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  • Writer's pictureWidex Emirates Hearing Care

Cochlear Implants: How Do It Work?

Updated: Oct 20, 2023


cochlear implants
Image Credit: https://media.healthdirect.org.au/images/inline/original/cochlear-implant-illustration-445004.jpg

Cochlear implants are electronic devices that diminish hearing loss. They do not restore the normal hearing of the person. Yet, they can provide the patient with a useful representation of sounds that help in understanding speech. Most people benefit from it by receiving audiologic therapy, a process that helps in relearning how to hear.

Let us have a look at their parts, benefits, procedures, risks, stages, and all that is needed. Your journey with cochlear implants will take time, so knowing all these and cooperating with your hearing team will help you a lot.

  1. What are cochlear implants?

  2. Why choose cochlear implants and not hearing aids?

  3. How do cochlear implants work?

  4. Who can benefit from cochlear implants?

  5. What criteria are considered to be eligible for a cochlear implant?

  6. What are the advantages of cochlear implants?

  7. What are some risks of cochlear implementation?

  8. How can you get prepared for cochlear implants?

  9. What are the stages of cochlear implants?

What are cochlear implants?

They are complex and small electronic devices that can aid in providing a sense of sound to people severely suffering from hearing loss. They can recognize warning signals, understand speech over the phone or in person, and understand different sounds in the environment.

They consist of an external portion, placed behind the ear and another part placed during surgery under the skin. Its parts consist of:

  • A microphone, picking sounds from the environment

  • A speech processor selects and arranges sounds picked up by the microphone

  • A transmitter synchronizes with a stimulator. It collects the signals from the speech processor and alters them into electric impulses.

  • An electrode array gathers the converted impulses and sends them from the stimulator to different areas of the auditory nerves

Why choose cochlear implants and not hearing aids?

Cochlear implants are an option for those who suffer from severe hearing loss due to inner ear damage. When the hearing aids stop being effective in this case, cochlear implants are the solution.

  • They dodge damaged portions of the ear and deliver sound signals immediately to the hearing or auditory nerve.

How do cochlear implants work?

Cochlear implants use a specific sound processor that is placed behind the ear and captures sound signals. It then sends them to a receiver implanted behind the ear under your skin. This receiver sends signals to electrodes that are instilled in the cochlea. These signals accelerate the auditory nerve, whose job is to direct the signals to the brain.

It usually takes time and some training to learn how to interpret the signals received from the cochlear implant.

  • People with cochlear implants are able to understand speech after 3 to 6 months of use.

  • They can be positioned in one ear or both ears.

Who can benefit from cochlear implants?

  • Adults and children who are severely suffering from hearing loss or deafness can benefit.

  • At first, adults will have one cochlear implant and one hearing aid. They then evolve into two cochlear implants when hearing loss advances in the hearing aid ear.

  • Cochlear implants are placed in both ears simultaneously in children who are learning how to speak and process language, particularly those having bilateral severe hearing loss.

  • Children as young as 6 to 12 months old can benefit a lot from these cochlear implant surgeries.

What criteria are considered to be eligible for a cochlear implant?

There are some criteria that are taken into consideration when choosing cochlear implants, such as:

  • Hearing loss interrupting spoken communication

  • Limited benefit from hearing aids, determined by the audiologist when performing specialized hearing tests

  • Having the motivation to participate in hearing therapy

  • Pragmatic expectations of cochlear implants- what they can and cannot do for hearing

What are the advantages of cochlear implants?

  • All those who have cochlear implants had a huge progress in:

  • Hearing speech without the need for visual cues like reading lips

  • Recognizing the everyday environmental sounds around them

  • Listening without difficulty in noisy environments

  • Acquiring speaking in the case of children born with hearing loss

  • Knowing where sounds are coming from

  • Hearing television programs, telephone conversations, and music

  • Reducing the symptoms of ringing and buzzing associated with tinnitus in the implanted ear

What are some risks of cochlear implementation?

Cochlear implementation is very safe. However, there are some risks that patients might encounter. Such include:

  • Loss of residual hearing

Some people might suffer from loss of unclear or remaining natural hearing in the implanted ear.

It is the swelling of the membranes that surround the brain and spinal cord. There are vaccinations given to adults and children before the implementation. This is to help reduce the risks of meningitis. Nevertheless, the risk of this condition is infrequent.

  • Failure of the device

Sometimes a faulty internal device may require being repaired or replaced. This takes place in less than 5% of people over many years.


There are some complications that might take place. Although they are rare, we are going to mention some:

  • Some bleeding

  • Infection of the device

  • Facial paralysis

  • Infection at the surgery site

  • Dizziness

  • Some taste problems

  • Worsened or new ear noise (tinnitus)

  • Spinal fluid leak

How can you get prepared for cochlear implants?

Cochlear implant surgeries are performed under general anesthesia. That means you or your child will be in a sleep-like condition during the whole procedure. There are some instructions that are necessary before the surgery. The surgeon will provide you with all the instructions and details needed to help you get prepared. Such include:

  • Stop taking medications or precise supplements for a specific period of time

  • Avoid drinking or eating for a particular amount of time

What are the stages of cochlear implants?

1. Before the procedure

Your healthcare provider or your audiologist will conduct a detailed medical evaluation to determine if the cochlear implants are a good option or not. They will operate:

  • Speech, hearing, and sometimes balance tests

  • Physical exams to evaluate the health and anatomy of the patient

  • CT or MRI imaging tests of the skull to evaluate the current condition of the cochlea and the structure of the inner ear

They will also coordinate with the surgeon to determine which type of cochlear implant best suits your needs and condition.

All cochlear implants include external and internal parts:

  • Internal cochlear implant with an external unit

i) It is associated with the side of the head.

ii) The external unit contains a speech processor which is combined with a microphone and transmitter, all in one device.

iii) It can be charged when it is necessary.

  • An internal cochlear implant added to an external sound processor

i) It fits behind the ear.

ii) The transmitter is attached to the side of the head.


2. During the procedure

The surgeon will cut behind the ear (incision). They will form a tiny hole in the portion of the skull bone, which is the place where the internal device rests (mastoid).

They will then form a small opening in the cochlea to thread the internal device’s electrode. The skin incision is usually stitched closed to keep the internal device under the skin.


3. After the procedure

Cochlear implant surgery is an outpatient process. Most people feel well enough to go back home on the day of surgery. They don’t have to remain in the hospital overnight. The audiologist will turn the device on. You might experience:

  • Pressure/discomfort over the ear where the device has been implanted

  • Nausea

  • Dizziness

4. Activation

  • After two weeks of the surgery, follow-up appointments are required. Your audiologist will:

  • Fine-tune the sound processor to fit you

  • Check the components of the cochlear implant, making sure they work

  • Regulate what sounds you hear

  • Provide you with information on the use and care of the device

  • Set the device to give you the best sound quality

5. Rehabilitation

It involves training your brain to comprehend sounds it hears through the cochlear implant. Everyday and speech environmental noises will sound very different from the sounds you used to hear. Your brain needs the time to recognize what they mean. It is an ongoing process and is best obtained by wearing the speech processor regularly during waking hours.

Regular and follow-up visits to check and program the device are a must. It can help you benefit more from the implant.


Hearing is an acquired behavior. If you experience hearing loss, your brain needs time to relearn how to process sounds again. Choosing a cochlear implant requires knowing what it is, how it functions, and what requirements it needs. It is life-changing. Since patients will have it for life, they must commit to undergoing auditory-based relearning or hearing rehabilitation therapy in order to optimize the benefits of it.

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