These FAQs support ENTs in counseling patients who might qualify for a cochlear implant.
Reviewed by Univ. Prof. Dr. Gerd Rasp, ENT specialist and cochlear implant surgeon at Salzburg University Hospital.
A cochlear implant (CI) may be considered for patients with severe-to-profound hearing loss or deafness when sufficient speech understanding can no longer be achieved despite optimized hearing aid fitting. In ENT practice, the first important conversations about a possible CI indication often take place amid concerns surgery, preservation of residual hearing, anesthesia, and what hearing with a CI will be like.
Gerd Rasp, Head of the ENT department at the Salzburg University Hospital and an expert cochlear implant surgeon, answers the questions most frequently asked by CI candidates during consultations.
Univ. Prof. Dr. Gerd Rasp, Head of the ENT department at the Salzburg University Hospital and an expert cochlear implant surgeon, answers the questions most frequently asked by CI candidates during consultations.
Key Points for ENT Practice
- Consider CI evaluation when sufficient speech understanding is no longer achieved despite optimized hearing aid fitting.
- Address common concerns proactively: residual hearing, surgical risk, anesthesia, hearing perception, the audio processor, and tinnitus are frequent sources of uncertainty.
- Do not consider age in isolation: older patients may also benefit from cochlear implants if their general health, activity level, and communication needs support it.
- Refer patients early when a CI indication is suspected — ideally to a specialized cochlear implant center.
Which questions do patients ask most frequently before cochlear implantation?
Dr. Gerd Rasp: Most questions revolve around personal concerns: “Is the surgery risky?”, “Will I lose my residual hearing?”, “How challenging is anesthesia?”, “When and how will I hear again?” or “Will the implant be visible?” Underlying these questions is often uncertainty about whether candidates should take this step at all.
Will I lose my residual hearing after cochlear implantation?
Dr. Gerd Rasp: For every patient, we use every suitable option to preserve the structures of the inner ear as much as possible, something we have successfully achieved in many cases. EAS, for example, is one such option, and we have been achieving good outcomes with it for more than 20 years.
That said, realistic counselling is important: residual hearing may change after surgery or become somewhat poorer. At the same time, many patients find that hearing with a CI provides significantly better speech understanding than their remaining acoustic hearing. For many patients, this helps alleviate their fears.
> more about this topic:
Study: Long-term Hearing Preservation in Electric Acoustic Cochlear Implant Candidates
Is CI surgery a major and risky procedure?
Dr. Gerd Rasp: No, cochlear implantation is not a high-risk procedure. Quite the opposite. Cochlear implantations are generally performed only by highly trained surgeons, which is why complication rates are extremely low. Many patients imagine the procedure to be much more extensive than it actually is. It usually takes only 60 to 90 minutes.
I can tell patients with complete confidence that a tonsillectomy is more painful and carries greater risk.
How risky is anesthesia, especially in older adults?
Dr. Gerd Rasp: Older patients, or their relatives, sometimes report that a previous anesthetic, for example during hip surgery, was followed by a recovery period lasting several months. Such concerns should be taken seriously and discussed individually.
If an older person can barely participate in social life because of hearing loss, but is cognitively fit and active, they should not be denied CI treatment. If there are concerns about anesthesia due to comorbidities, alternative options can be considered. While this is still relatively uncommon, it is likely to become increasingly relevant as our population ages.
When will I hear again after surgery? And what does hearing with a CI sound like?
Dr. Gerd Rasp: In adults, we usually activate the CI as early as the first day after surgery. As a result, most patients leave the hospital having already experienced their first hearing impressions. Further fitting is generally done on the second day.
The first auditory impressions do not yet amount to speech understanding and often sound unfamiliar, but they are usually perceived positively. Many patients report early on that hearing feels more “spatial” again. In addition to outpatient rehabilitation, motivated patients can benefit greatly from several weeks of inpatient CI rehabilitation. However, our experience shows that timing is crucial. For this reason, we generally recommend inpatient rehabilitation only after around six to nine months of fitting and adaptation. In the early stages, many patients would still be overwhelmed by the sheer number of new impressions and sounds. This recommendation is based on our experience and is discussed individually with each patient.
