MISSION

“Our community-based cochlear implant program strives to advance our patients’ quality of life, improve their ability to communicate with loved ones, and enhance their cognitive well-being. Our interdisciplinary cochlear implant team at PNI treats patients across the lifespan (from infancy to older adults) using evidenced-based practices, innovation, and a compassionate approach to care.”

Unveil a world of vibrant soundscapes through our transformative cochlear implant program.

What is a Cochlear Implant? Adult CI Evaluation Process Pediatric CI Evaluation Process Surgery Rehabilitation for adults Rehabilitation for Pediatrics Cochlear Implant Manufacturers

What is a Cochlear Implant?

A cochlear implant is an electronic device that is implanted into the inner ear (the cochlea) and is used to restore hearing in patients who no longer benefit from traditional hearing aids or have hearing loss in just one ear.
The evolution of cochlear implant technology development began in the 1960s and became FDA approved for adults in 1984 and for children in 1990. The cochlear implant is an electronic device that is implanted into the inner ear (the cochlea) and is used to restore hearing in patients who no longer benefit from traditional hearing aids or have hearing loss in just one ear. For children, cochlear implants are FDA approved for infants as young as 9 months old and can often be approved off-label at even younger ages (which is routine in other parts of the world). Candidacy for this miraculous device has dramatically expanded over the past decade offering better access to speech and language, environmental sounds, and music to those who are struggling.

Though a cochlear implant does not re-create normal hearing, it can give a hearing-impaired person auditory understanding of the world and help people understand speech again. While hearing aids amplify sound and deliver it to a damaged hearing system, the cochlear implant bypasses the damaged inner ear structures to deliver sound directly to the hearing nerve. Research and development have improved the sound quality of these devices and created smaller external speech processors over time. As a result, patients benefit from future advancements in technology without subsequent surgeries because the manufacturers ensure the new speech processors are compatible with older internal devices. It is also important to note that the cochlear implant is not a “quick fix” and involves time, patience, and practice to meet your listening goals. Our team will guide patients through their follow up programming visits and rehabilitation program.

Cochlear implants are covered by insurance policies including Medicare, Medicaid, private insurance carriers, and vocational rehabilitation. Candidacy criteria may be specified by specific insurance plans and our team can help guide a patient through that process.

Adult CI Evaluation Process

The purpose of the cochlear implant evaluation is to obtain a comprehensive view of how the individual is performing with optimally fit hearing aids so we can determine if a surgical approach is best suited for the patient. The evaluation does not mean you must have surgery. During the process we obtain diagnostic information to determine implant candidacy based on FDA criteria. We also work with the patient, the patient’s support system and our multidisciplinary team to determine the best care for individual. We ensure each patient is well informed and comfortable with their decision. It is strongly recommended to bring a support person to these visits, and we urge you to bring questions about any aspects of our process. If you are determined not to be a CI candidate at the time of your evaluation, we will explain the thought process and create a plan for your hearing healthcare. We are also able to re-evaluate in the future should a patient’s hearing change and/or FDA criteria expands.

You should think of the cochlear implant process as the start of a lifelong relationship with the PNI cochlear implant team!

The Evaluation Process:

Audiologic CI Evaluation
- The evaluation lasts approximately 90 min.
- You can expect to complete diagnostic testing with and without hearing aids to assess your hearing status.
- You will be provided with counseling and information about hearing loss and cochlear implant benefits and limitations.
- We will discuss each patient's specific aspirations and goals for their hearing journey.
Balance Assessment
- A referral is made for individuals who need to have their inner ear of balance assessed more thoroughly.
- Individuals with a history of balance issues.
- This assessment can also help us choose which ear to implant if both ears hear equally. We would choose to not implant the ear with the stronger inner ear of balance.
Surgical Consultation
- Dr. Voelker will review her surgical approach, surgical risks, and answer all questions.
- She will decide if you are medically a cochlear implant candidate.
- She will review the structure of your inner ear via MRI and CT imaging.
- Dr. Voelker will be able to have the meningitis vaccine administered the same day as your consultation – this vaccine is indicated for patients undergoing cochlear implant surgery.
Brain Health Assessment
- As one of the leading institutions for studying dementia and Alzheimer’s, we understand the important role cognition plays in cochlear implant outcomes.
- We administer cognitive screeners when indicated and will make appropriate referrals to members of our team at PNI.
CI Manufacturer Choice
- We want our patients to make a well-informed decision about which company they will have a life-long relationship with.
- We can connect you with recipient outreach managers from all 3 device companies (or a narrowed down selection) to further review equipment options and resources.

Your journey will be organized and guided by our CI coordinator and CI surgery scheduler to ensure the process is seamless and efficient.

