Cochlear Impants
This page shares information from what we've learned along our journey and from medical professionals and experts in the field. This is our family’s experience in Aotearoa New Zealand. We ourselves are not medical professionals, and this is not medical advice.
Understanding Cochlear Implants
A cochlear implant (CI) is a medical device that helps people with moderate to severe hearing loss access sound when hearing aids are no longer effective.
Unlike hearing aids, which simply make sounds louder, a cochlear implant works in a different way. It bypasses the damaged parts of the inner ear and sends sound information directly to the hearing nerve.
Instead of amplifying sound, it converts sound into electrical signals that the brain can learn to recognise as meaningful sound.
How does it work?
A cochlear implant has two main parts - one internal and one external.
The internal part
The internal component is surgically placed under the skin behind the ear. A small receiver sits just under the skin, and a thin array of electrodes is gently inserted into the cochlea (the spiral-shaped structure inside the inner ear).
These electrodes stimulate the hearing (auditory) nerve directly. When activated, they send tiny electrical signals along the nerve to the brain.
This internal part typically does not need to be updated or changed and usually there is no need for further surgery to replace this.
The external part
The external part is called the speech processor. It sits outside the ear and contains a microphone that picks up sounds from the environment - voices, music, everyday noises.
The processor analyses these sounds and turns them into digital signals. These signals are sent through a small transmitter coil, which connects magnetically through the skin to the internal implant.
The internal device then converts the signals into electrical impulses that stimulate the auditory nerve.
This external part can last between 5-10 years and typically would then be replaced with upgraded technology - but still will work exactly the same with the internal part. Small parts of the external part do also need to be replaced if they get damaged or worn over time.
Cochlear implant surgery
Cochlear implant surgery is done under a general anaesthetic, which means the person is asleep during the procedure. The surgeon places the internal part of the implant under the skin behind the ear and gently inserts the electrode into the cochlea.
The surgery usually takes a few hours, and most people stay one night in hospital so doctors can monitor recovery. After going home, there is typically a few weeks of recovery, during which physical activity may be limited while the incision heals.
It’s also important to know that in most cases cochlear implant surgery means that any natural hearing remaining in that ear will be lost, as the implant replaces the way the inner ear processes sound. This is something families discuss carefully with their medical team before making a decision.
This surgery is a well-established and generally safe procedure. There is a small scar behind the ear where the incision was made, but this will fade in time and is barely visible. A small patch of hair is shaved during surgery, but will grow back and the CI can sit on top of hair.
What happens next?
Over time, the brain learns to interpret these signals as sound. Hearing through a cochlear implant is different from natural hearing, especially at first, but with use and support many people learn to understand speech and environmental sounds more clearly.
Cochlear implants don’t “restore” hearing in the traditional sense - but they can provide meaningful access to sound and improve communication, safety, and participation in daily life.
Cochlear implant brands
There are three main cochlear implant manufacturers used worldwide:
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Cochlear Limited
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MED-EL
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Advanced Bionics
All three produce medically regulated, research-backed devices and are widely used internationally.
While they all do the same overall job, there can be differences in:
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Electrode design (the internal part placed in the cochlea)
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Sound processing technology
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External processor style and size
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Connectivity options (Bluetooth, streaming, accessories)
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Waterproofing and durability options
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Upgrade pathways over time
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Compatibility with accessories and assistive technology
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Long-term service and support structures
The choice is usually based on a combination of:
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Medical or anatomical suitability
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Surgeon recommendation
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Audiologist advice
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Availability within a public funding programme
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Insurance coverage or self-funding considerations
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Technology features that suit the child’s lifestyle
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Family preference after learning about options
The right choice depends on the individual child and their circumstances.
Bilateral cochlear implants
Some people receive cochlear implants in both ears, either at the same time or at different times. Having two implants can help with things like telling where sounds are coming from and hearing more clearly in noisy places. For some children, especially when implanted early, it can support learning to hear with both ears.
We don’t have personal experience with bilateral cochlear implants, but many families choose this option based on their child’s hearing needs and medical advice. As with all hearing decisions, what’s right will depend on the individual person and their situation.
Cochlear implants for single-sided deafness (SSD)
In the past, cochlear implants were less commonly recommended for single-sided deafness, but increasing evidence suggests they can improve listening, sound localisation, and overall hearing outcomes for many children.
Children with SSD can face challenges that aren’t always obvious to others, including:
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difficulty understanding speech in noise
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difficulty locating where sound is coming from
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increased listening effort and fatigue, which can affect school and learning
What does the research suggest?
Research into cochlear implants for children with single-sided deafness is still growing, but the findings so far are positive.
Studies looking at children with SSD who received a cochlear implant have found that many experienced noticeable improvements in hearing. In research that measured outcomes, around 80% of children showed better understanding of speech in noisy environments, and a similar number showed improvements in understanding speech in quiet settings.
When it comes to sound localisation - knowing where a sound is coming from - results vary between studies. However, many report improvements in sound awareness and direction after implantation.
Another theme that comes up in research is timing. The longer the ear goes without sound, the harder it can be for the brain to learn to use it later. Some studies suggest that earlier implantation may be linked to better outcomes.
That doesn’t mean earlier is always the right choice for every child — but it is one of the factors families and clinical teams consider when making decisions.
A key reality for families with single-sided deafness (SSD)
Because public criteria generally focus on bilateral hearing loss, children with single-sided deafness often do not qualify for public funding unless they meet special-case criteria (for example, if someone had hearing loss from meningitis).
Possible benefits and challenges
Every cochlear implant journey is different. While many people experience significant benefits, outcomes vary from person to person.
Possible benefits
A cochlear implant doesn’t restore natural hearing, but it can provide meaningful access to sound. For many children and adults, this may include:
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Hearing sounds and understanding speech
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Better listening in everyday situations, including classrooms and social settings
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Greater awareness of environmental sounds (like traffic, alarms, or someone calling their name)
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Improved ability to hear in noisy places
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Support for developing listening and language skills
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Increased independence and confidence
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The opportunity to experience sound from both sides (for those with single-sided deafness)
Possible challenges
At the same time, cochlear implants require commitment and ongoing support. They may involve:
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Surgery and recovery
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Regular follow-up appointments for mapping and adjustments
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Speech or listening therapy
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Managing equipment (charging batteries, replacing parts, keeping track of accessories)
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Listening fatigue, especially in busy environments
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Physical considerations during sport or swimming
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Outcomes that vary between individuals
It’s also important to remember that hearing through a cochlear implant is different from natural hearing, particularly at the beginning. It takes time, patience, and practice.
Eligibility
Who might be eligible for a cochlear implant?
Cochlear implants are typically considered for people with moderate to profound sensorineural hearing loss who receive little benefit from hearing aids. Eligibility is determined through detailed hearing assessments and medical evaluation.
In many countries, publicly funded cochlear implant programmes prioritise people with bilateral (both ears) severe to profound hearing loss, particularly when hearing aids are no longer effective. Criteria can vary depending on age, country, funding systems, and clinical guidelines.
Some people with single-sided deafness (SSD) may also be considered for cochlear implantation, although eligibility and funding pathways differ widely around the world.
Who may not benefit from a cochlear implant?
Cochlear implants are designed to help when the inner ear (cochlea) is damaged but the auditory nerve is still functioning. Because of this, they are not suitable for all types of hearing loss.
A cochlear implant may not be beneficial for people who:
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Have hearing loss caused by damage to the auditory nerve itself
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Have certain structural differences where the auditory nerve is absent or non-functional
Have hearing loss primarily due to middle ear problems (which may be treatable in other ways) -
Have types of hearing loss that respond well to hearing aids