Pros and Cons of a Cochlear Implant. (The Only Way is Up!)

I'll start by telling you a short story. Once I did a presentation to people considering having a Cochlear Implant. I focused more on Cochlear Implant Cons. I then spoke briefly about the Cochlear Implant Pros. After my presentation, a woman presented on her experiences with the Cochlear Implant. She was positive about the benefits it had brought her and focused on the Pros. With both presentations concluded, no one approached me at the luncheon to ask me further questions. The vast majority of the audience surrounded the woman. Her story gave the audience raised expectations. It's what they wanted to hear. Her story gave them hope.

But, my differing experiences means that I've always been conscious of raising expectations. My first processor switch-on was very anti-climatic. I've embarked on a journey to get my hearing to the level it is now. It's wasn't easy. Some people adapt quicker than others, and for some, the Cochlear Implant hasn't worked for them.

I have three cousins and a brother with hearing loss. They had their Cochlear Implant operations after me. I never once had a dialogue with them whereby I raised their expectations. I always kept discussions focused on the cons more than the pros.

My advice to those of you considering a Cochlear Implant is to keep your expectations low. From there, the only way is up!

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Having relayed this short story to you, this is the scenario:-

You are experiencing hearing loss. You are struggling to communicate in your daily life and want to know the Pros and Cons of a Cochlear Implant. Here is a comprehensive list below. I have tried to include examples based on personal experience.

PROS

Greater hearing consistency

Usually, people take the Cochlear Implant plunge when their hearing aids prove redundant. There is no longer consistency in what they can hear. At least with a Cochlear Implant, there is potential access to these sounds again. Your hearing then has the potential to develop with a more solid foundation in place. Regular listening exercises and stimulation will help in this respect.

Exposure to new sounds and the sounds you thought you'd lost

It's possible that you will hear sounds that you thought you would never hear again or sounds that you have never heard before. For example, after my Cochlear Implant and processor first switch-on, I walked out to a University campus full of students. I heard so many sounds and noises to the extent it was overwhelming. I had to ask my friend what the noise was and she explained. As time progressed, my brain started to distinguish between sounds. The rustling of a plastic bag, the sound of me walking around my apartment, the birds singing in the morning. All these sounds became distinguishable and identifiable to me.

Speech improvement

Much to my delight, my speech clarity and pronunciation has improved since my surgery. Before surgery, I would often mispronounce words. It is a lesser occurrence today. I can hear my voice now much better than I did pre-op.

Safety

My perception of environmental sounds increased with Cochlear Implant and processor usage. There was a noticeable improvement in my hearing levels at the higher frequencies. It meant that I was alert to the sounds of alarms and sirens. My road safety perception has improved. When I cycle, I am more alert to the sounds around me. But, note that safety has improved with my processor switched on. When it is off, my safety becomes an issue. Please see the Cons for further information about this.

New technology

I've always been a real techie. I love to experiment with the technology available with the Cochlear Implant processor. I use the original Cochlear mini-mic for conversational purposes in noisy environments. When I listen to music, I sometimes use the Phonak Roger Pen for listening purposes. I use the SubPac M2X Wearable Physical Audio System for a vibrating, enhancing music experience. For video conferencing and telephone experiences, I use the Cochlear Mini-Mic 2. My advice is to embrace and try the technology available.

New MRI friendly (Magnetic Resonance Imaging) technology

The latest Cochlear Implants from Advanced Bionics, MED-EL allow 1.5 / 3.0 Tesla MRIs with internal magnet intact and no compression bandage. Cochlear's new device is awaiting regulatory approvals outside Germany.

Tesla is defined as the unit of measurement used to describe the strength of the magnet used in an MRI (Magnetic Resonance Imaging).  This magnet is the basis of how images in MRI are acquired.  The strength of the magnet directly affects the quality of those images, however there are several other factors that determine which magnetic strength is best suited for the person being imaged.

Improved confidence

I am a more confident and rounded person with my Cochlear Implant. Before my surgery, I had low self-esteem and confidence. Here I am now travelling the world. I am participating in and communicating every day in an international community. I demonstrated confidence to leave a well-paid job and commenced to a new chapter in my life. It's a far-reaching statement but 'having a Cochlear Implant has enabled me to regain my identity.'

