Bionic Hearing–When is it time to get a cochlear implant?

Photo credit: Hear hear! licensed under CC BY-SA 4.0

by Daniel Fink, MD, Chair, The Quiet Coalition

The title of this post is also the title of an informative article in the current issue of Acoustics Today, a publication of the Acoustical Society of America. I’m covering this topic because I don’t think most American adults are aware of cochlear implant technology to treat profound hearing impairment, or that starting in September 2022, Medicare now covers cochlear implants. As the article notes, “uptake rates globally are low among adults.”

What are cochlear implants? According to Medicare, “A cochlear implant device is an electronic instrument, part of which is implanted surgically to stimulate auditory nerve fibers, and part of which is worn or carried by the individual to capture, analyze, and code sound.”

The Medicare Coverage Database lists the criteria for Medicare coverage:

Effective for services performed on or after September 26, 2022, cochlear implantation may be covered for treatment of bilateral pre- or post-linguistic, sensorineural, moderate-to-profound hearing loss in individuals who demonstrate limited benefit from amplification. Limited benefit from amplification is defined by test scores of less than or equal to 60% correct in the best-aided listening condition on recorded tests of open-set sentence recognition. Patients must meet all of the following criteria.

  • Diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefit from appropriate hearing (or vibrotactile) aids;
  • Cognitive ability to use auditory clues and a willingness to undergo an extended program of rehabilitation;
  • Freedom from middle ear infection, an accessible cochlear lumen that is structurally suited to implantation, and freedom from lesions in the auditory nerve and acoustic areas of the central nervous system;
  • No contraindications to surgery; and
  • The device must be used in accordance with Food and Drug Administration-approved labeling.

Cochlear implantation involves surgery, the willingness to have part of the device protruding from the scalp, and the desire and ability to participate in an extended program of auditory rehabilitation, i.e., learning to use the devices to understand speech. Cochlear implants are the most successful sensory prosthetics available. I have met several people with cochlear implants over my years as a noise activist, and all report great success at hearing better.

According to a recent report, use of hearing aids or cochlear implants was associated with almost a 20% reduction in the hazards of long-term cognitive decline.

Anyone who thinks he or she might meet the Medicare criteria, or their own health insurance coverage if below Medicare age, should ask an audiologist or otolaryngologist about whether this not-so-new technology might be helpful. And if you know someone with severe hearing loss who isn’t having much success with hearing aids, please let that person know about cochlear implants.

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