FAQs – Cochlear Implants

In our view, the best choice would be the one where you end up with the most hearing possible.  We think that listening with two ears is always better than listening with one, if that’s at all possible.  In an ideal world, we would like both adults and children who would benefit from having a cochlear implant to have both ears implanted as we know that this will give the best possible outcomes.  However, at this point in time, the NHS will only fund one cochlear implant for adults (children are funded for two implants).

If you are over 18 (and so only eligible for one implant); currently using two hearing aids, and getting better sound from one than the other, then our first choice will be to see if we can implant your worse hearing ear so that you keep the best of what you have and we add to it.  If your hearing on both sides is about the same, we’ll look to see whether there’s a clinical reason why one side might work better than the other – and if not, we’ll leave it up to you to decide which ear you’d prefer to have the implant in.  If you only have residual hearing on one side, we’ll check first at all if there’s any way at all that the ear that isn’t currently working could be implanted, but if we can’t be sure it would be successful (for example, if you haven’t worn a hearing aid on that side for 10 years or more), we’d probably suggest implanting the side that is working.

That said, first and foremost our intention and commitment is to help you hear better.  If we honestly thought there was a real risk that you wouldn’t get as much or more from a cochlear implant we would advise you not to go ahead.  Our priority is to help you hear better than you hear now with your hearing aids.

We have samples of all the different processors at the Implant Centre.  At the end of your assessment, after we know whether a cochlear implant is going to be helpful to you, you will have a one-to-one appointment called “Choosing My Device”, where you can try on all the different models and ask your Key Contact any questions, and then choose which device you would like.  It won’t feel quite the same as wearing a real speech processor, when the magnetic transmitting coil will have something to attach to, but it will give you an idea about the size and shape.

For children, we can give you a hand to work out how it might be best to set up the equipment (for example, having the batteries pinned to your child’s clothing rather than behind their ears), and we’re always happy to help you troubleshoot and rethink the wearing options as your child grows to help keep everything in place and out of the way.

Unless your surgeon or audiologist has a reason to recommend a particular device for you it is important that that you make your own decision about which device you would like. People have different reasons for the choice they make. You may be really interested in the technology, accessories, functions and features of the different devices and be keen to research these thoroughly. You may decide the look or feel of the speech processor is what is most important to you.

We will ask you to let us know why you have made your choice but all reasons are good reasons. The most common reason people give for their choice is they like the fit and feel of the speech processor.

In the early days, cochlear implants only had one electrode (single channel), then just a few electrodes (4 channels), and when the technology developed to put more electrodes in the little silicon array that goes into the cochlea (8 and 12 channel electrodes) there was a big difference in how well speech, environmental sound and music could be represented and understood.  They carried on experimenting with more electrodes, but generally they found that more than 10 electrodes in an array didn’t give better results, and so the researchers began looking instead at how to get the best possible use of a smaller number of electrodes.  As long as you have 10 working electrodes, roughly speaking, all of the sounds in speech can be distinguished from each other.

The three main manufacturers have different numbers electrodes in the array that is implanted (12, 16 or 22).  They all use the electrodes in different ways, stimulating pairs and patterns of electrodes hundreds of times a second, to represent the sounds out there in the world.  More isn’t better.  Fewer isn’t better. It’s just what each of the manufacturers have decided on in order to create their patterns of stimulation. Outcomes with a cochlear implant depend on a variety of factors such how the sound signal is processed, how far apart the electrodes are and how sound is collected by the microphones and analysed.

We suggest keeping the wound behind the ear dry until you have seen the surgeon in the Clinic, which is usually about 10 days after the operation. This means very careful hair washing with help or avoiding hair washing for this period of time. If the wound does get wet carefully dab it dry. Avoid swimming for 4 weeks.

In the early days, a cochlear implant sounds very different from a hearing aid or listening with your own ears.  It can take a while for your brain to adjust to the new sound, but once you do, it may begin to sound ‘normal’ – just as you remember things sounding in the past.

This is a tough question to answer as the answer can vary for each patient. Some of the most common descriptions we hear from patients are “beeps,” “mechanical,” “cartoonish,” “alien-like,” “someone talking under water,” “someone talking with marbles in their mouths,” “tinny,” “echo-like” and for some folks they may feel pulses before they even hear the sounds.

