• Numbness around the ear
• Dizziness or vertigo
• A ringing or buzzing sound in your year called tinnitus
• Changes in your sense of taste. The nerve that gives your tongue its sense of taste goes through your middle ear and the implant surgery may irritate this nerve
• Partial or complete loss of natural hearing in the implanted ear. If this does happen, usually you still hear better with a cochlear implant

Very rare cochlear implant surgery risks include:

• Injury to the facial nerve
• Meningitis
• Cerebrospinal fluid leakage

Making sure you are informed and confident is of the utmost importance to our team and we will review all of these risks and benefits in detail during the evaluation and process and leading up to surgery.

Does insurance cover cochlear implants?

Many insurance plans cover cochlear implants, but it’s important to reach out and talk to your insurance company and review your plan. Some insurance companies may require a prior authorization which our cochlear implant team would submit if you meet criteria for the procedure. Medicare provides coverage for a single-side cochlear implant surgery without prior authorization of indications are met.