This is especially important for the aging population. “As we get older, we lose clarity of hearing. So, while the elderly can still hear sounds, the words are not clear. In more severe cases, they understand fewer than four out of 10 words in a sentence,” Dr. Lalwani said. “While a well-fitted hearing aid is excellent at enhancing signal-to-noise ratio, it can’t improve clarity. The cochlear implant is able to bypass the dead hair cells in the inner ear and stimulate the auditory nerve directly, thereby restoring clarity.”
Current Criteria and Controversy
Identification of candidates for cochlear implantation is a process that is still under debate. One problem is that there is not one set of criteria for candidacy. In fact, the criteria for implantation vary based on the individual manufacturers’ specifications (MED- EL, Cochlear Device, and Advanced Bionics), the Centers for Medicare and Medicaid Services (CMS) guidelines, and individual insurance carriers.
“I don’t think anyone who does cochlear implants believes that the guidelines are adequate,” said Debara L. Tucci, MD, professor of head and neck surgery and communication sciences at Duke University Medical Center and medical co-director of Duke’s cochlear implant program. “Those of us who work with these patients see a large number who fall in the middle—they are no longer benefiting from a well-fitted hearing aid, but they don’t quite meet the criteria for a cochlear implant,” she said.
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