Cochlear Implantation

As of April, 2009, approximately 188,00 people have received cochlear implantation worldwide. Most cochlear-implanted adults can converse on the phone and most children are able to be educated in mainstream classrooms. Criteria for the use of these devices are evolving as their clinical use becomes more widespread. Some centers may consider only children with severe-to-profound bilateral hearing loss who have little or no benefit from amplification as candidates for cochlear implantation. Other centers consider cochlear implantation for children with speech delay and auditory neuropathy. The child's medical, psychological, and educational status is always taken into consideration prior to cochlear implantation.
The typical age of cochlear implantation varies by institution. Cochlear implantation is typically performed at 1 year of age or older, but in some cases may be performed at a younger age. It is important that parents consider cochlear implantation early in their child's life and receive early referral, if desired, since the effectiveness of cochlear implantation is dependent on age with better outcomes associated with early implantation.
Cochlear implants have several internal and external components including: an electrode array implanted into the cochlea, a receiver and magnet set into the bone behind the ear, a transmitter coil and a microphone worn behind the ear, and a speech processor carried in a pocket or fanny pack. The microphone receives speech and an electrical signal is sent to the speech processor through a connecting cable. The speech processor converts the electrical signal into a code that has been optimized for speech recognition. This code is then sent back over the cable to the headpiece and transmitted via radio waves to the implanted receiver. The code is then passed to the electrode array that stimulates the afferent auditory neurons within the cochlea.
cochlear implant diagram (Children's Specialists of San Diego)
Cochlear implant diagram (Advanced Bionix)
Cochlear implant sound processor
Cochlear implant sound processor (South of England Cochlear Implant Centre Web Site)
The integrity of the cochlear implant is tested at the time of surgery, immediately after surgery, and during routine follow-up visits. In addition to assuring parents return for ongoing audiologic testing and adjustment, the primary care physician should closely monitor and inquire about the child's language development and school performance during routine well child checks and follow-up appointments.
Children with cochlear implants may be at greater risk for bacterial meningitis (138 cases of meningitis per 100000 person-years). [Reefhuis: 2003] The Centers for Disease Control and Prevention recommend the following for individuals over 2 years of age with cochlear implants: [Centers: 2007]
  • Children with cochlear implants aged 2 years and older who have completed the pneumococcal conjugate vaccine (Prevnar®) series should receive one dose of the pneumococcal polysaccharide vaccine (Pneumovax® 23). If they have just received pneumococcal conjugate vaccine, they should wait at least two months before receiving pneumococcal polysaccharide vaccine.
  • Children with cochlear implants between 24 and 59 months of age who have never received either pneumococcal conjugate vaccine or pneumococcal polysaccharide vaccine should receive two doses of pneumococcal conjugate vaccine two or more months apart and then receive one dose of pneumococcal polysaccharide vaccine at least two months later.
  • Persons aged 5 years and older with cochlear implants should receive one dose of pneumococcal polysaccharide vaccine.


Information & Support

For Professionals

Cochlear Implants and Immunization, CDC Fact Sheet
Recommendations from the Centers for Disease Control and Prevention and the US Food and Drug Administration.

For Parents and Patients

Exploring the Possibilities (NCHAM - Wisconsin) (PDF Document 449 KB)
From the site of the National Center for Hearing Assessment and Management and Wisconsin's Babies & Hearing: An Interactive Notebook for Families With a Young Child Who Is Deaf or Hard of Hearing, providing a detailed overview of choices for supporting children with hearing impairment.

Cochlear Implants (NIDCD)
From the National Institute on Deafness and Other Communication Disorders, this page offers an overview of cochlear implants and links to more information.

Cochlear Implants: Yesterday, Today, Tomorrow (NIH Research Timelines)
From the National Institutes of Medicine, a perspective on research about cochlear implants and a prediction for its future.

Cochlear Implants (ASHA)
From the American Speech-Language-Hearing Association, an overview of cochlear implants.



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Pediatric Otolaryngology

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Cochlear Implants (
Listing of clinical trials of which may be recruiting subjects; National Institutes of Health.

Helpful Articles

Zwolan TA, Zimmerman-Phillips S, Ashbaugh CJ, Hieber SJ, Kileny PR, Telian SA.
Cochlear implantation of children with minimal open-set speech recognition skills.
Ear Hear. 1997;18(3):240-51. PubMed abstract

Waltzman SB, Cohen NL.
Cochlear implantation in children younger than 2 years old.
Am J Otol. 1998;19(2):158-62. PubMed abstract

Rauschecker JP, Shannon RV.
Sending sound to the brain.
Science. 2002;295(5557):1025-9. PubMed abstract

Bishop CE, Eby TL.
The current status of audiologic rehabilitation for profound unilateral sensorineural hearing loss.
Laryngoscope. 2010;120(3):552-6. PubMed abstract

Belzner KA, Seal BC.
Children with cochlear implants: a review of demographics and communication outcomes.
Am Ann Deaf. 2009;154(3):311-33. PubMed abstract


Authors: Richard Harward, AuD - 8/2010
Karl White, Ph D - 9/2008
Content Last Updated: 8/2010

Page Bibliography

Centers for Disease Control and Prevention.
Use of Meningitis Vaccine in Persons with Cochlear Implants.
Department of Health and Human Services; (2007) Accessed on 3/22/2010.

Reefhuis J, Honein MA, Whitney CG, Chamany S, Mann EA, Biernath KR, Broder K, Manning S, Avashia S, Victor M, Costa P, Devine O, Graham A, Boyle C.
Risk of bacterial meningitis in children with cochlear implants.
N Engl J Med. 2003;349(5):435-45. PubMed abstract