Deciding whether to get a cochlear implant is not a simple decision. It involves a lot of practical, medical, financial, communication, and lifestyle considerations that are not always fully discussed until later in the evaluation process.
This article isn’t an attempt to sway you one way or the other. It only outlines some of the real-world pros and cons people should weigh when considering a cochlear implant for yourself or your deaf child. These experiences can vary widely from person to person. Outcomes are not guaranteed.
There are people who do well with cochlear implants, and there are people who don’t. This is to give you an idea of what that can look like from either perspective while you decide.
If you’re new to cochlear implants, please check out this article, too:
What Is a Cochlear Implant?
There’s also a layer of cultural context behind the technical considerations: Cochlear Implants: Then and Now from a Deaf Perpsective
Using this list to consider the pros and cons of cochlear implants
This is not medical advice or a complete list of every possible outcome. Cochlear implant candidacy and results depend on many individual factors, including the type and degree of hearing loss, age, and access to communication and support.
The goal here is to highlight some of the common considerations people may weigh when deciding whether to pursue a cochlear implant.
Pros of cochlear implants
Here’s the good stuff. The potential perks. The ideal experience.
Increased access to sound
This is the main draw. For individuals with severe to profound hearing loss, cochlear implants can provide access to sounds that hearing aids may not be able to deliver. Think of it this way: hearing aids work with whatever hearing is already there. Cochlear implants bypass that, taking a different route, to send signals directly to the auditory nerve.
Potential for improved speech discrimination
Right behind sound is speech discrimination, or understanding of speech. Some users report improved discrimination compared to what they were able to access with hearing aids alone. New hearing route, new experience.
Potential for improved speech clarity
Likewise, someone’s speech (output) may become more clear if they are successfully using a cochlear implant. This is, of course, highly individual, and something that may happen over time.
Access to spoken communication in more environments
With improved speech clarity, cochlear implants may make it easier to participate in conversations in certain environments, depending on the individual and the setting.
May reduce tinnitus for some individuals
Some users report a reduction in tinnitus when using their cochlear implant, likely due to increased auditory input.
Expands communication options
For some individuals, cochlear implants can expand their perception of auditory language and may be able to use a phone.
Can be life-changing for some individuals
For some users, cochlear implants significantly expand communication options and access to sound.
However, this is not the experience for everyone. Let’s look at the cons.
Cons of cochlear implants
Some of these are basic hoops everyone has to jump through, others are the potential risks involved with cochlear implants. I realize these may look like a longer list, but it’s what puts the “cautious” in cautious optimism.
Requires surgery and recovery
Cochlear implantation is a surgical procedure that requires anesthesia and a period of recovery.
Period of no auditory input after surgery
After surgery, there is typically a period of several weeks before the device is activated. During this time, individuals may not have access to sound through the implanted ear.
Natural hearing may be affected
Cochlear implant surgery may affect any remaining natural hearing in the implanted ear. In some cases, hearing is preserved, but this is not guaranteed.
Tinnitus may persist or increase
While it’s true cochlear implants can help some people reduce their tinnitus, for others, their tinnitus can remain the same or even increase after receiving a cochlear implant.
Outcomes vary widely
Cochlear implants do not work the same way for everyone. Some individuals experience significant benefit, while others may have more limited results.
Device failure and revision surgery
Like any electronic device, cochlear implants can fail. In some cases, this may require additional surgery to repair, replace, or remove the device.
MRI and medical considerations
Certain medical procedures, such as MRI scans, may require special precautions depending on the type of implant. Some newer devices are designed to be more MRI-compatible, but this can vary.
Financial and insurance considerations
Costs related to cochlear implants, including surgery, device maintenance, and upgrades, may depend on insurance coverage. Out-of-pocket costs can be significant for some individuals.
Technology changes over time
External processors can often be upgraded as technology improves. However, internal components are not as easily replaced and may require additional surgery to upgrade.
Access depends on wearing the device
Cochlear implants provide access to sound when they are being used. Just like the period after surgery, when the device off (sleeping, swimming, or when batteries die) there is no auditory input.
Communication and access are critical during those times, too. Routine visual and tactile systems should be in place, not just for emergencies but for day-to-day life. Because ultimately, a cochlear implant is a tool.
Cochlear implant or not, the person is still deaf.
What to expect: adjustment and learning
Cochlear implants do not work instantly in the way someone might expect. Because they provide sound through a different pathway, the brain needs time to learn how to interpret those signals.
This process often involves auditory training or rehabilitation. This has the potential to be an important and rewarding part of adapting to cochlear implants , but it’s some work.
Definitely not a plug-and-play experience. It’s a learning process.
Effort, expectations, and support
Cochlear implants can come with high expectations, especially for deaf children and their families.
Sometimes the assumption is, with enough effort, the person will “learn to hear” more effectively over time. While it’s true consistency may help someone acclimate, it’s important to know that a deaf person following spoken language and an auditory environment is already working hard.
So using a cochlear implant can be tiring, especially in the beginning. New auditory input is an additional stimulation that might feel overwhelming to some. It can create discomfort that may be difficult to describe. It’s important they feel heard and respected.
It’s a balance, not a race. Consider regular breaks from it, or specific visual or tactile activities to enjoy when it’s off.
That said, communication strategies should not depend solely on the device. The person using the cochlear implant should still feel supported, and able to communicate, whether it’s on or off.
A critical factor: access to language
One of the most important considerations, especially for children, is access to language.
A cochlear implant does not guarantee full access to spoken language. This is because access to sound does not guarantee access to language. For this reason, many experts and organizations emphasize the importance of ensuring access to a complete language, such as American Sign Language (ASL), alongside any use of technology.
Final thoughts
Cochlear implants are a tool that when used in combination that when used with others, can be very effective. While they can provide significant benefits for some individuals, they also present challenges for others.
They are not a one-size-fits-all solution. They’re not a standalone solution. Or the only solution.
Understanding both the potential advantages and the trade-offs can help individuals and families consider everything while making this decision.