How a Cochlear Implant Works

It can be difficult to navigate the world for those with a hearing loss. Some people with a mild
hearing loss can benefit from a hearing aid, which simply amplifies sound, but only a cochlear
implant can give the gift of sound to those who are truly deaf. A cochlear implant is a device
which electrically stimulates the inner ear to allow a person with profound hearing loss to
perceive sound. The basics of a cochlear implant, including the device components and the
mechanism of sound perception, can describe how the device bypasses the user’s normal biology
and gives him or her the ability to hear. However, the hearing and speech details of the device,
such as the multi-channel electrode array and speech coding programs, are the key elements that
allow the user to decipher speech at the same level as someone with normal hearing. Despite the
ability to reproduce speech with impressive accuracy, the cochlear implant also has important
limitations and considerations that can potentially impact its overall efficacy and practicality.

Basics of the Cochlear Implant

The cochlear implant is able to bypass many steps of the traditional hearing process and provide
direct stimulation to the cochlea, a spiraling organ in the inner ear which is responsible for
hearing. The complete device consists of internal and external parts which work together to
provide basic sound perception.

Internal and External Parts

A cochlear implant consists of two separate units, one worn outside of the head and the
other implanted within the skull and inner ear. As seen in Figure 1, a microphone and
speech processor are worn over the user’s ear in a similar manner to a traditional hearing
aid. Unlike a traditional hearing aid, the cochlear implant also has a small, disk-shaped
external transmitter which is typically worn on the side of the head. A magnetic
connection to the internal receiver allows the transmitter to stay in place. Connected to
the internal receiver is a thin wire roughly 15mm in length that consists of an array of
electrodes and is wrapped around the inside of the cochlea.

Figure 1)
Diagram of
Cochlear
Implant
Components

[Link]
 Basic Sound Perception
The process of sound perception with a cochlear implant begins when a source in the
environment vibrates and creates sound waves in the air. These sound waves are captured
and recorded by the external microphone worn over the ear. Then, the speech processor
interprets these signals and passes the information to the transmitter on the outside of the
head. Next, the transmitter wirelessly communicates through radio waves with the
receiver implanted inside of the skull. Finally, the receiver sends electrical impulses to
the specific electrodes on the thin wire that will stimulate the proper areas of the cochlea
to reproduce the desired sound.

Hearing and Speech Details

The ability to reproduce the sense of hearing is the core function of a cochlear implant, but
accurate speech perception and understanding would not be possible without key hardware and
software components including a multi-channel electrode array and speech coding programs.

Multi-channel Electrode Array

The multi-channel electrode array is found on the thin wire wrapped inside of the
cochlea. This crucial component allows the user to distinguish between different
frequencies of sound. Each electrode on the wire is at a different position and therefore
stimulates a different part of the basilar membrane, the neurologically active membrane
inside of the cochlea. Their position on the wire is important because different areas of
the basilar membrane are naturally stimulated by different sound frequencies, as seen in
Figure 2. Thus low frequency sounds, like the beat of a drum, would cause the stimulator
to fire electrodes at the apex of the array while high frequency sounds, like the screech of
chalk on a chalk board, would cause the stimulator to fire electrodes at the base of the
array.

Figure 2)
Diagram of
Frequencies
along Basilar
Membrane

[Link]
 Speech Coding Programs
Speech coding programs make use of the ability to stimulate different frequencies in
order to reproduce speech in the most accurate way. Earlier devices used a simple analog
processing method and only four to eight electrodes (Namasivayan, 2004). The processor
would determine the highest energy sound frequencies (up to four) in a speech sample
and then tell the stimulator to fire electrodes in the proper areas of the cochlea, all at the
same strength. The relatively small number of electrodes limited the range of possible
frequencies; however, an 8-channel implant could reproduce speech to the quality of a
standard telephone.

In modern devices, digital speech processors and more electrodes have vastly improved
the quality of speech reproduction. Today, most cochlear implants have sixteen to twenty
two different electrodes, allowing for a much greater range of frequencies. Moreover,
modern digital processors are able to stimulate up to six electrodes simultaneously and at
different strengths. As illustrated in Figure 3, this process, called current steering, allows
the implant to reproduce even more frequencies than the number of electrodes it contains
(Namasivayan, 2004).

Figure 3)
Current
Steering to
Create New
Frequencies

[Link]

Limitations and Considerations

The cochlear implant is a marvel of technology that can bring the perception of sound and the
ability to understand speech to those who are deaf. However, the device is not a miracle cure for
all types of hearing loss and does come with several important limitations to consider, including
age of implantation and loss of residual hearing.
 Age of Implantation
The effectiveness of a cochlear implant is largely associated with the age of the user.
Children who receive the implant are able to learn faster and recognize speech better than
adults who are implanted. Researchers believe this is due to a child’s natural brain
plasticity and ability to learn new languages, both of which decline in adulthood. This is
not to say an implant cannot benefit an older adult, as implants have been shown to
improve cognitive outcome in some older patients (Claes et al., 2018). However, the
user’s ability to understand and develop speech is greater when the procedure is done at a
younger age. With today’s screening and implant technology, children as young as 12
months of age can be candidates to undergo surgery.

Loss of Residual Hearing

Because the cochlear implant is an invasive procedure that directly impacts the major
hearing organ of the ear, all residual hearing that a patient may have had before the
procedure is lost in the process. This consequence becomes important when the potential
candidate has some amount of residual hearing to begin. In that case, non-invasive
options to restore hearing, like hearing aids, are usually tried first. More often than not,
doctors would prefer to save any natural hearing ability, if possible, rather than destroy it
and replace it with a reproduction.

In conclusion, the cochlear implant is an amazing integration of technology, biology, and

engineering used to give back one of the most important senses to those who have lost it. Even
today, the field of cochlear implant research is blossoming as new speech coding processes and
electrode designs are able to simulate 120 different channels, providing enough detail for not
only excellent speech recognition but also music appreciation.
References

Namasivayan, A. K. (2004). Cochlear Implant Technical Issues: Electrodes, Channels,

Stimulation Modes and More. AudiologyOnline, Archives.

Claes, A. J., Van de Heyning, P., Gilles, A., Van Rompaey, V., & Mertens, G. (2018). Cognitive
outcomes after cochlear implantation in older adults: A systematic review. Cochlear implants
international, 1-16.