Improved independence

Before my surgery, I was reliant on friends and family to make phone calls. They would attend appointments with me and provide communication support. I'd often apologise to them. I felt like a burden to them. I am now able to take control of my life. I embrace my independence. My dependency on others has disappeared.

Cons

Surgery

All surgery carries an element of risk due to anaesthesia. In 2001, filled with hope, I had a Cochlear Implant operation. My first operation failed. It was devastating. The little hearing that I had left destroyed, I felt suicidal. Three months later, the surgeon operated again. After surgery, I woke up to silence. They wrote a sentence on a piece of paper for me, 'Your operation has been a success.' I held back the tears. It was all I needed to know. (Switch-on of a Cochlear Implant takes place 3-6 weeks after surgery.)

I had not anticipated such complications in my surgery at all. Surgery failure is a rarity, but it does happen. Being aware of this is essential.

The implant may not work well for you

The worst case scenario is that the implant will not work well. You could lose any remaining or residual hearing. It's a rare occurrence but, it does happen.

Side effects of surgery

In 2001, I remembered being dismissive of side effects as I wanted to have the operation. It was the be all and end all. The glossy advertising blinded me, ‘This amazing device will change my life,’ I said to myself. It meant that I brushed all side effects information under the carpet.

After my surgery, my tinnitus levels increased from mild to moderate to severe. It took six to eight months for my tinnitus to calm down. Today my tinnitus is almost non-existent. But, do not underestimate the impact of tinnitus. It’s alarming to hear the constant sound of ringing in your ear, and it can drive some people to feel suicidal. Please read my article Tinnitus and the DJ: Suffering in Silence for further tinnitus information.

Other conceivable side-effects are dizziness, nausea, taste disturbances and balance difficulties. Some Cochlear Implant recipients have complained of losing their sense of taste for some time. Some have lost their sense of taste permanently.

During pre-op times, what scared me most was the risk of nerve damage causing weakness or paralysis in my face. At the time, there was a one per cent chance that this might happen. Technology has improved since then. Also, the likelihood is that you will have an experienced surgeon conduct the operation.

Overall, my advice is to be very aware of what the side effects are. Do not sweep these under the carpet as I did! Talk to your surgeon pre-op, in detail, about these. Ask questions! I felt reassured to go ahead with my surgery once I had this discussion.

Safety and dependency

At times, I have to remove my processor and then I am in a world of silence. Sometimes it's nice to have this silence. For example, when I'm on a bus, and someone is bellowing into their phone nearby, I can switch my processor off. But, there are times when my world of silence can leave me vulnerable and disadvantaged. For example, when I remove my processor at night to sleep, I am oblivious to any environmental sounds around me. In eighteen years, I have lost my processor on two occasions. Once, also, my processor stopped working. Coincidentally, these incidents happened on a Friday! It was the worst possible time for this to occur due to the closure of support facilities for the weekend. I remember feeling very exposed and frustrated as I couldn't communicate with anyone around me. I'd shut myself away in my room and watch box sets with subtitles. It was a stress-free strategy. At times like this, there is the realisation that dependency on my processor is a disadvantage.

Variation in cost by country

Not every country's health service will cover the cost of a Cochlear Implant. For example, in America, many insurance companies will cover or assist with the cost of a Cochlear Implant. If you do not have insurance, or if your plan does not include the procedure, it may have cost prohibitions for you.

Long waiting lists for surgery

In some countries, there are long waits to get a free Cochlear Implant. For example, in Ireland, some people can wait up to five years for their surgery or pay for the operation themselves. Indeed, there are charities in Ireland that raise money to pay for children to have surgery.

Background noise

At times, after switch on, I would struggle to cut out background noise. As time progressed, I became more adept at differentiating between sounds. But, even today background noise is problematic for me. Our society is very much a noisy society. Social experiences can be daunting for Cochlear Implant Recipients. I've learned to combat background noise with technological additions. So, I use the Cochlear Wireless Mini Microphone in social situations when it is particularly noisy.

Some Cochlear Implant users cope well in background noise. They can use their processor/s settings and built-in microphone. It’s in the user’s control to change settings to suit their environments. They can do this manually on the processor or through a remote control provided with the processor. Cochlear recently developed an app for Smartphones which allows adjustment of settings on their latest processor the Nucleus 7.

Then there are those wise Cochlear Implant users who opt to meet in quieter environments.

