MedStar Health: Otolaryngology at MedStar Washington Hospital Center

Cochlear implant candidacy is made up of many factors, such as:

• Your hearing test results
• Your speech testing results
• How much benefit you get from appropriately fit hearing aids

The following factors are also important in determining whether you are a good cochlear implant candidate:

• Realistic expectations and motivation
• Understanding of the effects of cochlear implantation
• Commitment to wearing the sound processor and following the recommended appointment timeline

You will have testing to make sure that a cochlear implant is a good option for you. Our team can answer your questions and guide you through this process. You will learn 
how cochlear implants work, and what an implant can and cannot do to help you.

Before considering a cochlear implant, it is important to understand that:

• Cochlear implants do not restore hearing to normal.
• In a small minority of people, a cochlear implant may not help with hearing at all.
• Some patients lose their remaining natural hearing in the ear where the implant is placed.
• The benefits of a cochlear implant vary from person to person.
• It takes time and practice for the brain to adjust to hearing with a cochlear implant.

A cochlear implant requires care over a person's lifetime. Therefore, choosing a cochlear implant system is an important decision. You will want to understand your options to make an educated decision about your hearing health. Our cochlear implant team will help guide you through this process. In addition, we will give you individualized information about the cochlear implant manufacturers we work with. We also recommend that cochlear implant candidates consider the following when choosing a cochlear implant system: 

• Sound processing technology
• Sound processor options and features
• Wireless connectivity options
• MRI Compatibility
• Accessory options
• Equipment reliability and quality

We work with two FDA-approved cochlear implant manufacturers at MedStar Washington Hospital Center: Advanced Bionics and Cochlear.

While very rare, meningitis can occur as a complication of cochlear implantation. If it does, it can cause serious consequences.

Meningitis infects the lining of the surface of the brain. Early symptoms of meningitis include headaches, stiff neck, nausea, vomiting, and confusion or alteration in consciousness in adults. Physicians are encouraged to consider a diagnosis of meningitis in cochlear implant patients when such symptoms exist and to begin appropriate treatment as soon as possible.

The unusual occurrence of meningitis can be decreased even further through appropriate vaccination. Therefore, we recommend vaccinations for patients with cochlear implants. Please ask our office staff if you are still waiting to receive a vaccination recommendation sheet. If you have any questions regarding this issue, please contact your physician.

Based on CDC recommendations, all persons with cochlear implants should receive age-appropriate pneumococcal vaccination with the 7-valent pneumococcal conjugate vaccine (PCV7) (Prevnar®), 23-valent pneumococcal polysaccharide vaccine (PPV23) (Pneumovax®23), or both according to the Advisory Committee on Immunization Practices (ACIP) schedules for a person at high risk.

Because the rate of pneumococcal meningitis is higher in children with cochlear implants and Streptococcus pneumoniae is the most common pathogen causing bacterial meningitis in cochlear implant recipients of all ages with meningitis of known etiology, ACIP recommends the following for persons who have or are scheduled to receive a cochlear implant:

• Persons aged 5 to 64 years with cochlear implants should have received PPV23 according to the schedule used for persons with chronic illnesses, a single dose is indicated.²
• If possible, people planning to receive a cochlear implant should be up-to-date on age-appropriate pneumococcal vaccination ≥2 weeks before surgery.
• Adults (age 19 years and older) who have NOT had any prior pneumococcal vaccinations need either (1) one dose of PCV20 (Prevnar 20) or (2) one dose of PCV15 (Prevnar 15) followed 8 weeks later by PPV23. A PPV23 booster is required at age 65. Adults (age 19 years and older) with prior vaccination only with PPV23 now also need one dose of PCV13 to be given 12 months after their PPV23 shot.

While meningococcal vaccinations are recommended for all preteens and teens, the CDC does not recommend routine meningococcal vaccination, specifically for younger children and adults with cochlear implants. Data do not suggest that people with cochlear implants are at increased risk for meningococcal meningitis. This is why CDC does not recommend meningococcal vaccination specifically for people with cochlear implants.²

References:

1. CDC. Pneumococcal vaccination for cochlear implant candidates and recipients: Updated recommendations of the advisory committee on immunization practices. MMWR. 2003;52:1-2
2. CDC. Cochlear implants and vaccination recommendations. January 27, 2022. Accessed May 5, 2023. https://www.cdc.gov/vaccines/vpd/mening/public/dis-cochlear-faq-gen.html

Cochlear implant surgery is performed under general anesthesia. It typically takes 2-3 hours to complete. Most cochlear implant recipients go home from the hospital on the same day. A small incision is made behind the ear during the surgery. A pocket under the skin is developed to place the internal stimulator/receiver. Next, the mastoid bone is partially drilled away to expose the inner ear structures. This allows the internal device to be placed. An audiologist will likely perform testing on the cochlear implant in the operating room.

The cochlear implant initial activation appointment is when we will turn on your sound processor for the first time. The initial activation takes place about 1 month after surgery. This time between surgery and the activation appointment is required to heal your incision site. The cochlear implant initial activation appointment can be very exciting and overwhelming at the same time. Our main goal on this day is to provide you with sound detection.

• Selena Briggs, MD
• Abbie Parks, AuD, CCC-A
• Breanna Corle, AuD, CCC-A
• Emma Woolf, AuD, CCC-A, ABAC