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  • A cochlear implant (CI) is a surgically implanted device used for hearing rehabilitation of adults and children with advanced sensorineural hearing loss (SNHL) and/or poor speech discrimination who gain limited benefit from conventional hearing aids.

  • At a fundamental level, a CI is a transducer that transforms acoustic energy into an electrical signal, which is used to stimulate surviving spiral ganglion cells of the auditory nerve.

  • There are currently three FDA-approved CI manufacturers: Advanced Bionics Corporation (Valencia, CA, USA), Cochlear Corporation (Lane Cove, Australia), and Med-El GmbH (Innsbruck, Austria).

  • Over the last three decades, advancements in surgical technique, electrode design, and improved speech processing strategies have led to increasingly better outcomes in CI recipients. As a result, FDA candidacy criteria have gradually expanded from initially only implanting postlingual deafened adults with profound bilateral SNHL to now implanting adults and children with greater degrees of residual hearing (Table 20-1). Furthermore, a growing proportion of patients are undergoing CI for off-label or nontraditional indications including single-sided deafness, retrocochlear hearing loss, asymmetrical SNHL in adults and children with at least one ear that is better than performance cutoff for age, and children less than 12 months of age.

Table 20-1Cochlear Implant Candidacy Guidelines

Cochlear Implant Design

External Components

  • Components of the CI device are illustrated in Figure 20-1.

  • Microphone: placed near earhook and receives natural acoustic information and converts it to an analog electrical signal, which is sent to the behind-the-ear (BTE) or single unit off-the-ear sound processor.


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