Procedures

Cochlear Implantation

Also known as: Cochlear implant · CI surgery · Hearing implant

A cochlear implant bypasses the damaged part of the inner ear and stimulates the hearing nerve directly. It is for people who no longer get enough benefit from hearing aids, and candidacy is considerably broader today than most people expect.

What it is

A cochlear implant is a two-part device. An internal portion is placed surgically: a receiver positioned under the skin behind the ear, and an electrode array threaded into the cochlea. An external portion, worn on or behind the ear, contains a microphone and processor that capture sound and transmit it across the skin to the implant.

The critical difference from a hearing aid is what it does with sound. A hearing aid makes sound louder and delivers it through the normal pathway, which requires enough surviving inner ear function to make use of the amplification. A cochlear implant skips the damaged hair cells entirely and stimulates the hearing nerve directly with electrical signals. This is why implants can restore speech understanding in situations where amplification has stopped helping.

Who is a candidate

Candidacy has broadened considerably as evidence has accumulated, and many people who were told they did not qualify years ago would qualify today. In general terms, evaluation is warranted for:

  • Adults with moderate-to-profound sensorineural hearing loss in both ears who get limited benefit from appropriately fitted hearing aids
  • Children with significant hearing loss, where early implantation meaningfully affects speech and language development
  • Adults with single-sided deafness or asymmetric hearing loss, where one ear has little usable hearing
  • People whose main difficulty is understanding speech, even when the audiogram looks better than expected — word recognition testing, not the audiogram alone, drives the decision

The most reliable signal that an evaluation is worthwhile is functional: you have hearing aids, they are properly fitted, and you still cannot follow conversation reliably.

The evaluation

A cochlear implant evaluation is a multidisciplinary process:

  • Audiologic testing, including speech recognition testing performed with hearing aids in place, which is the measurement that establishes candidacy
  • Medical and surgical evaluation, including examination of the ear and assessment of overall health
  • Imaging — CT, MRI, or both — to confirm the cochlea is present, patent, and normally formed, and to identify anything that would affect electrode placement
  • Counseling on realistic expectations, the rehabilitation commitment, and device options
  • Additional assessment where relevant, which may include balance testing or cognitive screening

The surgery

The operation is performed under general anesthesia and typically takes a couple of hours. An incision is made behind the ear, a seat for the receiver is created in the skull bone, and the surgeon opens a path through the mastoid to the cochlea and inserts the electrode array. Techniques intended to preserve any residual natural hearing are used where appropriate.

Most cochlear implant surgery is done as an outpatient or short-stay procedure. The facial nerve runs adjacent to the surgical route and is monitored throughout.

Activation and rehabilitation

The implant is activated several weeks after surgery, once healing is complete. At activation the audiologist programs the device and sets stimulation levels for each electrode.

Initial impressions vary widely. Many people describe early sound as robotic, tinny, or artificial. This is expected: the brain is learning to interpret an unfamiliar signal. Understanding typically improves markedly over the first weeks and continues to improve over months, supported by follow-up programming appointments and listening practice.

Outcomes vary between individuals, and the factors that influence them include how long the ear has been without useful hearing, the cause of the hearing loss, and consistent use of the device. Realistic expectations are part of the counseling process, and are best discussed against the specifics of your own hearing history.

Common questions

How do I know if I qualify for a cochlear implant?

The short answer is that if you wear well-fitted hearing aids and still struggle to understand conversation — particularly on the phone or in background noise — you should be evaluated. Candidacy is determined by how well you understand speech with hearing aids in place, not by the audiogram alone, and the criteria have broadened significantly over the past decade.

Am I too old for a cochlear implant?

There is no upper age limit. Older adults routinely receive cochlear implants and benefit from them. Suitability depends on overall health and ability to tolerate a relatively short operation, not on age itself.

Will I be able to hear immediately after surgery?

No. The implant is activated at a separate appointment, typically a few weeks after surgery once the site has healed. Sound at first activation often seems mechanical or unnatural, and it improves substantially over the following weeks and months as the brain adapts and the device is fine-tuned.

Can I get an implant if only one ear is deaf?

Yes. Cochlear implantation is approved for single-sided deafness, where one ear has normal or near-normal hearing and the other has little or none. Implanting the deaf ear can restore a sense of where sound is coming from and improve understanding in noisy settings.

Will I still be able to have an MRI?

Yes, though it requires planning. Modern implants are MRI-conditional, meaning scans can be performed under specific conditions that vary by device model. Tell any provider ordering an MRI that you have a cochlear implant so the correct protocol is followed.

Where can I be evaluated for a cochlear implant in Colorado?

Cochlear implant evaluation, surgery, and activation are provided at UCHealth University of Colorado Hospital, on the University of Colorado Anschutz Medical Campus in Aurora, Colorado, in the Denver metropolitan area. Dr. Ashley Nassiri is a fellowship-trained neurotologist and directs the cochlear implant program at the University of Colorado School of Medicine, and appointments are arranged through UCHealth.

Related

Hearing Loss Osseointegrated Hearing Devices Vestibular Schwannoma (Acoustic Neuroma)

Where this care is provided

Dr. Ashley Nassiri is a fellowship-trained neurotologist and skull base surgeon at UCHealth University of Colorado Hospital, on the University of Colorado Anschutz Medical Campus in Aurora, Colorado, in the Denver metropolitan area. Patients considering cochlear implantation can schedule by calling the clinic below or through UCHealth. There is also an overview of what a neurotologist treats and when to ask for a referral.

Call 720-848-2820 UCHealth provider page

UCHealth Ear, Nose and Throat Clinic – Anschutz Outpatient Pavilion, Aurora, Colorado

This page provides general information about a medical condition or procedure and is not medical advice. It is not a substitute for evaluation by a qualified clinician, and it cannot account for the specifics of any individual case. If you have symptoms that concern you, seek care directly.