The important thing to realise is that the sounds will get better over time and often an odd sound quality will change as your brain better understand what it is hearing. There is no way to predict how an individual will respond with a cochlear implant. It is helpful to talk to as many people who use a cochlear implant as possible to better understand the way it sounds to different people.

If you have a cochlear implant in one ear and have no access to sound with your other ear it is difficult to tell where sound is coming from or who is speaking in a group without looking.

Many cochlear implant users still participate in and enjoy sport. However, some sporting activities can present a risk to the implant so special precautions should be taken.  You may need to make some adaptations to the equipment to keep it safe during activities, especially for sports where there is a high likelihood of getting hit on the head.

In most sports the speech processor can be worn as long as it is protected from physical damage. In more energetic sports it may be a good idea for the external part of the speech processor to be removed. If there is a risk of a blow to the head then it is also advised to wear head protection.

For some sports, such as swimming or water sports, the external part is usually removed beforehand, just as you would remove a hearing aid, although several companies now make waterproof versions.

Read more about Sports with a Cochlear Implant

These activities are not recommended in the first 6 weeks after surgery. If cochlear implant users do undertake these activities they should take extra precautions.

Read more about participating in sports with a cochlear implant.

There may be risks from scuba diving, or diving to any depth, because of the pressure, wearing tight fitting masks/headgear, and other possible medical risks. Different models of cochlear implant are approved to different depths but all are safe to at least 10 metres. 

It is difficult to say what a safe height for using a diving board is. A bad dive from a high board can put the internal part of the implant at risk.

All the recent cochlear implants offer features to help with listening in noise but none will make listening in noise easy or comparable to a person with normal hearing. Most people find they use lipreading as a backup in these situations.

Yes, you may switch to T with a remote control or by choosing a specific programme in your processor.

The speech processor will likely come off during sleep and so we recommend taking it off before you go to bed. We supply a dehumidifier dry box for your processor, to keep your equipment moisture free, and the majority of people find it most convenient to keep their processor in the dry box overnight.

If you live alone, and are thinking about possibly sleeping  with your speech processor on for safety reasons, we suggest that an additional assistive listening device might be more practical.  There are some suggestions on the Connevans website here: http://www.connevans.co.uk/catalogue/122/Alerting-Devices.  Your local Social Services department might be able to offer some advice too.

Cochlear implants are primarily designed for hearing speech. Some people find music enjoyable with a cochlear implant but some do not. We can offer tips and advice about listening to music with your implant.

Visit the page on Listening to Music

We would suggest you wear a hard hat as you normally would, where the implant can be worn underneath. You may need to try some different styles to see what works best, and make sure there is not too much pressure on the implant site.

Arc and MIF welding and RF PVC welding do not cause a threat to the implant but the user may hear interference.

Care should always be taken to avoid high voltage electric shocks, sparks or magnetic fields which could damage the implant. Speak to us if you have a job where these issues may arise.

Unfortunately USAIS is not able to send any replacement equipment abroad, however each of the cochlear implant companies have their own holiday loaner schemes that work slightly differently to each other.

You can find out more information at the links below:

Advanced Bionics Holiday Loaner Form
Cochlear Travel Programme Leaflet
MED-EL Holiday Loaner Request Form

Yes, you’ll need to carry your device identification card with you as the security arch you step through may flash (there are metal parts in the implant). Provided there are no surgical complications, most patients can resume airline travel after two months from time of surgery. However, it may be best to discuss this topic further with your implant surgeon.

Rides which involve high speeds and/or extreme forces are not recommended as there is the potential of dislodging the internal part. This risk is greatest in the first 6 months after surgery. For less extreme rides you may want to remove the external equipment to prevent it coming off.

Yes, X-rays and CT are fine. Just remove the external equipment. MRI scans (of any part of the body) are possible for many cochlear implant patients if specific precautions are taken. The MRI specific requirements are different for different makes and models of cochlear implants, so it is important to contact the implant centre before any MRI’s are performed.

Read more about MRI Scan Guidelines

There are certain treatments which could cause harm for people with a cochlear implant and therefore should never be used. You should ensure that you carry your ID card/ medic alert bracelet so medical professionals know you have a cochlear implant.

