Cochlear Implants & Hearing Technology Candidacy
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Hearing InterventionFree preview
How a Cochlear Implant Works
A cochlear implant (CI) bypasses damaged hair cells. An external processor codes sound into electrical patterns and sends them to an internal receiver; an electrode array in the cochlea stimulates the auditory nerve directly. A CI does not amplify and does not restore normal hearing. The brain must learn to interpret a degraded electrical signal, so habilitation and consistent use drive outcomes.
Candidacy Across the Life Span
Exam-level summary: CI candidates have bilateral (or single-sided) severe-to-profound loss with limited benefit from appropriately fitted hearing aids; exact age, hearing-level and speech-recognition cutoffs vary by manufacturer label and payer.
Criteria come from FDA labeling, payer policy, and team judgment, and they have broadened steadily.
| Group | Audiologic picture | Functional criterion |
|---|---|---|
| Infants (from 7 or 9 months, by label) | Bilateral profound sensorineural loss (90 dB HL or greater) | Limited progress on auditory milestones with fitted hearing aids and aural habilitation. Labels differ: Cochlear Nucleus from 9 months (FDA 2020; 3- to 6-month hearing aid trial recommended), MED-EL from 7 months (FDA 2025; trial of at least 1 to 3 months), Advanced Bionics from 12 months |
| Children 2 years and older | Severe to profound bilateral loss; hearing-level cutoffs vary by label (Advanced Bionics requires 90 dB HL or greater; MED-EL accepts moderate to moderately severe low-frequency loss at ages 6 to 17) | Limited aided open-set word recognition; Cochlear labeling uses 30 percent or less on the LNT or MLNT, and other labels use different tests and cutoffs |
| Adults | Moderate to profound bilateral sensorineural loss | Limited aided speech recognition. Cochlear labeling uses 50 percent or less sentence recognition in the ear to be implanted and 60 percent or less in the other ear or binaurally; MED-EL uses the same cutoffs on CNC words; Advanced Bionics uses 50 percent or less on HINT sentences. Medicare covers at 60 percent or less best-aided on open-set sentences (NCD 50.3, effective September 2022) |
| Single-sided deafness or asymmetric loss (age 5 and older) | Severe to profound loss in the poorer ear; normal or near-normal hearing in the better ear (some labels also accept up to moderately severe loss) | Very limited aided word recognition in the poorer ear (5 percent or less in several labels; Advanced Bionics uses 20 percent or less on CNC words for adults), after a trial of a CROS or other device. MED-EL labeling approved 2019, Cochlear 2022, Advanced Bionics 2026 |
All candidates need medical clearance, imaging that shows an implantable cochlea and a present auditory nerve, realistic expectations, and access to follow-up. Cochlear ossification after meningitis is a reason for urgent implantation before it completes.
High-Yield: Candidacy is decided on aided speech recognition after an appropriate hearing aid trial, not on the unaided audiogram alone.
The rest of this outline 8
- Mapping Basics
- Bimodal and Bilateral Fitting
- Expectations and Outcomes
- Hearing Aids: Types and Verification
- Assistive Listening and Classroom Acoustics
- The SLP's Role Versus the Audiologist's
- Common Traps
- Sources to Know
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