Is the processor visible?
Dr. Gerd Rasp: This depends on several factors. Men, in particular, are often concerned about the visibility of the audio processor. During counselling, we therefore consider aspects such as shape, color, hairstyle, and individual day-to-day needs.
Leisure and professional activities, such as wearing helmets or head coverings, are also taken into account when selecting the appropriate system. Modern audio processors now offer individualized solutions for different needs and life situations.
Does a CI affect tinnitus?
Dr. Gerd Rasp: Tinnitus is an important issue for many CI candidates, as it often occurs together with hearing loss. Modern hearing aids frequently include integrated tinnitus management features, although these are not always used to their full potential.
At the same time, clinical experience shows that bothersome tinnitus can improve or even disappear in many CI users after implantation. However, there is no guarantee, and tinnitus alone is not an indication for a cochlear implant. For many patients, however, the possibility of improvement is a welcome additional benefit of CI treatment.
> more about this topic:
Study: Does Cochlear Implantation affect Tinnitus?
In Brief
Before cochlear implantation, patients are primarily concerned with the following questions: Will my residual hearing be preserved? How safe is surgery? Will I tolerate anesthesia? When will I hear again?
Experience from specialized CI centers shows that many of these concerns can be addressed effectively through thorough counselling. For ENT specialists in private practice, this represents an important opportunity: they can reduce anxiety and ensure that candidates are referred to a CI center at an early stage.
About the Expert:
Univ. Prof. Dr. Gerd Rasp is Head of the Department of Otorhinolaryngology at Salzburg University Hospital and President of the Austrian Society of Otorhinolaryngology.
When should ENT doctors consider CI evaluation?
A cochlear implant evaluation, or CI evaluation, should be initiated when patients no longer achieve sufficient speech understanding despite optimized hearing aid fitting. In addition to the pure-tone audiogram, speech understanding under best-aided condition is particularly important.
If a CI indication is suspected, early referral to a specialized CI center is recommended. Age alone should not be regarded as an exclusion criterion.
Is residual hearing preserved after cochlear implantation?
Residual hearing may be preserved after cochlear implantation, but there is no guarantee. Modern CI surgery aims to spare the structures of the inner ear as much as possible.
In suitable patients, EAS (Electro-Acoustic Stimulation) may be an option. In ENT counseling, it is important to emphasize that a CI often enables significantly better speech understanding than residual acoustic hearing alone.
Is cochlear implantation safe?
Cochlear implantation is an established procedure with a low complication rate when performed in a specialized CI center. Surgery usually takes around 60 to 90 minutes and is performed by specialized CI surgeons.
Many patients perceive the surgical risk to be greater than it actually is. ENT physicians should address this concern proactively and, where a CI is indicated, refer patients to a CI center at an early stage.
Is anesthesia an exclusion criterion for older CI candidates?
Anesthesia is not, in principle, a reason to exclude older patients from cochlear implantation. The decisive factors are general health, comorbidities, cognitive fitness, activity level, and communication needs.
Concerns raised by patients or relatives should be assessed individually before surgery. If hearing loss leads to social withdrawal, CI treatment may be beneficial at an advanced age, too.
When do patients hear again after CI surgery?
In adults, the cochlear implant is often activated as early as the first day after surgery. Initial auditory impressions are then possible, but they usually sound unfamiliar and do not immediately translate to stable speech understanding.
Hearing with a cochlear implant develops gradually over time, improving with fittings, auditory training, and rehabilitation. ENT doctors should consult and prepare patients for this learning process.
Can a cochlear implant improve tinnitus?
Tinnitus may improve after cochlear implantation, although there is no guarantee. Tinnitus occurs in many CI candidates together with severe-to-profound hearing loss.
Tinnitus alone is not an indication for a cochlear implant. In suitable patients, however, a potential reduction in tinnitus may be an additional positive effect of CI treatment.
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