Devices which cause electric current to flow through the head and / or neck should never be used. If you are considering using equipment that could involve electrical current passing through other parts of the body, you should check with your cochlear implant centre first.

Treatments not suitable for cochlear implant users include:

1. Electrosurgery
2. Therapeutic diathermy
3. Neurostimulation
4. Electro-convulsive therapy
5. Transcranial magnetic stimulation
6. Electric hay fever relievers

After having the operation for a cochlear implant you should not drive until you feel completely well and safe to do so.

The use of wireless accessories with pacemakers has been looked into by each of the cochlear implant companies, and no interference has been found.

However it is recommended to contact a doctor and/or the manufacturer of the accessory before use, and to stop use of the device instantly if any influence is suspected.

Normal precautions should be taken regarding the distance between the pacemaker and any source of interference.

The implanted unit is designed to last a long time. The internal part is deliberately kept quite basic and straightforward so that new developments are incorporated into the outside parts instead of you needing another operation. There are regular updates to the software in the external speech processor, which are done as part of your normal tuning appointments.

No, the internal part only works with the external processors made by the same manufacturer. If a new model of processor becomes available for your specific implant after you have used your processor for 5 years you can be changed to the new model.

The hearing implant manufacturers design their implants so that you can access new technological advances with a new model of external processor without having the internal implant/fixture changed. It’s impossible to know what developments and discoveries might be available to patients in another 25 or 50 years’ time.  It is always possible that a young person having an implant today might need something different at some point in their life, but we don’t anticipate any major changes in the short- to medium-term.

No, the design of the surgically implanted receiver and electrode array has changed relatively little during the history of cochlear implants. However, speech-coding strategies, which are responsible for delivering the signal to the internal unit and are stored in the externally worn speech processor, have improved significantly over the years. The speech processor can incorporate new technology when available.

We are involved in cochlear implant research at our centre, and look forward to new technological advances as much as our patients do.  Given the timescales for the research, development, and safety testing for all new technologies, we can’t see anything on the immediate horizon which would make it worth missing out on what a cochlear implant could do for you at this stage of your life.  Things might change in a few decades, but even then there would be no way of knowing whether any new inventions might be something which would be suitable for you or not.

The cochlear implant is a lifelong commitment. Usually you will need to come to the CI centre in Southampton regularly to have your individual settings (maps) programmed in.  This is called tuning.  We start tuning  approximately 4-6 weeks after you have had your operation to give everything a chance to heal up. On average, the cochlear implant will require programming about 4 times in the first month after activation, again at 3 and 6 months post implant and at 1 year post implant. We would then normally see adult patients annually for the first 3 years and then at the time of their speech processor upgrade. Children will be seen at more regular intervals. If you have any problems or concerns with your cochlear implant, of course, we would see you as quickly as possible to sort things out for you.

Repairs for equipment funded by the NHS will be covered by NHS England. Self-funded patients should contact the centre for equipment prices.

All parts of the equipment that are essential for you to operate the processor to hear sound are funded by the NHS and will be replaced free of charge by the University of Southampton Auditory Implant Service if they become faulty.

Some extra accessories provided by the manufacturers that can be used to connect to Phones/Music Systems/TV/Computers have a limited manufacturer’s warranty that will not be replaced by University of Southampton Auditory Implant Service outside of these terms.   

The SONNET and Kanso processors uses disposable batteries at the moment but all of the others use rechargeable batteries. USAIS supplies disposable and rechargeable batteries and can post them out to you if needed. If the processor you choose has a rechargeable option USAIS will provide you with one box of 60 disposable batteries per year for emergencies or holidays.

This is rare but the implant can be removed and replaced but obviously another operation is needed. Most patients do just as well with the re-implanted device.

It is not possible to answer this with certainty because it would depend on the particular treatment. The prospect of new treatments possibly becoming available at some point in the future needs to be balanced against cochlear implantation which is available now to give significant help with hearing for suitable candidates.

The three companies we use are all well established with a strong market presence and have been making cochlear implants for many years. In the unlikely event that one of these companies were to stop trading, we would try to maintain existing patients devices however we could.