Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Overview ++ 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 Graphic Jump LocationTable 20-1Cochlear Implant Candidacy GuidelinesView Table||Download (.pdf) Table 20-1 Cochlear Implant Candidacy Guidelines Cochlear Implant Candidacy Guidelines Cochlear Nucleus Hybrid System Candidacy Guidelines Adult Children (2-17 y) Children (12-24 mo) Adults Only (≥ 18 y) Hearing threshold Moderate to profound SNHL in both ears (> 40 dB) Severe to profound SNHL (> 70 dB) Profound SNHL (> 90 dB) Normal to moderate hearing loss (thresholds better than 60-dB HL) in the low frequencies (≤ 500 Hz) and severe to profound mid- to high-frequency hearing loss, PTA (2,3,4 kHz) ≥ 75-dB HL in the ear to be implanted and moderately-severe to profound mid- to high-frequency hearing loss, PTA (2,3,4 kHz) ≥ 60-dB HL in the contralateral ear Word recognition Limited benefit from binaural amplification defined by ≤ 50% sentence recognition in the ear to be implanted (or ≤ 40% by CMS criteria) and ≤ 60% in the contralateral ear or binaurally. Limited benefit from binaural amplification defined by ≤ 20%-30% word recognition scores Limited benefit from binaural amplification trial based on MAIS Aided CNC word recognition score between 10% and 60% (inclusively) in the ear to be implanted. Contralateral ear equal to or better than that of the ear to be implanted but not more than 80% correct CMS, Centers for Medicare and Medicaid Services; MAIS, meaningful auditory integration scale; SNHL, sensorineural hearing loss. +++ 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.... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.