You can find videos about the Step-By-Step process here.

Pediatric CI Evaluation Process

The purpose of the cochlear implant evaluation is to obtain the following information from your child and family to determine cochlear implant candidacy, provide information to you and your family, answer questions and make recommendations.

The Evaluation Process:

Audiologic CI Evaluation
- Discuss your child’s health, communication, and school history.
- Assess your child’s hearing status with and without hearing aids.
- Hearing aid trail to determine benefit.
- Confirm the family’s understanding of the child’s hearing loss and the influence of hearing loss on listening, language, and literacy development.
- Assess the family’s goals and expectation.
- Answer questions.
- Discuss current service plans including school and community services offered through an IFSP, IEP or 504 plan for the child.
- Help to identify additional resources and services to the child and family to maximize outcomes.
Speech and Language Evaluation
- Assess your child’s communication abilities through standardized or informal testing, parent/caregiver interview, play interactions and clinical observations.
- Provide information and strategies to optimize communication skills for the child in the home environment.
- Collect information regarding your child’s current educational services and support.
Surgical Evaluation
- Determine if your child is medically a candidate for a cochlear implant.
- Investigate possible causes of hearing loss (genetic testing, imaging with MRI/ CT scan).
- Discuss the surgery and risks involved.
- Provide meningitis vaccination information and/or administration of the vaccine prior to surgery.
Interdisciplinary Cochlear Implant Team
- Following the completion of all cochlear implant evaluation visits. Our team will meet to discuss whether each child meets criteria for cochlear implantation in this program.
- If your child is considered a candidate for cochlear implantation, we encourage you and other members of your family to ask additional questions and reach out to our team for support at any time.
- If your child is not considered a candidate in our program, we will explain our reasoning in detail and make recommendations regarding other avenues for learning language and achieving academic success.

Surgery

A cochlear implant surgery procedure:

Cochlear Implant Surgery:
- The cochlear implant surgery is a 1-2 hour, outpatient procedure (the patient will return home the day of the procedure) that involves making an incision behind the ear. The mastoid bone is drilled to get to the inner ear and the electrode is threaded into the cochlea. Most patients resume their normal activities within days of the surgery. You will have a post-operative visit with Dr. Voelker 1-2 weeks following the surgery. Following cochlear implant surgery, the device will be turned on (activated) by the CI audiologist after 3 weeks to allow for the swelling to subside and the incision to heal.

Rehabilitation for adults

Rehabilitation for Adults

What happens after you get a cochlear implant?

The cochlear implant is not a “quick fix” and involves time, patience, and practice to meet your listening goals. In fact, recipients usually can’t understand speech at the activation visit and may only hear a robotic quality voice or beeps/static. This is completely normal! Most patients perceive great benefits by 3 months post their cochlear implant activation visit. With each follow up programming (called mapping) visit with your audiologist; the auditory rehabilitative sound quality of the cochlear implant improves. You will see your audiologist for your activation, 1 month post activation, 3 months post activation, 6 months post activation and then annually or as needed.

Auditory training and rehabilitation techniques are a vital part of being a successful cochlear implant recipient. Our cochlear implant program team will provide you with a rehabilitation training plan. We also offer to connect you with our auditory verbal therapy partners, who can tailor a personalized plan for a successful aftercare.

Cochlear implantation is a journey for you and your support system. Hearing loss and cochlear implantation effects the recipient and their loved ones. Our team will guide you through your post implantation visits and rehabilitation. You will have a lifelong, collaborative relationship with your cochlear implant team at PNI!

Rehabilitation for Pediatrics

What happens after you get a cochlear implant?

Initial Activation

- The activation is scheduled 3-4 weeks following surgery.
- After the surgical site has healed and swelling has subsided, your child will return to PNI to be fit with the external sound processor by our pediatric CI audiologist.
- The programming of a cochlear implant is a process called mapping.
- Our CI coordinator will ensure your 2-day activation visits are scheduled and ensure you are familiarized with all your equipment
- During these visits, the cochlear implant will be turned on or activated for the first time.
- When the device is initially turned on for the first time the child may respond in one of 3 ways, all of which are normal behaviors: happy and response, crying and scared, or no observable responses (which does not mean the child is not hearing).
- Review cochlear implant troubleshooting, equipment and maintenance

The First-Year Visit Schedule

- Due to the adaptation of the hearing system, several mapping changes are needed during the first year following cochlear implantation.
  - Activation visits - 2 back-to-back appointments which occur 3 weeks after surgery
  - 1 month following activation mapping visit
  - 3 month following activation mapping visit
  - 6 month following activation mapping visit
  - 9 months or 1 year following activation visit
- At approximately 3 months post activation, a cochlear implant detection audiogram will tell us if your child is able to detect soft sounds across the frequency range. We will also assess the child’s speech perception using age-appropriate measures.
- Annual speech and language evaluations are also performed to document your child’s development of communication skills and in older children, literacy skills.
- After the child’s one year anniversary, children are seen once per year, or more often as needed.
- We collaborate with the child’s educational and service providers routinely to we are working together to achieve the family’s goals.

