Candidate Expectations and Outcomes

As with most anything in life, expectations have a significant influence on the cochlear implant process. It is very important that both the patient and the family have realistic expectations. Questions regarding expectations should be addressed during pre-implant counseling. What can really be expected in the beginning? In the long run? What will happen after I (or my family member) start to use the device? Is the hearing “normal”? What about the phone? Will I be able to get a better job? Will my child do better in school?

Rehabilitation needs vary from one person to the next. No one can predict exactly how much benefit you, your child, or other family member will receive from a cochlear implant. There are many factors that contribute to how well a person does with a cochlear implant. Some factors are essentially beyond control, such as cause of deafness, number of functioning nerve fibers, or the presence of scar tissue (ossification) in the cochlea. Other factors can be controlled, such as how long you wait once the deafness is identified, selection of implant surgeon and team, compliance with follow-up programming, participation in appropriate therapies, and keeping the device in good working order. Your expectations for how well you or your child will hear should be based on your discussions with your audiologist and surgeon. Their experience combined with medical and demographic factors will enable them to set your expectations realistically.

As you consider a cochlear implant you are likely to encounter examples of monumental success, as well as major disappointment. Always keep in mind that your hopes and expectations should be based only on what your cochlear implant professionals tell you

Approximately one month after surgery, you or your child will return to the implant center to receive the external components of the system. The initial programming of the cochlear implant sound processor is a very exciting and emotional time for everyone involved.

While sounds are clearly audible and distinct, in some ways it is still like learning a new language. Most adults take between one and three months before they can really appreciate the full benefits they receive from a cochlear implant. Typically their hearing continues to improve over time as they gain experience listening to sounds and speech. For some people, the process may take longer. For children, they really are learning a new language - the language of hearing. It will take a long time and a lot of hard work to reach different milestones, but it's certainly worth it. In the weeks and months that follow your initial programming, you will return to your audiologist to further optimize your hearing programs. Visits to your audiologist will continue until they are only necessary for annual check-ups or to take advantage of new technology developments.

The average adult cochlear implant user will understand about 80 percent of what is spoken to them. They will recognize individual’s voices, sounds in the environment, even music in some cases. However, listening in noisy places is difficult. Receiving cochlear implants in both ears helps some people understand language better in noise. It also helps identify the direction sound is coming from.

Children who had normal hearing for 4 years or more before becoming deaf do extremely well with cochlear implants, usually keeping up with their peers. Children who are born deaf, however, count their initial programming and stimulation as ‘day 1’ of their hearing life. Since normal hearing children hear in-utero, it is critical that ‘day 1’ if hearing with an implant begin as young as possible. Practically speaking, this means around 1 year of life. With the cochlear implant, children are able to acquire language skills at the same rate as their hearing peers, but have a gap equal to the time they went without hearing. Using sign language during this time is not helpful and may reduce the ultimate benefit of implantation.

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