Weight on the ear

Manufacturers of Cochlear Implant processors are producing modern, slick and lighter processor designs. For some Cochlear Implant recipients, a processor on your ear does carry considerable weight. It can take time to get used to this. My processor is a Cochlear Nucleus 6, and it’s relatively light.

I use a Cochlear Snugfit to keep my processor secure. It fits over my ear and around my earlobe. My processor attaches to it. You could describe the Snugfit as a modern looking ear hook. The upper and lower ear hooks adjust for a more secure fit. It is an excellent accessory. The Snugfit gives me confidence that my processor won’t fall off. It is particularly useful when participating in more strenuous activities such as hiking. Advanced Bionics provide some wearing options, and MED-EL has a page about their fixation options.

When travelling, some climates are hot and humid, and you will sweat a lot. Ear Gear is a means of protecting your processor from dirt, sweat and accidental loss. Please see the Amazon US website for Ear Gear and the Amazon UK website for Ear Gear.

My processor is weightier with the addition of Snugfit and Ear Gear. I am used to this weight now.

Sports risks

You must be careful participating in some physical activities. High contact sports and water-related activities can be risky. For example, I stopped playing eleven-aside football. Nowadays I play five-a-side football where the ball does not travel in the air. I don’t wear my processor when I play football. Many children and adults that I know continue to do high contact sports. The general advice is to wear a helmet to protect your equipment.

When travelling, I take part in strenuous activities. These entail sports such as tennis and squash. I also join social groups and do the local walks. To keep my processor in place, I use a Cochlear Implant headband as well as the Ear Gear.

A great headband that I use is the Cochlear Implant Comfort Headband by HearBand. The material it's made from is a stretchy cotton-elastane which is washable and comfortable. Please see the Amazon US website for the headband and the Amazon UK website for the headband.

When swimming, I can remove my processor, or I use the Cochlear Aqua Plus. It's an excellent and innovative accessory. I place the silicon coating over my processor, and I change the coil. My processor is then waterproof, and I can swim and hear at the same time! Advanced Bionics offers a similar product called the AquaCase Enclosure. They also sell the world’s first and only waterproof sound processor called the Neptune. Please click this link to find out Advanced Bionics Water Innovations. MED-EL offers the WaterWear for all their processors.

For scuba divers, the internal implant is validated to withstand pressure at a depth of 25 metres (82 feet) underwater.

My advice is to talk to your surgeon, before your surgery, about sports risks in detail.

Ongoing maintenance

You will need maintenance support in place for your Cochlear Implant and processor. For example, I needed help with my MAP. Cochlear America describes a MAP as an "individualised listening program.” To get the right MAP can be time-consuming. My processor became active for the first time in 2000. I did monthly visits to the audiologist. They would tweak my processor settings until I finally had a MAP that worked well for me.

I've also had to visit the Manchester, UK Cochlear Implant team when the processor has not been working. They have been able to issue replacement parts and provide me with invaluable support. I cannot praise them enough! A big thank you to them for putting up with me over the years!

Expectations

Unfortunately, even amongst those people close to me, there can be the perception that once implanted that you will have better than ‘normal’ hearing. Yes, the Cochlear Implant has been successful for me. But, It’s important that I manage expectations which I do effectively. However, it's negative to have such pressure. It’s a widespread issue that I’ve raised here and a gentle reminder to family members and friends of Cochlear Implant recipients to lower their expectations.

Travelling can be a cumbersome experience!

But fear not. To find out more and to prepare for this, please see my article:

Travelling with a Cochlear Implant Top 15 Essentials

Music will sound different

When I listen to music now, I appreciate songs that I would have dismissed before. They match with my new and differing range of hearing. Sadly, I've discarded some of the older songs that I used to like as they do not sound the same as before.

To find out more and prepare for this, please see two very useful articles:

My top 12 tips on listening to music with a Cochlear Implant

Cochlear Implant Music: The top 36 songs to listen to with your Cochlear Implant

-End-

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If you like this article, you might like… What is a Cochlear Implant? This overview includes simple factual and video information.

If you like this article, you might like... The Cochlear Implant Animator. A fascinating interview with Animator and Director, Eric Giessmann, who talks about his path to success, losing his hearing and what inspired him to create the ‘Ciborg/Cochlear Implant animation.'

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