Cochlear Implantation

As of 2012, approximately 324,200 people worldwide and 38,000 children in the United States had received cochlear implantations. [National: 2018] Most cochlear-implanted adults can converse on the phone and most children are able to be educated in mainstream classrooms.

Criteria for Implantation
Criteria for the use of these devices are evolving as their clinical use becomes more widespread. Candidacy is evolving for asymmetric, single sided deafness, auditory neuropathy, and hearing preservation. The child's medical, psychological, and educational status is always taken into consideration prior to cochlear implantation.

The age of cochlear implantation varies by institution. Cochlear implantation is typically performed at 1 year of age or older, but in some cases may be performed at a younger age. It is important that parents consider cochlear implantation early in their child's life and receive early referral, if desired, since the effectiveness of cochlear implantation has better outcomes associated with early implantation. Current evidence for implantation earlier than 12 months of age is lacking. [Bruijnzeel: 2016]

Components of the Cochlear Implant
Cochlear implants have several internal and external components including an electrode array implanted into the cochlea, a receiver and magnet set into the bone behind the ear, a transmitter coil and a microphone worn behind the ear, and a speech processor carried in a pocket or fanny pack. The microphone receives speech and an electrical signal is sent to the speech processor through a connecting cable. The speech processor converts the electrical signal into a code that has been optimized for speech recognition. This code is then sent back over the cable to the headpiece and transmitted via radio waves to the implanted receiver. The code is then passed to the electrode array that stimulates the afferent auditory neurons within the cochlea.

The integrity of the cochlear implant is tested at the time of surgery, immediately after surgery, and during routine follow-up visits. In addition to assuring parents return for ongoing audiologic testing and adjustment, the primary care physician should closely monitor and inquire about the child's language development and school performance during routine well child checks and follow-up appointments.

Bacterial Meningitis Prevention
Children with cochlear implants are at greater risk for bacterial meningitis. This risk can be higher with those with cochleovestibular dysplasias. [Sennaroglu: 2010] Streptococcus pneumoniae (pneumococcus) is the major cause of bacterial meningitis in people with cochlear implants. With the widespread use of pneumococcal conjugate vaccine (Prevnar® or "PCV13") and the pneumococcal polysaccharide vaccine (Pneumovax® 23 or "PPSV23"), the incidence has decreased dramatically. [Kahue: 2014] To reduce the risk of bacterial meningitis, the Centers for Disease Control and Prevention recommend the following vaccinations for individuals with cochlear implants. [Centers: 2018] Please look at the CDC site for recommendations and additional information on vaccination.

13-valent pneumococcal conjugate (PCV13) (Prevnar 13®)
23-valent pneumococcal polysaccharide (PPSV23) (Pneumovax®)
Haemophilus influenzae type b conjugate (Hib) (ActHIB®, Hiberix®, PedvaxHIB®, and Pentacel®)
Meningococcal conjugate (Menactra® and Menveo®)
Serogroup B meningococcal (Bexsero® and Trumenba®)

There is no evidence that people with cochlear implants are more likely to get meningococcal meningitis (caused by Neisseria meningitidis) than people without cochlear implants.

Resources

Information & Support

For Professionals

Vaccines to Prevent Meningitis in Persons with Cochlear Implants (CDC)
Pneumococcal recommendations by age and vaccination history; Centers for Disease Control and Prevention.

Cochlear Implants (FDA)
Information about cochlear implant benefits and risks, recalls, what happens before, during, and after surgery, where to report problems, and what educators of implant users need to know;U.S. Food and Drug Administration.

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Studies

Cochlear Implants and Children (clinicaltrials.gov)

Helpful Articles

Zwolan TA, Zimmerman-Phillips S, Ashbaugh CJ, Hieber SJ, Kileny PR, Telian SA.
Cochlear implantation of children with minimal open-set speech recognition skills.
Ear Hear. 1997;18(3):240-51. PubMed abstract

Waltzman SB, Cohen NL.
Cochlear implantation in children younger than 2 years old.
Am J Otol. 1998;19(2):158-62. PubMed abstract

Rauschecker JP, Shannon RV.
Sending sound to the brain.
Science. 2002;295(5557):1025-9. PubMed abstract

Bishop CE, Eby TL.
The current status of audiologic rehabilitation for profound unilateral sensorineural hearing loss.
Laryngoscope. 2010;120(3):552-6. PubMed abstract

Belzner KA, Seal BC.
Children with cochlear implants: a review of demographics and communication outcomes.
Am Ann Deaf. 2009;154(3):311-33. PubMed abstract

Bruijnzeel H, Ziylan F, Stegeman I, Topsakal V, Grolman W.
A Systematic Review to Define the Speech and Language Benefit of Early (<12 Months) Pediatric Cochlear Implantation.
Audiol Neurootol. 2016;21(2):113-26. PubMed abstract

Sennaroglu L.
Cochlear implantation in inner ear malformations--a review article.
Cochlear Implants Int. 2010;11(1):4-41. PubMed abstract

Authors & Reviewers

Initial publication: September 2008; last update/revision: January 2019

Current Authors and Reviewers:

Author:

Albert H. Park, MD

Authoring history

2018: revision: Albert H. Park, MD^A

2018: update: Jennifer Goldman-Luthy, MD, MRP, FAAP^CA

2010: update: Richard Harward, AuD^A

2008: first version: Karl White, Ph D^A

^AAuthor; ^CAContributing Author; ^SASenior Author; ^RReviewer

Page Bibliography

Centers for Disease Control and Prevention.
Use of Vaccines to Prevent Meningitis in Persons with Cochlear Implants.
Department of Health and Human Services; (2018) https://www.cdc.gov/vaccines/vpd/mening/hcp/dis-cochlear-gen.html. Accessed on 1/15/2019.

Kahue CN, Sweeney AD, Carlson ML, Haynes DS.
Vaccination recommendations and risk of meningitis following cochlear implantation.
Curr Opin Otolaryngol Head Neck Surg. 2014;22(5):359-66. PubMed abstract

National Institute on Deafness and Other Communication Disorders.
Cochlear Implants.
National Institutes of Health; (2018) https://www.nidcd.nih.gov/health/cochlear-implants. Accessed on 1/15/2019.

Sennaroglu L.
Cochlear implantation in inner ear malformations--a review article.
Cochlear Implants Int. 2010;11(1):4-41. PubMed abstract