Cochlear Implant Manufacturers

Better support and training: Most manufacturers offer training programs and support services for their products. Our cochlear implant program works closely with the manufacturers to ensure our patients are experiencing the best outcomes.

Advanced Bionics

Advanced Bionics develops cutting-edge cochlear implant technology that restores hearing to many with severe-to-profound hearing loss.

Contact Advanced Bionics Representative

Contact: Megan Landis

Email: megan.landis@advancedbionics.com

Phone: (661) 289-4549

Cochlear Americas

Cochlear Americas mission,

"We help people hear and be heard. We empower people to connect with others and live a full life. We help transform the way people understand and treat hearing loss. We innovate and bring to market a range of implantable hearing solutions that deliver a lifetime of hearing outcomes."

Contact Cochlear Americas Representative

Contact: Carla Sánchez Cabañas, M.S.Ed

Email: csanchezcabanas@cochlear.com

Phone: (818) 415-8831

MED-EL

Med-El is not only the innovators provides multiple wearing options and design their audio processors to be compatible with previous implants.

Contact MED-EL Representative

Contact: Sally Tannenbaum, M.Ed. LSLS Cert. AVT

Email: sally.tannenbaum@medel.com

Phone: (919) 451-8576

Frequently Asked Questions

How does a cochlear implant work?

A cochlear implant is made up of equipment worn on the outside of the ear and equipment surgically placed inside the ear. During surgery, an incision is made behind the ear and the internal device is secured under the skin with the electrode array delicately threaded into the cochlea. The electrodes stimulate the hearing nerve which sends the auditory signal to the brain. The external equipment (sound processor) picks up sound and sends it across the skin to the internal device.

External Hardware (includes microphone, speech processor, coil/cable and battery)

- The microphone captures sound in our environment.
- The speech processor converts the environmental sound into a digital signal.
- The signal is sent through the cable to the transmitting coil.

Internal Receiver

- The signal is sent across the skin to the implant, where it is converted to electrical energy and decoded.

Electrode Array

- The electrical energy is sent to the electrode array within the cochlea, where it stimulates the hearing nerve.

Hearing Nerve

- The stimulation of the hearing nerve is perceived as sound in the brain.

Who is a cochlear implant candidate for adults?

Cochlear implants are recommended when a person cannot hear well with hearing aids or with significant hearing loss in just one ear. The Food and Drug Administration (FDA) has approved the use of cochlear implants for adults who meet specified criteria. Cochlear implant criteria have expanded over the past years! Shockingly only 5% of patients who would benefit from a cochlear implant receive them.

Your CI team will complete a comprehensive evaluation with optimally fit hearing aids to determine candidacy based on insurance and FDA criteria.

Medicare criteria is the most conservative. Moderate to profound hearing loss and poor speech understanding in both ears. The ACI Alliance is lobbying to improve access for Medicare patients.
Hybrid Candidacy: Patients who have good low frequency hearing and very poor high frequency hearing benefit from hybrid stimulation (acoustic and electric in the same ear).
Single Sided Deafness/ Unilateral profound hearing loss: One normal hearing ear and the other ear with profound hearing loss.
Asymmetric Hearing Loss: Hearing loss in both ears with poorer hearing in the ear to be implanted.
Traditional criteria for patients 18 years old or older: Limited benefit from amplification defined by aided speech understanding in both ears with poorer understanding in the ear to be implanted.
At PNI we are here to advocate for our patients if a cochlear implant is requested for “off label” use and authorization (non-FDA approved).
A cochlear implant requires an in-tact auditory nerve to deliver the sound to the brain. Examples of where cochlear implantation may be appropriate include:
- Sudden sensorineural hearing loss
- Noise induced trauma to the ears
- Hearing loss associated with the aging process
- Ototoxic effects of certain medications
- Hearing loss due to meningitis or infection
- Inherited forms of progressive hearing loss
- Fractures of the skull base that impact hearing
- Severe otosclerosis (abnormal middle ear bone formation) involving the inner ears

What are impacts of untreated hearing loss on health in adults?

Hearing loss is one of the leading causes of overall disability worldwide. Globally, approximately 466 million
adults and children (6%) have disabling hearing loss. This is projected to rise to 630 million by 2030. Hearing loss has a substantial impact on people’s quality of life.

