Cochlear Implants

Some patients have hearing loss so severe that traditional amplification can no longer service their ears. These patients may be candidates for cochlear implants. The Texas Ear Clinic has a comprehensive cochlear implant team, including a neurotologic surgeon who has performed hundreds of implants in patients ranging in ages from 2 months to 94 year old. In addition, the clinic has experienced audiologists and advanced practice providers to support our implant patients.

What is a cochlear implant?

A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin. An implant does not restore normal hearing. Instead, it can give a deaf person a useful representation of sounds in the environment and help him or her to understand speech.

A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds so they may be detected by damaged ears. Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn. However, it allows many people to recognize warning signals, understand other sounds in the environment, and enjoy a conversation in person or by telephone (NIH).

During the surgical procedure, patients may lose any residual hearing that they had prior to surgery, and thus the device is recommended only to those who have little meaningful hearing despite the use of hearing aids. Indeed it is the standard of care when hearing aids are not enough, and selected patients typically perform better with cochlear implantation than they do with the hearing aids. However, there are some limitations. Patients that are born deaf perform best when implanted early in life, and typically surgery is scheduled after their first birthday when timely identification and evaluation has been done. There is no upper age limit for implantation so long as the patient is healthy to undergo surgery and is motivated to use the device.

The surgical procedure for implantation typically takes around one and a half hours. Complications of surgery are quite rare but can include device failure, infection, tinnitus or ringing in the ear, weakness of the face on the same side, and changes in taste.

In our practice, an audiologist tests the device in the operating room following implantation in order to rule out device malfunction. During the surgery, a very small tunnel is drilled in the bone right next to the nerve that moves the face. Although there is no substitute for a surgeon’s experience, a facial nerve monitor is used as an extra precaution in surgery to warn of proximity to the nerve. Indeed in the right hands, the occurrence of temporary or permanent facial weakness is extremely rare.

After surgery our team will schedule an appointment for activation within approximately three weeks. The clarity of the sound will improve substantially within the following weeks after device activation. Patients will require follow up appointments with the audiology team for fine-tuning of the device program.


Currently, the number of patients that would benefit from cochlear implantation is far greater than those that are actually evaluated for it. This is most likely related to lack of awareness of the existence of this technology and misconceptions regarding the surgery, the postoperative performance, or medical insurance coverage.

In a contemporary setting, cochlear implantation is the standard of care for poor speech understanding performance with appropriately fitted hearing aids. The surgical procedure is safe for patients without anesthesia risks, and both the device and surgery are covered by insurance almost universally.

Different manufacturers of cochlear implants are available in the United States. Advanced Bionics, Cochlear Americas and MedEl (https://www.medel.com/en-us/hearing-solutions/cochlear-implants?gclid=Cj0KCQjwheyUBhD-ARIsAHJNM-NAGbUZq-eTzfFsjho4aX7wSntdtktiXflrPHuNlSaKtqSEMRcs73AaAm0eEALw_wcB) are all very reliable and widely used devices. Device selection is typically made in conjunction with the surgeon depending on patient’s preference of each device features, availability, and surgeon’s/ audiologist’s experience.

Below are the various manufacturers of cochlear implants (CIs) that Dr. Cristobal most commonly implants. All of these devices require surgery for implantation, therefore, there are specific medical and audiological qualifications for each. If you think you may be a candidate, please have your primary care provider send a referral to our office.

Cochlear Americas - Cochlear Implant (CI)

Cochlear Implants - Nucleus and Kanso Sound Processors

Med-El Cochlear Implant

Advanced Bionics Cochlear Implant