Effects of untreated hearing loss on aging:

Quality of Life
- Increased feelings of loneliness, isolation, and depression
- Less inclined to participate in activities they used to love and often “give up” participating in conversation with friends and family
Cognitive Decline
- Hearing loss is associated with accelerated cognitive decline and dementia in older adults
Depression
- Significant association between hearing impairment and moderate to severe depression
Falls
- The brain uses sound cues to maintain spatial orientation and can home in on spatial orienting landmarks
- People with mild hearing loss of 25 dB or greater are 3x more likely to have a history of falling
- Every additional 10 dB of HL increases the chances of falling by 1.4 times the original risk
Heart Health
- The inner ear is extremely sensitive to blood flow
- Studies have shown that a healthy cardiovascular system has a positive effect on hearing – conversely, inadequate blood flow and trauma to the blood vessels of the inner ear can contribute to hearing loss
Hypertension
- Significant association between high blood pressure and untreated hearing loss.
- Can be an accelerating factor of hearing loss in older adults
Diabetes
- Hearing loss is about twice as common in people with diabetes as compared to those without disease.
- Pre-diabetic adults whose blood glucose is higher than normal have 30% higher rate of hearing loss as compared to those with normal blood sugar
Osteoporosis
- This is linked to the demineralization of the three middle ear bones which may contribute to or cause a conductive hearing impairment

What is a pediatric cochlear implant program?

Our dedicated cochlear implant team is made up of our CI surgeon, pediatric cochlear implant audiologist, CI coordinator, speech-language pathologists, auditory-verbal therapists, and we collaborate with social workers, geneticists, developmental pediatricians, educators, and psychologists. Together, we ensure each step of our process is executed for the child’s specific needs. Your family and child’s best interests are at the core of our process. We feel it is important to present all communication modality options including American Sign Language (ASL), Total Communication and Oral Communication. Every family and child’s experiences and needs are different which directly effects our combined efforts to develop the child’s communication journey. A full hearing and health evaluation is the beginning of the process. We collaborate with the child’s family, educators, and healthcare providers to develop our team’s approach for the child.

Who is a cochlear implant candidate for pediatrics?

To determine if a child is a cochlear implant candidate, we first need to know the extent of his or her hearing loss. Children with mild to moderate hearing loss are not candidates for cochlear implants. Hearing aids and other forms of amplification can usually help those patients. Cochlear implants are used to help children who have limited benefit from hearing aids. Children with unilateral profound sensorineural hearing loss (or single sided deafness), asymmetric sensorineural hearing loss or some children who are plateauing in the language development with appropriately fit hearing aids are also cochlear implant candidates.

The earlier your child receives an implant, the greater the potential is that he/she will develop listening/speaking skills at the same level as their normal hearing peers. Our multidisciplinary cochlear implant team has the ability and resources to help your child make as much progress as possible with listening/speaking skills.

Finally, for your child to be successful with their cochlear implant, your family must make this strong commitment together. We know that you are the most important part of the process for any child.

General Criteria:

At least 9 months of age; however, we can request cochlear implantation “off label” at earlier ages
Limited benefit from well fitted hearing aids that are worn all the time
Minimal progress in auditory development and speech and language development
Children whose families are motivated to follow through with therapy to support language learning and full-time cochlear implant device use

Older Children Considerations:

Mode of communication
Consistent use of hearing aids
Hearing aids are no longer providing adequate benefit
Poor speech understanding with properly fit hearing aids
Motivation to follow through with therapy and full time CI use
Understanding the benefits and limitations of cochlear implant use

Why choose PNI for your hearing health care?

Experience and Expertise:

Our team of professionals have extensive knowledge in diagnosing and treating complex hearing disorders.

Collaborative Care:

Multidisciplinary approach to comprehensive care is the core value of the PNI. Our cochlear implant surgeon, specialized CI audiologist, vestibular audiologists, brain health neurologists, auditory verbal therapy and speech therapy partners meet routinely to discuss and tailor treatment for each individual patient.

Accessible Care:

We can deliver super specialized care at the community-based level. We can deliver same-day services with appointments for audiology, otology, vestibular assessment, vaccine administration, and often imaging.

Support:

We have an in-house team to help schedule your visits and ensure a timely, seamless process where the patient feels well informed and part of the decision process. Our goal is also to create a PNI cochlear implant recipient community where we host gatherings and classes that will range from hearing aid technology, cochlear implants to speechreading and communication strategies.

Innovation:

Our team is involved in research projects to push the envelope of cochlear implant care. We apply the latest research and offer and forward-thinking approach to care.

Second Opinions:

Our team of experts can offer review of your medical records and meet via in person or virtual platforms. Hearing health issues can feel complex, especially when making a difficult treatment decision. Getting a second opinion can help you make an informed decision about your care.